Thank you to councillors who approved my re-election to the chairmanship of the Forum for the coming year. As indicted, we will concentrate on Lourdes
Hospital Drogheda and its relationship with primary care and other
institutions in the catchment area. WE will also look at the proposed
solutions to the A&E problems at Mater, Beaumont and Connolly in Dublin.
Councillor Robbie Gallagher asked the following questions:-
Can the HSE give an overview of where it currently stands with regard to
its planning for a disease management programme in the area of diabetes?
Cllr. Robbie Gallagher
Response:
Prof Richard Firth has just been appointed as Clinical Lead of the National Diabetes Programme in the National Directorate of Quality & Clinical Care under Dr. Barry White. The National Diabetes Programme is beginning its work under the following prioritised headings:
A meeting of the elected Chairmen of the HSE Forums is due to take place in
early June. I am trying to get agreement to streamline the administrative
structures of the health service to focus public money on the doctor/patient/nurse/health professional interaction which has been reduced to comply with the budget allocations set out for 2010 by the government.
Dear Dr Conroy,
I would like the Forum Chairman’s Meeting to be presented with a table of
the number of staff at grade 4 and above at this date with the comparison
data representing the staff rank numbers at the end of the first year of
the HSE and the final head count under the same criteria in the final year
of the Health Boards.
Read more
REGIONAL HEALTH FORUM – DUBLIN NORTH EAST
FÓRAM RÉIGIÚNACH SLÁINTE – BAILE ÁTHA CLIATH AGUS AN TOIRTHUAISCEART
24TH MAY, 2010
AGENDA ITEM NO. 6
HEALTH SERVICE EXECUTIVE UPDATES
Emergency Department, Our Lady of Lourdes, Drogheda
The opening of the new ED in Our Lady of Lourdes Hospital in Drogheda has
experienced a number of delays outside the control of the HSE – industrial
action which commenced on the 25th of January 2010 saw unions across the county and the public sector instruct members not to co-operate with any reform or Transformation agenda. In the North East meetings in relation to progressing the service changes for the transfer of services from Louth County Hospital Dundalk to Drogheda were postponed due to lack of
engagement. In March in a very welcomed move unions agreed to give the
North East Transformation programme derogation from this industrial action and commenced re engagement and discussion on the service changes. A framework document on the redeployment of staff has now been agreed, this document will now allow the appointment of the essential staff to proceed to facilitate the opening of the new ED.
The HSE have now advertised an expression of interest in all Dublin North
East Hospitals seeking staff interested in working in the new ED in OLOL,
which should allow the ED to open after a period of training, orientation
and induction. Once staff have transferred and the ED service established
in the new department there are plans for the vacated space to be used for
the establishment of a Medical Assessment Unit.
There are also plans to open two new additional wards over the ED, and a
new CCU, work is also due to commence on the expansion to the intensive
care unit.
The date for the opening of the new ED cannot be finalised yet but the HSE
remain committed to opening it as soon as possible now that the discussions
with unions have been finalised to allow the redeployment of staff. A good
response from experience staff currently within our hospitals will assist
this process and allow the centralisation of emergency services within
County Louth to occur in the near future.
County Infirmary (Community Nursing Unit) – Navan
The HSE is examining options to relocate the service provision at the
County Infirmary site in Navan. This will allow for the release of staff
for training and induction towards commissioning of the new Unit. All
clients availing of respite service will continue to be accommodated during
this interim period.
The new Community Unit will replace the Co. Infirmary, Navan. All Co.
Infirmary respite clients and staff will transfer to this new purpose-built
facility, located on HSE grounds beside OLH Navan. This unit will comprise
of 50 residential beds, to include respite care, rehabilitation, assessment
& review and continuing care. The unit will also extend a range of day
care services to both psychiatric & older person, ranging from medical,
nursing, physiotherapy, occupational therapy and speech & language therapy. The unit will accommodate both clinic and administration accommodation for palliative care service.
This unit will require to be registered by HIQA so a specific timeline for
opening is not yet identified.
Update on reconfiguration of Services for Older Persons, Drogheda
Louth PCCC are currently in the process of reconfiguring respite beds in
Drogheda. This will not affect our ability to continue to provide the
current level of respite service to over 130 older people. This reconfiguration means that the HSE will continue to have 15 respite beds
in Drogheda across the three sites of Drogheda Services for Older People:-
The Cottage Hospital, Boyne View House and St Mary’s.
