New Year, same old problems. On Monday 4 January 2016, as the country creaks into gear, figures from the Irish Nurses and Midwives Organisation (INMO) report 516 patients on trolleys in Irish public hospitals (409 patients in emergency departments; 107 on trolleys in wards). Although down on the equivalent time in 2015 (over 600 patients), the then Minister for Health Leo Varadkar suggests a resolution won’t be reached anytime soon: “Anybody who makes such promises does not understand the true complexity of what we face in the health service.”
Meanwhile, the annual general meeting of the NAGP hears that people spend more money insuring their hamster than the Government pays GPs to provide 24/7 medical care. “It is bizarre that GPs are paid less than it costs to insure a pet for a year,” outgoing NAGP President Dr Conor McGee tells the meeting. “Literally overnight, the Government cut funding to general practice by 38 per cent under the Financial Emergency Measures in Public Interest (FEMPI) Act, but I guarantee that no GP in the country is giving 38 per cent less of a service. That situation is simply not sustainable.”
Ireland’s first national strategy for maternity services is launched. It proposes that each mother or family will be offered choices about their care according to whether they are classified as normal-risk, medium-risk or high-risk. Minister Varadkar promises that an implementation plan will be published within six months.
The IMO announces that it will commence a legal action against the HSE on behalf of interns, SHOs and registrars to seek to compel the HSE to honour agreements to pay an agreed Living Out Allowance of €3,182 per year. The IMO says the allowance is a component of the NCHD Contract, which was part of the High Court settlement agreed between the IMO and HSE following threatened strike action in 2010.
The month is dominated by a range of political issues in the run-up to the General Election on 26 February.
The <strong><em>Medical Independent</em></strong> (<strong><em>MI</em></strong>) exclusively reveals that the National Electronic Healthcare Record (EHR) programme will cost an estimated €875 million to roll-out over a 10-year period, making it potentially the most ambitious and expensive single project undertaken by the State in the health sector, and certainly the biggest ever healthcare ICT project, dwarfing the maligned PPARs project.
Also reported exclusively in <strong><em>MI</em></strong>, Medical Council CEO Mr Bill Prasifka reveals that 30 per cent of doctors are not meeting their mandatory professional competence requirements. Mr Prasifka moots annual licencing if the situation cannot be resolved.
President of the IMO, Dr John Duddy, calls on the HSE to take urgent action to tackle the low number of female doctors and consultants at senior levels in the health services. He says equal numbers of men and women qualify as doctors but only 29 per cent of hospital consultants are women.
Also at the IMO’s AGM in Sligo, the union says it has commenced legal proceedings in the High Court to “secure the release of salary increases due in 2009 under the terms of the 2008 Consultant Contract which the HSE has unlawfully withheld”.
The Government agrees to support a motion establishing an all-party committee to devise cross-party agreement on a single long-term vision for health policy in Ireland. New Minister for Health Simon Harris says the health service “would benefit enormously from a single unifying vision that we can all get behind and that can help to drive reform and development of the system over the next 10 years”. The Committee is due to report in January 2017.
Meantime, a new HIQA report finds that nutrition and hydration care are not viewed as a priority in some Irish hospitals. Some 21 per cent of public acute hospitals do not have a system of screening in place for risk of malnutrition, states HIQA, despite the fact that malnutrition affects more than one-in-four patients admitted to hospital.
The HSE and the Irish Pharmacy Union (IPU) announce that the Minor Ailment Scheme will be launched as a pilot to run in 19 pharmacies in four towns (Kells, Roscommon, Macroom and Edenderry) for three months. After this time the pilot will be evaluated to establish the value of such a service.
The Minor Ailment Scheme is an extended pharmacy service, which allows pharmacists to improve public health access and broaden pharmacy roles. The Scheme will allow medical card holders to receive treatment for a list of common ailments (dry eye, dry skin, scabies, threadworms and vaginal thrush) directly from their local community pharmacy without the need for a visit to the GP.
A number of hospitals do not have an antimicrobial stewardship programme in place and lack specialised resources, according to a review conducted by HIQA.
