€77 million Winter Plan unveiled

The Health Service Executive’s Winter Preparedness Plan was belatedly published in early November 2021, pledging over €77 million to deliver on Winter Plan funded initiatives, as well as the implementation of 2021 Service Plan aims such as the delivery of 205 acute beds over the winter.

Of the €77 million dedicated to Winter Plan specific measures, the two initiatives receiving the most funding will be the increasing of acute services purchased from private capacity (€20.16 million) and the funding of transitional care for older persons (€20 million). Most notable among the supports to be implemented during the winter of 2021/2022 from the 2021 Service Plan are the addition of 205 acute beds, 1,100 private bed days per week, 275 community beds and 100 additional private community beds.

The full year 2022 cost of the Winter Plan will be €77,051,157 overall, with the costs broken down into four basic categories. In line with government priorities under continuing efforts to progress Sláintecare reforms, community services are the most well-funded of these categories, receiving €41,654,978, 54.1 per cent of the total. Acute services will receive €29,345,777 (38.1 per cent); the National Ambulance Service will receive €5,700,402 (7.4 per cent); and €350,000 (0.45 per cent) will be pledged towards communications.

Aside from the additional beds to implemented as part of the 2021 Service Plan, the winter of 2021/22 will also see the expansion of the ECC Programme, circa 4,000 GP diagnostics per week and the addition of 2.7 million home support hours available “in the context of pressures caused by unfunded price increases” as part of the Service Plan. The five priorities for the winter, as outlined in the plan, are: building capacity; pathways of care; testing and contact tracing; population health; and vaccinations.

New initiatives to be rolled out to ensure the meeting of these priorities include the implementation of new community based models of care; the introduction of new roles such as ED phlebotomists; the expansions of the Pathfinder Frailty model; additional emergency Placement, Respite and Complex Packages of Care; and the identification and targeting of those who have not yet been vaccinated with a communications campaign addressing hesitancy.

With the number of beds in both critical care and general acute care a major talking point and point of criticism of the Government’s recent Budget 2022 due to its addition of just 19 additional ICU beds, the plan includes Covid-19 demand and capacity modelling. Broken down into conservative and pessimistic scenarios, the modelling predicts the need for between 43 and 89 or between 152 and 164 critical care beds in conservative and pessimistic scenarios respectively. The 19 additional beds will bring the total to 340; in January 2021, when there was a capacity of 348 due to the leasing of private beds, occupancy peaked at 330.

Between 119 and 313 general acute care beds will be needed in the conservative scenario, with between 513 and 615 needed in the pessimistic scenario. Before the announcement of Budget 2022 and the recent uptick of Covid-19 cases, the Irish Medical Organisation (IMO) had stated that the number of critical care beds in hospitals would need to be doubled. “The fragility of our health services was exposed during the pandemic and had it not been for exceptional efforts of doctors, and other professionals across the country and huge temporary financial support, the services may have collapsed entirely,” IMO President Ina Kelly said in September 2021.

“As it is, the services have been severely weakened and patients are being forced on to ever-lengthening waiting lists which should shame a leading EU state.”

Upon publication of the plan, Minister for Health Stephen Donnelly TD said: “I particularly welcome the enhanced focus on service restoration in disability services, mental health, services for older people and social inclusion care groups. I fully support the HSE’s commitment to improve Patient Experience Times, particularly in terms of keeping everyone safe while we respond to Covid-19.”

However, the IMO has labelled the plan “inadequate”, pointing to the pressure that the healthcare system was under at the time of its launch in terms of both bed capacity and staffing. Kelly said: “This plan was launched at a time when we have only 21 ICU beds available in the country. Every doctor and healthcare worker is working beyond capacity right now and it is untenable that they are being asked to face into a winter with insufficient support.

“We have 700 vacant consultant posts meaning huge extra pressure on those consultants we do have. We have NCHDs working excessive and illegal hours putting them under enormous strain, and we have GP services facing unprecedented demand from patients. The capacity is simply not there to meet demand and it is not all Covid-related.”

An additional 16,000 hours whole-time equivalent was approved in the 2021 Service Plan “for a comprehensive range of new initiatives”, but just 10,716 were taken on, with an additional 3,200 staff recruited for vaccination and contact tracing. Further criticism has surrounded an apparent lack of clarity as to how the staffing increases still needed given the failure to meet this target will be met, with no details offered in the Winter Plan.