The reasons for this reconfiguration is necessary are as follows:-
As part of this reconfiguration, Unit 1 in the Cottage Hospital will be
closed and vacant beds in other units within the Drogheda Services will be
opened to ensure the current level of service is maintained while meeting
the challenges as outlined above. A communication process has commenced with patients and their families plus our staff and the HSE would hope to be in a position for initiate these changes within 6 – 12 weeks.
HSE Staff are not being redeployed outside the service but may be
redeployed within the three sites for Drogheda Services for Older People.
Louth County Hospital one of six hospital haematology laboratories to be
awarded accreditation by Irish National Accreditation Board. The scope of accreditation of the Laboratory at Louth County Hospital has been extended to include Haematology.
Last year the Irish National Accreditation Board (INAB) presented Accreditation Certificates to the Blood Transfusion Departments of Our Lady
of Lourdes Hospital, Drogheda, Our Lady’s Hospital, Navan and Louth County Hospital, Dundalk. At its board meeting on the 13th April, 2010 the Irish National Accreditation Board awarded an extension to the scope of
accreditation to the laboratory at Louth County Hospital to include
Haematology. This is now one of six hospital haematology laboratories, in
the country to be awarded accreditation by INAB to date.
The hospital had received registration from the Irish National
Accreditation Board (INAB) and had been granted the International
Organisation for Standardisation Award ISO 15189 Certificate from the Board of INAB for the quality of work and service at the Blood Bank of the
hospital. This involved the establishment of a rigorous Quality Management
System and intensive internal audit programme in the Blood Bank Laboratory, phlebotomy and haemovigilance to achieve the certification. Accreditation to ISO 15189 is mandatory for all Hospital Transfusion Laboratories in Europe since the ratification of new EU Legislation for Blood/Blood Products in 2008. This award has now been extended to include the Haematology Department.
Celebration of Nursing and Midwifery and Presentation of Elaine McCluskey Award at Cavan General Hospital
The celebration of Nursing and Midwifery Day and the presentation of the
Elaine McCluskey Award took place recently in Cavan General Hospital.
The celebration of Nursing and Midwifery Day is held to acknowledge the
contribution of nursing and midwifery to patient care and to share examples
of good practice within Cavan and Monaghan Hospital Group. Nursing and
midwifery staff present posters on quality improvements made within
hospital services and the day also incorporates presentations on key
nursing and midwifery developments in the hospital such as nurse
prescribing, clinical audit projects, oral care in intensive care, smoke
free hospital achievements and practice development updates.
A key part of the day is also the presentation of the Elaine McCluskey
Award by Mrs. McCluskey. The winners this year are Mary Kennedy and Chris O’Connor from the Resuscitation Department for the implementation of a new training programme for advanced cardiac life support. The training
programme uses interactive computer technology to simulate cardiac arrest and assists the medical and nursing staff to learn how to correctly manage cardiac arrests and patient care in this situation. The training on the
computer is then followed up with practical sessions with the staff. This
is the first time this type of training has been delivered in Ireland, and
it has been very positively received by staff. The aim of the training is
to continually improve the standards of care in looking after critically
ill patients. We congratulate the winners on their success and also thank
the family of the late Ms Mc Cluskey for funding and supporting this annual
award in her memory.
CDC launches new Hand Hygiene in Healthcare Settings Website
In association with the World Health Organisation’s ‘Save Lives: Clean Your
Hands’ annual initiative, the Centre for Disease Control (CDC) has launched
a new ‘Hand Hygiene in Healthcare Settings’ website.
This site provides healthcare workers and patients with a variety of
resources including guidelines for providers, patient empowerment
materials, the latest technological advances in hand hygiene adherence
measurement, frequently asked questions, and links to promotional and
educational tools published by the World Health Organisation, universities,
and health departments.
HPV Vaccine – Protect Now, for the Future
The Health Service Executive has announced details of the HPV Vaccination
Programme, which began in second level schools during May.
The HPV vaccine will protect girls from developing cervical cancer when
they are adults and will be available free of charge from the HSE.
The HSE confirmed that during 2010, all girls who are now in 1st Year and
all girls who are starting 1st Year in September will be offered HPV
vaccine. Vaccines will in the most part be given to girls in second-level
schools by HSE immunisation teams, with some girls being invited to special
clinics for their vaccine.
