Health Minister Leo Varadkar speaking to the media at St James Hospital earlier this week. Photo: Gerry Mooney

A third of the 300 beds promised last autumn to prevent another hospital overcrowding crisis are still not available as almost 500 patients languish on trolleys.

One hundred of the promised extra new beds to ease patient misery in the country's emergency units remain unused - including in the worst-hit hospitals, such as Beaumont in Dublin.

Many frail and elderly patients endured dangerous levels of overcrowding in emergency departments again yesterday.

Nationally, the predictable post-Christmas surge left 395 patients on trolleys in hospital emergency departments - and another 78 on trolleys in wards.

Beaumont Hospital suffered the most acute bottlenecks, with 54 patients waiting for a bed yesterday morning.

The Irish Nurses and Midwives Organisation (INMO) called on Beaumont to go off call last night amid claims of "unsafe conditions".

Patients with seasonal illnesses, including flu, also piled into other hospitals, with the Mater and St Vincent's in Dublin under severe pressure and forced to trigger an escalation measure which will see people, desperate for admission from public waiting lists for procedures, having their treatment postponed.

Outside of Dublin, the worst hit was Cork University Hospital, where 36 patients were waiting for a bed, but the overcrowding also spread to Sligo, Kilkenny, Limerick and Cavan.

Some 300 new beds were promised in the Government's winter pressure plan as part of its €117m blitz to reduce trolley gridlock. But a failure to attract staff and other delays mean many are still not available to seriously ill patients, many of whom are languishing on chairs. Some 115 beds that were temporarily closed have now reopened, however.

Health Minister Leo Varadkar, who is also facing a strike by nurses in seven hospital emergency departments next Thursday, admitted he was disappointed the scale of congestion was only "marginally better". But he insisted: "I cannot invent nurses where they don't exist."

The minister, who visited six hospital emergency departments earlier this week and plans to inspect more at short notice, conceded some of them were in chaos.

The gridlock comes despite €117m being thrown at the A&E crisis over the past year.

The additional funding allocated to try to fix overcrowding had resulted in more nursing homes and other supports being available outside of hospital.

This is intended to allow the transfer of patients from badly needed beds but, the minister said, "I cannot pretend to personally manage all emergency departments".

Blocking

There were still 509 delayed discharge patients blocking hospital beds yesterday, although the figure is dramatically down from 728 in January 2015.

Meanwhile, Tallaght Hospital emergency consultant Dr James Gray warned that a directive from the minister was not being fully complied with.

Mr Varadkar has ordered hospitals to spark escalation measures when emergency departments became crammed.

But Dr Gray said not enough patients on trolleys in emergency departments are being moved to wards. "This is poor risk reduction, nurses are resisting and some managers are not spreading the risk."

Moving patients to wards, even though they are still on a trolley, means emergency departments are less jammed for everyone and the threat of infections being passed on eases. But it can put severe pressure on nursing staff elsewhere in the hospital.

The executive committee of the INMO meets today to discuss the ballot and next Thursday's planned strike following the rejection of a deal which the union's chief, Liam Doran, recommended for acceptance.

He said the rejection of the deal, involving educational bursaries and other elements, highlighted the nurses' lack of faith that overcrowding promises will be implemented.

There are hopes the action will still be averted as informal talks took place at local hospital level between the union and the HSE yesterday.

The HSE said it hoped there was scope to prevent the action and reassure nurses.

Beaumont Hospital said it cannot comment on individual patient cases, but it "acknowledges and regrets the difficult conditions experienced by patients at its emergency department".

"The hospital has one of the busiest EDs in Ireland, providing services to over 50,000 patients each year," it said.

Irish Independent