What will this winter trolley season bring?

It is difficult to remember a time over the past few decades when hospital overcrowding was never an issue.

Indeed, on any given day, there remain hundreds of patents waiting for admission to a hospital bed, placed on a trolley, chair, or other area of a hospital.

Records have been broken over the years and the highest number recorded on a single day was on 3 January, 2023 when there were 931 patients waiting.

August worst month

Earlier this month, the Irish Nurses & Midwives Organisation (INMO) reported that over 9,945 patients were admitted to hospital without a bed in August, making this the worst August on record for hospital overcrowding it said.

The most overcrowded hospitals in August were: University Hospital Limerick with 1,784 patients waiting, Cork University Hospital with 830, Letterkenny University Hospital with 730, St Vincent's University Hospital with 728 and Sligo University Hospital with 710.

Most days University Hospital Limerick has the highest number waiting and is a persistent outlier.

The situation is unlikely to significantly improve at Limerick until the new capital developments for more capacity in the mid-west region are in place and this is realistically going to take many years.

Given the weather has been so exceptional for months, some will question how can trolley numbers be so high during one of the best summers in years?

Part of the answer is that overcrowding is no longer a winter issue, it has been an all-year round challenge for years.

Capacity constraints

The medical and health unions, the Irish Medical Organisation, the Irish Hospital Consultants Association and the Irish Nurses & Midwives Organisation have consistently pointed to capacity constraints – a lack of beds as well as staffing – as the core issue.

The Irish Hospital Consultants Association has said ministerial demands to push hospital consultants onto weekend rosters, under the new Public Only Consultants Contract (POCC), without providing essential supporting staff, diagnostics, or bed capacity will actively damage patient care and deepen the waiting list crisis.

The weather can have a big impact on overcrowding, especially during the clinical winter and very cold weather, and in conjunction with a difficult flu season. Very hot weather, driven by climate change, has health effects too. Heatwaves are linked to increased illness, hospitalisations and deaths, and Ireland and its emergency departments have to plan for it and the bigger impact over the years ahead.

Flu vaccination

We do not know what this winter will bring but the HSE will be looking for a good uptake of the influenza vaccine among both the public and health staff, to limit any negative impacts. Low uptake among health staff sends the wrong message to the public about the benefit of vaccination protection.

The HSE winter flu vaccination campaign is due to launch shortly and already pharmacists and others are offering the flu vaccination and are currently prioritising high-risk groups like those aged 65 years and older.

While the HSE has said it expects to receive its full supply of flu vaccines for the forthcoming season, there are supply pressures being experienced and the Irish Pharmacy Union has said there is no confirmed supply for private patients, who fall outside of the at-risk groups.

The current shortage is affecting private healthcare providers and companies that offer flu vaccination to staff each year.

The delay in some supplies is understood to be related to designing and producing the flu vaccines fast enough, to take account of virus strain changes seen in the Southern hemisphere. If any significant delay occurs, and there is a bad flu season, it could impact illness levels this winter and have a knock-on effect in terms of overcrowding.

Minister for Health Jennifer Carroll MacNeill has regularly emphasised that the issue around overcrowding is not about the number of patients waiting in emergency department per se, but more about how long patents have to wait for admission. The pressures vary around the country, depending on what region is examined.

Consultants on Saturdays

The minister has been pushing hard for the full implementation of the Public Only Consultants Contract which provides for rostering on Saturdays. The aim is to have sufficient consultants on Saturdays, in each region, to help with discharges and admission decisions, to prevent the build-up of patients in emergency departments, especially on Bank Holiday weekends.

Tensions have undoubtedly increased between consultants and the minister in recent months over this issue. The subject is likely to dominate the annual conference of the Irish Hospital Consultants Association next month.

Stephen McMahon, of the Irish Patients' Association, said there is no honest basis for saying hospital overcrowding has improved. He said that between January and August this year, 86,739 patients waited for admission to hospital - 12.6% more than during the same period last year.

"In the first six months of 2026, people aged 75 and over accounted for 34% of patients who spent more than 24 hours in an emergency department, although they comprise only about 7% of the population. That is almost five times their population share. No patient should spend a day or night on a trolley waiting for the care they need," he said.

For many years, we have witnessed different daily figures issued on hospital overcrowding by the HSE, and the INMO.

The organisations collect their own data and provide figures for different times. For example, the HSE provides figures on 'surge capacity' at 2pm each day - this is the number of beds taken from elsewhere in a hospital to meet emergency department demand.

If we look at last Tuesday, the INMO recorded overcrowding levels of 692 patients at 8am while the HSE recorded 495 patients at 8am.

Whatever about the differences in the numbers, the problem remains.

Delayed discharges

Another factor contributing to overcrowding is delayed discharges. These are patients in hospital beds whose clinical care has ended and they are good to be discharged, but there is no suitable place yet found to discharge them to – a step-down bed, a nursing home, or home with home support.

While the number of delayed discharges varies, on any given day there may be 500-600 delayed discharges. That means 500-600 beds not available to admit emergency department patients to. Hospitals can also have beds closed due to financial pressures, short staffing, infection control and refurbishment.

Hospital overcrowding may have eased somewhat and we have not seen very high numbers approaching previous records, but the situation is unpredictable and a bad winter could potentially see new records set.

Hospital overcrowding is an ingrained part of the hospital system. When I first began covering health as a medical journalist in 1988, overcrowding was an issue then especially in the Dublin hospitals but at nothing like the current levels.

Ongoing overcrowding will continue to cause anxiety and discomfort to patients, their families and staff, and pose threats to patient safety.