The HSE has today, Thursday, November 24rd, published the latest Performance Report. While the report outlines the significant challenges being experienced across the system, it also points to increased activity and improvements in many areas.
Covering August and September, the Report shows the number of delayed discharges having decreased in the period from 638 in August to 629 in September. However, in the intervening period that figure has dropped to 547. With the target set at 500, the HSE is successfully moving closer to achieving this, resulting in those individuals who no longer require an acute bed being managed in a more appropriate setting.
The pressures being experienced by Emergency Departments can be seen through the increase of 5.8% on expected activity in this period – with a total of 1,023,637 people attending at EDs across the country in the year to date.
While this report reflects on the position up to the end of September, the HSE Winter Initiative is currently targeting the seasonal pressures experienced in both hospitals and community based services.
To achieve the decrease in delayed discharges, the Initiative allows for measures that ensure that, where appropriate, those individuals who can be cared for in their own homes are managed through home care packages, community intervention teams and home supports.
Community Intervention Teams are led by nurses and provide a rapid integrated response to ensure that the patient’s medical needs are met without the necessity for acute hospital admission. While the Performance Report points to an increase in the number of patients accessing these teams in September; through the Winter Initiative a further 6,640 patients will benefit over the coming weeks. Over 3000 individuals will also benefit from an increase in funding for the equipment and appliances that they need in their homes (like walking aids).
An extra 950 Home Care Packages (these are specific supports that act in addition to those already available in the community like home help but are tailored for the person’s particular needs) are also being made available through the Winter Initiative for the October to February period. These are targeting ten hospitals - Our Lady of Lourdes Hospital, Drogheda, Mullingar Midlands Regional Hospital, Cork University Hospital, University Hospital Waterford, University Hospital Limerick, Tallaght and St James’s Hospital, University Hospital Galway, South Tipperary Hospital and Beaumont.
The HSE has also identified the need for ‘transitional care’ recognising that individuals who may need further convalescent care or are awaiting access to the Nursing Home Support Scheme, but who no longer need an acute hospital bed, can be supported on an interim basis until the longer term solution becomes available.
By late November, a total of 6530 ‘transitional care beds’ had been approved, with five hospitals receiving particular focus to ensure they were accessing additional beds because of the pressures they were experiencing.
An extra 950 Home Care Packages (these are specific supports that act in addition to those already available in the community like home help but are tailored for the person’s particular needs) are also being made available through the Winter Initiative. These are targeting ten hospitals - Our Lady of Lourdes Hospital, Drogheda, Mullingar Midlands Regional Hospital, Cork University Hospital, University Hospital Waterford, University Hospital Limerick, Tallaght and St James’s Hospital.
Five acute hospitals will also benefit from an additional 55 acute beds - Midland Regional Hospital Tullamore, Beaumont Hospital, Naas General Hospital, University Hospital Waterford and in the Midland Regional Hospital Mullingar. The HSE is continuing to build on the extra capacity made available in winter 2015 which saw an additional 300 acute beds being provided. These beds will remain open over the coming winter period.
Overall the Performance Report shows an increase in activity levels across all hospitals in the year to date. Access to specialist inpatient beds exceeded target in August, while there was an increase of three per cent on inpatient discharges compared to the same period last year. More people accessed day services for procedures that do not require hospital overnight sta. Emergency inpatient discharges were up 5.1% on the same period last year, while the HSE met its target for urgent colonoscopies during this period.
The number of children in the care of the children’s outreach nursing team/specialist palliative care team increased – 67 more children accessed the service in September compared to August, representing an increase that exceeded target.
A total of 7,919,541 home help hours have been provided so far this year - 0.6% ahead of target. Overall, 97,993 more hours of home help were provided this September compared with the same period last year.
The number of Medical Card/GP visit card applications processed within the 15 day turnaround time (98%) exceeded the 95% target. By September the number of people covered by a medical card was 1,705,791. Of these, 111,904 are covered by a discretionary medical card. With under six GP visit cards having become available on July 1 last year, the total number of people covered by the end of September was 243,557 with that figure rising to 245,000 by November 1.
The numbers of babies visited by the Public Health Nurse within 72 hours was ahead of target while the number of babies breastfed at first and second visits was also ahead.
Screening uptake rates in Breastcheck and Diabetic Retinascreen were ahead of target, with Breastcheck experiencing a 7.4% increase and Retinascreen experiencing a 10.6% increase. With World Diabetes week celebrated in November, it is timely to note the increase and point to the importance of this service in helping those with diabetes to maintain their overall health with particular focus on eye health.
A total of 790.494 people availed of GP out of hours services in the year to date and for the period of this report they were substantially ahead of target (74,461 in September, above the target of 69,215).
The Report notes two particular initiatives being undertaken between the hospitals and GP/community based services. The first allows for the many minor operations that have traditionally been carried out in hospitals to be done at GP level. Twenty four GPs are currently participating in a minor surgery pilot initiative being run by the ICGP and this is expanding. The second offers GP diagnostic services which were previously solely available at hospital level. Ultrasounds are now available across ten sites nationally with around 1,300 being carried out per month at present. This is clearly a development that benefits the patient removing the necessity for a hospital visit.
Within the National Ambulance Service, ECHO (life threatening cardiac or respiratory arrest) incidents responded to within the target timeframe of 80% in 18 minutes and 59 seconds were at 85% in September. There were 421 more ECHO calls this September compared to the same period last year – an increase of 28%. Year to date activity has increased by 51% in relation to these specific call outs.
Within mental health, referrals for those general adults and those older persons being referred through Psychiatry of Old Age being offered their first appointments was ahead of target.
In relation to acute hospital waiting lists, it should be noted that while the Performance Report points to challenges in attaining targets, the current position shows that overall, there has been an average four per cent increase in inpatient and daycase activity in acute hospitals. The key issue for patients is the time they have to wait before accessing the necessary service. The current position shows that 33% of patients are waiting less than three months for an inpatients/daycase procedure while 88% of adult patients are being treated within the national target of 15 months and 65% within the eight month target.
The HSE has prioritised long waiting times and since the introduction of the Waiting List Action Plan last August, the waiting list for patients waiting in excess of 18 months for inpatient/daycase procedures has reduced by almost 5,000.
Addressing specific patient group needs, the HSE has successfully ensured that 24 children had been referred to the Blackrock Clinic for scoliosis treatment while 22 adolescents were also being scheduled for the treatment (throughout October). Cappagh Hospital were also scheduling scoliosis treatment for 330 adults.
Last updated on: 28 / 11 / 2016