Paul Murphy Presses Tallagh on Insourcing and Single Sign-On

Deputy Mark. Thanks a lot. Thanks for coming before us. Just to start with Tala Hospital, not insourcing related, first of all, just in the briefing you mentioned that you did a pilot with a single sign-on for access to all these different systems. You might have to access 17 different systems over the course of a shift, and the time saved per clinician was 58 minutes on average per shift, which is incredible, in the sense of it suggests, if I'm not wrong, that on average, the average clinician is spending an hour every shift, presumably eight-hour shifts, signing on to different systems, is that right? Yes. And I presume that goes also for the matter? So we have a patient centre at the minute, we have a legacy, so we're very excited for the new EHR that's coming on board, but our patient centre was actually set up as a legacy where we have it all compatible in one service, so it's always been really efficient from that perspective. And from the point of view of Tala then, effectively you're saying that one out of any, the equivalent of one out of every clinicians are full-time just logging on to various systems? And I might just pass that on to... As a user of the single sign-on, I might give you the experience, so we would have an electronic patient record, we would have a radiology system, a lab system, and it's like if you log on to your laptop, there's a few minutes where the laptop logs on and gets your different passwords, where with this one system you tap your identity card to the sensor beside the laptop or PC and it effectively logs you into all of the systems that you would normally use automatically, so that it saves you time, and that accumulated time over 8, 10, 12 hour shift, whatever it is, that was the average time sort of gained back. So yes, it's really good. It's incredible. And therefore, if we move to a single sign-on system, you're talking about, there's effectively a 10% increase in time available for clinicians to do work. And that's probably going to become more important across the state as we look at electronic health records. Yes. Electronic health records will speed everything up, but paper is actually often a lot faster in practice, so you have to get used to those. So these sort of innovations are really important. Yes. Okay, just to move to the issue of insourcing, again, in the briefing you state, I agree with this, that basically it's a short-term solution, but it's not a sustainable solution to waiting lists. It depends on repeated use of overtime by existing staff, rather than recurrent investment in core work and capacity. It places an unhealthy burden on those staff members and creates operational risk for the hospital. Could you expand on what you mean by that in terms of the unhealthy burden and the operational risk for the hospital? In terms of health and well-being, everybody needs to work a certain amount and is entitled to their time to disconnect and to take time off. And anybody that works over their hours, it does impact on their, or potentially can impact on their efficiency in work. So while it is a really good solution and it addresses our wait lists directly, the long-term sustainable solution would be preferred where we have permanent consultants, permanent staff, permanent administration and nursing staff to actually carry out the procedures and the outpatients within our existing facility, because we don't have 12 over 7 working. We don't have 12-hour shifts every Monday to Sunday. Also, some areas lie idle because we don't have the resource on the Saturday and Sunday. We are working towards that, but we need it incrementally and we need the support put in place to do that. Are some staff working unsafe numbers of hours because of these insourcing arrangements? As Professor Lavin would have said, it's not that much, but in the long-term, it's not sustainable. And the majority of the staff that we have on NTPF are actually employed solely for this purpose, so there's a small bit of overtime on top of that, but most of the people who are employed for that purpose. Yeah, okay. And can I just dig in a little bit into the story about the NACE General Hospital consultants being paid on a per-patient, rather than overtime basis, their HSE audit finding that basically they were paid over the odds as a result of that. One thing in reading the story I don't fully understand is why is TALA Hospital involved in this? TALA Hospital was in some way in the middle of this and making payments. They were converting per-patient payments into overtime payments and then paying the consultants on that basis, which was a fee worked out on a per-patient basis, but then transposed into being an outpatient or an overtime, and then getting the money back from NACE. Why wasn't NACE just directly paying the consultants company? So I suppose firstly, there are a lot of consultants who work over more than one site, and that's not just TALA Hospital, it's every hospital in the country, I would say. So the paymaster is usually one hospital. So in that report of the internal audit, while no findings were made against TALA Hospital and all the recommendations were implemented as outlined by NACE, we were the paymaster. So the NACE General Hospital converted the hours into overtime hours and signed off from their general manager, and that was transferred to our TALA University Hospital payroll system, and then we issued the payment as requested. So you're saying that these consultants were getting paid via companies, they had a company set up. No? Well, there's two. Okay. Anyone who would be paid by a company would never have been paid through payroll. Okay, so the ones who were paid through TALA Hospital were not. This would be the equivalent of someone who would have been working overtime, you know, but I suppose in the other hospital. And was TALA Hospital aware that what was coming to you as payments to be paid for overtime was actually a kind of converted figure from a per patient basis? I'm going to hand over to the CFO because he would be more clear on the process of that. No. Wouldn't be aware. Okay. So you simply get the overtime amounts. It's an overtime submission form. Yeah. And you had no awareness of that and no involvement in the creation of this kind of way of paying for them and so on. Okay. Perfect. Yeah. Deputy Murphy, just to confirm as well, TALA's role in this was to facilitate transaction. Obviously the approval was coming from NACE General Hospital, but just to confirm, after that report, before that report was actually finalized, the recommendations were all taken on board and in fact, further to that, no further insourcing was since used from roughly June last year. Okay. Thanks a lot. Okay. Just to zoom out again, in the opening statement you make the point the hospital runs at an occupancy rate of approximately 110 to 115% resulting in delays in admissions of patients through emergency department. Have you got a recommended bed occupancy rate either for TALA or for the hospitals in general? The hospital should run at 85 to 90% for best practice. So we run at 110 to 115 for the last few months we have as well. And I saw that across the OECD, they also operate on the basis of 85%. The average bed occupancy rate in 2023 was 72%, but the rate was higher than 85% in only two of the 29 countries with comparable data, Ireland and Canada. So we're definitely an outlier in this sense. I know there's also studies in Britain about the relationship between that effectively for every 82 patients delayed for longer than six hours in emergency departments, there was one excess death. Have you any assessment of excess deaths that result in TALA hospital as a consequence of these sometimes quite long waiting lists? Okay. I might pass that on to the clinical director. So short answer, no. But as we do get NOCA data, which is the National Office for Audit, and I suppose our death rates for various specialty conditions are always within the normal parameters, so we don't have that. But we are very aware of that data. The normal parameters in Ireland or? In Ireland. To the hospitals across Ireland. But they often also have like long waiting lists or long waiting times. Absolutely. We are very aware and very conscious of that data. I suppose I would also be even more conscious, I suppose, of the patient experience time data from the time the patient arrives in the emergency department to when they ultimately leave it to a bed in the ward or whether they go home. I suppose what's not captured in that data is the fact that we are at this occupancy and all of this activity effectively comes through the front door and it's the other activity that we suppress, the planned operations that we need to get for people. So that's probably not captured because it's activity almost, not planned because we know that we don't have the capacity. So that would be one of my concerns and I suppose ultimately there is a plan for additional hospital beds and I suppose hopefully that can be expedited as well because I suppose that's really what we need. Thanks a lot.