The HSE has warned the Government has virtually no capacity to deal with any chemical, biological, radiological or nuclear incident stemming from an accident or terrorist activity.
It has signalled that any such incidents could lead to mass casualties, and urged the Government to provide funding to allow the health authority to bring in outside expertise to assess its preparedness and requirements, and to outline a national strategy and training requirements.
The warning is contained in a confidential internal assessment carried out by the HSE for the Government on critical unmet needs in the health service.
Overall, the HSE told the Department of Health and the Department of Public Expenditure last autumn it would cost over €971 million this year, including the provision of more than 7,500 additional staff, to deal with critical needs across hospitals, primary care, mental health, social care and other parts of the health service.
The plan forecasts that close to a further 3,000 additional personnel would also be needed in 2019 and 2020 at a total pay and non-pay cost of just over €600 million.
In the assessment report the HSE said it had “no standing level of preparedness, education, resources or capability to practically respond to a chemical, biological, radiological or nuclear [CBRN] incident”.
"External expertise is required to guide the HSE in the development of a HSE- wide strategy and process. A CBRN incident either terrorist or a Seveso-type [a major chemical plant accident in Italy in the 1970s] incident may well become a mass casualty incident. If this initiative is not funded the HSE will continue to fall short of its responsibilities to the public and under legislation in this regard."
The HSE sought €100,000 this year to carry out “an evaluation relating to CBRN preparedness and requirements, and to outline a HSE-wide strategy and process to include training requirements”.
The HSE also warned it could face major problems in paying tens of thousands of healthcare staff from next year as a result of an obsolete payroll system.
“The HSE currently lacks sufficient visibility and control over how 70 per cent of its annual budget, relating to workforce costs, is spent annually. It is essential that this is addressed to ensure costs are controlled, and workforce utilisation is maximised for patient benefit.
“Another core driver, which is becoming a key HSE-wide strategic risk, is the end-of-life risk associated with the Unipay Payroll system in operation since the 1980s. A failure to address this issue urgently [with the vendor stating it can no longer provide payroll after June 2019] will result in the potential of 47,500 HSE staff and 10,500 pensioners not being paid accurately or at all.”
The assessment report also reveals the HSE maintained the largest areas of investment required to meet unmet needs were in the social care and primary care areas, which required about €400 million each this year.
It suggests services in acute hospitals, including the women’s and infants’ programme, needs an additional €188 million.
The HSE in the report set out its own assessment of the current state of some services, and the impact on these of a lack of the investments it proposed.
HEALTH AREAS THE HSE HAS WARNED ABOUT
Benign gynaecology: There is now " a critical service deficit around the country", the HSE has said. "Long waiting lists and poor access to treatment have left thousands of women with a poor quality of life. The long waiting lists for outpatient appointments also increase the chance that a malignancy will go undetected."
Anaesthetics risks: "Serious clinical risk exists because general hospitals, with emergency departments and maternity units, have only one line of anaesthetic call. It is a critical safety requirement to introduce a second."
Critical care beds: The HSE said there was a national shortage of critical care beds impacting on access to scheduled and unscheduled care services. It proposed opening new critical care facilities as well as high dependency and intensive beds in Cork and the main Dublin hospitals. This would involve recruiting over 150 staff.
Ophthalmology: The HSE said ophthalmology theatre closures and waiting lists were affecting preventable deterioration in vision and potential blindness.
Endoscopy: The HSE warned if priority investment in endoscopy services in a number of hospitals around the country was not funded – at an estimated cost of €2.7 million in 2018 – "overall endoscopy waiting lists will continue to risk significantly, and urgent colonoscopy targets will be further breached on a more regular basis". It said a range of improvement initiatives associated with the national endoscopy programme (particularly those associated with training and patient safety) were unlikely to proceed where there is not staff capacity to release clinical staff.
GP shortage: The HSE has proposed appointed 15 GPs on a salaried basis to work in rural and urban disadvantaged areas over a three-year period. At present GPs operating the medical card scheme are not HSE employees but rather contractors. The HSE has experienced difficulties in attracting GPs to take up posts in some rural and urban areas under the existing contract model
Cancer care: The HSE said additional staff in surgical, medical, radiation oncology as well as haematology, child and adolescent, palliative care, geriatric oncology were needed to address current and growing demands.
“Additional staffing will be required just to get to acceptable international standards based on size of population and prevalence of disease. There is a staffing deficit of all clinical staffing numbers in line with international standards and best practice based on size of population and prevalence of disease.”
It suggested 58 additional staff were needed this year.
Paramedics: The HSE said additional frontline paramedics were required to meet current capacity shortfall – which it described as a "manpower crisis"– improve response times and meet planned development requirements.
Our Lady of Lourdes Hospital: The HSE said over 80 beds were needed as well as five theatres at Our Lady of Lourdes Hospital in Drogheda; a new dialysis unit in Galway; and a new modular build emergency department unit at Mayo General Hospital. It said this would cost nearly €12 million in 2018.
Policy: The HSE said there was no defined policy, framework, structure or strategy for the co-ordination of business continuity across its infrastructure in the aftermath of events such as power failures within hospitals, ICT crises such as the recent Ransomware virus, or flooding such as experienced at Letterkenny General Hospital.
“It is international best practice to mitigate the potential effect of such events on service provision through the implementation of an effective business continuity management (BCM) process. Expert external assistance is required to advise on policy drawing from risk assessments to develop appropriate business impact analyses. This critical need is required in order to initiate such a large scale project appropriately.”