We need to streamline our management processes- HSE Chief

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More than ever it was clear that we needed to streamline our management processes to allow more decisions to be made by the right people at hospital and community level, according to HSE CEO, Mr. Paul Reid.

The HSE, in collaboration with the NTPF and DoH, developed an Access to Care Action Plan for 2021, which will support additional patient access, including inpatient, day cases, GI scopes and outpatients, through the NTPF, private providers and within HSE sites and services.

He said our experience in dealing with COVID-19 had given us an invaluable insight into how we might permanently embed the better ways of working together that emerged by necessity

“Despite the disruption caused by COVID-19, during 2020 the health services made progress on a number of strategic and operational developments, he wrote in the HSE Annual Report 2020.

“Before the onset of COVID-19, I commissioned the HSE Corporate Centre Review in order to put in place more effective structures to support service delivery, and to ensure that our resources are invested in frontline health services as far as possible.

“Since October, stakeholder meetings and design workshops have taken place with a key focus on cross-functional scenarios covering a range of topics including service planning, health and wellbeing and service improvement, and on the development of organisational structures for the integrated operations and clinical functions. The design activities for the remaining functions will take place in 2021. 

“June saw the launch of Sharing the Vision – A Mental Health Policy for Everyone, the successor strategy to A Vision for Change which was first published in 2006. Fully aligned to Sláintecare, Sharing the Vision focuses on providing wider access for all patients at primary care level where possible, and support for greater usage of digital health interventions. The policy advocates provision of additional access routes to treatment, where service users are included in care planning and interventions provided are outcome measured. Since June, the HSE has progressed over 100 actions consolidated in an Implementation Roadmap. 

The HSE’s CervicalCheck programme successfully changed to human papilloma virus (HPV) cervical screening as planned in March. While services were then paused due to the impact of the pandemic, when the programme resumed all CervicalCheck screening tests were now HPV cervical screening with follow-up cytology if required. Based on significant improvements in science, technology and research into the development of cervical cancer, HPV cervical screening is now the best available primary screening test. 

Many capital projects were progressed in 2020, including the National Forensic Mental Health Service Portrane, a new bed block at University Hospital Limerick, the National Rehabilitation Hospital and continuing work on the National Children’s Hospital. Work also continued on the Connolly Outpatient and Urgent Care Centre unit throughout the year.

“COVID-19 has had a significant impact on our ability to achieve the objectives and targets of our National Service Plan 2020. The most significant impact was felt with the pausing of all non-urgent care in March on the recommendation of the National Public Health Emergency Team and Government. Phased reintroduction of elective activity began on May 5, in line with national and international clinical guidance. The volumes of patients who can be seen are lower than prior to the pandemic because of necessary additional infection control measures including patient screening, PPE measures and additional cleaning of rooms and equipment. 

Prior to the onset of the pandemic, our efforts in scheduled care were beginning to yield gains in the reduction of waiting lists. These improvements were brought about as a result of focused measures by the HSE, working with the Hospital Groups and with the support of the National Treatment Purchase Fund (NTPF). However, COVID-19 has impacted negatively on these improvements, with waiting lists now larger than at the outset of the pandemic. To meet the need and regain some traction in addressing waiting lists, the HSE, in collaboration with the NTPF and DoH, developed an Access to Care Action Plan for 2021. This will support additional patient access, including inpatient, day cases, GI scopes and outpatients, through the NTPF, private providers and within HSE sites and services.

COVID-19 also impacted on unscheduled care attendances to emergency departments (EDs) with the number of emergency presentations and the number of trolleys recorded in acute sites significantly lower than the previous year. 

“Due to targeted investment in primary and community care, the number of people waiting for home support has fallen since January. This has also contributed to keeping our delayed transfers of care positively below target. Access to primary care therapies and their ongoing capacity has been adversely affected by COVID-19 due to the need for infection prevention and control (IPC) measures. The percentage of patients waiting for less than 52 weeks for speech and language therapy, physiotherapy, occupational therapy and psychology are all below target. Palliative care and child and adolescent mental health services (CAMHS) have performed better, surpassing targets for waiting times. The numbers of disability assessments of need have significantly increased in recent months and we are on target to clear the waiting list in 2021

“Despite the associated challenges, delivering services in a COVID-19 environment has accelerated many service transformations that have been advocated for many years, aligned to the vision of Sláintecare. These are particularly evident in the areas of eHealth, community delivered care and service integration. In addition to the material advancements achieved, this transformation has provided the HSE and our stakeholders with confidence that we can deliver meaningful change in a short time period 

“Our HSE Corporate Plan was developed in 2020, setting out the key actions we will take over the next three years to improve our health service and the health and wellbeing of people living in Ireland. Our vision is for a healthier Ireland, with the right care, at the right time and in the right place. The implementation of our Corporate Plan has commenced during a time when there is still a lot of uncertainty. We have taken the approach of prioritising a small number of large service transformations, which allow us to focus our efforts and resources to make demonstrable improvements. Our implementation approach, coupled with a ‘one team’ focus on patients, service users, families and the public, will guide us as we face the new and enduring challenges of providing the best care in the right place, when it is needed.”