The year begins on a disturbingly familiar note, with record numbers of people on trolleys in emergency departments (EDs) and wards awaiting hospital admission.
On 2 January, an all-time high of 656 people are on trolleys, according to figures from the Irish Nurses and Midwives Organisation (INMO). This is quickly followed by another record on 3 January (677 people), prompting a statement from Minister for Health Simon Harris. He says all Winter Plan measures, including “increased access to home care, transitional care and diagnostics, along with additional acute bed capacity, are being implemented”.
Later in the month, The Irish Times reports that the HSE privately warned the Government it could face an unprecedented financial shortfall of up to €881 million this year.
The Department of Health publishes the Health Service Capacity Review. It finds that if key reforms and productivity measures are not implemented, nearly 2,600 extra acute hospital beds will be required by 2031.
INMO Trolley Watch peak: 677 people (3 January).
IHCA President Dr Tom Ryan welcomes the commitment to provide €10.9 billion in capital funding for the health services in the next decade, as outlined in the National Development Plan 2018-2027. The plan commits to 2,600 additional acute hospital beds.
Meanwhile, the IMO announces the #ReverseFEMPI campaign to raise awareness among politicians and patients “on the negative impact that the 38 per cent FEMPI cuts to general practice funding has had on the service and the consequences for the future of the GP service if the cuts are not reversed”.
In a story titled ‘Islamic centre in Dublin supports ‘female circumcision’’, the Medical Independent (MI) reports how a senior representative of the Clonskeagh mosque in Dublin, Mr Ali Selim, believes “female circumcision” should not be banned “but reasonably practised”. Subsequently, RTÉ’s Prime Time interviews Mr Selim, whereupon he repeats his comments, leading to national and international controversy. Minister Harris tweets: “Female genital mutilation is never, ever justifiable, has no place in healthcare, is illegal, dangerous, can have a devastating impact and is a violation of human rights… ” Mr Selim and the mosque backtrack from their position.
Also in February, MI reports that concern has been raised by some senior GP members of the NAGP about the Association’s financial stability.
INMO Trolley Watch peak: 643 (19 February).
The beginning of March is dominated by extraordinary weather events: Storm Emma and the ‘Beast from the East’. Many healthcare staff stay overnight at their workplaces or in nearby hotels to ensure availability of services.
HSE Director General (DG) Mr Tony O’Brien tells staff he will not be seeking an extension of his term when it expires in August.
At the NAGP AGM in Cork, President Dr Emmet Kerin warns that “we are seeing a broken health system nationwide, where new patients are unable to sign-on to GP practices as they are beyond capacity”.
Trolley numbers reach a new ‘low’ — a high of 714 on 12 March.
The IMO AGM returns to its spiritual home of Killarney, where Minister Harris tells delegates that engagement with the Organisation on GP fees will start “in the coming weeks and I hope this results in us moving into a post-FEMPI era”.
President of the High Court Mr Justice Peter Kelly voices serious concern over agency recruitment of doctors, who are not on the Medical Council’s specialist register, to work as consultants in Irish hospitals.
Separately, Limerick woman Ms Vicky Phelan settles a High Court action against Clinical Pathology Laboratories Inc, Austin, Texas, US, to the amount of €2.5 million without admission of liability. Ms Phelan initiated legal proceedings after it emerged a smear test she had in 2011, which reported no abnormalities, was found to be incorrect in a 2014 audit.
While diagnosed with cervical cancer in 2014, Ms Phelan did not learn of the audit until 2017.
Speaking to reporters outside the court, Ms Phelan calls for an investigation into the CervicalCheck screening programme.
“To know for almost three years a mistake had been made and I was misdiagnosed was bad enough, but to keep that from me until I became terminally ill and to drag me through the courts to fight for my right to the truth is an appalling breach of trust,” she says.
Later that week, Ms Phelan tells RTÉ News she has received a call from Minister Harris, who apologised to her and thanked her for encouraging women to continue to go for smear tests.
On 27 April, Minister Harris says he does not have confidence in the management of the CervicalCheck programme, leading to the resignation of Clinical Director Prof Gráinne Flannelly.
The HSE says 206 cytology reviews suggested “a different result that would have recommended an investigation to occur at an earlier stage”. As the year progresses, many unanswered questions will remain surrounding the number of women affected and how many cases involved negligence.
During the month, the IMO announces the appointment of Ms Susan Clyne as CEO, a position left unfilled since the controversial departure of Mr George McNeice in late 2012.
INMO Trolley Watch peak: 595 people (11 April).
HSE DG Mr O’Brien tells the Oireachtas Health Committee he could not take full personal responsibility for the CervicalCheck controversy.
“As the head of the organisation, I have to recognise that those who ‘cocked-up’, to use the Taoiseach’s phrase, were in that organisation but I didn’t personally make that cock-up so I can’t take full responsibility for it,” says Mr O’Brien, who adds that his remaining time in office will be focused on addressing failings in the programme.
