‘Limited impact’ from €265m spent on initiatives to ease hospital pressures

Hundreds of millions of euro spent on tackling overcrowding in the State’s emergency departments and on cutting waiting lists produced only limited or temporary results, a new spending review has found.

Since 2014, €265 million has been spent on a variety of emergency actions. “Despite this there appears to have been limited or temporary impacts,” said the paper published by the Department of Public Expenditure.

Between 2014 and 2017 the number of people attending seeking emergency care at hospitals increased by 100,000 a year, or 8 per cent. Repeat visits by patients increased by 16 per cent.

The spending review also found the introduction of free GP care for children under the age of six did not lead to a reduction in the number in this age group presenting at hospital emergency departments.

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Extra State funding under the Fair Deal nursing home scheme and the National Treatment Purchase Scheme, along with money for community beds and homecare packages, is “not entirely once-off in nature”.

In all €225million, or 85 per cent of the emergency funding, was built into the Health Service Executive’s base budget for subsequent years, which means it is recurring every year.

Not all of the actions were “specifically targeted” at hospital emergency department, but extra primary care and community care spending should have “knock on implications for the numbers arriving” there.

“Furthermore, given that all but one of these investments were subsequently built into the budget base for future years, it is not unreasonable to expect that the impact should be long-lasting rather than temporary in nature,” it went on.

Underlying issues

The paper says the findings raise questions regarding the appropriateness of short-term funding initiatives which have limited impacts on outcomes and do not address the underlying issues.

The review also says that while the primary aim of the free GP care initiative for children under six was not to reduce pressure on emergency departments or even the numbers presenting at such facilities, “it is reasonable to expect that by increasing access to the primary care network at no charge this would subsequently lead to a decrease in the numbers presenting at the emergency departments”.

It says the findings, therefore, raise significant issues regarding the aim of moving towards free universal care.

The paper also maintains that following the development of local injury units – they have restricted opening hours and provide limited medical services – there was a subsequent slow down in the growth of local emergency department presentations at Cork and Limerick.

“It suggests that when appropriate care is available to patients outside the acute setting, it can reduce the pressure facing hospitals.”

Demographic factors

The review says the numbers presenting at hospital emergency departments had been rising at a faster rate than could be accounted for solely by demographic factors.

It says between 2014 and 2017 key performance indicators for hospital emergency departments worsened “with patient experience times increasing and the proportion of patients leaving the emergency department before completion of treatment increasing”.

The report says that by the end of 2017 the percentage of people leaving the emergency department without being formally discharged was 5.6 per cent.

Dealing with the number of people making repeat visits to emergency departments, the report says the 16 per cent increase is concerning, although the number is divided into scheduled and unscheduled return visits.

“It is not possible to determine if this outcome indicates inadequate symptom control or misdiagnosis,” said the Department of Public Expenditure review .