The Department of Health asked that warnings about why an initiative to tackle hospital overcrowding might not work should be moved prior to publication of the plan.
In a section of the official plan called ‘assumptions and dependencies’, the HSE warned that targets set in the initiative might not be met, depending on circumstances.
In particular, it warned of “unusually high demand”, particularly among older people, the potential for flu, and the possible impact of weather conditions.
However, the Department of Health asked that the focus be taken off these provisions so that the plan would come across more positively.
An internal departmental memo said: “We fully understand the need to include assumptions and dependencies, and you are of course correct in stating that unusually high demand and other factors could hypothetically have an adverse effect on delivery.
“However, we would advise, prior to publication, that this section might be moved to the end of the submission; we would prefer to focus on the very positive effects of the proposed initiative, towards the beginning of the document.”
In a separate email to the HSE, the department suggested that these negative notes, which had featured in the opening pages of the submission, would be better placed “probably towards the end of the document”.
The first page could then be focused on the “objectives and benefits which the plan aims to achieve”.
Not everybody in the Department of Health was so confident about the plan, however. One senior official noted that the ability to secure and retain staff was going to present a major difficulty, particularly in providing additional acute beds.
“Based on recruitment track record this could be a major challenge in implementing these initiatives before year end,” wrote Fionnuala Duffy of the Acute Hospitals Policy Unit.
The warnings which the HSE tried to make prominent in the plan did eventually become reality. Trolley figures from last week show that, last Tuesday, there were 541 people on trolleys at hospitals all around the country, with staff shortages forcing beds to close, according to the Irish Nurses and Midwives Organisation. Those figures were significantly worse than on the same date last year, when 331 people were on trolleys in hospitals.
A pledge in the winter initiative said there should be no more than 236 patients on trolleys on any given day while the plan was in place.
The Department of Health said the initiative had been successful in some respects, with the number of “delayed discharges” down from 638 at the start of the plan to 488 last week. It said 4,100 people had made use of community intervention team services, meaning it had been able to avoid hospital or were discharged earlier.
In addition, new home care packages were provided, with 250 transitional care beds, as well as 28 step-down beds in Mercy Hospital in Cork and Beaumont in Dublin.
The department said it had fully acknowledged the importance of the ‘assumptions and dependencies’ section ” being included in the winter initiative plan.
It said: “They were moved to the back of the document for stylistic reasons and in order to ensure that focus would be maintained by the HSE and the Department on the key deliverables of this very important initiative.”
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