Harris and HSE at war over targets for trolleys
Targets of 236 not achievable, say health off icials
THE HSE has clashed with Simon Harris over its Winter Initiative. It says the trolley target, which the Health Minister insisted was achievable, was in fact based on a very unlikely best-case scenario.
A HSE target to limit trolley numbers this winter to no more than 236 on any one day was a best-case scenario that assumed full recruitment and bed capacity, neither of which was likely.
Following a week of recordbreaking trolley numbers – which hit 612 on Tuesday – last night the HSE and the Health Minister Simon Harris appeared to be at odds over the basis for the target.
It comes as senior sources at the Department of Health told the Irish Mail on Sunday that high-level health managers will be sacked if standards do not improve.
When the HSE launched the Winter Initiative Plan, Simon Harris was emphatic that the 236-trolley target would not be exceeded.
But the HSE has indicated to this newspaper that the plan was very clear about the assumptions and caveats that the targets relied on in order to be achievable.
A spokesman for the HSE said: ‘This number [236 trolleys] is applicable if all the acute beds that are in the system are available, without beds closed for staffing issues, meaning optimum staffing, and if all delayed discharges were being moved through the system with enough transitional beds in the community, and stepdown beds. The modelling
‘A myth that people can’t be dismissed’
would tell us that 236 is the optimum figure.’
However, well-placed health sources indicated that targets were not clearly articulated as achievable only in a best-case scenario. They said: ‘It’s clear there are assumptions and there are targets; the assumptions are there in the plan but given trolleys are about people, it could have been more clearly explained from the outset what the HSE was trying to achieve.’
The contradiction comes at the end of a week where Mr Harris wrote a three-page letter to HSE chief Tony O’Brien, asking why managers weren’t being held accountable and asking that the health service do more to tackle the crisis.
The 10 extra measures included hospitals throwing all resources at problems for one week to clear backlogs or implementing a ‘perfect week’; ‘rostering of senior clinical decision-makers over seven days per week’; and potentially opening Acute Medical Assessment Units (smaller non-A&E medical units) for longer to ensure they are helping to alleviate Emergency Department pressures in the major hospitals. Last night, Minister Harris told the MoS that he wanted to see accountability in the health service.
‘The most recent health budget was the highest ever,’ said Mr Harris. ‘We now enter a new era of reinvestment in health after a number of extraordinarily difficult years but increased funding must go hand-in-hand with new and tough accountability structures. I was clear with the HSE this week that these structures allow managers across the health services to be held to account for meeting targets on patient care and delivering the measures we are putting in place.’
Senior sources at the Department of Health said that if the minister did not get sufficient answers to his strongly worded letter to HSE chief Tony O’Brien ‘within weeks’, he expected underperforming HSE managers to be sacked.
‘It is a myth that people cannot be dismissed because the framework says in black and white that they can. But they haven’t [yet],’ said the source.
There is also exasperation in Government at the procession of hospital consultants taking to radio and television programmes to criticise the Health Minister when the doctors themselves are considered to be part of the problem.’
The fact that many hospital consultants and GPs took long breaks at Christmas without cover is said to have contributed to long waiting lists.
Reacting to the Winter Initiative target, Fergal Hickey, spokesman for the Irish Association of Emergency Medicine, said: ‘We need to stop denying that overcrowding is such a serious and continuous problem. The only acceptable target for patients on trolleys is zero.’
A HSE spokesman responded: ‘Obviously zero is the optimal figure but then you are into extra funding.’
Liam Doran from the Irish Nurses and Midwives Organisation said yesterday of the initiative: ‘That target suggested something that is not going to materialise until we have significant sustained investment.’
THE current flu outbreak is not at an abnormally high level, a disease expert has confirmed to the Irish Mail on Sunday.
This week, Health Minister Simon Harris used the outbreak as an excuse for the record-breaking trolley numbers.
But the figures show that, far from being extraordinarily high, the outbreak figures were just over what would be considered average, posing deeper questions about the cause of this week’s chaos.
At the height of the crisis this week, Simon Harris said: ‘It isn’t acceptable, the health service must do better, and I want to see absolutely everything done to try and improve this situation.
‘This situation is not helped by the significant outbreak of flu and the particular strain of flu that has seen the flu impacting particularly on older people.’
