Significant progress has been made in the ten months since the start of the COVID 19 pandemic in relation to the funding and provision of additional hospital beds. 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.
The Department of Health is working with the HSE to increase acute capacity in hospitals throughout the country to meet Covid 19 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 (excluding critical care beds). As part of this, over 400 beds, opened in 2019/2020 on a temporary basis, will remain open on a permanent basis.
In addition, a proportion of these 1,146 beds are being provided 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. The HSE has reported that 427 of these beds had opened by 4th February. This represents a significant step towards achieving the recommendations in the 2018 Health Service Capacity Review.
Furthermore, significant additional critical care capacity has been put in place in response to the Covid-19 pandemic, with funding for 40 additional adult critical care beds provided in March 2020. A Strategic Plan for Critical Care was noted by Government in December 2020 and aims to bring permanent adult critical care capacity in Ireland to 321 by the end of 2021 and to 446 in the long term, in line with the recommendations of the Health Service Capacity Review.
A total of €52m was provided to advance the Critical Care Strategic Plan in Budget 2021. This will retain, on a permanent basis, the 40 adult critical care beds put in place on a temporary basis last year and add significant new build bed capacity, as well as allowing for the development of a workforce plan and education initiatives to grow the critical care workforce.
However, where necessary, the number of critical care beds can surge beyond the baseline of 280-285 as part of an emergency response. This is the scenario that our hospitals are in now. The HSE has advised that surge capacity up to around 350 is possible while maintaining clinical risk at an acceptable level. The greater the reliance on surge ICU capacity, the greater the clinical risk with potential impact on patient outcomes.
The situation which is now being faced by our critical care units presents a greater challenge than even the first wave of COVID. While there are indications the number of patients in ICU are plateauing at a high level, it remains essential that we stay at home and reduce the transmission of Covid-19 in the community as much as we possibly can as the only way to reduce the numbers of Covid patients requiring ICU care.
Following the termination of the original 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 include a safety net arrangement for any further surge of Covid-19 cases. The HSE has advised that all 18 hospitals have now signed Service Level Agreements to provide additional hospital capacity to the HSE, to deal with the surge in Covid-19 cases and any further surges in the pandemic, if they arise within the next 12 months. The arrangement is valid for 12 months and is a standard agreement for all 18 hospitals. Under the arrangement, the hospitals have agreed to supply, depending on the incidence of the disease or the number of patients with Covid-19 in public hospitals, up to 15% or 30% of their capacity. The additional capacity provided by the private hospitals is critical to enabling the public health system cope with large scale surges in the incidences of the disease. It is intended to use the capacity of the private hospitals for urgent, time-dependant and complex care.
It is recognised that waiting times for scheduled appointments and procedures have been impacted in the last year as a direct result of the COVID-19 pandemic. The HSE is currently recommending that only critical time dependent elective procedures are undertaken at this time due to the on-going and significant increased demand for bed capacity related to Covid-19. This decision was made arising from the rapid increase in Covid-19 admissions and to ensure patient safety and that all appropriate resources were made available for Covid-19 related activity and time-critical essential work. 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.