The HSE has released its winter plan amid expectations of a surge in cases of Covid-19, in addition to the expected pressure the health service will face due to seasonal illnesses.
The HSE is expecting a rise in levels of Covid-19 and has prepared a contingency plan aimed to mitigate the worst excesses of the virus. As such, there will be a projected rise in unscheduled care, which the Department has rationalised will take place for the following reasons:
• a lack of bed capacity to meet demand;
• reduced staffing levels and recruitment challenges;
• scheduled care waiting lists and the impact of delayed and postponed care;
• developments in primary and community care services;
• challenges in integrating patient care across acute and community services;
• increases in population, particularly the ageing population, and increasing numbers of patients requiring health services including refugees and those seeking international protection; and
• the ongoing need for separate Covid-19 and non-Covid-19 pathways and the resulting infection prevention and control requirements in both acute and community services.
The HSE has further made plans for the combatting a potential ‘twin-demic’ of both influenza and Covid-19, although it does state that Covid-19 in Ireland appears to be transitioning to an endemic proportions. The plan will be funded to the tune of around €169 million.
It is to be measured by a set of key performance indicators, including a 97 per cent patient experience time (PET), a 99 per cent PET for over 75s, a delayed transfer of care (DTOC) of 350, a length of stay of 4.8 days, an 8am trolly count of less than 236, and a National Ambulance Service (NAS) turnaround time of 80 per cent. None of these targets have been met to date in 2022.
Winter plan priorities
As outlined by the Department of Health, the Winter Plan identifies key priorities which aim to address the objectives of the of the plan and align with corresponding initiatives at national and local level.
• Delivering additional capacity in acute and community services: To deliver additional acute and community bed capacity and increase staff capacity through the implementation of the Safe Staffing and Skill-Mix Framework and prioritisation of recruitment for existing funded posts to support Winter Plan 2022/23. The HSE also plans to extend the opening hours of several local injury units to operate between 8am and 8pm.
• Improving pathways of care for patients: To implement alternative patient pathways during the winter period to support admission avoidance, patient flow and discharge, including Enhanced Community Care (ECC) supports.
• Rolling out vaccination programmes for flu and Covid-19: To deliver an influenza vaccination programme alongside a Covid-19 vaccination programme, and increase awareness and uptake for these respective programmes.
• Implementing Pandemic Preparedness Plan: To implement the Public Health Plan which includes the development of a surge and emergency response plan, in the event of a significant surge in Covid-19 infections.
Local immediate action plans and national initiatives
Due to the potentially localised nature of virus control, the HSE has devised local area action plans which are akin to the response to the Covid-19 lockdowns, providing a local approach to different areas based on their need.
The Department has, however, stated that the overall aim is for an integrated response where local and national measures work in tandem.
On the national level, the HSE will:
• implement bespoke integrated local action plans focused on improving USC performance and alleviating seasonal winter pressures;
• deliver new nationally led, locally delivered initiatives, based on best practice, to enhance admission avoidance, patient flow and discharge during the winter period; and
• continue the implementation of the ongoing initiatives funded through the Winter Plan and National Service Plan 2020/21 and 2021/22, including the provision of additional acute and community capacity.
On the local level, as part of the local immediate action plans, the HSE will:
• make available an integrated response fund so that local governance structures can develop initiatives to respond rapidly to newly emerging challenges during winter;
• set KPI targets for each site as part of the plan;
• engage with sites to develop initiatives requiring longer-term investment and implementation to drive improvements in USC activity as part of three-year USC Improvement Programme; and
• establish local integrated governance structures and implementation teams to monitor and report initiative implementation, KPI performance, and proactive responses during the winter period.