Only 50% of primary care teams in place by year end

THE number of primary care teams (PCTs) in the Health Service Executive (HSE) South is less than half the figure required to support the reconfiguration of hospital services, according to a leaked report.

A Review of Acute Services in the HSE South estimates 139 PCTs are needed, but according to the HSE, 63 will be operational by the end of 2009. These 63 teams were in development between 2006 and 2007, but just 34 have had their first clinical team meeting, according to a HSE performance report.

Teams are not defined as “operational” until they have held a clinical team meeting. A HSE statement said all 63 teams will be operational by the end of 2009 and an additional 16 teams will be “in development”. The teams – GPs, public health nurses, home helps, speech and language therapists, occupational therapists, physiotherapists, psychologists, social workers and administrative personnel – are the cornerstone of health care delivery in the community and essential to the HSE’s transformation programme.

The review identifies a number of difficulties in the Primary, Community and Continuing Care (PCCC) sector, including

nInsufficient service provision for those under 65 years of age in community hospital units.

Criteria for admission include that a patient be 65 years or over. This means younger patients who no longer require acute care cannot be discharged to community hospitals. The end result is almost half of all excessively long stays in acute hospitals are patients under the age of 65. The report says “plans need to be developed in primary and continuing care to address this shortfall” because freeing up acute beds is essential to successful reconfiguration. This requires increasing home care packages, rehab beds, hospice beds and mental health beds.

nLack of access to community therapists limiting rehabilitation potential for patients.

nPoor infrastructure of community hospitals, including “old, cramped ward spaces and inadequate facilities that offered little privacy and dignity”.

The report says there are “major gaps in the portfolio of services provided by PCCC”.

“These include services for those under 65 years, primary and community services provided outside of nine-to-five weekdays, bed and home-based rehabilitation services, preventative programmes and diagnostics.”

The report says the PCCC needs to take over the care of all patients identified as “inappropriate admissions” to acute hospitals. According to a HSE 2007 bed utilisation review, 13% of admissions in Cork and Kerry could have been avoided and 40% of patients occupying acute beds could be cared for in more appropriate settings.