The Government says it will establish a non-statutory inquiry to provide immediate answers to the CervicalCheck controversy before deciding if a commission of investigation is required.
As questions mount on the handling of the communications on the CervicalCheck audit, Mr O’Brien resigns as HSE DG “in order to avoid any further impact to the delivery of health and social care services”.
MI reports of opinions within the medical profession that the Government decision to offer free repeat smears is politically motivated and a poor use of public resources.
Ireland votes to repeal the Eighth Amendment of the Constitution, paving the way for the legalisation of abortion in some circumstances. Some 66.4 per cent of people vote to remove the amendment, with over two million votes cast.
MI reports that the planned launch of primary human papillomavirus (HPV) testing within CervicalCheck later this year appears in doubt after the HSE refused to confirm a timeline regarding its roll-out. Minister Harris had said he expected HPV testing to be introduced by October.
INMO Trolley Watch peak: 514 people (9 May).
The IMO and IHCA welcome the settlement of proceedings in the legal action taken against the Minister for Health, the Minister for Finance, Public Expenditure and Reform, and the HSE in respect of the unilateral breach of the 2008 consultant contract.
MI reports that the HSE has found the majority of consultants are compliant with their public/private hospital ratio commitments.
INMO Trolley Watch peak: 430 people (6 June).
The ICGP informs Minister Harris of the “great disquiet” caused by the term ‘GP-led’ in relation to proposed abortion services, according to a story in MI.
The Government approves the appointment of Ms Laura Magahy as Executive Director of the Sláintecare Programme Office. The Sláintecare implementation strategy is published the following month.
INMO Trolley Watch peak: 414 people (24 July).
MI reports that the HSE paid over €117,000 to private investigators to monitor consultants in order to defend its position in the recent High Court proceedings on salary increases due under the 2008 consultant contract.
The terms ‘anaesthesia’ and ‘anaesthetist’ will be replaced with ‘anaesthesiology’ and ‘anaesthesiologist’ following a recent ballot of Fellows and trainees at the College of Anaesthetists of Ireland (CAI), reveals a story in MI.
INMO Trolley Watch peak: 520 people (8 August).
The Scoping Inquiry into CervicalCheck, led by Dr Gabriel Scally, is published. Dr Scally finds that there are serious gaps in the governance structures of the screening services. In the specific case of CervicalCheck, there was a demonstrable deficit of clear governance and reporting lines between it, the National Screening Service and the higher management structures of the HSE. He also describes the current policy and practice in relation to open disclosure as “deeply contradictory and unsatisfactory”. Dr Scally’s recommendations do not include a commission of investigation.
Minister Harris tells the Dáil that Dr Scally has stated “in unequivocal terms that he had found no evidence of conspiracy, corruption or a cover-up — his words”.
He adds that the Government accepts all 50 recommendations in the Scally report and he expects to “return to Government in three months with a full implementation plan”.
INMO Trolley Watch peak: 492 people (18 September).
At the IHCA Annual Conference in Galway, President Dr Donal O’Hanlon says there are over 500 permanent hospital consultant posts that are unfilled, which is compromising patient care. “The root cause of the vacancies is the persistent discrimination by the State against new-entrant consultants, who are being paid up to 57 per cent less than their colleagues who were appointed prior to October 2012.”
An increase of €1.05 billion in health funding for 2019, bringing that Department’s total budget to €17 billion, is announced in Budget 2019.
The Public Health (Alcohol) Bill, initially introduced into the Oireachtas in December 2015, passes all stages. Minister Harris says the legislation was the subject of “the most intense lobbying by the alcohol industry”.
MI reports that almost 300 abortion pills/abortifacients were detained by the Health Products Regulatory Authority (HPRA) during the first half of this year.
INMO Trolley Watch peak: 542 people (16 October).
Minister Harris announces that construction of a four-bed extension at the Critical Care Unit in Our Lady’s Children’s Hospital, Crumlin, has been jointly approved by the Departments of Health, North and South. It will support the enhancement of services being delivered by the All-Island Congenital Heart Disease Network.
The National Patient Experience Survey 2018 finds that 81 per cent of patients say they were always treated with respect and dignity in an ED. However, long waiting times in the ED are highlighted as a problem, with only 31 per cent saying they were admitted to a ward within the HSE’s target waiting time of six hours.
INMO Trolley Watch peak: 591 people (7 November).
More than 300 doctors attend an ICGP meeting in Malahide, Co Dublin on the issue of provision of abortion services. According to the College, over 250 GPs “stayed for a meaningful debate”.
Medical Director of the ICGP Dr Tony Cox comments: “The College’s remit is to provide training and education for all GPs, and for those GPs who wish to offer this service. We are aware of the concerns of those with a conscientious objection to providing termination of pregnancy services, and we have successfully advocated for an ‘opt-in’ service and for a 24-hour helpline as the first point of information for those who seek the service.”
A national abortion service is scheduled to operate from 1 January, but there are major doubts that this deadline will be unilaterally met.
INMO Trolley Watch peak: 558 people (12 December) as of press day.