The long wait for change at MUH continues

There was something very symbolic about newly-appointed Minister for Health Jennifer Carroll MacNeill holding a press conference with local reporters outside the front entrance to Mayo University Hospital (MUH).

Given the hospital’s issues with overcrowding, it was quite apt that no room could be found inside the hospital and instead the interview took place out in the cold and the rain. Maybe it was one way to ensure the exchanges did not go on longer than the minister desired. One can only hope that none of the reporters or, heaven forbid, the minister, had to be admitted to the hospital afterwards.

Her visit was at an extremely busy time for the hospital in the aftermath of Storm Éowyn but anyone who has been in the hospital recently or has spoken to any member of staff there will know it has been under a lot of pressure all year.

There were hopes that overcrowding figures were on the way down after a considerable reduction in overcrowding – patients on trolleys throughout the hospital – numbers for 2024.

Earlier this month, the Saolta Hospital Group, which covers hospitals in the West and Northwest, issued a press release highlighting a 31% reduction in overcrowding in 2024. MUH manager Catherine Donohoe welcomed the development.

“Improving the wait times and care experience for our patients remains a priority and we are heartened to see that the initiatives we put in place to ensure patients access care as quickly as possible are bearing fruit,” she said.

However, the portents for 2025 thus far are not good.

The figures for overcrowding in January were up 33% on the corresponding figure in January 2024 (up from 338 to 439). Only so much of that can be put at the door of Storm Éowyn – the numbers were high before the storm too.

As of last Friday, February 21, the figures are up on the full month of February last year, from 314 for the month of February 2024 to 362 for just the first three weeks of the month this year.

And lest anyone think that the 2024 numbers represent any sort of commendable benchmark, it is worth recalling that those figures were the third highest ever for overcrowding at Mayo University Hospital since the Irish Nurses and Midwives Organisation (IMNO) first started tallying their Trolley Watch data at the hospital in 2005.

The reality is the figures had been record-breaking for far too many recent years. In 2019, the overcrowding figure was 2,519, a then record (surpassing the previous record of 2,285 in 2006).

Covid was undoubtedly a factor in 2020 but the figure only dropped slightly to 2,156. Alarmingly, since then, the figures have skyrocketed. A new record in 2021 of 2,776, a massive increase in 2022 to 4,452 and another record in 2023 at 4,452.

A damning report from the Health Information and Quality Authority (HIQA) in 2022 laid bare the problems at the Emergency Department (ED) at MUH. The hospital was found to be non-compliant in three areas, all relating to the ED, which was found to be non-compliant in terms of staffing and in terms of ‘person-centred care and support’, highlighting how overcrowding issues compromised the ‘dignity, privacy and autonomy’ of patients.

So while a 31% reduction in the figure in 2024 is to be welcomed, the bar it is being set against is very low. And now to see increases against 12 months ago in the first two months of this year is very concerning.

Anyone who has had to use MUH's Emergency Department in recent years has likely experienced a good flavour of what it is like. It can be extremely distressing, especially if you are there with a sick family member.

However, it is also extremely stressful for staff. From conversations with many staff at the Emergency Department and indeed throughout the hospital, it is clear that morale is low and has been for some time. Staff turnover is high and who knows how much worse it would be were it not for nurses from many other countries being able to take up roles in the hospital.

Overcrowding leads to unsafe conditions for patients and staff. To give but one example, many patients have infectious conditions but are not able to be quarantined because there simply isn’t enough space or bespoke facilities.

The solutions are not the third secret of Fatima. Organisations and unions like the INMO, the Irish Medical Organisation and the Irish Association for Emergency Medicine have been highlighting them for years. They can be simplified as follows: staffing shortages, insufficient clinical beds, not enough step-down facilities or beds therein and, in some cases like MUH, emergency departments that are simply too small.

Yet various Ministers for Health and the HSE have continuously failed to come even close to solving them.

Capacity at the Emergency Department is one part of the problem. Construction of a long-overdue new Emergency Department is finally underway but it will not be a panacea on its own.

Increased use of the hospital’s Acute Medical Assessment Unit (AMAU) in 2024 relieved some overcrowding in the Emergency Department with GPs able to refer certain patients directly there and relieve numbers going straight to the ED. However, when the Emergency Department gets full – an all too common occurrence – overflow patients from the ED are often put in the AMAU, which then cannot perform its primary function and patients for the AMAU may have to come through the doors of the ED, further exacerbating the overcrowding there.

Bed capacity in the hospital is a long-standing issue as are problems with step-down facilities. There are over 300 beds in the hospital and staff estimate there could often be as many as one-third of those – approximately 100 beds – being taken up by people with ‘non-acute needs’. That is to say people whose condition has improved and who can be served just as well in step-down community facilities like the Sacred Heart Hospital in Castlebar, district hospitals, nursing homes and even their own homes after occupational therapy assessment.

However, staffing issues in many facilities often limit the discharge of patients from MUH to community care which in turn creates a bottleneck at the Emergency Department with a lack of beds for people coming in the door of the Emergency Department who need to be admitted. Many, as a consequence, end up on trolleys while patients who could be discharged to a step-down facility are unable to leave.

Increased bed capacity both in the hospitals and in step-down facilities is only beneficial with matching staff resources which is proving challenging now with so many nursing staff leaving.

It is a staggering, long-running series of failures in our health system.

It is never nice having to write about problems at Mayo University Hospital. Negative headlines can impact staff and create tension among some less-than-understanding members of the public who come in the doors. Abuse of staff has become, sadly, all too common. And there is a cohort of people with vested interest who condemn negative headlines as ‘scaremongering’ or ‘agenda-driven’.

But the numbers don’t lie and ignoring them only normalises the problems. Nobody should be in doubt about the extent of the issues and the challenges at Mayo University Hospital. Staff there are doing their very best in very trying conditions.

Jennifer Carroll MacNeill said she wanted to see Mayo University Hospital when it was at its busiest. What she saw along with the data and information that must cross her desk daily must be deeply unsatisfactory to her.

Can she boldly go where no Minister of Health has gone before and actually fix the inherent problems in our health service and, particularly, in our hospitals?

It is long past time for change. Our people deserve better.