Dáil Éireann Debate, Thursday - 23 July 2020
208. Deputy David Cullinane asked the Minister for Health the measures which were taken to expand capacity in the health service in response to the Covid-19 pandemic; and the associated cost for each of these measures [17724/20]
View answerThe Department of Health is working with the HSE to increase acute capacity in hospitals throughout the country. In the context of the current COVID-19 Pandemic response, the HSE advised on 22 June 2020 that an additional 324 acute beds have opened since March, bringing the current total of acute beds in the system to 11,597 excluding critical care capacity. It should be noted that this is the total current bed capacity. However, beds are unavailable when they are temporarily closed for reasons such as infection control, maintenance/refurbishment, or staffing shortages.
The HSE’s Critical Care Programme Census from September 2019 reported that there were 255 adult critical care beds in public hospitals. At an early stage of the Covid-19 pandemic, additional funding was provided to the HSE to increase the number of critical care beds. 42 critical care beds have been funded since March in addition to the baseline critical care capacity already identified in hospitals.
In line with the HSE’s Critical Care Major Surge Preparedness Planning Framework, surge plans for further capacity for each Hospital Group have been developed in order to create additional capacity if required.
A major part of the Government's Action Plan in response to Covid-19 was to substantially increase the capacity of public healthcare facilities to cope with the anticipated additional demand. In order to urgently ramp up capacity for acute care facilities, an arrangement was agreed with the private hospitals to use their facilities as part of the public system on a temporary basis, to provide essential services. A Heads of Terms of Agreement between the HSE and the Private Hospitals was agreed at the end of March 2020 and all 18 of the acute private hospitals signed up to it. Under the arrangement, all patients in the private hospitals were treated as public patients and their treatment was prioritised based on clinical need.
The agreement was reviewed at the end of May and the Government decided that the existing arrangement should not be extended beyond the end of June. It has however mandated the HSE to negotiate a new arrangement with private hospitals which would provide the HSE with full access to private hospital capacity in the event of a surge of Covid-19 and separately with ongoing agreed access, to enable the HSE to meet essential and elective care needs.
My Department has been advised by the HSE that as of the 3rd July, 12,959 patients had been discharged from private hospitals having undergone an inpatient procedure since the arrangement between the HSE and private hospitals came into force. In the same period 53,609 daycase procedures took place in private hospitals, as well as 85,658 diagnostic appointments and 52,096 outpatient appointments. Utilisation rates show that for the period 17-23 June 2020, 47% of private inpatient beds were in use, and for the period 24-30 June there was a 43% utilisation rate.
Under the agreement, payment to the private hospitals is on a cost only Open Book model whereby the hospitals are reimbursed only for the operating costs properly incurred during the period. The costs covered are limited to normal costs of operating the hospital. The hospitals will only receive their actual operating costs when these have been verified. The final cost will be verified by independent firms of accountants appointed by the HSE and the private hospitals and there will be an arbitration mechanism in place in the event of any disagreement. At the time of the agreement the cost only open book model was the most effective way of ensuring the arrangement was value for money for the State.
In terms of costs incurred, at 30th June private hospital expenditure was €294.3m. The expenditure is based on the actual costs for April-20 (€97.5m), actual costs for May (€91.6m), estimated final cost for June (€89m), consultants costs for April – June (€14.5m) and consultants expenses for April – June (€1.7m).
The actual costs submitted for May were €91.6m against the estimated €111m and the HSE are recording an estimated final cost for June of €88.9m against the estimated June costs of €108.9m.
For primary care services, the response to Covid-19 was predominantly based around the reallocation of resources and the more effective use of existing capacity rather than through an expansion of capacity. This included new ways of working such as greater use of digitally enabled healthcare and enhanced integration of care pathways as well as the repurposing of a network of Primary Care and Health Centres as Community Assessment Hubs (CAHs). The gross cost of CAHs is estimated to be €7.37m as of 3rd July 2020.
In relation to supports for General Practice, measures were put in place to help maintain regular essential services, and for the provision of Covid-19-related services without charge to the public. A range of special fees to GPs were introduced from 16 March including fees for the provision of remote consultations, respiratory assessment clinics and extended opening hours and it has been agreed that the majority of these will continue until 10 August.
