The postponing of scheduled appointments at hospitals in the midwest will be required “periodically” to cope with emergency department (ED) demand, with the current pause lasting for two or three weeks, the Health Service Executive (HSE) chief executive said.
In an interview with The Irish Times, Bernard Gloster said a support team deployed to University Hospital Limerick (UHL) to tackle overcrowding told him the hospital will need “resets” to cope with demand for emergency care, during which scheduled care will be postponed to ensure there are sufficient beds for those most in need.
“They’ve reported that, regardless of all the developments that are being done, Limerick does need, and will periodically need, an intervention that we would call a reset,” he said.
“A reset means we would have to pause, reduce or divert optional work, elective work, and focus the whole region – not just the hospital but ... the community, the general practice, community, the ambulance service, our elderly care facilities, focus the entire region on emergency care only.”
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This was utilised this week, when the hospital group announced there would be a significant reduction in scheduled care being carried out across the region “until further notice”.
Mr Gloster said it is likely to be mid to late August before this care resumes, “to see if we can just stabilise the site, because we’re a very short step off the autumn, which is a very short step off the winter. And we know what the winter is like in any event”.
Hospital consultants have criticised the move, stating it is “unbelievable, unnecessary and an abandonment of the people” in the region.
UHL has faced significant scrutiny in recent months after an inquest into the death of 16-year-old Aoife Johnston, who waited more than 15 hours to be administered with vital antibiotics, returned a verdict of medical misadventure.
In the days after the inquest, a support group led by Grace Rothwell, the HSE’s national director of acute hospitals, was tasked with addressing the current issues of overcrowding in the midwest.
Separately, an independent report into Ms Johnston’s death has been completed by former chief justice Frank Clarke. Mr Gloster declined to say what the report found, stating he was awaiting responses from a “number of people” and then he will “reflect on what next steps are required”.
“But I can’t know at this stage until I hear those responses. I know people would like quicker and shorter and, you know, even perhaps more dramatic responses, but that’s not how real life works,” he added.
Disability services is another area of the health service that receives criticism. Mr Gloster acknowledged there is a need for improvement.
“I would find our performance in disability services, even though we provide many, many, many good services and have many, many, many good people working in them, I would say our overall performance in respect of disability services is not something I’m proud of,” he said.
“There are too many children and families who really are left struggling either because of a particular prevalence of disability or a particular type or a particular wish for a service that they just can’t get quickly enough.”
In relation to the finances of the HSE, Mr Gloster acknowledged the executive is often referred to as a “black hole”. Last month, Government approved an additional €1.5 billion in recurrent funding for the health service, as well as €1.2 billion next year. This, Mr Gloster said, has provided clarity the executive has not had before.
After the budget last October, he was vocal in his disappointment with the funding allocation, stating it was “not adequate” to support the cost of running the health service.
“That [additional] €1.5 billion means I could keep 4,000 jobs that I wasn’t funded to have. That is a serious investment in the health service for the country and for its sustainability,” he said.
“But in return for that, I have to bring in a level of control that perhaps the HSE hasn’t been used to, certainly not for some time. If we apply adequate controls, I firmly believe that by the end of 2025 our financial sustainability will be so marked, different and improved to what it has been for at least a decade.”
The biggest challenge since he took over the helm of the HSE 17 months ago, he said, has been the focus on urgency.
“I often talk about how precious time is in healthcare. I suppose we tend to talk about our time, but actually we shift the focus to talk about the patient’s time and how valuable the patient’s time is, and how much of it we can waste by our maybe inefficiency, or by perhaps our inability to look at how we might do it a little bit better.”
But he also seems pleased with progress made in terms of people waiting on trolleys for admission to hospital.
In the year to date, there have been more than 928,000 presentations at emergency departments, which is 8.9 per cent more than the same period last year. However, there has been a reduction in the number of people on trolleys, he said, standing at 66,738, a 9.9 per cent decrease.
“That’s a serious improvement in how our healthcare system functions, and part of that is productivity. Is that a good place to be sitting today? It’s only a good place if we keep doing more of that. It’s no good otherwise. So we have to keep changing that.”
This is a time of transformation for the health service. Sláintecare, the long-promised overhaul of the system, is kicking up a notch with the establishment of the six regional areas, due to be up and running by the end of September.
There are moves to do more digital healthcare, with the launch of virtual hospital wards, and the publication of the digital framework that will see a national patient app, as well as electronic health records – an innovation on which Ireland has lagged.
“I don’t ever believe in this big bang, change tomorrow. We continuously improve. I will be gone out of this job, and it is quite likely someone will be still talking about either waiting lists or trolleys, I just hope they’ll be talking about them in a much more sustainable, improved way than what they were before I started,” he said.
“Because demographic pressure will challenge us. Workforce changes will challenge us. Things will challenge us into the future. So the nature of what we do is responding to challenge, and we have to accept that.”
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