An internal high-level HSE memo warned that “clarity” was still awaited from the Department of Health on the “total level of resourcing they can make available” to combat the rise of carbapenemase-producing Enterobacteriaceae (CPE), six months after the issue was declared a public health emergency by Minister for Health Simon Harris on 25 October 2017.
The 26 April 2018 memo from the then HSE Director General (DG) Mr Tony O’Brien to the then Chief Operations Officer Mr John Connaghan outlined how the HSE Management Response on CPE was discussed at Leadership Team meetings in January and March this year.
Part of this discussion involved details of the business plan for ‘pot 1’ of resourcing for the CPE implementation plan. According to Mr O’Brien, the Leadership Team supported proceeding with “all elements” involved in pot 1 of the work of the national response team, “which, importantly, encompassed laboratory resource requirements at Hospital Group level” to support implementation of CPE screening. “Pot 1 of the business plan focuses almost exclusively on screening and outlines phased investment requirements, with a full-year impact totalling approximately €6 million per year. The paper also indicated the level of resources required per Hospital Group to deliver the diagnostic service and the reference laboratory support service.
“The Leadership Team asked to be advised of the outcomes from the NPHET [National Public Health Emergency Team] meeting on 25 January 2018 in terms of any funding that the Department of Health may also make available to support this response. I understand from our recent Leadership Team meeting on 16 March that you are still awaiting clarity from the Department on the total level of resourcing they can make available to respond to this public health emergency and they have requested some further prioritisation work.”
Mr O’Brien said it was “now essential to proceed immediately to implement the plan up to the limit of expenditure outlined in ‘pot 1’… ”
Given the “risks involved” and the need for “further clarity on the position of the Department with regard to available funding in 2018 and 2019”, Mr O’Brien also wanted CPE to remain on the Leadership Team agenda.
A Department spokesperson told the Medical Independent: “The actions arising from Ireland’s National Action Plan on Antimicrobial Resistance 2017-2020 (iNAP) and identified through the NPHET on CPE are being progressed. The Department held back dedicated funding for 2018 and the HSE is prioritising work programmes for this funding in line with CPE risk, which also addresses strategic interventions in iNAP.”
While the Department said it had provided “confirmation” to the DG on total funding available, these figures have not been released.
The issue of drug-resistant organisms would form “part of the estimates process and service planning for 2019 and beyond”.
In late 2016, the spread of CPE was described as “quite advanced” in an internal HSE paper.