WITH a record 600+ people on trolleys in emergency rooms, it seems timely to post this set of documents on the so-called Winter Initiative to tackle overcrowding.
In the Irish Times this morning, Simon Harris was reported as saying nobody could have predicted things would be so bad.
Except the HSE had warned that the winter initiative could be ineffective if there was an outbreak of flu, bad weather and so on in their draft plan.
And what did the Department of Health do? They asked that this warning be moved prior to publication of the plan so they could emphasise the “positive effects” of the initiative.
The HSE had been keen to say that targets set in the initiative might not be met depending on circumstances.
In particular, they had warned of â€œunusually high demandâ€ particularly among older people, the potential for flu, and the possible impact of weather conditions.
However, the Department of Health asked that the focus be taken off these provisions so that the planâ€™s publication would come across more positively.
An internal Departmental memo said: â€œWe fully understand the need to include assumptions and dependencies, and you are of course correct in stating that unusually high demand and other factors could hypothetically have an adverse effect on delivery.
â€œHowever, we would advise, prior to publication, that this section might be moved to the end of the submission; we would prefer to focus on the very positive effects of the proposed initiative, towards the beginning of the document.â€
In a separate email sent to the HSE, the Department suggested that these negative notes would be better placed â€œprobably towards the end of the documentâ€.
The first page could then be focused on the â€œobjectives and benefits which the plan aims to achieveâ€.
Not everybody in the Department of Health was so confident about the plan however. One senior official noted in an email that the ability to secure and retain staff was going to present a major difficulty, particularly in providing additional acute beds.
â€œBased on recruitment track record this could be a major challenge in implementing these initiatives before year end,â€ wrote Fionnuala Duffy of the Acute Hospitals Policy Unit.
The warnings which the HSE tried to make prominent in the plan did eventually become reality and trolley count figures from the last few weeks have been appalling.
A pledge in the winter initiative had said there should be no more than 236 patients on trolleys on any given day while the plan was in place.
The Department of Health said that the initiative had been successful in some respects with the number of â€œdelayed dischargesâ€ down from 638 at the start of the plan to 488 last week.
They said 4,100 people had made use of community intervention team services, meaning they had been able to avoid hospital or were discharged earlier.
In addition, new home care packages were provided, with 250 transitional care beds, as well as 28 step-down beds in Mercy Hospital in Cork and Beaumont in Dublin.
In a statement, the Department said they had fully acknowledged the importance of the â€œassumptions and dependenciesâ€ being included in the winter initiative plan.
They said: â€œThey were moved to the back of the document for stylistic reasons and in order to ensure that focus would be maintained by the HSE and the Department on the key deliverables of this very important initiative.â€
In terms of recruitment, they said the HSE continued to run campaigns and that efforts continued to recruit suitable staff to open new acute beds.
The full set of documents below. If you don’t have time to read through all of them, the most relevant are records 8, 21, 24 & 25.