The shortage in bed was entirely created by deliberate decisions by Mary Harney and the first head of the HSE. They insisted Ireland had far too many hospital beds and slashed the number to a far too low level. (Note: a 'bed' does not mean the physical bed but also the staff needed to look after that patient.) Until the disastrous decisions of Harney and Drumm are completely reversed there will always be people on trollies unable to get a bed.
Secondly, the HSE blames 'bed-blockers' for the queues, meaning patients who should not be in hospital but at home or in care facilities, but cannot leave hospital as the care package for being at home, or space in a retirement home, is available. There actually is a simple solution - turn one of closed hospitals into a step-down facility where the person can be moved to, and receive non-medical care, until the final home can take place. That was the obvious use that Baggot Street Hospital could have been put to. Instead it sold it to a developer. The County Infirmary closed down in I think the 1990s. It too would have been ideal as a step-down facility for the north east. Instead the 18th century was left to go semi-derelict, then sold to a developer who is letting it go completely derelict (you can see through the roof as it is disintegrating) so it can be knocked down.
I happened to know that hospital well. My mother was a nurse there. I often dropped into her there when in Navan, and she showed me around it. The upper floors were the nurses used to live were derelict but the rest of the building was perfectly fine for use as a care facility.
However, joined up thinking is not something the HSE, a monstrous incompetent bureaucracy, is capable of. One part closes a hospital, while another part never thinks what other uses do we have for that building? If the HSE created a step-down facility, then potentially hundreds of beds in hospitals could be freed up.
The biggest farce is that every year the health service spends more than the budget allocation given by DPER (Dept of Public Expenditure). DPER throws a hissy fit, as to commentators in the media, and accuse the Department of Health of losing control of spending. It hasn't. It knows, and people in politics knows, the DPER never ever gives health the budget it needs. It always gives too little, so invariably proper necessary spending exceeds the budget allocation. It always will. If it stuck within the budget, then it would have to decide to allow X% of patients die.
The average health spend across the EU is 10% of GDP. Ireland spends the fourth Lowest in the EU on Health - at 6.6%. Only Hungary, Luxembourg and Romania are lower. (Eurostat figures). And yes I know the GDP percentage is problematic in Ireland. Even if you use GNI, Ireland is way below the average. So it is no wonder the health system is in the mess it is in when Ireland is chronically underspending on Health. If DPER gave Heath the correct allocation there would be no "overspends". The so-called 'overspends' are entirely a creation of inadequate allowances by DPER. It constantly gives Health far too little money, then throws a tantrum when Health inevitably "overspends", meaning it spends the right amount that it needed to spend. One former Health Minister openly admitted to me that there are no health overspends. The 'overspend' is simply the amount that the heath service was underfunded by DPER.
Then again, DPER has long shown itself unfit for purpose. It doesn't allocate funds based on what is necessary for a system to function, but clueless book-keeping. It doesn't focus on limiting excessive spending but on chronic underfunding that in health would mean patients would die if the health service stuck to its budget. It so chronically underfunded Defence that it left the Defence Forces unable to fulfil its basic duties.
Then again it continually insists that Ireland has too many nurses. As anyone in hospital knows, it hasn't. It has too few. A TD who is a friend of mine went on a rant on there being too many nurses. I was in Beaumont Hospital, in a ward with a couple of elderly patients. They were confused and had mobility issues. They were supposed to have a nurse full-time watching them. However our nurse had to look after three wards - two with large number, one a single room with a seriously ill Covid patient.
I ran that TD at 3am to tell him the reality of the shortage of nurses. The nurse for two hours had been stuck in the woman's ward dealing with a series of problems there. I was going through radiation and chemo and was not supposed to be out of bed, but I and a young man opposite has spent the last two hours helping elderly male patients go to the toilet, and changing the sheets for another patient who was incontinent and had shat in the bed. We then had to bring him into the shower to clean him up. That young man and I were acting as nurses looking after a ward of patients despite being patients ourselves. The nurse was in the other ward doing the same with elderly patients there. One nurse physically could not look after those three wards. Yet she had to because Beaumont couldn't hire another nurse.
The young man and I both left the hospital on the same day. The night before, the nurse thanked us both for all the help in acting as stand-in nurses and that she would miss us enormously as she we did things she couldn't do as she was stuck in the other women's ward fulltime. She would hear bells going off in our ward but she was in the middle of helping old women go to the toilet, or cleaning up people who had thrown up. She would get back to our ward as quickly as she could, only to find to her relief that Dean and I had helped all the old men get to the toilet.
The TD was initially miffed at I calling him but at the end said he was glad I had. He had no idea what was really happening. He later withdrew his statement that there were too many nurses and realised there were too few in many hospitals. There were a large number in daytime, but they too were so busy to be spared so they could work nights.
Yet, whenever the government gives money to hire nurses they would find that most of it wasn't used for that, as the HSE used it to hire yet more bureaucrats for itself.
So the next time you hear about about a supposed overspend in health, realise that there was no overspend. They are simply spending the basic amount they needed to run the health service. The problem isn't that they are overspending. It is that DPER never gives enough for the health service to run. It chronically underfunds the health service, then has a hissy fit when health spends the funds it has to spend to keep the health service functioning and stop patients dying. Ireland in fact chronically underfunds health. Countries that are far poorer than Ireland, like Slovenia, Czechia, Greece, Malta and others spends a far greater amount in percentage terms than Ireland. Ireland spends just 6.6%. Slovenia spends 9.3%, Czechia spends 8.4%. Malta spends 8.8%.
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