HSE cuts down on overtime and agency spending to help meet its reduced budget
By Mary O’connor
Reducing overtime and agency spending and optimising income collection from private health insurance companies are ways being earmarked by the HSE West to help it cut costs and meet its reduced budget this year.
Bill Maher, the chief executive of the Galway and Roscommon University Hospital Group, told a meeting of the health authority’s regional health forum in Galway earlier this week that it was facing financial challenges as it attempted to address the reduction in its 2012 budget.
He outlined that the group has a budget of €288m for this year which is a reduction of €25m on last year. However with the deficit carried forward from 2011 the actual challenge for this year is €36m, explained.
“We are addressing this by optimising income collection through fees charged to private insurance companies, savings in procurement, and a reduction in agency, premium and overtime payments.”
He stated that to date it has reduced its spend on agency staff by 40 per cent and on overtime payments by eight per cent which allows it to invest more to increase staff numbers.
“Our challenging cost containment plans are starting to deliver and we can demonstrate we have already reduced spending compared to the same period last year. We continue to focus on cost containment and income generation.”
He pointed out that the hospital group is committed to delivering a high quality patient-centred healthcare service, to improve patients’ access to the emergency departments and to meet the Special Delivery Unit target for inpatient waiting lists which is nine months for adults and 20 weeks for children. He said this will be achieved by using the resources (treatment capacity and theatre allocations) of all hospitals in the Galway and Roscommon University Hospital Group.
“A range of measures have been introduced which is helping us to achieve this target,” said Mr Maher. “These include waiting list validation, improved reporting and focus, more effective use of resources across all of the hospitals in the group, patient education and engagement as well as increasing theatre capacity by opening previously closed theatres.
“In January GUH [Galway University Hospitals - UHG and Merlin Park] had 9,901 patients who would potentially breach the target of waiting longer than nine months if they were not seen by the target date of 30 September. As of 21 June, we have reduced the number waiting to 3,661 patients and we are on course to achieve the SDU target in September. This is a tremendous achievement and has only been possible because of the integration of all the hospitals in the group and the efforts of all the staff involved. I would like to acknowledge the dedication of the staff in the four hospitals who remain focused on achieving the target.”
He said the number of patients waiting for outpatient department (OPD) appointments should be viewed in the context of the overall number of patients who attend the hospitals each week.
“On average GUH treats over 4,000 outpatients each week; in 2011 there were 217,766 outpatient attendances which is the target for this year also. Currently there are 40,721 patients on waiting lists for an outpatient appointment at GUH. It is important to note that more than half of patients are waiting less than one year. There are a few specialities with patients waiting a long time and this is also a situation seen nationally and will be a focus of attention in the coming months.”
He explained that the Department of Health’s Special Delivery Unit launched a national initiative in March to deal with outpatient waiting lists.
“The SDU have not yet set the targets for waiting for OPD appointments. However in preparation we have already started working on action plans to reduce the waiting time at GUH. We have identified key specialities that have long waiting times and we will address these as a matter of priority; our aim is to use the resources of all the hospitals in the group to reduce the numbers waiting.
“The OPD waiting lists are validated as patients are called to each clinic and this ensures that only patients who still require an appointment are given a date.”
He outlined that the HSE West will be working with patients to reduce the high number who fail to turn up for hospital appointments.
“This reduces our capacity to see new patients and adds considerably to our waiting lists. In 2011 there were 35,000 appointments missed by patients not showing up. We ask our patients to make every effort to attend their designated appointments or if they are unable to attend to notify us in advance so that their slots may be offered to other patients.”
Tony Canavan, the chief operating officer of the Galway and Roscommon University Hospital Group, said the emergency department at Galway University Hospitals is “extremely busy” with more than 60,000 presentations expected this year.
“In May on average 181 people presented at the ED every day and approximately one fifth of these needed to be admitted. In Portiuncula there will be over 21,000 presentations to the ED this year; in May 57 people on average presented every day and on average, 17 needed to be admitted.
“Patients who present at the ED are triaged, assessed and prioritised by a nurse within 10 to 15 minutes of arrival and then are treated according to urgency. The decision to admit a patient is made after assessment and the relevant tests are carried out.”
He stated that patients start their treatment while waiting for a bed and nursing and support staff are provided to ensure good patient care.
“Every effort is made to keep patients as comfortable as possible. GUH and PHB have robust processes in place for the transfer of care of a patient from an ED consultant to the admitting consultant.”
Mr Canavan remarked that GUH opened a 24 hour/seven day medical assessment unit comprising a short stay medical ward at the end of January. This means that medical patients are admitted under the speciality and into the appropriate ward which has improved access for patients into the hospital considerably.
“We monitor the bed situation in the hospital very closely. So far this year GUH has made significant progress with the number of patients who have to wait for a bed and the length of time they have to wait.”