Harney's broken record on A&E

Repeated promises on A&E have been broken by Mary Harney and there is still no eivdence that her declaration of a 'national emergency' will solve the A&E crisis. By Sara Burke

Just eight weeks before Mary Harney announced "a national emergency" over the Accident and Emergency (A&E) crisis, she insisted in the Dail

(on 31 January): "I do not accept that the accident and emergency action plan has failed. On the contrary, a wide-ranging approach has been adopted by the Health Service Executive (HSE) to improve access to accident and emergency services…. The HSE has made considerable progress and is continuing to make sustained efforts in this regard".

The only change that has occurred in the meantime has been the furor unleashed by the actor, Brendan Gleeson, on The Late Late Show on 17 March in which, referring to the A&E department at Beaumont (and by inference to the A&E crisis generally) he said: "Its' akin to a war crime what's happening in there. Old people particularly are being left on trolleys ad nausium until they, you know some of whom have died … They are dying in these places that are not fit to put anybody in. … There are people here whose parents are going to die in disgusting circumstances…. If they don't sort this thing out in three to six months, anybody who votes for this crowd to get back in next time might as well kill themselves".

On the day that the national emergency was declared, 29 March 2006, there were 384 people waiting on trolleys in the morning according to the Irish Nurses Organisation (INO) and 314 in the early afternoon according to the HSE. On 31 January, the day she made her Dáil statement, there were 335 people on trolleys, according to the INO and 270 according to the HSE.

Her tone was markedly different on 29 March to what it had been exactly eight weeks previously.

She spoke of "A&E is being treated as the emergency it is". She said: "Every resource is being prioritised and every action needed will be taken to improve care for patients at A&E." She went on to echo what Brendan Gleeson had said on The Late Late Show: how no one, particularly an older person, should sleep overnight on a trolley in a corridor, how she is determined to that people who need to be admitted will have beds, not trolleys, and the basics for human dignity. She said that this will be put in place in the coming months and "anything less than this is not acceptable to the public, not acceptable to me, and not acceptable to the HSE."

The task force set up on 28 March to deal with the "national emergency" comprise HSE personell, consultants, senior doctors, one director of nursing and a hospital CEO. However it does not include the most senior people in the HSE, Brendan Drum, CEO, John O'Brien, director of the HSE hospitals office, and Maureen Lynott, chairperson of the strategic planning, reform and implementation unit are not on the task force. There is no union representation on the task force. A potential way to deal with the national emergency could have been a joint union/management team which would agree actions and tight implementation time frames.

Liam Doran of the INO welcomed the announcement despite its lateness. He said the gap between rhetoric and action remains and that without extra beds and extensive primary care development the plan will not be achieved. While Ireland has 2.9 beds per 1000 in the population, the OECD average is 3.9 beds per 1000.

Mary Harney became Minister for Health and Children 29 September 2004. On 13 October 2004 she met the chief executives of the Dublin hospitals to discuss A&E. She said: "It is unacceptable that people have to spend up to 12 hours on a trolley before they are admitted to a bed in an acute hospital.

On 17 January 2005 she promised improvements by the autumn (2005) in A&E. She said: "It is a priority for me and for the government to ensure that solutions are put in place that require nobody to have to wait for long hours on trolleys before they can be admitted to a public hospital".

On 7 May 2005 she told the Irish Nurses Organisation conference: "You describe (A&E) as an emergency crisis… crisis and emergencies deserve crisis and emergency responses". On 12 December 2005 she said on RTE Radio that progress on A&E had been slower than she had wished but she claimed the number of people on trolleys was down on the same time the previous year.

These commitments have not been achieved.