Preparation of a winter plan for dealing with hospital overcrowding was placed in difficulty amid uncertainty over how much funding would be available, according to internal HSE documents.
They reveal the HSE warned it would be impossible to come up with a “credible” plan unless it knew exactly how much money it would have.
The Department of Health insisted however that the HSE come up with a plan anyway, saying that planning and preparation should continue “notwithstanding… uncertainty” on what extra money would be allocated by the Government.
Correspondence between the HSE and Department of Health from September reveal tensions over whether a winter plan to deal with the expected surge would be in place in time.
The department said it had “impressed” on the Department of Public Expenditure the need for an early decision on funding.
“Early confirmation of funding will make the initiative more effective,” it said. “However, the reality is that factors such as the emerging 2018 financial position, Sláintecare and the upcoming Budget mean that we may not have full certainty on the funding position until later in the year .”
The HSE said in response that its ability to come up with a plan was “frustrated by the absence of any clarity on specific funding levels”.
HSE chief operations officer Anne O’Connor wrote: “It is therefore not possible to prepare and submit a credible plan within the timeline indicated in your letter.”
Ms O’Connor said the HSE had already explained that there was an “absolute need” for early decisions to give it enough time to recruit, establish temporary facilities, and fund other services.
“While acknowledging the complexities of the discussions… it is nonetheless disappointing that we remain at this point in the year without a decision. A key lesson learned from previous winter initiatives has been the need for an early decision in this regard.”
The department later accepted it would be “sensible” if plans were instead drawn up “within current funding parameters”.
Instead of looking for a revised plan on a specific deadline, it asked the HSE when it thought a draft would become available.
On October 19, it wrote to the HSE finally confirming funding that would be available with a “once-off” boost of €10m.
Ms O’Connor said that while the boost was welcome, the absence of any “significant surge capacity” meant its impact would be limited.
“Based on current percentage bed utilisation, in the absence of increased bed capacity, winter 2018 will be challenging,” she warned.
A draft winter plan was finally given to the Department in early November but problems with it were identified by department officials.
Three options presented in it were “not in line with the funding” that had been allocated which meant the extra €10m “must” be spent in 2018.
It also said there were no measures for additional home support or community care measures for early 2019 and did not include projections in terms of “activity, demand, and outcomes as requested”.
The Department of Health said in a statement that there had been “continuous engagement” between it and the HSE in developing a “robust plan” for this winter.