Sometimes, fact can appear stranger than fiction. In January, a hospital in London advertised for Corridor Care Registered Nurses. The jobs involve 12-hour shifts nursing sick patients waiting for a hospital bed. Professor Nicola Ranger, of Patient Safety Learning, responded to the initiative by saying – “Recruiting tired nurses to do extra shifts solely in corridors is desperate. It shows how normalized this practice has become”. Last autumn, doctors and nurses in the UK spoke of their fears arising from the installation of power sockets and oxygen lines in hospital corridors in anticipation of another winter surge.
The NHS in Britain commenced in 1948 and was universally admired for many years. Nye Bevan, who is credited with the successful introduction of the NHS project, would be disappointed with the way it has regressed in recent years. In a recent poll of 30,000 people in the U.K, only 31% said they were satisfied with services provided by doctors and hospitals in the NHS. In Northern Ireland, only 16% said they were satisfied. Prime Minister, Keir Starmer, is reported as having made statements like “I will not let the NHS die” and promised “to drag care out of the hospital and into the community”. Health Secretary, Wes Streeting, described the NHS as ‘broken but not beaten’. Starmer and Streeting didn’t appear to see any contradiction between their statements quoted above and the Labour Party’s decision to delay its plans for social care reform until 2028. It appears that Bevan’s successors are faced with the reality that quality healthcare is expensive and that universal entitlements funded from the public purse are not exchequer friendly.
Our health service struggles, sometimes badly, to cope with ‘winter surges’ but has not sought, unlike some parts of the NHS, to normalise urgently needed care in unsuitable and unbecoming environments. Capacity is an issue here. An OECD occupancy statistics report for acute care beds in 2021 revealed that Ireland had the fourth highest occupancy rate of the 28 systems reported and the highest in Europe. That is not a reason for repeating approaches that are known to consign patients and those who have to treat and care for them, to places that do not meet general workplace and healthcare standards or do not afford patients the standards of dignity and safety they are entitled to expect.
Most of our acute hospitals cater for a defined catchment, which means that patients requiring acute care must be catered for even when the hospital has exceeded its bed capacity. That problem is often compounded when hospitals are unable to discharge patients who no longer require the services of an acute hospital but are not yet well enough to return home. Sometimes referred to disparagingly as ‘bed blockers”, they ought to be offered the range of health care suited to their assessed needs in the way other care groups are treated.
Nursing Homes tend to be full in winter and do not have surge capacity. Our older age population is expanding at a time when the nursing homes sector is undergoing radical change involving mergers, acquisitions and closures involving homes mostly in rural areas. One of the lessons from storm Éowyn, I suggest, ought to be consideration of the role of nursing homes in rural areas and the supports they require to fulfill the service expected from them.
While the high-cost solutions to the facilities deficits that exist are being planned and put in place, other short-term solutions ought to be considered. When the war in Ukraine brought many refugees from there to Ireland, the response to the accommodation need involved was both prompt and effective. The post Covid surplus accommodation provided an early solution that benefited many. Many parts of our hospitality sector experience a low or closed season that corresponds with the health services’ winter surge. Has the potential mutual benefit there been explored?
Facilities in our hotels and guesthouses are of a high standard and could be easily configured to meet the needs of residents receiving health care. Fixed term contracts would provide comfort for the renter that the fixed term nature of the contract would be honoured. The major benefit of the arrangement would be that patients, even the disparagingly named ‘bed blockers’ would be cared for in an environment suited to their needs: emergency department staff would be enabled to meet the needs of their patients in a much more normal environment and nurses and carers with summer months’ commitments might be interested in the winter employment opportunities that would transfer from costly acute hospital settings to less costly ones.
In the 1970s and ‘80s, local communities played valuable roles in meeting the social and health care needs of older people in their communities, especially those in small villages and sparsely populated rural areas. They worked closely with public health nurses and community welfare officers. They received grants from health boards to cover approved expenses they incurred. Professional homecare is now an expanding and well-regarded service. However, it does not replace the role voluntary orgaisations play in identifying and responding to needs that require an urgent response. To be most effective they require the option of being involved in trusted funder/provider relationships, based on meeting the urgent needs of vulnerable people.
Storm Éowyn showed us just how reliant some patients are on electricity and perhaps water and telecommunications support systems. UPS (Uninterruptible Power Supplies) may be a solution in some situations. The big storm and its predecessors will have identified the geographies where patients receiving homecare are most vulnerable to interruptions to public utilities. The approach ought to be one of localising services consistent with justifiable cost considerations.
Vaccination against flu and covid provide protection against these illnesses. When I first heard HSE ads, at the turn of the year, advising those eligible to get vaccinated, my fist thought was “Ní hé lá na gaoithe lá na scoilb” (A windy day is not a day for thatching) but I quickly realised that would be an unfair interpretation of the message. The availability of vaccines had been extensively advertised and presumably the take-up rate justified repeating the offer. I feel sure our public health professions are working on ways and means to increase the take-up of vaccines. We owe it to ourselves and to others to protect ourselves and to not place others at risk of contracting illnesses that could have been prevented. The prospect of corridor care provided by exhausted corridor care nurses ought to be sufficient incentive to avail of the vaccines capable of reducing the risk of that.
