Going into the COVID19 Pandemic, our Health Care system was ‘fragile’ even to meet expected demand in 2020. On the day before the Republic of Ireland’s first case of COVID-19 was declared, on February 28th 2020 it was the 104th day of the IPA’s monitoring of the 2019/2020 winter period vs the previous year.

The source data we analysed from the Irish Nurse Midwives Organisations’ Trolly Watch.

So, on Feb 27th we had 73 days with more than 500 patients on trolleys and wards vs 28 in the previous winter.

Serious and sustained overcrowding had the knock impact on patient safety. It was, and still is an undeclared national emergency that has now been massively overshadowed by COVID-19.

This winter’s surge was planned for in the HSE budget, and demand was not much dissimilar to the previous winter. The HSE tried to control this surge with various escalation protocols to meet the demand; such as cancellation of elective surgeries, improving home care packages and the addition of 200 extra beds up to Match 2020.

Ireland has a very unfair two-tier health care system nowhere is this more evident than the huge waiting lists that have existed for many years despite so many political promises to the public in the mist of so many vested interests.

On the day before our first COVID19 case was recorded, our public waiting lists as per National Treatment Purchase Fund (NTPF) for February 2020 were.


Inpatient Elective waiting lists eg Hip Replacements

Total 0-3 Mths 3-6 Mths 6-9 Mths 9-12 Mths 12-15 Mths 15-18 Mths 18+Mths

66,705 27,709 16,119 7,901 5,301 2,934 1,959 4,782


Outpatient Appointment awaiting first Consultant led Appointment

Total 0-3 Mths 3-6 Mths 6-9 Mths. 9-12 Mths 12-15 Mths 15-18 Mths 18+Mths

558,554 158,173 100,174 70,468 56,537 36,944 30,358 105,900


International comment noted, that even if we met the Governments target time of treatment within 15 months we would still be the worst in Europe.

In addition to those waiting for access to treatment there are also many people with disabilities who often may need care from family, partners or health system.

The 2016 Census tells us that there were 311,580 Males with a disability and 331,551 Women.

Other vulnerable groups such as Asthma, Diabetes add a further 470,000 and 250,000 respectfully. In addition to this patient groups there are some 250,000 suffering from Depression not including other mental health illnesses.

To deal with this significant demand, red flags were raised about falling numbers of family doctors, consultants and nursing shortages.

This was the demand, and will continue to be during our handling of the COVID19 pandemic.


Patient’s and Health care service users, need a new Government to be formed. One that is built on transparency, solidarity and where the ask is ‘what can you do for your country’. Ethically we need to decide, that vested interests in all their guises can no longer command a disproportionate influence on consumption and use of resources, which will ultimately impact on fellow citizens.

In Healthcare delivery, The fragile domain of Trust must be protected, built on Performance and Accountability not PR and spin.

CV19-0320-2 Queries for Community Care and Acute Care

Continuity of Business as Usual in the Community

While most attention has been placed on Acute services, ICU beds, clearing beds, extension of cancellations of outpatient appointment’s, and elective surgeries.

The World Health Organisation have stated that now we need more nursing home services in the community and at home testing kits.

We need to enhance service provision extend role of pharmacy and community IV in the community to treat patients in their home or residence.

It was established Monday 9th March that the National Emergency Plan for Managing Epidemic’s has not been updated since 2007 and is currently being updated.

The following are concerns that have been raised with us by members of the public and experienced professionals.

  1. What enhanced supports have we put in place to stop all patients being transferred to Hospital. This refers to the most vulnerable eg Residents in Nursing Homes, and those requiring care at home.

  2. What enhanced supports are being put in place to keep patients away from congregation? example: in nursing homes and pharmacies’ in the community.

  3. Have we developed a home testing kit for patients?

  4. Have we a plan to collect same?

  5. How are pharmacies being used to protect patients in the community?

  6. Will we develop a triage app that will allow pharmacies to triage and dispense medication service and testing? This is urgent as the GPs will be under enormous workload in the coming week

  7. Elderly patients are still being transferred to hospital for treatment they should be getting in Nursing Homes such as IVs and minor falls. What steps are being put in place to avoid transfers for our most vulnerable?

  8. Reports are coming in that families are very worried about what will happen to their

  9. loved ones if they get sick.

Principle: Patients come first and should not be used as a pawn by any party in dealing with this historic challenge to our society. Flexibility among and within professions will be needed to share the burden among the frontline in acute and community settings.

Some models of the impact of Coronavirus as high as 60% of population with 5% being critical and up to 3% total mortality, Our Acute system cannot cope with this demand in addition to normal demand, this is why treatment in the community is a HIGH PRIORITY now.

We have unconfirmed reports that St James Hospital has an emergency pop-up tent hospital that they have not been able to erect due to the space being occupied reserved for the children’s hospital development. Is this true? if so, where will this tent be erected ? and with it, the same services as previously planned for?