In anticipation of the projected surge in Covid-19 cases and the expected impact on the health care system a major part of the response was to urgently ramp up capacity for acute hospital care facilities. A critical element of the strategy was to put in place an arrangement with the private hospitals to use their facilities as part of the public system, to provide essential acute hospital services for the duration of the emergency. Following negotiations with the Private Hospitals Association an overarching agreement with the 18 private acute hospitals and the HSE was agreed at the end of March. In the interests of transparency, a copy of the Heads of Terms to the Agreement, which sets out the broad terms of the arrangement, was laid before the Oireachtas last April. It is not proposed to publish the details of arrangements with individual hospitals as that information is commercially sensitive and as such to publish it would be a breach of the Heads of Terms to the Agreement. The agreement provided that the HSE would secure 100% of the capacity of the private hospitals until the end of June. The final costs of the arrangement are still subject to verification. However, it is estimated that the costs arising from the agreement will be in the region of €305 million euros.
Under the agreement, payment to the private hospitals was on a cost only Open Book model whereby the hospitals were reimbursed only for the operating costs properly incurred during the period. The costs covered were 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 is an arbitration mechanism in place in the event of any disagreement. At the time of the agreement it was determined that the cost only open book model was the most effective way of ensuring the arrangement was value for money for the State.
Following termination of the private hospital agreement in June, the Government mandated the HSE to seek to agree with the private hospitals a new arrangement which would provide the HSE with access to private hospital capacity to cover three areas:
- To secure a safety net arrangement against the potential of a further surge of Covid-19 cases;
- Capacity arising from the need to run the public hospitals in a Covid-19 environment; and
- To secure elective activity to assist with waiting lists.
Discussions are still ongoing between the HSE and private hospitals with regard to a safety net arrangement in the event of another surge in Covid-19 cases.
In addition, the HSE is in the final stage of a procurement process to secure access to additional acute services and diagnostics from private providers which is required to address some of the anticipated shortfall over the next two years. A panel will be put in place, following which each hospital will run mini competitions for the services they need. In the meantime, the Department has approved a HSE temporary arrangement for the treatment of patients in private hospitals.
In terms of broader hospital capacity 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.
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. The Department of Health 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 from the baseline at the start of 2020.
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 National Development Plan provides for the addition of the full 2,590 beds by 2027.
