The HSE has been accused by patient advocates of engaging in a 'culture of secrecy' as it emerged that an unpublished independent review of emergency care in nine HSE hospitals discovered “unsafe” and “unacceptable” treatment caused by overcrowding and staff shortages.

The 2019 report, which the HSE decided not to publish in the wake of Covid-19, was released to the Irish Patients Association under Freedom of Information.

Its co-founder Stephen McMahon said: “Surely our patients deserve better than this, and we can and must do better than putting the whole problem down to overwhelming demand.”

He said the issues highlighted point to a “lack of appetite” for meaningful reform within the HSE.

The HSE, meanwhile, said that the draft of this report has “limited if any material benefit” to be considered today, given the changes brought about by Covid-19, and said that “significant progress has been made in enhancing capacity in both our acute and community services”.

The report states that 50% or more of patients spent at least one night in the ED on a trolley before getting a bed or being discharged. In at least one hospital, they found patients spending up to 10 nights on trolleys.

For a start, the dignity, privacy, and safety of patients on trolleys needs attention,” the report said, criticising especially the lack of weekend staffing.
The 'Independent Review of Unscheduled Care Performance' made 30 recommendations, and was carried out in late 2019 under Professor Frank Keane, former president of the Royal College of Surgeons Ireland.

Other members included Scottish government and NHS Scotland unscheduled care director Helen Maitland, as well as Lewisham and Greenwich NHS Trust chief nursing officer and deputy chief executive Angela Helleur.

Almost 18 months on from that letter, frontline representatives are still raising concerns about many issues that were highlighted as needing attention.

Among the worrying findings from the three-month review are concerns about “the adequacy of executive leadership and operational grip”, with managers often acting in a reactive rather than a proactive manner.

Out-of-hours executive leadership commonly relied on tight (on numbers) rotas, often on a goodwill basis, which could promote burnout and become unsustainable,” the report states. “Hospital staff did not always know who was in charge,” it also states.

They criticised the HSE’s TrolleyGar system for counting patients on trolleys which was used instead of patient experience time, stating: “TrolleyGar is not a helpful measure and can introduce perverse behaviours.”

Reflecting other issues with staffing, the review found: “Access to diagnostics in EDs was good for life-threatening conditions, however for clinical decision-making it was slower, particularly at weekends.”

The review team tracked patients’ journeys into the main hospitals, and found that due to overcrowding pressures, wards contained patients with a range of illnesses, meaning consultants and nurses were constantly moving around the building to find their patients.

They noted “any bed, anytime, anywhere, and including mixed gender”, and they warned it had become normal for patients to be treated from a trolley and to never get a bed.

Based on experience with reform in NHS Scotland, the team recommended putting senior management more visibly on the floor and improving communication between managers and staff.

source: https://www.irishexaminer.com/news/arid-40843562.html