I thank the committee for the invitation to attend. I am joined by a number of my colleagues: Ms Laverne McGuinness, deputy director general, Mr. Liam Woods, national director of the acute hospital division, Dr. Áine Carroll, national director of clinical strategy and programmes, Mr. Pat Healy, national director of the social care division, and Ms Anne O’Connor, national director of the mental health division.
The committee requested information and replies on a number of specific issues prior to this meeting and members will have received a written response to each of them. In my opening remarks I would like to update the committee on a number of issues. The first relates to the HIQA report concerning the Midland Regional Hospital, Portlaoise, MRHP.
The HSE on Friday last received the final report of the investigation into the quality, safety and standards of services provided by the HSE to patients at the Midland Regional Hospital, Portlaoise. The HSE welcomes the conclusion of the HIQA investigation, accepts all of the recommendations of this report and acknowledges that their implementation will contribute to improving the quality and standard of services delivered in Portlaoise hospital and similar hospitals. The HSE has already taken objective steps to improve the quality and safety of services in Portlaoise over the past two years. These important steps are included within many of the HIQA recommendations. As a consequence of the measures taken, the HSE is confident that MRHP provides a safe level of service to its patients in the midlands today, although there are undoubtedly questions of sustainability to be addressed.
The HSE has already acknowledged that there have been failings at Portlaoise over the years. The HSE has in the past apologised for these failures and the suffering and distress that they caused to the families concerned, and I reiterate that apology once again today. Last year in the context of some of the very distressing reports, I wrote to every health service staff member about this and that letter is appended to the printed version of my statement.
The hospital in Portlaoise provides extremely important services to the midland counties and is a very busy hospital today. For example, it is expected that there will be approximately 1,900 births in its maternity unit this year. I am also very conscious of the potential of negative publicity surrounding this report to undermine the confidence of some of the patients who use the hospital's services. Any negative publicity is also likely to impact on the hard working and dedicated staff who have been putting their hearts and souls into their work in the hospital in very trying circumstances, where demand for services is increasing and resources continue to remain limited. I wish to emphasise that any failings relating to the past either have now been or are being rectified and that Portlaoise hospital is now on a path to being an excellent hospital as part of a wider group. Significant improvements have been, and continue to be, implemented in both maternity and general services at the hospital, which is overseen by a joint steering group comprised of representatives from Portlaoise and other hospitals in the Dublin-Midlands hospital group, including the recently appointed chief executive officer of the group, Dr. Susan O'Reilly.
An important improvement is the introduction of an expanded and new management and governance structure, both clinical and operational, for the maternity unit and the general hospital. This new structure allows for strengthened management at local level and clearer reporting relationships within the Dublin-Midlands hospital group. Central to these new arrangements is the formalisation of existing pathways between the maternity unit and the Coombe Women and Infants University Hospital. In this regard a clinical director for integration has been appointed. Furthermore, existing relationships between Portlaoise and Tullamore, Tallaght, Naas and St. James's hospitals are being further developed and strengthened particularly in the areas of emergency medicine, ICU, surgery and bed capacity.
An area of concern, raised in a number of reports over the recent past, has been in relation to staffing levels. The staffing moratorium across the public service over the past five years has impeded a full resolution of this situation up to recent times, as a consequence of a much reduced health budget arising from the financial emergency. A considerable number of staff have been, and continue to be, appointed to key posts of concern in both the maternity and general services. This includes a number of additional consultant posts in anaesthetics, surgery, emergency medicine, paediatrics, obstetrics, and physician posts. In relation to midwifery posts, 16 additional midwives have been appointed and are in place. Approval has been given for further midwifery posts to include shift leaders in delivery, and posts in diabetics and ultra-sonography. Additional general nursing posts are also in progress. A full review has been conducted of the structures and processes of quality, safety and risk in both the maternity unit and the general hospital. Following this review a significant number of improvements have taken place.
The appointment of quality and patient safety, QPS, managers for both the maternity unit and the general hospital will considerably strengthen the QPS function. The management of complaints has also been examined and improved. Following the national patient safety culture survey, conducted by the quality improvement division of the HSE in 2013 and 2014, a report of the results from the Midland Regional Hospital, Portlaoise has been produced and disseminated to all relevant parties. Among the many other improvements in Portlaoise hospital, patients, following triage in the emergency department, are now under the care and accountability of a named consultant at all times. Portlaoise hospital has also fully implemented the national open disclosure policy, the national consent policy and national bereavement care guidelines.
Additionally, the maternity unit has implemented the national early warning score, NEWS, and the Irish maternity early warning score, IMEWS. Furthermore, all midwifery staff in the maternity unit have received training in cardiotocograph, CTG, and additional online training facilities have been introduced. In light of this report I have taken the decision to bring in an external investigator in accordance with our disciplinary procedure to look at issues of concern. Many issues were escalated but they did not always find their way to the right decision making levels and that must be investigated in accordance with fair procedures Many of the issues which arise in Portlaoise hospital are not just about resources or the quality of clinical care but about the human and compassionate care that was or was not provided. Accordingly, a separate examination will examine this matter. The names of the investigators and terms of reference will be published shortly.
It is important, starting in the maternity unit in Portlaoise hospital and the wider hospital and other maternity hospitals, that we have a thorough programme of empowering nursing and midwifery leadership and interdisciplinary leaders to drive compassion in care. Following the lead of the NHS in England and Scotland, respectively, we intend to implement the Florence Nightingale Foundation’s leading for compassion programme and the caring behaviours assurance system, CBAS, programme throughout the health service.