The first schools are being visited during May 2010, with the remainder of
schools commencing the programme in September 2010. Parents and schools will be sent information by the HSE in the coming week, letting them know of the programme and when their daughter’s vaccinations will begin. A
detailed information pack and consent form will be sent to parents of those
schools beginning vaccinations.
Parents whose daughter’s vaccinations begin in September will also be sent
a flyer from the HSE, outlining the programme, their daughter’s start date,
and where they can get more information in the meantime.
The following second level schools in Dublin North East will be
administered the HPV Vaccination during May, for 1st Years only. These
schools will be revisited in September to vaccinate girls starting 1st year
in September 2010. All other second level schools will start in September:
Additional information on the HPV vaccine programme is attached at Appendix
A new cross border initiative called ‘Improving Outcomes for Children’ is
attempting to measure the health and well being of children and young
people and to support agencies coming together to plan services in order to
make improvements to children’s lives. The initiative is being supported
by the European Union’s INTERREG IVA funding, secured by Co-operation and Working Together (CAWT), the cross border health services partnership. It will work at two levels. Locally, it will involve the setting up of four pilot sites in the border region, both in the Republic of Ireland and
Northern Ireland, through which local agencies and communities will be
supported to plan services for their children together. It will also support inter-agency committees in Northern Ireland and the Republic of Ireland, to use an approach to planning based on improving children’s outcomes to improve all services for children and young people.
To progress the work of CAWT’s ‘Outcomes for Children’ project, a workshop
was held in Monaghan recently, attended by representatives from a range of
agencies including Government departments, health, education, housing,
councils, voluntary and community organisations from both sides of the
border. This event focused on giving practical guidance to policy makers
and those providing public services to work together with local
communities, to plan and deliver services so that better outcomes are
achieved for children and young people.
Delegates at the event had the opportunity to ask questions and discuss how
the outcomes based planning could be adopted within their work areas. The
CAWT ‘Outcomes for Children’ project will continue to support partnerships
and individual agencies who wish to adopt this approach and to complete the establishment of the four pilot sites in the border region.
REGIONAL HEALTH FORUM – DUBLIN AND NORTH EAST
FÓRAM RÉIGIÚNACH SLÁINTE – BAILE ÁTHA CLIATH AGUS AN TOIRTHUAISCEART
24TH MAY, 2010
AGENDA ITEM NO. 3
MOTIONS
Motion:-
“That the Forum Members receive detailed information on the plans in each
of the Hospital in Dublin and the North East to tailor their services to
the budget allocation for 2010.”
Cllr. Bill Tormey
Response:-
Breakeven Plans 2010
The HSE acknowledges that 2010 is proving to be an extremely challenging
year.
In line with Government policy to reduce gross current expenditure, the HSE needs to reduce its costs by €400m. The DNE Hospitals’ share of the
government measures in 2010 is an actual expenditure reduction of
approximately €65.2 million. This represents an average of a 5% reduction,
in real terms, for each hospital/hospital group on their 2009 allocation.
However, the challenge may be more significant for individual agencies,
depending on such factors as their prior level of expenditure or case-mix
adjustments. The hospitals must also reduce staff numbers by 240, but
this headcount reduction only represents a proportion of reduction in pay
expenditure that must be made.
All management teams within DNE were briefed on a potential challenge of
this scale in November and December last year. Sample budget scenarios were presented, including a scenario of an expenditure reduction of €100m across the entire DNE Region. Management teams were asked to commence preparing cost containment plans. 2010 allocations were subsequently issued in early February. Since then, every hospital/group has engaged with the hospitals network office in the development of breakeven plan measures to address their potential deficit. Given that the majority of health
expenditure is pay related, the areas where agencies can act to save
significant monies is restricted. A key priority is to minimise the impact
on front line services. Appendix 1 is a summary of 2010 allocations to
hospitals. There is no doubt that the scale of fiscal challenge is
daunting; opportunities to reduce expenditure continue to be identified and
exploited.
Detailed activity reports are not available as a result of the industrial
action, but the indications are that hospitals to date are meeting the
commitments outlined in the service plan.
The HSE 2010 service plan commits to a 5.6% reduction in in-patient
admission and a commensurate 6.5% increase in day cases. A reduction in bed numbers is therefore to be expected as in-patient admission avoidance
measures, such as higher day case provision and enhanced access to
diagnostic services, become operational. Hospitals have included bed
closures as part of their breakeven plans.
