Funding was left too late to hire medics

Funding for last year’s winter plan was not signed off until December making it difficult for hospitals to recruit extra staff to cope with the annual predicted post-Christmas surge in demand.

The late sign-off is highlighted in a review of the HSE’s plan for winter 2017/2018 by the Special Delivery Unit, where it is identified under “areas for improvement”.

Based on feedback from the HSE leadership team, the review recommends that funding for 2018/2019 “needs to be signed off at a much earlier stage” — by the end of June.

“This did not occur until December last year and negated localised recruitment to allow for impact during winter 2017/2018,” the paper says.

It adds that “late decision-making can lead to funding not being operationalised to deliver the proposed service improvements to mitigate surge in demand for hospital services”.

HSE leadership also warned that resources were “not available to support effective forecasting techniques within the system”.

In addition, home service providers were “often hesitant to provide resourcing without certainty of supply, while some emergency departments (EDs) had “less than two consultants in situ resulting in continuous issues around the availability of senior decision makers”.

Moreover, it was “difficult to predict trolley numbers as a single bad day can have a knock-on effect of poor performance at site level for a full week”.

Hospital group feedback outlined a number of challenges, including how “boarding” in acute medical assessment units was “becoming a frequent occurrence in 2018” and how recruitment and retention of staff across all disciples is “severely impacting the system”.

Bed capacity was “widely reported” as insufficient.

The review calls for winter plans for 2018/2019 to be “signed off by September at the latest”.

The HSE said this week that “winter planning is currently well underway”, that €10m in once-off additional winter funding has been allocated for 2018 and that a final plan will be submitted to the Department of Health for approval this week.

Key among the challenges faced last winter were two extreme weather events, Storm Emma and Storm Ophelia. The review says “The severity of such storms and their effects on the healthcare system were profound”.

“Such weather events greatly exaggerate congestion in the hospital system due to an inability to discharge patients during times of ‘Red’ weather warnings and a subsequent sharp influx of post-storm presentations on an already congested system,” the report says.

One of the knock-on effects was the cancellation of scheduled procedures.

High rates of seasonal influenza and a prolonged ‘flu season compounded difficulties, along with an increase in presentations to EDs and increased admissions.

The review says among the actions required moving forward are “reinforcement of principle that winter is now a ‘whole year’ process” and a need for joint integrated winter plan proposals to be submitted to HSE Corporate by the end of June 2017.

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