No overcrowding fines for hospitals despite record numbers on trolleys

Not a single hospital has been fined for failure to implement a policy that is supposed to reduce overcrowding in emergency departments — at a time when numbers on trolleys are at record levels, writes Catherine Shanahan.

The HSE said “no fines have been issued in respect of the escalation framework” a policy brought in by mandatory national directive in November 2015.

The directive requires that hospitals follow specific steps once patients are on trolleys for more than nine hours. The Irish Nurses and Midwives Organisation reported 7,781 patients on trolleys waiting for a bed last month.

The HSE said the Special Delivery Unit (SDU) was tasked with evaluating if hospitals were implementing the escalation policy appropriately and that site visits by the SDU “are ongoing in this regard”.

None of the 46 hospitals were fined last year for excessive inpatient/day case waiting times, compared to €6.6m in fines the previous year.

In 2015, 18 months was set as the maximum permissible wait time to reduce to 15 months by year end. The HSE said no fines were imposed in 2016 for excessive inpatient/day case waits as they met the target of no more than 1,800 patients waiting over 18 months.

However these targets are no longer being met, paving the way for a return of fines. As of the end of August, 10,800 patients were waiting over 15 months for treatment according to the NTPF, of whom 6,490 were waiting over 18 months. No fines have been imposed to date in 2017, the HSE said.

The Saolta Group, incorporating Galway University Hospitals, was responsible for almost €2m of the €6.6m in fines between August and December 2015.

The RCSI group accumulated fines of almost €1.5m of which Beaumont Hospital in Dublin was responsible for almost €1.4m.

The third worst-performing group was the SouthSouthwest Hospital group (SSW) which attracted fines of €1.08m. University Hospital Waterford was the biggest offender, at €358,097, followed by Cork University Hospital at €295,417 and the South Infirmary Victoria University Hospital at €191,111. The Mercy University Hospital attracted fines of €126,567.

A number of hospitals were penalised last year and this year for exceeding the 28-day target for an urgent colonoscopy. The penalty so far is more than €60,000: €16,500 for the latter half of 2016 and €44,250 so far in 2017.

The worst-offending hospitals included St Columcille’s in Loughlinstown where fines of €20,250 were applied for the first six months of 2017.

Our Lady’s Hospital Navan was fined €17,250 between November last year and end of February this year. The Mercy University Hospital in Cork was fined €6,000 in 2016.

The issue of delayed colonoscopies has been an emotive one since the death in 2007 of 41-year-old mother Susie Long.

Ms Long had spoken on the national airwaves of how a seven-month delay in obtaining a colonoscopy led to terminal bowel cancer.

The HSE said all hospitals continue to minimise the number of urgent colonoscopy waiting time breaches, adding that the NTPF endoscopy initiative in 2016 “achieved a 99.8% reduction in the number of patients waiting over 12 months for a routine endoscopy”.

This article first appeared on the Irish Examiner.

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