The revelation comes as both flu experts and frontline staff confirmed they are expecting the trolley crisis to return this week, with one doctor saying he is expecting ‘groundhog day’.
Dr Joan O’Donnell from the Health Protection Surveillance Centre on Influenza told the MoS that she expects the disease to peak in the next two weeks.
She said: ‘The numbers are increasing, we can’t predict exactly but we think in the next week or two.
‘The numbers are not unusually high at the moment, they have just gone over the median threshold reported by GPs.
‘The season started about three weeks earlier than usual. There were two other years when it started in November or December. Last year and the year before it was around this week when it started to take off.
‘This season went over the baseline on December 11.’
When Dr O’Donnell was speaking to the MoS, she quoted the figures for Week 50 (up to December 18), which showed ‘60 GP consultations per 100,000’ for potential flu.
In fact, since speaking to the MoS, the rate for week 52 (up to January 1), has fallen back to 50.9 per 100,000. ‘It would have to go to 113 to be high,’ she explained.
‘Even last year it went up to 80, that would still not be considered an epidemic.
‘We can’t predict how high it will go, you have a sense of the flu but you can’t predict it exactly. The main thing is it increasing, it’s gone over the median threshold but it’s still not that high, it’s lower than the peak last year anyway.
‘It could peak in the next week or two. It will continue above the baseline for the next four weeks anyway. It’s usually about a nineweek span for the median, being above the median.
‘The baseline is 18, the median is 57 and the high line is 113.
‘The flu has not peaked, we will definitely see increased activity going on until the end of January. No, it’s not a pandemic, it’s just the seasonal flu virus. There is a vaccine.’
The Surveillance Centre reported yesterday that six people died from the flu since Christmas, making a total of seven deaths.
But this compares to some 75 deaths in the 2015/2016 flu season, and is not an unusually high number at this stage.
The use of flu as an excuse by the Health Minister has led some consultants to question whether the underlying crisis in health is being taken seriously enough.
Fergal Hickey, Sligo emergency medicine consultant and spokesman for Irish Association for Emergency Medicine, said: ‘We haven’t had a lot of flu really, what we’ve had is a lot of respiratory illnesses. You get a variety of viral illnesses, not a lot of that has been genuine influenza yet.’
He added: ‘This year it may have come a little earlier, and in that sense the minister was correct, but it was going to come anyway and it hasn’t peaked.
‘At the root of this overcrowding is the fact that we have not enough beds, yet it’s being treated by some senior managers in the HSE as if the problem is in another country and not their problem.’
Looking to next week, Dr Gerry Lane, A&E consultant at Letterkenny General Hospital and IAEM spokesman said: ‘I’m actually sitting here with a sense of dread for this weekend and how the hospital is going to handle the number of patients who attend in the flow.
‘I have a complete sense of dread, come Monday or Tuesday. Because things are going to get worse, and groundhog day is coming again on Monday or Tuesday.
‘Maybe it won’t be 612 or 602, but it is going to be some big groundhog number. For every one of those numbers, there’s a patient and a family who are heartbroken. As well as that there is a nurse that is destroyed.’
‘Still not considered an epidemic’ ‘I have a complete sense of dread’
THE current crisis in hospitals and GP surgeries has come as a surprise to the Health Minister, Simon Harris. Interestingly, it comes as a surprise every January to every Minister for Health. It’s almost like the movie Groundhog Day!
Despite this being the mildest winter on record and the fact that there was a winter initiative planned by the HSE, a new record has been created: the highest number of patients on trolleys in our emergency departments.
It’s important to remember that these are patients, usually elderly, who are sick enough to require a hospital admission. They have already waited hours to be seen and examined by a medical team as well as undergo various investigations. By this time they will be sleep deprived, hungry, often dehydrated, cold, frightened and sick. If they are lucky enough to have a trolley to lie on, they will be covered in a light blanket; their belongings will be in a blue plastic bag, and someone else’s feet will be at their head as the trolleys are lined up along the walls of the busy corridors.
The lights will be on constantly, they risk losing their trolley by going to the toilet and no hot food can be served to them for health and safety reasons. Interestingly, health and safety concerns don’t seem to apply to the fire hazard faced due to the congested trolleys and wheelchairs. In war zones such conditions are used as forms of torture.
Meanwhile, in the community it is increasingly difficult to access GP services, in the normal day-time setting and especially over the recent Christmas and new year season.
