Dáil Éireann Debate, Thursday - 31 March 2022
64. Deputy Richard Boyd Barrett asked the Minister for Health his plans for dealing with the chronic overcrowding in hospitals, the ever-growing waiting lists and the crisis in non-Covid-19 care; if he considers that it is now time to take over the capacity in the private hospitals; and if he will make a statement on the matter. [16848/22]
View answerI acknowledge the distress overcrowded Emergency Departments (EDs) cause to patients, their families, and frontline staff working in very challenging conditions in hospitals throughout the country.
The current congestion in Emergency Departments is due to constrained bed capacity caused by combination of the high number of patients in hospital with COVID-19 (1624 nationally on Monday 28th March), the increased number of delayed transfers of care cases which is partly due to COVID outbreaks in nursing homes and the very high number of people attending EDs in recent weeks.
The three highest attendances ever recorded in our EDs have occurred in recent weeks with attendances trending over 28,000 a week.
While attendance and admission numbers are now exceeding pre-pandemic levels, the continued requirement to provide separate Covid-19 and non-Covid-19 pathways presents an additional challenge to patient flow in all hospitals and Emergency Departments.
Investment of €1.1bn was provided in budget 2021 to expand capacity, increases services and support reform and this level of investment is being maintained in budget 2022. A further €77 million has been invested in the 2021/22 Winter Plan. To date over 800 additional beds have been provided in acute hospitals since the start of 2020.
To provide leadership, governance and oversight of the implementation of the Winter Plan at local level and national level, the Chief Operations Officer has established the Integrated National Operations Hub (INOH) with defined membership from all relevant service and enabling functions with a clear Terms of Reference. For the purposes of coordinating the response to COVID-19, each geographical area has an Area Crisis Management Team (ACMT). Many of the Winter Plan measures will continue for the rest of the year.
The current situation in hospital Emergency Departments is under constant review by my Department through ongoing engagement with the HSE.
The 2022 Waiting List Action Plan, which was launched on 25 February, allocates €350 million to the HSE and NTPF to reduce active waiting lists for acute scheduled care by 18% this year, which will bring the number of people waiting to their lowest point in five years.
Under this Plan, the Department, HSE and NTPF intends to deliver urgent additional capacity to treat 1.7 million people as well as investing in longer term reforms to bring sustained reductions in waiting lists.
The 2022 Waiting List Action Plan will also progress work towards the achievement of intermediate waiting time targets this year, as set out in the National Service Plan (of 18 months for OPD; 12 months for IPDC; and 12 months for GI scopes).
As a response to the recent surge in both ED attendance and COVID-19 cases the CEO of the HSE has written to the CEOs of all hospital groups advising them of the need to prioritise unscheduled COVID-19 care and urgent time sensitive work for 14-day period. The resulting curtailment of elective care (and associated staff shortages) will negatively impact achieving waiting list reduction targets.
The HSE has confirmed to the Department that 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 Waiting List Task Force continues to regularly monitor the impact of COVID-19 on waiting list reduction targets. Additional capacity is bring sought through the Private Hospitals to minimise the impact of the current surge on core activity.
With the onset of the 4th wave of Covid-19 at the end of December 2021 and January 2022 the HSE with the support of the Department negotiated a new amended Agreement with the Private Hospitals to run to the end of June 2022. The new Agreement sought to draw on the lessons from the operation of Safety Nets 2 and 3.
The most significant change from the previous Safety Net Agreements was the adoption of a dual approach to obtaining access to the private hospital capacity. As with the outgoing agreement it would allow access of up to 15% or 30% of the private hospitals’ capacity depending on which metrics were met. At each level, the HSE would have the option to seek access on either a reasonable endeavours basis i.e. voluntarily, or by issuing a guaranteed capacity demand, which would require the private hospitals to provide the capacity. Under the agreement payments for capacity unused by the public system i.e. retainer payments will not be payable where the agreement is invoked on a reasonable endeavours basis but will be payable where a guaranteed capacity notice is issued.
In addition, in August 2021 the HSE established a procurement framework to allow public hospitals to access services in private hospitals. The procurement framework that was put in place sought tenders from private hospitals, based on competitive pricing, for approximately 700 types of medical and surgical procedures for adult and paediatric inpatient, day care and critical care beds. A separate procurement framework was put in place for diagnostic services. The Framework is in place for a period of 4 years.