The reduction of beds must also be seen in the context of the reduction of
delayed discharges. It does not follow that bed closures will
automatically result in a reduction in acute care services. Since the
introduction of Fair Deal the HSE has been actively working with hospitals
to reduce the number of acute bed days lost to patients who require long
term care placements. In 2009, Beaumont Hospital used approximately 46,000 bed-days for the care of delayed discharges patients. This was equivalent to 126 hospital beds being unavailable for acute care for an entire year. The number of delayed discharge patients in Beaumont has now decreased to 111 from a peak of 176 in November 09, a reduction of 65. Beaumont has now closed 62 in-patient beds and plan further bed closures as more long term care patients are discharged. This will be facilitated by the commissioning of 32 step-down beds in Clontarf from end of May this year, as well as the provision of an additional 100 long term care beds in St.
Joseph’s, Raheny. The St. Joseph beds will be commissioned from the end of
third quarter, providing the HIQA registration process has been completed.
We met with HIQA to seek priority for this development and HIQA agreed to
facilitate this, as far as their legislation permits.
It should also be noted that although Beaumont has now closed beds, their
Emergency Department performance has shown improvement since last year in terms of the 2pm wait time for admission targets. Beaumont has only
breached the 24 hour wait time twice since April and has significantly
reduced the numbers waiting in the 12-24 hour wait time, compared to the
same period last year. Work continues to improve ED performance further,
but it is acknowledged that it will be extremely difficult to maintain the
gains made in ED performance whilst the bed closures take effect.
The Mater hospital lost approx. 36,000 bed-days, which equates to 101 beds being unavailable for acute care for a full year. The total number of
delayed discharges in Mater hospital has now dropped from a peak of 121 in
June 09 to the current level of 72, a decease of 49. The Mater has also
commenced bed closures. Five beds were closed on Friday, 21st May, and
further closures will be phased in, bring the total to 60 by the start of
July. A further 20 beds may be closed later in the year.
For both hospitals, a number of these closed in-patient beds will be used
as day-case beds, to achieve the planned increases in activity. With
continued focus on ‘Fair Deal’ discharges, the hospitals should therefore
be on target to provide the acute care services, as outlined in the service
plan.
The aspect of the ongoing industrial dispute which targeted the
non-submission of financial data to corporate and regionally has recently
been lifted. Detailed expenditure trends will be available to management
in the next two weeks. Expenditure trends for the first quarter indicate
an excess of €16m over budget allocation for acute services for the region.
It is not expected that this level of over-expenditure will persist, as
future quarters will reflect the cost-saving measures that have been
implemented by the hospitals.
Non-Consultant Hospital Doctor Recruitment
A separate area of emerging concern relates to the filling of
non-consultant hospital doctor positions for their next appointment period,
commencing in July. Early indications are that the larger hospitals are
attracting the majority of applicants, whereas smaller hospitals, with
fewer recognised training positions, are finding it difficult to attract
suitable candidates. The specialities particularly affected are
Anaesthetics, Surgery and Accident and Emergency. Should this trend
persist there may be a significant impact on the provision of services at
smaller centres. The situation is being monitored and contingency plans
are being developed.
Appendix 1 2010: Hospital Allocations
Hospital 2010 Notified Budget Allocation Total
Measures required to
adhere to budget allocation
€000’s
Mater 213,026 17,300
Beaumont 241,179 19,095
Rotunda 47,289 2,158
Cappagh 26,245 1,623
Connolly 90,044 3,659
Dublin North Group 617,783 43,835
Louth Meath Group 160,085 9,857
Cavan Monaghan Group 77,361 7,990
NE Group 237,446 17,847
Total DNE Hospitals 855,229 61,682*
% 7.2*
* Note: The figure of 7.2% (€61,682m) represents the savings that must be
found to achieve breakeven as a percentage of the 2010 budget. The 5%
reduction referred to in the 2nd paragraph of this report is based on the
reduction from the 2009 budget, and is not therefore directly comparable.
Hospital Boards are supposed to order policy to direct the Chief Executive
in the management of the institution. In Public Hospitals, the Minister for
Health is responsible for Board appointments even if some members are
nominees of Unions, Medical, Nursing or other staff, medical school or
university interests.
With the proliferation of staff at higher grades in the HSE in general since
its establishment, has an independent Lean Study on the administration ever
been commissioned?