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Unfortunately, the year began with familiar stories of overcrowded emergency departments (EDs), with a record number of patients (612) on trolleys on the morning of 6 January. The Medical Independent (MI) reported on tense exchanges between the Irish Nurses and Midwives Organisation (INMO) and the IMO on the subject.
This month, the GP Committee of the IMO also warned that GP services across the country were “near breaking point” and that no new services could be extended to general practice unless additional resources were made available.
An RTÉ documentary, Living on the List, showed that the number of patients waiting for operations or medical procedures was significantly higher than the waiting lists published by the National Treatment Purchase Fund (NTPF). The ‘Pre-Admit’ and the ‘Pre-Planned’ lists were not included in the published NTPF data, despite comprising thousands of patients. The documentary generated fierce controversy after it was broadcast, particularly around children waiting for scoliosis procedures.
Meanwhile, MI revealed that sponsors of HSE leadership masterclass were promised ‘face-time’ with a ‘HSE buyer’. The promise was retracted by the HSE following queries by this newspaper and a spokesperson for the Executive said the original text had been put up in error.
This newspaper reported how the window of opportunity to prevent carbapenem-resistant Enterobacteriaceae (CRE) from becoming endemic in Ireland’s hospital system was “diminishing rapidly”. President of the Irish Society of Clinical Microbiologists Dr Eleanor McNamara told MI that CRE represented a “major” patient safety issue, with a significant increase in the number of cases recorded between 2013 and 2016. Six months later, it would be declared a HSE public emergency.
In another exclusive, MI revealed details from an unpublished HSE policy document that stated capitation should constitute the majority of payments to GPs, marking a departure from the current GMS GP contract, where nearly 30 per cent of payments are non-capitation based. The document, compiled in 2014, stated GP benefits and practice supports/input subsidies appeared to have “gradually built up over time, like barnacles on a boat”. Setting GP Fees for Under-Six Year-Olds in Ireland — Towards a Methodology was commissioned by the HSE and carried out by the ESRI and Trinity College Dublin.
The month began with Minister for Health Simon Harris welcoming the deferral of planned industrial action by the INMO.
Also this month, Minister Harris announced that the Government had approved the investment required to enable the National Paediatric Hospital Development Board to award the construction contracts for the building of the new National Children’s Hospital (NCH) on the St James’s Hospital campus and the two paediatric outpatients and urgent care centres on the Tallaght and Connolly Hospitals’ campuses.
Negotiations between the HSE and pharmaceutical company Vertex involving the commercial terms for the supply of Orkambi and Kalydeco to Irish cystic fibrosis (CF) patients concluded, resulting in a positive outcome for CF patients who had strongly campaigned for access to the drugs.
Front-page stories from MI included revelations that hospitals were hit with over €2 million in fines in the first nine months of 2016 for failing to abide by the maximum NCHD 24-hour shift limit, and that the Department of Health spent €704,804 on external consultancy services in 2016.
At the end of this month, the Oireachtas Committee on the Future of Healthcare published Sláintecare, its proposals for a 10-year strategy for healthcare and health policy in Ireland. It was the first time that cross-party consensus had been reached on a long-term model of healthcare.
It was also announced during the month that the new National Maternity Hospital would have no involvement with the Religious Sisters of Charity. The order said it was to give up ownership of the St Vincent’s Healthcare Group (SVHG), after outcry over ownership of the planned maternity hospital, which is to be built on the site owned by SVHG.
Meanwhile, the IHCA expressed its serious concern that an increasing number of temporary consultant posts are being filled by doctors who are not eligible to be on the Medical Council’s Specialist Register.
MI reported that the decision by the HSE to discontinue the Irish Hospital Redesign Programme (IHRP) and replace it with another initiative aiming to improve patient flow was strongly criticised by those behind the programme for needless duplication. The final report of the IHRP was highly critical of the HSE’s actions and also stated that the “political imperative for quick solutions” had resulted in declining support.
The signing of the construction contract for the National Forensic Mental Health Service (NFMHS) complex was announced. The new 130-bed adult forensic hospital, at St Ita’s Campus in Portrane, will replace the current outdated 94- bed Central Mental Hospital complex at Dundrum.
In an exclusive story, MI reported that the HSE has conducted 62 disciplinary investigations and dismissed seven staff members since 2015, according to data released to this newspaper under Freedom of Information legislation.
A new record of almost 687,000 patients were waiting for treatment in public hospitals, according to NTPF figures released this month. The ‘shocking’ figures represented an increase of nearly 9,500 on the previous month and were widely condemned.
