High numbers on trolleys expected as HSE launches its winter plan

The Health Service Executive has said that it “absolutely expects” that the number of people who will spend time on trolleys in hospitals this winter will be high.

Under its "winter plan", the HSE pledged to spend €30 million on extra beds, more homecare packages nationally, and quicker diagnostic tests in nine hospitals and community services for four weeks from mid-December to cope with higher demand.

However, consultants and nurses will not be banned from taking Christmas leave – as was suggested last month by Taoiseach Leo Varadkar, in remarks which were sharply rejected by medical staff.

HSE deputy director general for operations Anne O’Connor said staff would be rostered to ensure that all hospital services are operational and that beds remained open.

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The HSE will establish “winter-ready” clinics and community services for older persons and those with chronic diseases, but only with existing staff working longer hours.

Opening hours for local and minor injury units, and primary care centres, will be expanded “where possible and meaningful”, though the HSE said this will only apply to its own staff working in primary care facilities.

Diagnostic tests will be more freely available, the plan pledges , though less urgent, scheduled tests will be restricted. Outpatient clinics, elective and non-urgent admission will be restricted, too.

Scheduled in-patient surgery may be reduced to cope with emergencies, though the Royal College of Surgeons in Ireland (RCSI) warned that this could affect thousands of people.

Redeployed

Staff currently deployed on scheduled work could be redeployed, while senior staff will be more visible at “the front door” to speed up decisions in acute medical emergencies.

The plan also provides for new arrangements for public patients to be treated in private facilities for diagnostics, post-trauma surgery and step-down care.

“The scheduling of additional emergency theatre lists is being examined as a planned action over the focus period, recognising the likely increased demand for trauma and orthopaedics over the winter months,” the plan says.

Under the winter plan, enhanced measures will be put in place between December 17th and January 13th in nine hospitals and associated community healthcare organisations across the country: the Mater, St Vincent's, Tallaght, Naas, Tullamore, Galway, Limerick, Cork University Hospital, Waterford.

The Government is to invest €10 million in special funding to cover new winter measures in the final period of 2018, and a further €20 million in 2019.

The plan says this money will seek primarily to provide supports for older persons and to create some additional capacity in acute services.

The HSE plan optimises the use of existing resources, and provides an alternative for patients to the emergency department

“In terms of supports for older persons, 300 additional home support packages will be issued to year-end 2018 with a further 250 additional home support packages in 2019.

“[A total of] €4 million has been provided for aids and appliances and €1.5 million has been allocated to transitional care.”

Rehabilitation beds

The plan suggests that 145 additional community, acute and rehabilitation beds could be provided in addition to the 78 additional beds planned for 2019.

The Minister for Health Simon Harris said the plan represented "a new and innovative approach by the HSE" which sought to build upon lessons learned from previous winters and the success in handling major events this year.

“Importantly, the HSE plan optimises the use of existing resources, and provides an alternative for patients to the emergency department including extended opening hours and expanded services at local injury units, services, minor injury units and key primary care centres.”

The Irish Medical Organisation (IMO) maintained the HSE's winter plan would not alleviate the pressure on the health service, but would only act as a temporary relief for some patients.

The Irish Nurses and Midwives Organisation (INMO) said it was disappointed "that the plan does not significantly increase health service capacity or deal with understaffing".