Poor levels of vaccine uptake among healthcare workers, patient safety concerns at some HSE facilities and increased staff turnover that “outstripped all expectations” are among a string of issues the agency’s new chief executive, Bernard Gloster, was warned about before taking up the post.
Internal briefing papers prepared for Mr Gloster, who took up the job last month, offer an indication of stark challenges facing the health service.
He assumed the role amid the recruitment and retention crisis and in the wake of a period of unprecedented overcrowding in Irish hospitals due to a surge in respiratory viruses including influenza, Covid-19 and RSV (respiratory syncytial virus).
While the HSE had said there has since been a “significant downward trend”, concern remains in some quarters about ongoing overcrowding in some hospitals.
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The Irish Nurses and Midwives Organisation (INMO) this week called for a plan to tackle continued overcrowding in Cork University Hospital and Mercy University Hospital.
The INMO separately raised concern over the lifting of mandatory mask-wearing across healthcare settings on Wednesday. It said it wanted the HSE to “assure staff that they will be fully supported in the event of serious outbreaks but also if there is friction between those who have differing views on mask-wearing in healthcare settings”.
On the first day of the new guidelines, many staff and patients dispensed with masks for the first time in three years, though not in healthcare locations with Covid-19 outbreaks, and for aerosol-generating procedures.
There were 12 Covid hospital outbreaks last week, up from 11 the previous week and 311 patients with Covid in hospital on Wednesday. The situation in nursing homes was 12 outbreaks, down from 18.
The briefing documents for Mr Gloster, drawn up in February, were released to The Irish Times under the Freedom of Information Act.
They set out “ongoing threats” to public health including vaccine uptake levels among healthcare workers.
The briefing papers say: “Poor vaccine uptake, particularly among health and care workers, has contributed to increased risk of both Covid-19 and influenza cases and outbreaks in settings with vulnerable people.”
They add that this also increased the “risk of high levels of absenteeism in these important services.”
The document does not set out statistics for vaccination uptake levels among workers.
The briefing papers set out the “exceptional surge experience” that fuelled overcrowding in December and January and how this was receding by the time they were drawn up in February.
They also add, however: “While improvements have been made across the entire system to mitigate the pressures and resulting overcrowding, some patients are still experiencing unacceptable delays for admission in some sites giving rise to ongoing patient safety concerns.” The locations where there were concerns were not identified in the documents.
A HSE statement on Wednesday night said there has been a “continued significant downward trend” in cases of influenza, Covid-19 and RSV.
It said this, combined with “escalation actions” and supports under the HSE winter plan, has “resulted in sustained improvements in a number of KPIs [key performance indicators] over the last four weeks”.
The briefing papers separately include details of efforts to resolve recruitment and retention problems.
They outline a “significant undersupply” of health and social care professionals, nurses and midwives and how all graduates are being offered permanent positions.
The rate of increase in staff turnover in the HSE “outstripped all expectations” in 2022 – when it stood at 10 per cent – up from 7.7 per cent in 2021 and 6.7 per cent in 2020.
Factors affecting turnover rates are said to include the relaxation of Covid-19 travel restrictions coupled with delayed retirements due to the pandemic response, as well as “significant internal movement”.