IT IS therefore insulting to hear the same annual platitudes from our minister, his department and the HSE. Warnings have been issued by hospital doctors since last summer stating that the usual lull in demand on hospital emergency services had not occurred and that demand was ever increasing. This meant that bed occupancy levels were constantly over a safe and manageable level, and there was no extra capacity to deal with a rise in admissions.
GPs, meanwhile, have also been warning of an increasing crisis in general practice. Newly trained doctors are leaving the country, and 30% of Irish GPs are aged over 60, which means we face the loss of these established and experienced doctors in the near future. Also, new patients in many areas can not find a GP. In the week before Christmas, we had 29 requests to join our practice and, unfortunately, we could not accept them as our practice can barely cope with the number of patients it already has.
State funding to general practices was cut by 38% under FEMPI (Financial Emergency Measures in the Public Interest) , which has led to a number of practices closing and most others restricting the medical care they can provide.The minister and the HSE are fully aware of all these problems and yet their only response is to order a new report, blame the flu and hire more managers.
We know we have one of the lowest numbers of hospital beds per capita. Beds have been systematically taken out of the system after ‘reports’ suggested that we had too many beds. A refusal to replace critical nurses, physiotherapists, speech and language therapists and doctors who were on leave, or who had left their jobs, has meant that most hospital and community services are massively under-resourced. This has resulted in unmanageable workloads for the remaining staff, leading to poor morale and a choice by younger staff to leave the country.
The abysmal failure of the HSE initiative to entice nurses back to Ireland shows it either has no interest in or no understanding of the problem. It made for good news press releases and soundbites in the media but it sure didn’t bring home many nurses!
The most frightening thing is that the worst has not come yet, and this medical crisis will deteriorate further with each passing year. We have a rapidly growing ageing population, with figures showing that there are an extra 20,000 people reaching the age of 65 each year. Increasing life expectancy has resulted in a 20,000 rise in the over-80s since 2008, and this will continue to rise rapidly.
Unfortunately, as we age, we face increasing medical problems with high rates of diabetes, heart disease, chronic bronchitis and arthritis being among the most common. We have no plans in place to deal with the impact this will have on GP and hospital services. We have no programmes in place to adequately manage these chronic illnesses and prevent the complications that lead to hospital admissions and invalidity. Our health system continues to act in a reactive manner rather than planning and predicting the problems we will face.
Things have to change.
SUCCESSIVE ministers have each failed to take on the challenge of planning for our future healthcare needs. They react when the media forces them to. They blame hospital managers, GPs and disease outbreaks. They allocate some extra funds to dampen down the crisis and move on.
As we speak, hospital managers and consultants are being forced to make early discharges and cancel elective procedures. This is not solving the problem, it’s covering it with tissue paper on a rainy day. Minister Harris has talked about a 10-year plan. I somehow doubt he will be in place to see it come to fruition and it will now become the excuse of all future ministers for not actually bringing about the immediate and effective changes we need to have a functioning healthcare service in Ireland.
In the hospitals, we need more beds, more nurses, more junior doctors, more consultants and other clinical staff. In the community, we need to start adequately funding general practice. Until recently, everyone knew that no matter what, they could always see their GP and, better still, see them on that same day. Friends and family in the UK were envious as they faced waits of up to three weeks to see a GP and up to six months to register with one.
For more than five years we have warned of the crisis in general practice and yet each successive government has failed to act. Promises of ‘money following the patient’, that would have allowed for medical problems to be managed in a more cost-effective and accessible general practice, have proven to be mere words. The funding of general practice is less than 3% of the total budget. In the UK, it is 9% and they are agitating to increase this.
The minister needs to create a full, new contract for GPs which will allow them manage chronic illnesses and care for our vulnerable and elderly patients. Investment in general practice will not only lead to cost savings in the future through reduced hospital admissions and clinic attendance, but improved quality of life for all patients.
Is this Government willing to make the decisions that need to be made and provide the funding to invest in all of our futures?
The saying ‘your health is your wealth’ is commonly used in Ireland – and cannot be taken for granted. Each of us will face a time when we are ill and in need of medical care either in the community or in hospital. Each of us and our family members have the right to expect that these needs will be met in a healthcare system that is safe and accessible. Each of us must shout loudly to demand this from those we have elected to represent us, otherwise we will be the patient on the trolley.