The health service has launched an “ambitious” €600m plan to overcome additional challenges this winter, but has conceded that it is ‘not 100% confident’ that it will be able to recruit the 12,500 staff required to deliver services between October and April.
As the health service faces a range of additional challenges this winter due to the Covid-19 pandemic, the HSE has committed to spending €200m to bolster services for the rest of this year, and a further €400m between January and April next year.
Ordinarily, hospitals see more patients attending during the winter period, with between 100,000-120,000 attendances and 25,000 admissions to hospital emergency departments per month, while the number of patients on trolleys typically rises to between 250-350 per day in the winter months.
This year the health service will have to operate at a reduced capacity of 85% due to Covid-19, while also operating Covid and non-Covid services.
To manage these challenges, the HSE is investing heavily in community services and supports to keep more people out of hospital.
The HSE has committed to providing 4.7m home care hours at a cost of €138m, rolling out 20 community assessment hubs nationally, and providing more than 1,100 community beds to accommodate patients discharged from hospital.
The plan will also see 251 acute beds and 89 sub-acute or step-down beds open before Christmas as well as a further 232 acute beds open in the new year.
It also provides for an additional 20,000 elective procedures, 45,000 cancer appointments, and a provision to avail of private hospital services.
The absence of detail on the 12,500 staff required to deliver the plan over the next six months, however, has raised some doubt over whether the plan can be realised.
Health officials could not provide a breakdown of doctors, nurses, and other healthcare staff required to open the new beds, and said staffing requirements were being worked out as part of an implementation plan.
The winter plan acknowledges the “significant risk of not being able to attract and retain the appropriate number and calibre of staff” where key posts are not permanent.
HSE chief operations officer, Anne O'Connor, conceded she could not guarantee that the ambitious recruitment targets will be met.
“I can't be 100% confident, that's the reality. We have to aim for those levels of staff,” she said, adding that the HSE was doing everything it can to recruit staff.
Asked about the number of medical staff required to staff the new beds, HSE CEO Paul Reid said: “It’s a breakdown we haven't finalised for publication just yet”.
Health minister Stephen Donnelly, who could not attend the launch, welcomed the plan as a “critical component” to managing health services this winter, but accepted that the winter plan may not reduce waiting lists for care.
“The initial forecasting I've seen from the HSE suggested that even with this winter plan, the number of people waiting on elective care could go up,” he said, adding that between 20-50% of capacity had been knocked out by Covid-19.
Key points of HSE €600m winter plan include:
- 251 new acute beds will be provided in Q4 2020 and 232 in Q1 2021 at a total cost of €81.5m. There is a question mark over staffing requirements and whether staff can be recruited in time;
- 89 additional sub-acute or step-down beds: €12m will be spent on rolling out step-down beds over the next six months to alleviate pressure on acute services. A question mark remains over staffing requirements and recruitment;
- The HSE said it has been building ICU capacity during the pandemic, from 225 in March to 282 at present. The additional 17 beds will bring ICU beds closer to 300, but still far shorter than the 589 recommended in a recent capacity review;
- The HSE will roll out 631 rehabilitation beds and repurpose 530 long-term community beds for use in the community. This could help to keep patients out of hospital, but will be contingent on staffing;
- 47 specialist teams will treat and provide care in the community, alleviating pressure on the hospital system. These teams will be contingent on staff being in place.
- Almost one quarter of the winter plan budget — €138 million — will be spent on providing 4.7m homecare hours to provide care and support in the community. It is hoped that this will help to alleviate pressure on hospitals, but there are concerns about where staff will come from.
- Close to 5,000 staff will be recruited before Christmas, half of which will be for Covid-19 testing and tracing, and the rest to support winter plan measures. An additional 7,000 staff will be recruited in the new year. The HSE acknowledges that the challenges of recruiting staff presents a “significant risk” to the plan.
- €59m will be spent in the new year to access services and diagnostics from private hospitals and discussions are ongoing to access additional capacity in the event of a Covid-19 surge. The three-month takeover of private hospitals at the outset of the pandemic came at significant cost, and the HSE will not want to replicate that agreement.
The HSE hopes to reduce trolley numbers by 30% under the winter plan, raising doubts over previous commitments to adopt a “zero tolerance” approach to overcrowding, given the Covid-19 environment.
Some €55m will be spent on a flu vaccination programme this winter to reduce the number of people presenting with illness. The adult programme has commenced, and a child vaccination programme will begin in October. This will help to keep people out of hospital if it can be delivered on time.