Head of HSE: Memo related to old case

The head of the HSE has played down the significance of a memo which categorised some hospital patients as “trespassers”, saying it was drawn up in response to a case that arose in 2012.

Addressing the Oireachtas joint health committee quarterly meeting with the HSE and Department of Health, HSE director general Tony O’Brien said the case arose at a “particular hospital relating to a patient whose acute care phase was long completed” but who was refusing to move on.

He said staff at the hospital sought advice and this was the genesis of the document which this week entered the public domain.

“There have been other cases recently [where patients’ treatment was complete but they refused to move], hence the memorandum,” Mr O’Brien said, adding that such cases are “very rare”.

The now withdrawn memo was never meant to be widely distributed and the HSE “absolutely regretted and apologised” for the offence it had caused, said Mr O’Brien.

The memo outlined how a patient’s right to be on a hospital premises “is merely a licence and once that has been abused, the nurse is also legally entitled to remove the person as a trespass, using minimum force to do so”.

Asked by Sinn Féin TD Louise O’Reilly about the use of minimum force, Mr O’Brien said that “there was never, has never, will never, be a direction that people should use force”, but “there may be circumstances where the HSE has to seek the assistance of the courts to vacate hospital beds... to which patients have developed an attachment”.

Labour TD Alan Kelly questioned why it was necessary for 15 officials from the HSE and the department to attend the committee meeting. “The idea that there are 15 people here is insane. It is absolutely ridiculous and not good for the taxpayer,” he said.

When department secretary general Jim Breslin appeared amused by his remarks, an annoyed Mr Kelly said: “I don’t know what the secretary general is laughing at. Would you tell us?”

Mr Breslin said it was in relation to a previous point.

Health Minister Simon Harris said he “shared” Mr Kelly’s view that 15 officials was excessive but that it was “up to the committee to decide who they want here”.

Mr Kelly asked Mr Harris to guarantee the health service would not run over budget this year — as of August 31, the HSE was €22.7m over budget. Mr Harris said it should come in on budget but with the caveat that the State Claims Agency may be hit with additional unpredictable liabilities. Mr O’Brien said they “expect to come in collectively on the nose”, unforeseen circumstances notwithstanding.

Mr Kelly asked why private hospitals couldn’t be used to accommodate patients on trolleys in public hospitals. Mr O’Brien said public and private hospitals weren’t always directly comparable and that it was a “regular occurrence for blue light ambulances to have to bring patients from private to public hospitals”.

Faced by regular interruption from Mr Kelly, Mr O’Brien said: “You are hectoring me.”

Fine Gael senator Colm Burke asked what was being done to reduce spend on agency staff, which reached €225m in 2015 and was on target to reach a similar figure this year. Mr Harris said they were “actively in the business of trying to convert agency posts into permanent posts”.