Ireland’s ambitious new 10-year National Cancer Strategy was launched this month, following its approval by Government.
MI reported how the HSE was disappointed at the ICGP’s ‘failure’ to fill all the approved GP training places for 2017. Some 171 GP trainees commenced training this year, the ICGP confirmed, while the HSE said it was “extremely disappointed” at the ICGP’s “failure” to fill all 186 approved places.
The latest figures from the INMO confirmed a record number of patients (57,674) admitted for hospital care had to be put on trolleys in the first seven months of 2017. The Irish Association for Emergency Medicine (IAEM) questioned the commitment of the Government and the HSE to addressing the problem of ED overcrowding following the release of the figures.
Also, MI told the story of how a Kerry GP defied an instruction from the National Cancer Control Programme (NCCP) to cease removing suspicious skin lesions, asserting the procedures were often necessary due to “unacceptable” waiting times for patients in the local pigmented lesion hospital clinic in Cork. It also emerged that private health insurer LAYA had stopped covering the removal of suspect lesions in primary care, though agreement was later reached, following agreement with the NCCP on set guidelines, to reinstate payment to GPs under a new code.
This month, MI also reported that over 20 HSE staff received payments under its Assault at Work Scheme in a 20-month period, at a cost of approximately €1.6 million.
MI reported how a fire that occurred at the ICU in the Rotunda Hospital, Dublin, earlier in the year, resulted in babies having to be moved and the unit being closed for seven days.
MI also reported that almost €4 million was spent by the HSE on chaplaincy services in 2015 and 2016 at public acute hospitals.
In another exclusive, this paper revealed that public displays of preserved dead bodies would require a licence under proposed legislation. The Medical Council expressed concerns to the Department of Health regarding the ethics of the Real Bodies Exhibition, which was held in Dublin’s Ambassador Theatre, according to the report.
This month also saw the appointment of Prof Donal O’Shea, Consultant Endocrinologist, as the National Clinical Lead for Obesity. Previously tipped by MI for the role, Prof O’Shea will lead the implementation of national obesity policy.
Minister Harris announced that he was convening the National Public Health Emergency Team as a public health response to the CPE/ CRE superbug.
In this paper, it was revealed that Revenue’s probe into consultants tax affairs has yielded €61.9 million to date.
In another front-page exclusive, proceeds from the sale of the Medical Council’s former headquarters were revealed to have totalled €2.3 million, which was below the reported asking price of €2.75 million.
Also, MI reported how a number of recommendations made in an Interim Report and Second Interim Report of the Clinical Advisory Group (CAG) on medical card eligibility have yet to be acted upon by the HSE.
A story by MI that the Medical Council paid a “professional fee” of €23,079 to a former US astronaut for an approximate 45-minute speech at its Patient Safety and Leadership Conference last year caused huge consternation among readers.
Also, MI revealed that an external report into health and safety at the Department of Health headquarters at Hawkins House found “a large number of significant hazards” on each floor, including in the Minister for Health’s office.
This newspaper also revealed how the HSE was urged to declare a public health emergency in response to the spread of CPE almost a year before the emergency was declared in September.
In response to an RTÉ Prime Time Investigates programme showing some consultants breaching their private practice limits, the IMO and IHCA said most consultants work beyond their contracted hours in public hospitals treating patients.
Meanwhile, Minister Harris and the HSE insisted progress was being made on hospital waiting lists, stating that for the third month in a row, the total numbers of patients on the inpatient/day case list has fallen and NTPF initiatives had treated above the targeted number of patients. However, health unions blasted the ‘spin’ on very small reductions on the overall waiting list, which currently stands at 684,940.
In good news, the ICGP revealed that it had experienced a 50 per cent increase in the number of applications for GP training places compared to last year.
Intensive care capacity in Irish public hospitals could not currently accommodate a mass casualty incident, the Clinical Lead for the HSE Critical Care Programme outlined in an internal report sent to senior HSE managers and obtained by this newspaper.
MI also reported this month that the Department of Health has hired a consultancy firm at a cost of approximately €180,000 to work on its response to the Sláintecare report. The entire work of the Oireachtas Committee that drafted the report itself was just under €200,000.
Another MI story revealed how the HSE is reportedly paying three times the amount the UK NHS pays for curative hepatitis C drugs.
The unpopular name for the new NCH, Phoenix Children’s Health, meanwhile, came under more fire, with threats of being sued by a US hospital with the same name and acknowledgement from Minister Harris that a rethink was in order.
Finally, in good news, uptake of the HPV vaccine increased from 50 to 61 per cent this year, after a large drop-off in 2014/15.