Current State of Play at Beaumont Hospital

At the SSU an audit done on the 30th May by an independent team found that 100%
of patients in the ward had had a ward round carried out by a member of their team
on the previous day. In medical wards 100% of patients audited had had a ward round
carried out by a member of the team on the previous day. The senior medical person
was either a consultant or a registrar.

The audit consisted of a manual inspection of documentary evidence in each of the wards visited. The length of stay at Beaumont Hospital for January to April 2011 was 7.06 days. Corresponding length of stay
from January to April 2012 is 5.69 days. These figures are the medical length of stay for patients who were in the hospital less than 30 days. Per speciality the lengths of stay in January to April 2011 against 2012 were rheumatology 6.8 – 6.1; respiratory medicine 5.37 – 4.76; infectious diseases 7.04 – 5.31; geriatrics 10.11 –
9.21; endocrinology 5.52 – 5.32; gastroenterology 6.04 – 6.23; cardiology 8.16 – 7.82. The average length of stay in the SSU (Short Stay Unit) has dropped to 4.99 days on the 27th May 2012. This is down from 8.5 days on the 1st April 2012. Overall the reduction in bed stay has gone from 7.2 to 5.8 between 2011 and 2012. However, there are 40 patients on trolleys and there are surgical patients in medical beds and the
day ward is full.

The underlying problem is that mortality in the over 65’s was 60.9 per 1000 patients
in 2002 and this has dropped in the third quarter of 2011 to 37 per 1000 patients.
That means that there are crowds of elderly patients alive who would have been dead
10 years ago. Whether this is due to statins and what other medical interventions is
unclear but the facts speak for themselves. If you add in the fact that Dublin North
East has the least number of step down beds of any region in the country and it is
blatantly obvious why the Mater and Beaumont are packed with people on trolleys.
In countries where the medical system works for example Holland and France GDP
spent on health is around 17% and you could probably take about 10% off the amount
of money spent on health in this country by comparison. The UK has eliminated
most of its queuing in A & E because they have massively increased the number of
consultants and the amount of money spent on the health service over the past 12
years. For example in St. Georges in London the consultant staff in A & E has gone
from 3 when Aidan Gleeson was there 15 years ago to something like 17 now.
Currently there are 18 patients who are medical patients occupying beds in surgical
wards in Beaumont. There are at least 90 patients who are medically discharge
occupying beds in Beaumont at present. 65% of our patients in A & E are waiting
greater than 18 hours for admission which is the standard set in this country. Four
hours is the UK standard when they have many more step down beds and consultants.
The supposed benefits from the programmes instigated by the Department of Health
have not been realised in Beaumont. The Emergency Department continues to be
overcrowded. The numbers of patients waiting on trolleys in the Emergency
Department has not been reduced and the length of time spent waiting on trolleys in
the Emergency Department has not been reduced.

There is a need for the appointment of a Consultant for Psychiatry in the Elderly
which is singularly absent in Beaumont. There is a need to replace radiographers in
radiology so that there is an extended day and it is possible to get scans etc after 4 to
5 o’clock in the evening and blatantly there is a need for a second angiography suite
at Beaumont to allow the Consultant Cardiologists to do their jobs. The second angio
suite would improve the through put of patients and Beaumont has a phenomenal
through put of day case patients in cardiology with people being multi stented and
sent home on the same day.

The problem for health services in the north east is that there is a shortage of nursing
home beds. There needs to be a speeding up of the Fair Deal system to place people
in nursing home beds long term. The government should also give some financial
incentives or co-finance the building of nursing homes to be managed privately
because of the inefficiency of public sector management in my experience.

Both the Mater and Beaumont Hospitals on the northside of the city will continue to
be overwhelmed by blocked beds for the foreseeable future as things stand.