Hospitals fined over €3.7 million

The HSE has fined the country’s acute hospitals over €3.7 million for breaching waiting list targets for the last five months of 2015.  Maureen Browne reports.

But in an unexpected move, the fines have been levied not on the individual hospitals, but on their hospital groups.

A spokesperson for the HSE said all hospital groups had been communicated with in relation to the penalties and deductions had been applied to hospital budgets.

Each of the six Hospital Groups was fined where any of its participating hospitals failed to meet the targets which stipulated that nobody should wait more than 18 months for treatment in any hospital.

The Hospital Groups were fined €752,301 for December 2015, €1.236 million for November, €1.649 million for October, €1.666 million for September and €1.158 million for August.

The HSE itself may now be acknowledging the futility of the fining scheme as it may be set to abandon it, following a barrage of criticism.

The largest cumulative fine for 2015 – €1.189 million has been imposed on the Saolta Group, followed by the RCSI Group with   €1.048 million.  Next was the Dublin Midlands Hospital Group which was fined €691,537.  The South, South West Group was fined   €357,348, the University of Limerick Hospital Group was fined  €306,947, the Children’s Hospital Group was fined  €159,441 and the Ireland East Hospitals Group €9,182.

Hospitals have not received reallocations of deducted penalties. Penalties have been applied to each hospital group which was responsible for dissemination of same to each hospital within their group.

The HSE spokesperson said the fines levied against hospitals for waiting list breaches were intended to be used to support treatment for patients that had been waiting longest. “The required capacity will be sought through another Hospital/Hospital Group in the first instance supported by appropriate funding for the procedure or may be purchased through a private provider should capacity not be available in the public system.”

The HSE statement did not make it clear whether the HSE or the Hospital Groups would be responsible for seeking the extra capacity and re-allocating the “fined” money.

However, the HSE itself may now be acknowledging the futility of the fining scheme as it may be set to abandon it, following a barrage of criticism.

The HSE spokesperson said a decision in relation to the continuation of these fines into 2016 had yet to be finalised.

Managers had pointed out that it was mainly due to lack of resources that they were failing to meet targets and clawing back on their budgets  could only be expected to make matters worse.

They also argued that another reason why they were breaching waiting list targets was because they were trying to keep their ED waiting times down and that it was virtually impossible for them to meet both elective admission and ED waiting time targets, as they impinged directly on each other.

The HSE seems to have accepted the thrust of this argument as in November it stated that hospitals which met their ED targets would have their fines “deferred” if they breached their waiting list targets.

On ED waits the HSE said that a Mandatory National Directive issued by the HSE to hospitals on November 27 last “indicates that should Hospitals have a red TrolleyGar status or have any patient waiting greater than 9 hours on a trolley that they should invoke all steps in the escalation process. A National Escalation Policy was issued in December to all hospitals which sets out clearly the thresholds for escalation and the associated required actions at each stage up to Full Capacity Protocol.

“The Escalation Policy provides the framework against which hospitals will be evaluated in terms of the extent to which they have implemented the escalation policy fully.  The SDU, supported by the Clinical Care leads, has been charged with carrying such evaluations and they will report to the Joint Chairs on their findings. Where it has been determined that the Escalation Policy has not been implemented appropriately, the hospital in question will be subject to fine. Site visits by the SDU are ongoing in this regard.”