The startling truth about Ireland's broken health service is revealed today - with dire warnings over patient safety, a crisis in funding, staff shortages, and bullying.

The Irish Independent can today reveal the massive scale of the challenges facing new HSE boss Paul Reid.

Briefings prepared for him by senior HSE management just before he took up the post set out in stark terms the chaos in a health service on the brink.

Concerns raised by the HSE's top brass include:

Staffing levels are "too low for safe care in some areas";

Infection-control issues in hospitals and insufficient isolation facilities;

A focus on the HSE's financial performance that "deviates attention from quality care";

Emergency department attendance rising above the funded level and displacing elective care;

How €300m is needed for "essential equipment replacement";

Details of a survey which found that 42pc of staff had suffered bullying.

While the warnings make for grim reading, senior managers also set out efforts to tackle the health service's many problems.

Mr Reid's first weeks as director general have already seen industrial action by HSE support staff and the revelation that the health service already has a revenue deficit more than €100m this year.

Details of the briefings provided to Mr Reid by 20 senior HSE managers are contained in documents obtained by this newspaper.

Several executives raise issues of serious concern in the induction package compiled in April, before Mr Reid assumed office the following month.

Each of the managers outline the main areas of responsibility of their respective departments - and provide a list of "key current issues being dealt with" which contain details on the massive challenges facing the HSE.

Perhaps some of the most concerning issues were raised by then-interim deputy director general and chief operations officer Liam Woods.

The office oversees community operations, acute hospitals and other national services. Mr Woods identifies issues in four areas: access to health services; quality and safety; finance; and human resources.

The trolley crisis is referenced with the document noting a growth in emergency department attendances, which are said to be rising above the funded level and "displacing elective care".

Mr Woods raises waiting times for inpatient and outpatient services. He says there is an agreed funded plan for issues with inpatient waiting times and proposals are being developed with the Department of Health for outpatients. There is a "challenge between safety and cost constraint" listed under "quality/safety".

The document notes "staffing levels too low for safe care in some areas".

It says work is being carried out with the Health Information and Quality Authority (Hiqa) relating to "specific sites".

On human resources issues, Mr Woods outlines a "difficulty in attracting staff including consultants and nurses". The document says: "This is a big issue in mental health and particularly in the south east."

He also mentions a staff survey where four in 10 respondents said they had experienced bullying in the last two years and said actions to address culture are being dealt with.

In terms of finance, Mr Woods's document says there is a "lack of access to capital for equipment to provide safe services".

It also warns that "funding to the HSE is not matching the estimate of the demographic impact of demand for health services".

It says there has been "financial deficits for the first two months of 2019 associated with 2018 out-turn and continuing growth in demand for hospital services".

Meanwhile, the head of the HSE's National Quality Improvement (QI) Team, Dr Philip Crowley, warned that the "major focus" on the HSE's financial performance "deviates attention from quality of care".

Mr Crowley offers details of his team's strategy to develop a health service focused on quality of care.

A briefing by another senior manager, Angela Fitzgerald, sets out the issues in acute hospitals. It raises "infection-control issues" and an "increased requirement for isolation as a result of improved screening".

She warns that healthcare-associated infections (HCAIs) are only partially mitigated by existing measures like testing for superbugs.

There is said to be "insufficient isolation facilities and rapid turnaround of tests to ensure timely placement of patients in appropriate accommodation".

Under the heading of "clinical/corporate risks", Ms Fitzgerald also lists "essential equipment replacement (€300m)".

She highlights a "reliance on agency and locum provision due to [an] inability to recruit and retain key staff".

Ms Fitzgerald also speaks of leveraging Sláintecare funding to enable early implementation of reform proposals. The Government had to bail out the health service with €700m in 2018.

Mr Reid's induction package also includes details of the HSE's National Service Plan for 2019, which states that the "over-riding requirement is to prioritise the delivery of safe services within the available resources".

Last week, Mr Reid appeared before the Dáil's Public Accounts Committee (PAC) where he insisted that the HSE is in a stronger financial position compared to 2018. He also conceded that the deficit to the end of May will certainly be more than €100m.

Put to him that the HSE was heading towards a supplementary budget this year, Mr Reid said: "I certainly am not planning on it."

He outlined how he's focussing his attention on the €12bn of the HSE's €16bn budget where costs can be controlled.

Among issues raised by John Hennessy, the national director for acute planning and strategy, is preparing for Brexit "to ensure minimal disruption to services in the period directly following Brexit and in the medium to longer term".

Senior managers also outline extensive efforts being made to tackle difficulties in the health service.

These include measures being implemented as part of Sláintecare, the cross-party plan for long-term reform.

Mr Hennessy outlines how plans are being developed to increase acute bed capacity in hospitals.

Irish Independent