Inefficient hospitals hit for €4.4m

HOSPITALS guilty of bad management and delaying the discharge of patients have been hit with fines totalling €4.4 million.

Under the performance-related casemix scheme, Dublin’s leading hospitals have been penalised €2.8m. St Vincent’s, with a history of long patient treatment waiting times and a bed-blocking problem, has been worst hit and will see its budget slashed by €1.2m.

James Connolly Memorial has been docked €1.1m and Loughlinstown docked €871,622.

Tallaght Hospital, which topped the losers list in 2001 and 2002, has finally moved into the black, receiving €26,343 for improved efficiencies, in contrast with a €1.5m fine last year. The Mercy Hospital in Cork and Our Lady of Lourdes Hospital in Dublin are penalised for the third year running, but the fines are down by €435,768 and €585,661 respectively.

Hospitals in the Western Health Board (WHB) outperformed all the others, with University College Hospital Galway again topping the efficiency league and receiving an additional €2.2m to its budget. The North Western Health Board (NWHB) also did itself proud, with Letterkenny General earning €998,889 for efficiencies. However, the good news was marred by warnings from nursing staff and hospital doctors last night that chronic overcrowding in the A&E unit is making working conditions impossible. Hospital management said the overcrowding was so severe that it was compromising the carrying out of surgery in other parts of the hospital.

Irish Hospital Consultant’s Association secretary general Finbarr Fitzpatrick said admissions through A&E were skewering the casemix scheme.

“In excess of 70% of admissions are through A&E. With long-stay patients and bed closures, many hospitals have very little control over the way they run themselves. The casemix system is supposed to be applied where all things are equal and they are certainly not at the moment.”

Irish Patient’s Association (IPA) spokesman Stephen McMahon said while it was good to see hospitals like Beaumont and the Mater rewarded, following severe budgetary pressures and bed closures last year, it was disappointing to see hospitals like St Vincent’s, already under budgetary pressure, experiencing further funding cuts. He said the casemix system should be careful not to reward hospitals for efficiencies resulting from bed closures.

Labour health spokes-woman Liz McManus said she had grave doubts about the casemix system because it could result in over-eager hospitals discharging patients early. She said it was also unfair to penalise hospitals for inefficiencies arising from bed-blocking “because patients, more often than not, have no alternative care available to them”.

A spokesperson for the Department of Health said casemix encouraged greater efficiency and shorter bed stays and that it was “incentivising” for those hospitals who performed well.

This year, under the casemix system, €4.4m was deducted from the budgets of 18 hospitals and allocated to 16 better performers.

Casemix is the combining of hospital activity and cost data to give an average cost per case, length of stay and resource use, relative to other activity in the hospital and elsewhere.