Demand and staff vacancies trigger HSE warning

Health Service Executive managers have privately warned in recent weeks of significant risks in delivering safe care due to staff shortages and rising demand for services.

The executive’s internal “corporate risk register” – signed off by senior managers last month – provides an insight into the most urgent challenges facing the organisation. Among the key concerns are:

• Critical posts left vacant in areas such as maternity services and operating theatres due to the recruitment embargo and early retirement schemes;
• Difficulties providing timely access to acute hospitals as a result of demand exceeding capacity, resulting in overcrowding, long waiting times and delayed release of ambulances;
• Risks that older and vulnerable people will not be cared for in appropriate locations due to delays processing and funding the Fair Deal scheme for nursing home care;
• Concerns over services for people with disabilities in residential settings which are failing to meet standards for safe and effective care.

Funding shortages are cited as a key factor in emerging risks, such as modernising mental health services and tackling issues such as the growth in chronic disease.

Under Government pressure to cut public spending, the HSE’s budget has been reduced by more than 20 per cent, or €3 billion, since the financial crisis. It has also lost more than 10,000 employees over the same period.

Rising demand is also cited as a factor in risks associated with accessing nursing home beds and emergency departments. The numbers of people waiting for an outpatient appointment recently exceeded 400,000 for the first time.

The risk register outlines measures being taken by the HSE to tackle risks. In the case of hospital overcrowding, for instance, the documents state “patient flow” managers are now in place, along with new procedures to prioritise certain patients and reduce delayed discharges. To address staff shortages, managers are redeploying employees to maintain services and increasing the workload on some staff.

In a statement, the HSE said the risk register was a management tool to manage, review and reduce risks across the health service and help to provide safe and effective care to patients.