The head of the Health Service Executive has defended his and the organisation’s response to the worst ever emergency department overcrowding seen this week.
Asked whether he thought Irish hospitals were safe places to be over the past week, Paul Reid said they were, but they would be “much safer when we’re not dealing with the numbers we were dealing with”.
The first week of the new year has been the worst ever for hospital overcrowding, according to figures released by the Irish Nurses and Midwives Organisation on Friday.
Some 3,143 patients went without beds during the week, as trolley numbers hit a new daily record of 760 on both Monday and Tuesday.
This figure slightly exceeded the previous overcrowding record of 3,122 patients on trolleys set during the “Beast from the East” storm in March 2018.
There were 482 patients waiting for admission to hospital on Friday morning.
Mr Reid said he knew he was going to be dealing with a crisis in the winter from the moment he was appointed seven months ago.
‘Massive hit’
The HSE recognised early on that the flu in circulation “hits early and hard” and made good progress until the last weeks of the year when the system took a “massive hit” particularly due to a surge in frail, older patients.
Mr Reid said it was impossible for a system operating already at 95 per cent capacity to move up to 110 per cent capacity and still maintain the flow of patients through it.
While it would be “remiss” of him to say the worst was over, “we’re in a much better place now at the end of the week,” he told The Irish Times.
He denied this week’s record overcrowding was caused by spending controls he imposed in his first weeks in his post last May, which impacted on the supply of home-help hours, step-down care and agency staff levels.
“Just for the record, we haven’t put in any cuts anywhere. In fact, we’ve came in over our budget by €325 million. I’m confident what we’ve done for the health service is the right thing.”
In the UK, the national health service had a “significantly bad time” this week due to a winter surge in patient demand, he pointed out.
Mr Reid said achieving “financial predictability” strengthens the HSE’s case for extra funding for a “pipeline” of 2,500 more beds.
“No, I haven’t got the commitments [from Government] just yet but I’m clearly saying that’s what’s needed.”
Mr Reid says he would be misleading people if he were to promise the HSE would be able to deal with next winter’s surge. He wants the Government to front-load a plan to employ an additional 1,000 health staff in the community.
This year’s winter plan was criticised for having no provision for extra beds until funding was provided late last year. Mr Reid says additional beds need to be funded earlier in the year for the next winter plan.
He believes the HSE can make significant savings through greater use of biosimilar drugs, while the forthcoming designation of one Dublin hospital as a major trauma centre could free up other hospitals for elective work.
Outpatient appointments
Meanwhile, the number of patients waiting for an outpatient appointment fell in December by 10,000, the biggest single-month drop seen in several years.
There were 553,434 outpatients on the waiting list at the end of the month, while the inpatient waiting list remained unchanged at 66,563, according to the latest figures from the National Treatment Purchase Fund.
The fall in outpatient numbers will offer some relief to Minister for Health Simon Harris following record overcrowding in hospital emergency departments. Mr Harris is facing a motion of no confidence from backbench TDs next month.
The ED overcrowding has forced the curtailment of other services in many hospitals. As a result, the outpatient list for this month may rise again.
Outsourcing measures
The fall in outpatient numbers in December is the result of massive investment by Government in outsourcing measures channelled through the NTPF, which has a €100 million budget this year for such initiatives. Two-thirds of outsourced work is being performed in the private sector.
According to the latest figures, 172,000 patients have been waiting for an outpatient appointment for more than 12 months. More than 9,000 of those on the inpatient list have been waiting more than 12 months for a procedure. No patient has been waiting more than a year for a procedure in hospitals in Wexford, Cavan, Louth, Drogheda, Bantry, Clonmel, Kerry and Ennis.
The outpatient list grew by more than 37,000 during 2019, while the inpatient list fell by over 3,000.
Both Galway University Hospitals and the Mater hospital in Dublin have almost 43,000 patients waiting for appointments.
