Stephen McMahon: I think what you've outlined there [Jonathan] is a very fair assessment of how serious the situation is, as of yesterday. In actual fact it's been going on for many years [overcrowding] but I think the sheer scale of it yesterday, almost like a warzone, for both the staff and patients who have had to endure these situations. We're hearing questions about whether junior doctors are being properly used on the discharge of patients; issues [and] questions about whether some consultants, and whether some patients are even seeing a senior consultant for the last seven or eight days in some hospitals. We've raised that with the HSE, which is the appropriate area, to ask them to investigate these allegations but a strong fact of the matter is that this is been going on for many years, Jonathan. This morning we heard about Beaumont Hospital going to full capacity protocol and I’d just like to explain to your listeners how serious it is that activation of the full capacity protocol is the result of many moving parts that not in alignment such as staffing capacity, infection control, and or the lack of management of those moving parts locally nationally and indeed politically. There were 19,135 occasions of full capacity protocols up to August 2020 which took us nearly eight months to establish from the HSE and it should be a near never event. They were supposed to do a risk assessment to understand what moving parts weren't working that caused this to happen, because exactly as you pointed out, Jonathan, it means people's operations are cancelled, the ED is over-run with patients, and perhaps having to move them up to wards and so on and with all the associated risks. In the NHS yesterday there was a report that their consultants said there was something in the region of about 500 patients a week dying as a result of overcrowding, and I’m not saying that that's happening in Ireland but if we downsize that there could be anything from 35 to 40 patients suffering death as a result of the overcrowding crisis that we have at the moment.

Interviewer: Stephen, on that point, in any other organisation if you ended up with a critical situation in a single department you would have staff urgently redeployed from other departments to try and make a dent in that. Is that happening in hospitals? I mean are we seeing consultants who normally live upstairs, if I could put it that way, being brought down to the ED where they probably don't want to be, but they’re needed right now?

Stephen McMahon: Well, this is a key thing, I mean you even hear about where it could be difficult to contact them [consultants] out of hours. You will hear people that are doing Trojan work or you’ve given examples there from the GP about the amount of work, and you were quite in your assessment that they are entitled to their time off and so on, but if there are contractual arrangements there has to be oversight that these are actually being fulfilled. The simple fact of the matter, Jonathan, is that the winter plan that was prepared this year was not even signed off by the board of the HSE. All they did was note it because they didn't have enough time, I think, to actually review what was actually happening.  They noted that the executive management team that put it together and the Minister had published it. The one thing you will very seldom hear from politicians or from people with other vested interests within the health system is the issue of accountability - you've touched on it - but there is really no accountability for when these situations happen. There’s been report[s] from Professor Keane, HIQA and so on, that talk about government's governance and leadership, and I think that it would be appropriate for the chair of the agency to make a public statement about the crisis that's been declared by his own management team on Christmas Eve. And really we could talk about down the road in five years time and Slainte Care - it is a crisis situation at the moment with Covid and flu and the viral infections. But let's say for instance, how difficult would it be for community pharmacist be able to prescribe first line antibiotics for infections, you know like that would be something, but is that a turf war or is it something that can be actually drafted in, as you quite rightly say: all hands to the deck to try and solve problems today.

Listen to full podcast here (19 mins): https://www.goloudnow.com/podcasts/the-pat-kenny-show-highlights-47/hospital-overcrowding-is-at-breaking-point-382242