Meanwhile, the Medical Council publishes its 2015 <em>Your Training Counts</em> report on the career intentions of trainee doctors. It finds that 20 per cent of trainees intend to either definitely not (7 per cent) or probably not (13 per cent) practice medicine in Ireland for the foreseeable future. The three largest influences on trainee intent to leave medical practice in Ireland were understaffing in the workplace (82 per cent); carrying out too many non-core tasks (75 per cent); and limited career progression opportunities (72 per cent).
Also in July, a new survey by the IMO reveals that only 40 per cent of medical students plan to stay and practice in the Irish healthcare system following their intern rotations. More than one-third also say they are “unsure” as to whether they will stay or go.
The NAGP says it has formally proposed to the HSE that future primary care centres should serve as diagnostic and service hubs that support patient-focused care with the full engagement of all local GPs. This model would mean that, in future, Primary Care Resource Centres (PCRCs) “may not always serve as locations for GP practices, but would serve as resource centres for all GPs and patients in a designated catchment area, enhancing patient care in the community”.
<strong><em>MI</em></strong> reveals that the implementation plan for the National Maternity Strategy remains undeveloped, despite a promise to publish it within six months of the Strategy launch in January 2016.
A HSE ambulance is attending the Emergency Department at Naas General Hospital when an incident involving an explosion in the rear of the ambulance occurs. Tragically, a patient is killed and two paramedics injured. An investigation is ongoing.
Minister Harris and Ministers of State Finian McGrath, Catherine Byrne, Marcella Corcoran Kennedy and Helen McEntee receive a €14.6 billion health budget. The total allocation to the National Treatment Purchase Fund (NTPF) for 2017 will be €20 million to undertake an outsourcing initiative targeted at those waiting longest (€4 million for administration and development and €16 million for patient care). The NTPF budget for 2018 consists of €4 million for administration and development and €51 million for patient care.
<strong><em>MI</em></strong> reports that uptake rates for the HPV vaccine continue to fall, with a lower than 70 per cent rate for 2016/2017 so far, according to figures supplied by Dr Brenda Corcoran, HSE National Immunisation Office (NIO).
The Council of the IMO unanimously supports NCHDs in their ongoing efforts to have contracts honoured in terms of the withdrawal of a Living Out Allowance in 2012 and other issues around training. The union confirms that it will proceed to ballot its NCHD members on taking industrial action.
Just one of the seven Hospital Groups has a functioning board, despite the reorganisation of HSE-funded hospitals into Groups having been announced over three years ago, <strong><em>MI</em></strong> reports. Board members are in place for just one of the Hospital Groups (Children’s Hospital Group), while five Groups have chairpersons, a Department of Health spokesperson tells <strong><em>MI</em></strong>.
The Maternal and Newborn Clinical Management System, which will see the implementation of an EHR for all women and babies in maternity services in Ireland, commences at Cork University Maternity Hospital. It is planned to roll-out the system across the country, with the next implementation due to take place in University Hospital Kerry, followed by the Rotunda Hospital, Dublin, and the National Maternity Hospital, Dublin.
A HIQA review of progress at Midland Regional Hospital, Portlaoise, finds that many of the risks identified in the Authority’s 2015 investigation relating to general services, including critical care and emergency services for undifferentiated patients, remain unchanged. Maternity services, however, “are now being provided in a safer and more sustainable way”.
A record 438,931 patients were waiting for an outpatient appointment at the end of the previous month, according to the latest monthly data from the NTPF. This represents an increase of almost 700 on October.
The figures also show the number of patients waiting between 15 and 18 months for inpatient or day case procedures has reduced by 364, says Minister Harris.
Meanwhile, Minister Harris criticises Vertex, makers of cystic fibrosis (CF) drug Orkambi, during a speech in the Seanad. He says the company has refused, from the outset, “to put a fair and reasonable price on its treatment, in line with the price guidance provided by Prof Michael Barry and his team in the NCPE [National Centre for Pharmacoeconomics]”.
He adds: “It has refused to give absolute certainty to patients on managed access schemes or programmes that they will continue to receive their treatment for the rest of their lives, regardless of the outcome of its commercial negotiations with the HSE. And it has actively sought to place Irish CF patients in the centre of its commercial negotiations with the HSE, with a view to maximising the return for its executives and shareholders.”