HSE progress is slow but more patients are not waiting longer
It’s a new term for the HSE, with a brand new CEO, a new chairman of the board and a new progress report. On 9 September, they published their first figures for this year on their own performance. There is some good news, some bad, overall their own figures demonstrate progress is slow.. Today the numbers of public patients waiting for hospital care hit the headlines. However if you look at the figures and compare like with like for year on year, the waiting times for planned hospital treatment for both children and adults is slightly improved year on year. It is nowhere near government’s own targets (no adult waiting longer than six months and no child waiting more than three months) and the HSE’s own report shows us that the HSE is failing to meet its own targets.
But the report also gives us some explanation as to why. Occupancy levels (which is literally how many people are in (occupying) the hospital) for all Irish hospitals is over 90%. However, the international level for safe practice is 85%. This very high occupancy realises itself in patients on trolleys in corridors and over crowded wards and is deemed unsafe and unsustainable practice. The overly high occupancy rate also means much planned treatment is cancelled which is reflected in the continued long waits for public patients.
It also reflects in the high numbers of people who enter hospitals through Emergency Departments. While the HSE does not measure the numbers on trolleys, they do measure the amount of people waiting longer than six hours in Emergency Departments. According to the HSE, 93% of all patients presenting in Emergency Departments are seen and discharged within six hours which is also an improvement on 2009 figures. But the important figure for Emergency Departments is the length of time from presenting to being admitted. Again this figure is improved but 41% of patients needing a bed are still waiting longer than the HSE’s own six hour target for admission. Admission numbers for Emergency Departments in July 2010 are about the same as 2009 even though the HSE had hoping for a 10% decline in admission numbers.
Similarly, the HSE are treating more patients (both inpatients and outpatients) which again is contrary to their aim of transferring care from inpatient to day cases and from hospital to the community. Overall day cases are up 10%,while inpatient is down by just 2%. But also these same figures could be interpreted as improved efficiency because the HSE is treating more patients, with less money and fewer staff.
Also there are fewer beds now than there were at the beginning at 2010. In July, there were 966 beds closed due to ‘refurbishment, seasonal and planned closures.’ and 603 delayed discharges, so over 1,500 beds are not available for use.
But the report is not all bad news. There is significant improvement on aspects of cancer care for example by July, 99% colonoscopies are happening within 4 weeks if urgent. And 96% of people in need of colonoscopies within 2 weeks which was the target set by HIQA. Also in breast cancer services, which has led the change in cancer care, as of July 2010, 100% of women were diagnosed and had surgery if required in one of eight designated cancer centres. 97% of non urgent referral are seen in 12 weeks, 96% of urgent cases are seen in two weeks above the target of 95%.
There is bad news for the public patients in the public private mix figures which show a significant decline in numbers of public patients being treated in our public hospitals. The measurement the HSE use to monitor public private mix is the numbers of public patients who have had planned treatment. These figures went from 78.5% in 2009 to 73.1% in July – a 5% decline. This clearly shows the public interest is not being met and the new consultants contract is NOT working in the public interest.
There are other poor results in the report. Just seven of the 265 extra social workers committed to by government after the publication of the Ryan Report are in place. However, the HSE report says ‘employment contracts have been signed for 50 and issued to a further 140’ that means 197 of 265 are work in progress and the HSE say they are confident they will have the 265 in place by year end. They say the low numbers hired to date are a symptom of ‘slowness in recruitment’. The under staffing is evident in the fact that over 13% of children in care do not have a social worker and 20% of foster families do not, when the target is 100% for both of these.
The report also details a 6% decline in home help hours. The decline seems to have been a surprise to HSE management and a casualty of not having these figures earlier. They say the target of 11.9 million hours will be met by year end.
Overall, the HSE is living more or less within budget with a current deficit of €35 million. However, it will have to make a further €100 million cuts in order to live within budget by year end, however this is a vast improvement on financial control to previous years. The West and Dublin North East are the worst offenders on over spend. Also there are 525 fewer staff than in the HSE in July than in December 2009. Also it seems the HSE like everyone else is finding it hard to get paid on time. They pay people within 30 days but are findings it very hard to get €60 million of which is owed to them – €30 million of which is owed from private health insurers.
Spending money on buildings which is much needed both for health services, employment and the wider economy and yet the HSE is €41 million under spent in their capital budget. Also the report flags the unlikelihood of the realisation of €50 million promised for community mental health services which is dependent on selling old mental hospitals
Significant challenges lie ahead for the HSE; they are looking at €500-700m budget cut, continuing ‘to do more with less’, a real challenge managing the changed role of local hospitals, sore points like child protection, out patient wait times, cancelled surgery, the list goes on and on…