Data on number of patients who abandon their visit to emergency departments without being formally discharged

THE number of patients walking out of emergency departments without ever being formally discharged has reached record levels.

More than 13,500 people simply abandoned their visit to the accident and emergency ward during January of this year and December last.

It means that nearly one in sixteen patients who arrived seeking emergency medical care left instead, either frustrated by lengthy queues, going elsewhere for treatment, or returning home.

The figures for January 2018 and December 2017 include 859 children, whose parents thought they were sick enough to bring to hospital but later left without officially being told they were healthy enough to go.

In a statement, the HSE said there were a variety of reasons why patients might leave an emergency department, not only wait times.

However, the numbers have been climbing during precisely the same period as waiting lists in Irish hospitals reached their highest levels yet.

In January, 6,499 people were classified as “did not waits” compared to 4,777 people in the same month in 2017.
The figure was actually even worse in December when 7,055 people – or 6.3% of all patients presenting – went home without formal discharge from hospital.

There has been a steady rise in the percentage of patients not waiting for emergency treatment, from 4.8% in January 2017 to 6% and above in the two most recent months for which figures are available.

Ministerial pre-budget submissions on generous tax incentive regimes for executives from multinational companies

THE Department of Finance rejected a proposal to double the length of time a generous tax incentive applies to executives from multinational companies.

Minister Paschal Donohoe was also discouraged from allowing extension of another tax relief scheme for top executives amid fears it could create a “significant loophole”.

In a budgetary submission, Minister Paschal Donohoe was briefed on a plan to allow senior personnel benefit from ten years of a special tax scheme instead of the five years currently available.

Under the arrangement – known as the special assignee relief (SARP) – 30% of income above €75,000 is exempt from income tax.

Those who benefit are also allowed a €5,000 per child tax-free allowance for school fees, if those fees are paid by their employer.

A budgetary submission explained how the Department of Business had asked for the extension of the scheme to “facilitate the attraction and embedding of mobile investment and high calibre individuals”.

The document explained how the SARP scheme was designed to ensure that Ireland remained competitive when vying with other countries for foreign investment.

Reports from Leo Varadkar’s Strategic Communications Unit on visits to government PR teams in London and the Netherlands

TAOISEACH Leo Varadkar’s €5 million communications unit was warned of the dangers of getting caught in a “parliamentary bubble” in a special briefing from the UK government’s premiere public relations guru.

Two senior members of the Strategic Communications Unit (SCU) visited London in September for a high-level briefing with senior personnel in Britain’s Government Communication Service.

A report on the visit, obtained under FOI, reveals key parts of the advice that will shape Mr Varadkar’s controversial PR operation.

Among the findings brought back from the meeting were that there was “audacity in simplicity” and that “citizen needs are more important than government needs”.

The trip was undertaken by John Concannon, the director of the SCU, and Andrea Pappin, another of the leading officials from the unit.

A separate report from the Strategic Communications Unit warned that communications teams across government could suffer “the five stages of grief” if told they had to revamp their websites, PR and branding.

The advice came after two senior officials from the unit travelled to The Hague to meet communication experts in the Dutch government last September.

A report on the visit explained how some people would need to go through an “emotional journey” to let go of longstanding logos, branding, and internet home pages.

Correspondence between government and Facebook on controversial proposal to tie social media accounts to official identification documents

This is all correspondence between junior minister at the Department of Health Jim Daly and other organisations about his plan to link social media accounts to official forms of identity like passports or public services cards.

The plan has already been rejected by Taoiseach Leo Varadkar but Mr Daly does not appear to have given up on it.

The documents show that Minister Daly wrote personally to Mark Zuckerberg of Facebook about his idea for an “online verification code” and subsequently received a response from the company.

Facebook said it would raise “some very difficult privacy and data protection-related issues” but were happy to meet with him. That meeting took place on February 14, but the minutes of it would not have been subject to this FOI request.

Department of Health documents on difficulties in monitoring medical consultants and their work in public hospitals

AN INTERNAL report has revealed the chaos behind trying to manage the contracts of medical consultants and ensuring they work all the hours they are supposed to in public hospitals.

The document effectively admits that for many consultants, the HSE has no way of monitoring their earnings or private practice to ensure they fulfil their obligations.

The report was prepared by the HSE for the Department of Health and the Department of Public Expenditure amid concerns that some consultants were not doing all they were supposed to do in public hospitals.

The issue was highlighted in an RTÉ Investigates documentary last November which showed how some consultants were doing far below what their contract required, particularly in regional hospitals.

In one case, a consultant observed for an eight-week period was discovered to be doing just thirteen hours a week on average in the public system.

Documents obtained under FOI reveal the consultant contract issue was already a major concern of the HSE and Department of Health prior to the programme broadcast.

A report had been prepared highlighting the “key challenges” facing the HSE in guaranteeing that consultants met their obligations.

