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A&E Crisis and MRSA

Holding up a mirror to the health service

In my experience any debate on the health service inevitably comes around to the subject of Accident and Emergency (A & E) – it is the most visible manifestation of the ills of our health service.  What has come to be known as the A&E crisis is in fact representative of a health service which is ailing.  As the largest union in the health service SIPTU is acutely aware of the problems faced daily by our members.   

According to Maev-Ann Wren writing for the ESRI on the myth of the black hole for health spending “a detailed analysis of health spending reveals that Ireland has just begun the process of remedying a considerable and decades long deficiency in health and social service infrastructure.”

If the political will exists to solve this crisis then the solutions are simple:

We need more beds, more nurses, proper care of the elderly facilities, a structured and affordable primary care service, out of hours GP services and consultants available 24 hours a day, 7 days a week basis. 

When people get sick they simply have nowhere else to go but to A&E. Those who actually go to their General Practitioner first find, that if they have an urgent problem that cannot be dealt by the primary care system, they are referred to A&E. When A&E is overcrowded and elective surgery is cancelled our nursing members tell me that they often see patients presenting at A&E.  A&E is seen by many as the only access route into the health system.

The nurses’ journal, Nursing Standard has reported that:“Changes to the hospital environment had encouraged the spread of MRSA in the UK.” These were: “A reduction in the number of hospital beds, leading to increased ward transfers. Decreased lengths of stay, so that some infected patients leave before MRSA is detected. Increased staff workloads resulting in less time to deal with infection control.”

It is widely acknowledged that when bed occupancy rates go over 85 per cent MRSA infection rates start to rise despite the most stringent hygiene regime. In Ireland  - hospitals are often full and occupancy rates go over 100 per cent!

When a hospital is overcrowded and the A&E has become a breeding ground for hospital acquired infections such as MRSA what is the solution offered by the Tánaiste and Minister for Health and Children Mary Harney?  Moving the beds from the overcrowded A&E to overcrowded wards, this process is known as decanting. 

Decanting patients into wards that are full to capacity, to be cared for by staff that are already overstretched is not a solution and will be resisted by SIPTU and the other unions representing staff in the health services.  The A & E in our hospitals are a visible reminder to all Irish people that the health service is sick.  It is pretty clear that the Minister believes that removing the visible manifestations of the crisis, will on some level, make the crisis go away when the simple fact is that the decanting of patients will make the problems that already exist worse.

MRSA thrives in an environment of outsourcing, privatisation and overcrowding – hand washing is of course important but to believe that the spread of MRSA will be halted if the HSE could just convince hospital staff to wash their hands is dangerously naïve.  

It is so easy to blame the health professionals working daily at the coalface of this crisis for the spread of MRSA when in fact the blame lies squarely with the government’s policy of consistent under funding and refusal to tackle the real causes of the MRSA spread.  The media are quick to respond to the diversionary tactics employed by the HSE who seek to blame the spread of MRSA on health professionals which takes the focus off the overcrowding and the risks of cross contamination when there is a high turnover of bed occupancy with little time to clean the bed and the surrounding areas in-between occupants.

There are those that will tell you that there is no link between physical hygiene levels in hospitals and MRSA but I would argue that there is a very real link there.    It is my belief that hospitals were cleaner when they were cleaned by direct labour, when the person responsible for the cleaning was an employee of the hospital with a vested interest in the hospital’s cleanliness.  Now, our hospitals are cleaned by those who work for private companies, whose only motivation is profit. 

The recent hygiene audit of Irish hospitals showcased the achievements of the Minister in her role as Minister for Health.  This report showed that an abysmal 9% of hospitals reached the required standard.  This is privatisation and outsourcing in action.  This is the end result of running the health service into the ground by allowing one of the most important functions within a hospital to be outsourced to the private sector.  Perhaps in the short term the outsourcing of cleaning contracts will on paper be cheaper but what will be the ultimate cost? 

In Ireland nurses are at the forefront of this crisis, as advocates for their profession, for their patients and for a better health service.  However the solution to the ongoing crisis in the health service must involve a partnership between patients, their families, healthcare workers, trade unions, public representatives and the wider community.  The health service belongs to all of us and it behoves everyone of us to come together to fight for an improvement in investment and campaign for decent health care services.

It is our health service and we deserve a lot better.

Louise O’Reilly is a Branch Official with SIPTU’s National Nursing Unit.




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