Sunday 25 August 2019

HSE 'tried to hush up' bed inquiry

Hospital chief's shock claim to minister

MINISTER: Jim Daly. Picture: Arthur Carron
MINISTER: Jim Daly. Picture: Arthur Carron
Philip Ryan

Philip Ryan

The chairman of a major hospital group has said he was asked not to highlight significant under-reporting of delayed discharges from hospital beds, one of the main causes of the trolley crisis, the Sunday Independent can reveal.

In an astonishing claim to the Minister of State in the Department of Health Jim Daly, Graham Knowles of the University of Limerick Hospitals Group said he was told by a HSE official it was “important not to damage confidence in the HSE”.

Mr Knowles, who was appointed by the department to head up a national working group on the delayed discharge issue, told Mr Daly in a four-page letter that the HSE official’s “behaviour” was “unacceptable”.

Mr Knowles said the HSE official concerned accepted there was under-reporting of delayed discharges, but was “presumably hoping that it would not be highlighted”.

In a scathing email to the minister who established the independent expert group, Mr Knowles raised serious concerns about HSE data on delayed discharges.

He revealed he was even forced to delay the publication of the report after clashes with Department of Health officials, and struggled to get internal documentation from the HSE. “I fully accept we are a small State and individuals have many connections but as the review has progressed, issues, followed by behaviour, have undermined the independence considerably,” he said.

However, his most extraordinary claim is that a HSE official asked him not to emphasise the high number of under-reported cases of delayed discharges over fears it would undermine confidence in the health service.

He said the official “wanted to highlight to me that whilst we (HSE) know that delayed discharges are under-reported, it was important not to damage public confidence in the HSE and that the HSE needed extra capacity”.

“I find it unacceptable that [an official] called me accepting there was under-reporting but presumably hoping that it would not be highlighted,” he added.

The Government established a working group on delayed discharges in the aftermath of record-high numbers of people forced to wait for medical attention on hospital trolleys in the winter of 2017/2018.

A delayed discharge is a patient who has been deemed clinically fit to leave a hospital bed but requires ongoing medical care and cannot be immediately discharged. It is a major contributory factor to hospital overcrowding.

Correspondence released under the Freedom of Information Act shows Mr Knowles raised concerns about the scope of his review and the information he was asked to audit soon after he was appointed.

In a email sent to Mr Daly on June 10, 2018, Mr Knowles said he was "extremely concerned" about the figures available on delayed discharges as they "don't reflect the reality on the ground".

He also insisted his review should not solely focus on delayed discharge but also explore measures which encourage people to stay away from hospitals if they are not in need of acute care.

"I would have believed all angles were being reviewed, particularly after the recent winter experience," he said.

In August, he wrote to the minister asking him if he could "use his office to expedite" the release of delayed discharge figures because HSE officials told him they could not release the data because of "governance issues".

The following month, Mr Knowles sent a blistering email to Mr Daly outlining a litany of problems he encountered during his review. He said the figures for delayed discharges were "significantly flawed" and this was "limiting the ability for analysis and recommendations".

Mr Knowles noted that the interviews he conducted with consultants and senior nurses showed there were "significantly more" patients who were delayed than was reported.

He said there was a "policy vacuum" in the Department of Health which had led to hospital groups and community health organisations "making it up as they go along".

Mr Knowles said there were "clear tensions" at a meeting with Department of Health officials when he said they had a role in relation to policy on delayed discharges.

The officials said they would be "reviewing deeply to seek to identify delayed discharge policies (which of course they had already done)," according to Mr Knowles.

They also said they would be forced to make their own public statement if the final report included references to the need for the Department of Health to be involved in drafting policy.

"They suggested not issuing the report at the end of August, giving them time to ensure no policy existed and time to enhance the report," he said. Mr Knowles said he did not want a "public debate" so he agreed.

"With regard to policy, since then I have not received any policy information or documentation from the department, although references to what is and what isn't policy continue to be made," he added. He also detailed difficulties he encountered when seeking audits on delayed discharges from the HSE's special delivery unit. At a crucial meeting, he was told the audits would not be available for weeks.

However, the following day he was forwarded an email from the head of the special delivery unit, which was sent four minutes after the previous day's meeting started, which said the audits would be available the following week.

"I called one of the secretariats to express my surprise at having received an email a day-and-a-half after it was sent, and to clarify that this was different from what I heard at the meeting," he said.

"He was clear that (both) note-takers independently made notes stating that the HSE said in the meeting that the audits would be released the following week," he added.

Mr Knowles said he decided to call three consultants who also attended the meeting and found their recollection was the same as his.

"When considering the issue of policy and numbers reported, it is of interest to look at the current situation and consider who gains," he wrote.

"Where through omission or commission, if the absence of policy enables the under -reporting of delayed discharges, what organisation and/or individual benefit."

In November, the working group's report was published. It revealed there was a "significant under-reporting" of delayed discharges because the system in place for recording figures was "not fit for purpose".

The group made a series of recommendations including that the Department of Health should establish a national policy which ensures that delayed discharges are recorded consistently and accurately.

Last Friday, a HSE spokesperson said: "The HSE welcomes the report of the Independent Review on Delayed Discharges and is working to implement its recommendations."

The HSE did not respond to questions about the claim or whether it would be investigated.

Sunday Independent

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