A sustained surge in the numbers attending hospitals, insufficient bed capacity, staff recruitment and retention problems as well as a prolonged flu season and extreme weather all contributed to the pressures on the health service last winter which saw unprecedented overcrowding, a review has found.
The HSE analysis, completed in recent days, said special funding to address the pressures effectively came too late in the year to be of optimal use.
In a commentary on areas that could be improved the HSE’s leadership team told the review that additional Government funding of €40million was not agreed until December last year, and that “negated localised recruitment to allow for impact during winter 2017/2018”.
“Funding for winter 2018/2019 needs to be signed off at a much earlier stage,” says the review. “Early communication of outline levels of available funding would be beneficial to the planning process.”
Hospital groups in their feedback to the review also maintained that “funding for winter measures needs to be agreed earlier so initiatives can be in place before winter. This is imperative where initiatives are reliant on resource lead-in times.”
In their assessment of the challenges they faced last winter, the hospital groups said that “recruitment and retention of staff [all disciplines] is severely impacting the system”.
It said there was a risk that emergency escalation measures to deal with severe overcrowding in emergency departments would become the norm or become “business as usual for prolonged periods of time”.
Ageing population
The analysis says emergency department (ED) presentations had been increasing on average by 3.9 per cent annually over the past two years.
“This is further compounded by an ageing population which is in addition to an increasing number of ED presentations [+5.7 percent in 2017]. This cohort typically consists of more complex cases and longer stays in our acute hospitals.
“With these demographic trends predicted to continue, there is an immediate need to introduce further capacity into the system and realign the models of care as referenced in the Sláintecare and Health Service Capacity Review reports.
“Two extreme weather events occurred during winter 2017/2018, namely Storm Ophelia and Storm Emma. The severity of such storms and their effects on the healthcare system were profound.
“Such weather events greatly exaggerate congestion in the hospital system due to an inability to discharge patients during times of red weather warnings and a subsequent sharp influx of post-storm presentations on an already congested system.
“In spite of the commendable work of healthcare staff, particularly those working in front-line services, the resultant system pressures requires an extended recovery period, which includes the cancellation of scheduled procedures to enable the system to return to normal daily operations.”
Influenza Type B
The review said seasonal influenza during winter 2017/2018 was at its highest level since the 2011/2012 season. “This was further compounded by a prolonged season, and the prevalence of influenza Type B which typically results in more hospitalisations than Type A influenza. This resulted in peak influenza-like illness rates exceeding 100 per 100,000 population during the 2017/2018 season [90 per 100,000 during 2016/2017].”
The review said there were 4,680 confirmed influenza hospitalisation cases notified during the 2017/2018 season compared to 1,425 in the previous year.
The HSE said on Monday that €10million in once-off additional winter funding had been allocated for 2018, and a further €10 million would be invested in 2019 to enable additional beds to be opened for winter 2019/20 and the years beyond.
“The HSE is at present examining the options in terms of deliverability and impact for this winter in the context of the additional €10million once-off funding, and a final plan will be submitted to the Department of Health for approval this week .”
The Minister for Health Simon Harris said on Monday he was “worried” about the impact on patients attending hospital over the coming winter period as the problem of patients having to wait on trolleys for a hospital bed continued.
Last week the Irish Medical Organisation warned that the number of patients on trolleys on some days this coming winter could exceed 1,000.