Turning to the national service plan, members are aware that each month performance against our national service plan targets and deliverables is monitored and measured. The latest published performance report shows that in February 2015 there were 185,688 emergency attendances for the first two months of the year. While the average daily attendance is up 5%, or 177 per day on January, the overall attendances are 2.1% less than the same period for 2014. The number of delayed discharges has fallen from a peak of 850 on 4 January to 705 at the end of February. Additional funding of €74 million, provided by the Government, has assisted in alleviating pressures in acute hospitals by providing additional nursing home placements.
The two most recent delayed discharge reports of 28 April and 5 May 2015 recorded fewer than 700 delayed discharges for the first time since September 2014 and the trajectory is now downwards.
The national plan prioritises a reduction in waiting times for hospital care with a focus on those waiting the longest so that nobody will wait longer than 18 months at the end of June or 15 months by year end. In February, 98% of adults were seen within this timeframe for an inpatient or day case procedure and 82% of patient were waiting less than 52 weeks for an outpatient appointment. Plans are being finalised to ensure the June target of no patient waiting longer than 18 months is achieved.
With regard to emergency ambulances, the percentage calls responded to within eight minutes and 59 seconds by ECHO reached 78% and by DELTA reached 65% during the month. A total of 82% of referrals accepted by child and adolescent mental health teams were offered a first appointment within 12 weeks against a target of 78%. A total of 13,407 people were in receipt of a home care package during February, which is 10.5% more than the same time last year. In mental health services, difficulty in filling staff vacancies remains a significant challenge to providing timely and appropriate care. A number of recruitment campaigns are under way to address this.
In primary care, work is progressing on improving access to primary services through the extension of GP care free at the point of delivery to all children under six and all adults over 70. Contracts have now been issued to GPs for signing following agreement with the IMO on the details, and public registrations are due to commence from June 2015. This service enhancement due to commence from July will provide GP access, wellness health checks and asthma care for children, and care for patients with type 2 diabetes in primary care in accordance with the models of best practice for the management of chronic medical conditions.
The investigation into Áras Attracta and the disciplinary procedure is progressing on schedule, having received clearance from An Garda Síochána to recommence its work. The aim is to have the investigation work completed by the end of May or early June, with findings and a final report completed by the end of July. Dr. Kevin McCoy's assurance review is progressing well, having met residents, family members, staff and management. In addition to recommending specific plans for each centre in Áras Attracta, the output from the review team will help to inform our system-wide programme of improvement. A new governance structure is being implemented, with a new director of service post advertised. Under the leadership of the new director, three discrete centres will operate in the campus, each centre specialising on the particular needs of service users. A residents' council is being established as part of the national volunteer advocacy programme.
The new policy “Safeguarding Vulnerable Persons at Risk of Abuse” is being fully implemented with nine safeguarding and protection teams being established, one per community health care organisation. The recruitment of 20 additional social work posts has commenced. The quality improvement enablement teams are in place and are focused on supporting our centres, in transferring HIQA standards into good practice in front-line services. The initial phase has prioritised HSE residential centres, with the team visiting more than 50 centres delivering services to 448 people, representing almost 25% of HSE residential services. In addition, a confidential recipient, Leigh Gath, has been appointed, who is independent in her functions with the authority to examine concerns and to hear of issues and complaints in a totally confidential manner.
There have been recent media reports on the accessibility of mental health services for children and adolescents. The HSE is committed to ensuring that all aspects of child and adolescent mental health service, CAMHS, are delivered in a consistent and timely fashion regardless of where in the country the service is accessed . A number of measures have been put in place to improve access to and quality of these specialist services. These include a CAMHS service improvement project established to review and improve, where necessary, performance relating to both inpatient and community CAMHS.
I am also pleased to advise the committee that seven new suicide prevention officers have been recruited and they will take up duty shortly. It is also anticipated that additional suicide prevention resource officers will be recruited later this year through the 2015 mental health development funding.
Despite the progress being made in our mental health services I am particularly concerned at the significant challenges posed by the recruitment of nursing and medical grades, which are now impacting on service delivery. The mental health division is working closely with HR and the national recruitment service to progress overseas recruitment initiatives to address this issue.
Primary percutaneous coronary intervention, PPCI, commonly known as coronary angioplasty or simply angioplasty, is a non-surgical procedure used to treat the stenotic, or narrowed, coronary arteries of the heart found in coronary heart disease. In November, the acute hospitals division of the HSE requested the national clinical programme for acute coronary syndrome, ACS, programme to review the current configuration of PPCI services in Dublin, having regard to the requirement to deliver safe, sustainable services on the designated sites. The model of care produced by the ACS programme was informed by advice from the principals involved in centres in the UK and other European countries. The programme was also informed by models of care from the United States and Australia. Experience at national and international level highlights the importance of having sustainable rotas of clinical staff to support the 24-7 requirements of this service.
Based on this comprehensive review, the HSE took the decision to consolidate the service in Dublin into two centres, which reflects the international trend towards the consolidation of such specialised services on a smaller number of sites to allow for the concentration of volume and expertise. Since 17 April there are two 24-7 PPCI centres for Dublin, located in the Mater hospital and St. James’s Hospital. These centres now accept all ambulance transfers of Dublin patients with ST elevation myocardial infarction, STEMI.
In the wider context of percutaneous coronary intervention, PCI services, a review of these services is under way and will be completed shortly. Once complete, PCI capacity nationally, including Waterford, will be examined. This review will look at the further provision of PCI services nationally in the best interest of patients and on evidence on the volume of clinical need, the quality and safety of the service that can be provided, the ability to staff it safely and the resources available.
This concludes my opening statement and together with my colleagues we will endeavour to answer any questions the committee may have.
