Galway needs more than a new building to fix A&E crisis
As A&E nurses prepare to strike across the country this week, An Taoiseach Enda Kenny said in the Dáil that Galway A&E is not fit for purpose, continuing: “It is one of the most inadequate facilities in the country and it needs to be replaced.”
That Galway’s A&E service is at breaking point has been obvious to health observers in the West for many years — staff morale is at an all-time low and neighbouring areas’ health services have been defunded without any increase in Galway’s capacity to take on more patients.
There is no silver bullet that will fix Galway’s A&E service and, while a new A&E department facility is welcome, much more emphasis is needed on a range of measures that have three results — reducing need for A&E, streamlining A&E operations and unblocking ward beds.
Reducing need for A&E
The easiest way to ease pressure on A&E is to reduce the amount of people who need to go to A&E.
A major expansion in primary care would place greater emphasis on preventative care that will catch illnesses early before people need to go to A&E.
A phone triage service — with conservative clinical guidelines — would allow patients to get advice on whether they should go to A&E, see their GP or whether they need healthcare at all.
Finally, opening out of hours minor injuries units and using first responders in towns and villages across the West of Ireland will mean less serious injuries can be treated closer to home and would allow Galway A&E to focus on the more serious cases.
Streamlining A&E operations
Once patients arrive at A&E, they need to be assessed and prioritised, treated, and then discharged or admitted in as little time as possible. This is where a new A&E facility may help but, in my experience, the real solutions come from tackling “bottlenecks” by a number of recurring issues — including the number of doctors, waiting for diagnostics and bed availability.
When I worked in the NHS, the role of Nurse Consultant was expanded. Experienced and highly trained nurses could effectively and safely treat minor injuries, stitch patients, manage IVs and prescribe medication. Investing in our world-renowned nurses would reduce the pressure on our doctors and allow us to treat more patients in A&E. It would also act as a great career incentive and help attract Irish nurses back home from abroad.
Waiting for diagnostic results and their interpretation is often a cause of delay in treating and discharging patients. Linking results to a patient’s electronic record and alerting medical staff that diagnostics are available to review would further boost the capacity of A&E departments.
Unblocking ward beds
A major reason for the use of trolleys in A&E departments is that there are no hospital beds for patients to be admitted to.
In the Irish two-tier health system, hospitals are often paid per day for patients with private insurance. So even if a patient can go home, public hospitals can gain financially by keeping them in a bed. Changing these incentives and making anonymous case data available for analysis would go a long way to ending this problem that costs us beds.
Setting up “step-down” facilities across the West of Ireland would allow us to free up expensive beds in hospitals taken up by patients who need medical supervision but not the specialised care of a full hospital staff. This would save money and would make it much more convenient for families and friends to visit their sick loved ones.
Finally, a major issue improved in the NHS was the integration between social services and the health system. Often, hospital beds in Galway are used at a cost of thousands of euros per night because the social services do not have the budget to modify a patient’s home for a fraction of this cost. Better integration of the services and pooling of patient budgets across departments would free up beds, reduce the overall cost to the state, and allow more patients to live at home.
Healthcare doesn’t need to be a black hole for the state finances
Also announced recently was another supplementary budget of €665 million for the health service. While the programme outlined above needs investment, much of the solutions will actually reduce the cost of delivering our health service while improving the quality and convenience of our service. For example, a recent study in Rhode Island showed that a 23% increase in spend on primary care resulted in an 18% reduction in total spend on health. If we want to have a sustainable, high quality, and universally accessible healthcare provision in Ireland, these are the kinds of measures we must pursue urgently.
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Niall Ó Tuathail is the Social Democrats candidate for Galway West. Previously, he worked on healthcare reform of EU public health systems with the healthcare practice of McKinsey & Company. His father is a doctor in Galway University Hospital and his mother is a community health nurse in Galway.
