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HSE's high risk hospital strategy
[Posted: Mon 08/02/2010 by Niall Hunter, Editor www.irishhealth.com]
The Government and the HSE are undertaking a very high-risk strategy this year to ease pressure on hospital beds and improve patient care.
A reduction of 33,000 in admissions from hospital emergency departments, an overall cut of nearly 6% in inpatient care, further bed closures and savings measures of €106 million for 2010 are outlined in the HSE's latest service plan, which has been approved by Health Minister Mary Harney.
The plan to cut admissions will cause the greatest concern, as it is not clear exactly where the 33,000 patients will be diverted to.
While diverting these patients may free up more beds, the number of these hospital beds is set to decrease by 1,100 and it remains to be seen whether the radical admissions cut plan will ease hospital bottlenecks in A&E.
The feared drastic service cuts have been avoided as a result of the public service pay reductions, but there will be concerns on whether the resources will be put in place to provide alternative care for the patients due to be diverted away from inpatient hospital beds.
Many of the alternative care pathway plans for these patients have not yet been implemented or are at best vague.
What is made clear in the plan, however, is that there will be a continuing reduction of inpatient bed capacity in hospitals. At present, 1,700 beds are unavailable in the system due to capacity reductions and delayed discharges, and in some hospitals this has led to an increase in trolley waits.
In addition, the HSE has also outlined (see here) severe staffing and resourcing challenges to delivering not only reformed new services, but safe services at existing levels.
The Minister says the planned 33,313 reduction in emergency admissions will be achieved through increasing access to the specialist skills and senior clinical decision-making available in hospital medical assessment units, diagnostics including x-rays and other ambulatory care services.
Inpatient cases are to be reduced in total by 54,000
The Minister said there would be increased access to diagnostic testing for at least 10,000 of those who, on an annual basis, are admitted to hospitals only for that purpose.
However, HSE CEO Prof Brendan Drumm admitted at a meeting of the Oireachtas Health Committee this week that these assessment units, in which patients can be processed more quickly, are still not available in many hospitals.
In addition, it has yet to be clarified how 10,000 patients are going to be given better access to diagnostic testing, including x-rays, and thereby avoid having to be admitted to a hospital bed.
The HSE says the reduced emergency admission plan is targeted at the 29% of annual A&E admissions who stay in hospital less than 48 hours.
She said the HSE is projecting service activity levels for 2010 which are broadly in line with 2009 levels, and the savings target of €106 million is achievable without affecting patient or client care in any way.
Prof Drumm has stressed that in order to reduce emergency admissions, there will be a greater emphasis on diverting patients away from hospitals and treating them in primary and community care, particularly patients with long-term illnesses.
He has said projects will be set up this year which will link up care between GPs and hospitals in areas like diabetes, asthma and heart disease.
How such projects, which are not yet up and running, will have such a major impact on ED admissions in such a short space of time remains to be seen.
In addition, the HSE's plan presupposes that there is a well-oiled GP-centred primary care system in place that can take pressure off hospitals.
Judging from an Oireachtas Heath Committee report published this week, this is far from the case.
The report showed that we are a long way from the Government's 2001 strategy which envisaged at least 600 primary care teams, all operating from state-of-the-art centres acting effectively as one-stop-shop walk-in "mini-hospitals" in the community.
Instead we currently have 222 "virtual" primary care teams set up, which do not usually operate within the one centre. There is an eventual target of 542 teams being set up.
Under the HSE's current primary care plan, only two new primary care centres were built last year, although there are plans for more.
The teams being set up hold multidisciplinary meetings of GPs and other staff on patient care but do not operate under the one roof, something that Oireachtas Committee says is vital to divert more people away from often expensive and unnecessary hospital stays.
Worryingly, it has emerged that around 30 of the PCTs do not currently include GPs as team members, which is a bit like having hospitals operate without doctors.
The HSE says by the time around 530 primary care teams are set up at the end of 2011 "everyone in the country should ultimately be able to access up to 95% of the care they need within their local community."
This sounds ambitious, to say the least.
The service plan sets a target of only six hours for the time patients attending hospital A&Es are either admitted or discharged. How this ambitious target can be reached while at the same time cutting inpatient bed numbers has not yet been made clear.
Recent HSE figures show that the average waiting time from A&E registration to admission at Beaumont Hospital is currently 28 hours, while it is 24 hours at St Columcille's Hospital in Loughlinstown and 12 hours at St James's in Dublin.
The Minister said because of the savings made from public sector pay cuts and in non-pay costs, additional resources are being made available in a number of services.
There will be €10 million for home care packages; €97 million for the Fair Deal scheme; €230 million to bring the numbers with medical cards to over 1.6 million and for 114,436 GP visit cards, and €20 million for further development of cancer services.
HSE Chairman Liam Downey said the service plan, involving a total spend of €14.069 billion, reflects the continuing shift from inpatient to day case activity, with an increase in day cases of 6.5% planned and a reduction of the level of inpatient care by 5.6%.
"This will be achieved through a combination of continued reform in how health services are delivered through measures such as minimising length of stay in hospital, more day case procedures and providing alternatives for people who at present have to be admitted to hospital through emergency departments for very short stays, " Mr Downey said.
Recent HSE statistics show, however, that waiting lists for day case treatment have increased by nearly 8% over the past year.
Prof Drumm is confident that the HSE will continue to reorient services away from bringing people into hospital for care they should get on a day case basis and in community facilities.
"A high hospital admission rate is not a logical measure of the effectiveness of a modern health service," he said.
The HSE says new radiation oncology facilities for cancer treatment at Beaumont and St James's Hospitals in Dublin will be opened before the end of the year.
View the HSE's full service plan here
|Anonymous Posted: 15/02/2010 12:17|
How reducing admission of patients is going to improve patient care is beyond me.
A greater emphasis on diverting patients away from hospitals and treating them in primary and community care - according to this.
But WHAT primary and community care, I ask? There does not seem to be any to speak of.
|TonyB Posted: 16/02/2010 15:20|
I am in a desperate situation. My father keeps getting moved out of ICU quite promptly, and left to 'take his chances' on a ward. A few nights ago, only for the fact that I delayed going to the loo in order to stick my head in the door, he was a dead man. His heart had stopped.
He was waiting on an ICU bed when this happened. Problem is aspirational pneumonia, & mucus coming up. He is back in ICU and I am thinking we can't take this risk again, of him being unmonitored in a ward. Sorry to admin if I am hijacking here, but I'm frantic.
I'm thinking of hiring nurses of my own on 24 hour shift to watch him, or just moving him on from the ICU in the hospital to a private ICU of some sort. It may not affect the ultimate outcome, but hell, I'd be so unhappy if he died in a ward while someone was answering the phone.
Not wanting to distract the topic, but if anyone can suggest a feasable way around this I would be eternally grateful.
|bj Posted: 21/05/2010 21:38|
Really sorry to hear about your Dad's condition. My Father had the same condition, which went undiagnosed by the HSE and by his doctor. He needs round the clock care, don't see how you can get round it other than by being beside him, hope you have family to help. We were allowed to stay with our Dad, as his time was limited, we took it in turns to be with him and had a family member present at all times, so that we could advise the staff of his needs. Dreadful to have to monitor the situation yourslelf. Best of luck.
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