It said that it was impossible to keep tabs on 360 consultants with a specific type of contract. “[Their contracts] posed unique challenges for this cohort as it left no effective basis for monitoring compliance,” the report explained.

Many contracts had no provision for monitoring offsite private practice generally, the report said.

“The HSE has audited hospitals in relation to this issue; however, it does not lend itself to a routine monitoring, and random checks through websites have limited benefit. There is a need to determine the most appropriate mechanism for establishing whether there is inappropriate off-site practice.”

The HSE also had no way to check how much consultants were earning from the private work they did while other problems around determining whether patients were public or private were also identified.

Another issue was also raised where some consultants were working more than required and “strict enforcement” for all could well bring those doing excess hours “into sharp focus”.

Correspondence between judiciary and government on pensions and pay cuts

JUDGES asked the government for a special deal on pensions as part of the public service pay talks saying their retirement packages were anything but “gold-plated or platinum”.

The judiciary told Minister Paschal Donohoe that no other group of people had been hit with as many different pay cuts and other budgetary measures during the financial crisis.

In a series of letters, the Association of Judges in Ireland (AJI) expressed concern that they were going to be penalised again, this time for their “accelerated” pensions.

Like soldiers and gardai, the pensions of members of the judiciary build up much more quickly than is the case with other public servants.

Under government public pay plans, these fast-track pensions are to be hit with far higher levies to reflect the fact they can become lucrative faster.

However, judges complained they should not be lumped in with other groups in receipt of “accelerated” pensions and that their circumstances were unique.

Corporate enforcer forced to wait years to fill key vacancies for forensic accountants & IT expert: the paper trail

HIRING six forensic accountants for the Office of Director of Corporate Enforcement took more than two years amid chaos over getting the jobs approved and advertised.

At one stage, ODCE boss Ian Drennan said the entire process had been “nothing short of a disgrace” and that he was “mortified” about the prospect of a job advertisement filled with errors appearing in the national press.

The corporate enforcer also warned that it was being “compromised” on procurement laws because it did not have the capacity to analyse large amounts of electronic evidence.

The ODCE told the Department of Jobs that it did not have the in-house skillset to deal with huge amounts of data that had been seized as part of its investigations, including the Anglo probe.

The corporate enforcement office had first asked for a computer expert to be hired in 2014 but the appointment did not take place until nearly three years later.

600 pages of emails and internal records that catalogue a depressing saga.

Internal memos on dangers of fraud in €340-a-million a year childcare schemes

CHILDREN’S Minister Katherine Zappone has been warned that childcare schemes across the country are wide open to the potential for fraud.

In a submission, Ms Zappone was told there were “serious concerns” over the Department’s ability to monitor around €340 million in annual spending.

The memo said the current system allowed services to make “over-claims” and that it was impossible to be sure that funding was being used for the reasons it was provided.

More than twenty schemes were identified where the number of children officially registered was much higher than the numbers of kids actually attending.

Five separate schemes benefitting more than 100,000 children each year had been introduced in a “piecemeal fashion … at different times and when governance and compliance requirements were less clear”.

The submission was seen by Minister Katherine Zappone in April of this year who said she wanted a pragmatic approach to dealing with the problems raised.

Alarm bells had been set off in December 2014 when an audit of one childcare facility discovered over-claims of around €500,000. It is currently the subject of a garda investigation.

However, the internal memo warned that the problems identified were “systemic in nature” and could only be dealt with by new law, strong rules, sanctions, and new contractual requirements for service providers.

Department of Public Expenditure submission on RTÉ reviewing services and cutting loss-making public service broadcasting

THE Department of Public Expenditure said RTÉ needs to cut costs more before any commitment should be made to give them extra funding.

RTÉ should be asked to review loss-making public service broadcasting and even look at what services it was providing, an internal Departmental briefing note says. The memo for Minister Paschal Donohoe was prepared as part of discussions over the sale of lands at the broadcaster’s campus in Montrose.

It said that both RTÉ and the Department of Communications were looking for funding for the broadcaster to be restored to 2009 levels when it was €20 million higher. However, the Department of Public Expenditure said that they “did not necessarily accept that further additional Exchequer funding should be provided or that the level of Exchequer funding should be restored to its peak”.

http://www.documentcloud.org/documents/3912453-RTÉ-Records-Complete.html

Irish Water’s parent company Ervia & negotiations for a new chief executive

IRISH Water’s parent company Ervia looked for a €250,000 salary for its incoming chief executive despite being told the pay for the position had to be €30,000 less.

The appointment of former Bórd Na Móna executive Mike Quinn was eventually agreed with a pay package of €225,000, a hike of €5,000 on what had originally been agreed on by government.

Departmental documents obtained under FOI by Right to Know also show how Ervia, which runs Irish Water along with gas networks in Ireland, was having serious difficulties in finding a candidate for the job.

Internal records from the Department of Communications explain that 187 different candidates had been identified for the job originally.

However, many had withdrawn “due to the complex nature of the job” and what was described as a “significant gap in salary expectations”.