Dáil Éireann Debate, Tuesday - 3 November 2020
146. Deputy David Cullinane asked the Minister for Health the steps that will be taken during this lockdown to ensure Ireland is prepared in the event of a third wave; and if he will make a statement on the matter. [33614/20]
View answer1116. Deputy David Cullinane asked the Minister for Health the steps which will be taken during the current lockdown to ensure Ireland is prepared in the event of a third wave; and if he will make a statement on the matter. [33740/20]
View answerI propose to take Questions Nos. 146 and 1116 together.
As the Deputy will be aware, ‘Resilience and Recovery 2020-2021: Plan for Living with COVID-19’ outlines Ireland's strategy for dealing with COVID-19 over the next 6-9 months. It sets out a Framework of 5 Levels which outlines the broad measures which will apply depending on the level of the virus at any given time. The Plan is designed to help everyone – individuals, organisations and sectors – to better understand, anticipate and prepare for the measures that might be introduced to contain transmission of the virus.
The Plan sets out five levels of response, each with a number of measures designed to help us all lower COVID-19 transmission and setting out what is permitted at that moment in time. It aims to allow society and businesses to be able to operate as normally as possible, while continuing to suppress the virus. The Plan is framed to account for periods during which there is a low incidence of the disease, with isolated clusters and low community transmission, through to situations where there is a high or rapidly increasing incidence, widespread community transmission and the pandemic is escalating rapidly in Ireland and globally. It recognises the need for society and business to be allowed to continue as normally as possible and is designed so that either national or county level restrictions can be applied.
Over the past number of months my Department and the HSE have collaborated to increase capacity and readiness across the health service in response to the pandemic. This encompasses developments across all areas of the health service, including with regard to public health teams, contact tracing and acute hospitals.
The HSE now has standing capacity to test 120,000 people every week. As part of its ongoing process improvement, the HSE is currently running a nationwide recruitment campaign for swabbers and contact tracers, setting up temporary swabbing sites and making process improvements to the end-to-end test and trace system. Recruitment is a key focus. 500 additional contact tracers are being hired to provide standing capacity for contact tracing with 280 already in place and a further 60 - 70 being appointed on a weekly basis. A further 180 people have been appointed to date to carry out swabbing activities, whilst additional candidates are currently going through the compliance and interview process.
Work is ongoing to identify the products and funding level required to meet the clinical demand for PPE for the remainder of 2020 and 2021. My Department and the HSE are continuing to engage on future requirements to ensure adequate stocks of all required materials are sourced and maintained in line with forecast demand.
Ireland is also currently involved in an EU Procurement Exercise being operated by the European Commission on behalf of member states to procure suitable, safe and effective vaccines, in sufficient quantities, to combat Covid-19. Both my Department and the HSE have actively engaged in meetings of the Steering Board that is chaired by the Commission which provides the core governance and consultative forum for the EU procurement process.
The arrangements are intended to ensure a coordinated action at the European level to vaccinate the EU population. Ireland has already opted into two Advance Purchase Agreements (APA), (1) with the British-Swedish drug maker AstraZeneca, which is partnering with Oxford University and (2) with Janssen, a Belgian Pharmaceutical company owned by Johnson & Johnson
As the Deputy may be aware, a COVID-19 Immunisation Strategy Group has also been established. The purpose of the Group is to advise on and assist in the development of national policy relating to COVID-19 vaccines.
At the start of the year, permanent adult critical care capacity in Ireland stood at 255 beds, according to the National Office of Clinical Audit. This included 204 Level 3 ICU beds and 51 Level 2 HDU beds. As part of the initial response to the pandemic, funding was provided for an additional 40 adult critical care beds in March 2020 as well as two paediatric beds. The HSE has advised that between 280 and 285 critical care beds are currently open, with the number open any given day subject to fluctuation in respect of available staff and other operational considerations.
Where necessary, the number of critical care beds can surge beyond the baseline of 280-285 as part of an emergency response. However, it is essential to understand that the use of surge capacity for critical care is necessarily tied to a reduction of services in other areas of the hospital. Moreover, the clinical advice is clear that the greater the reliance on surge ICU capacity, the greater the clinical risk with potential impact on patient outcomes.
Our critical care units have coped well so far, largely due to the fact that the curve was flattened successfully in early stages. As a result, our outcomes for Covid patients in ICU have compared well with other jurisdictions including the UK.
Budget 2021 will allocate funding totalling €52m in 2021 to critical care. This will retain, on a permanent basis, the 42 critical care beds put in place on a temporary basis this year and add significant new capacity. Funded adult critical care beds will increase to 321 by end 2021, an increase of 66 over the baseline number of 255 funded beds in 2020. Funding for 2021 will also include money to allow for the development of a workforce plan as well as education initiatives to grow the critical care workforce.
It is recognised that waiting times for scheduled appointments and procedures have been impacted as a direct result of the COVID-19 pandemic.
In response to the Covid-19 pandemic the HSE had to take measures to defer most scheduled care activity in March, April, and May of this year. This was to ensure patient safety and that all appropriate resources were made available for Covid-19 related activity and time-critical essential work. This decision was in line with the advice issued by the National Public Health Emergency Team (NPHET) in accordance with the advice of the WHO.
Patient safety remains at the centre of all hospital activity and elective care scheduling. To ensure services are provided in a safe, clinically-aligned and prioritised way, hospitals are following HSE clinical guidelines and protocols.
The HSE continues to optimise productivity through alternative work practices such the use of alternative settings including private hospitals, community facilities and alternative outpatient settings.
In addition the National Treatment Purchase Fund (NTPF) is currently reviewing strategies to maximise activity and benefit for patients, to include, increased use of private hospitals, funding weekend and evening work in public hospitals, funding “see and treat” services where minor procedures are provided at the same time as outpatient consultations, funding hybrid services where public and private hospitals contribute to the treatment of patients, virtual clinics and clinical validation.
The Programme for Government, Our Shared Future, commits to continuing investment in our health care services in line with the recommendations of the Health Service Capacity Review and the commitments in Project Ireland 2040.
The Health Service Capacity Review 2018 found that the net requirement in combination with health system reform is for an additional 2,590 hospital beds by 2031 (2,100 inpatient, 300 day case and 190 critical care). The National Development Plan provides for the addition of the full 2,590 beds by 2027.
This winter is expected to be particularly challenging due to the presence of Covid-19 and the uncertainty around the level of Covid-19 and non-Covid-19 healthcare demands. My Department is working with the HSE to increase acute capacity in hospitals throughout the country to meet this and other health demands. Government allocated €236 million revenue and €40 million capital expenditure as part of Budget 2021 to fund additional acute beds on a permanent basis. This funding will provide, by the end of 2021, an additional 1,146 acute beds.
A proportion of these beds will be funded as part of the HSE’s Winter Plan 2020/21. The Winter Plan aims to provide additional health service capacity across a range of services. Initiatives comprise additional acute and community beds to increase acute capacity, help reduce admissions and facilitate egress.
This represents a significant step towards achieving the recommendations in the 2018 Health Service Capacity Review which found that an additional 2,100 inpatient acute beds were required, in a reform scenario, by 2031.
The Deputy may also wish to note that further details in relation to the delivery of health and social care services in the context of Covid-19 can be found in Resilience and Recovery 2020-2021: Plan for Living with COVID-19.
