How the €604 million HSE Winter Plan will be spent

The €604.173 million HSE Winter Plan, which runs from October 2020 to April 2021, provides for 2,000 additional beds, writes Maureen Browne.

The HSE has said that 10,260 extra staff will be needed this year and next year for the core elements of the new plan, which requires 2,760 additional staff this year and 7,500 next year.
It has allocated €59 million to procure additional activity from the private sector for specific specialties, including cancer diagnostics and care. This aims to minimise delayed diagnosis and increase provision of cancer care in public hospitals. Private hospitals will also be used to carry out elective work, thus freeing up public hospitals for unscheduled care and to protect services against future COVID-19 outbreaks.

And the HSE says starkly, “In the context of COVID-19, Winter 2020/21 will be the most challenging winter for our services in living memory.”

The key objectives of the plan are to improve Patient Experience Times in ED, reduce last year’s trolley count by 30%, cap Delayed Transfers of Care to 450, complete over 20,000 additional elective procedures and establish 20 functioning Community Assessment Hubs.

It says the Plan takes into account the need to reduce acute sector occupancy rates from 95% average to 85% average, in line with clinical guidance on safe practice for patients and staff and the impact on efficiency levels because of new ways of working. “Put simply, the implementation of the necessary changes will mean that the health services will deliver less activity for the procurement capacity.”

The impact of operating at 85% occupancy annual activity levels is significant – it is estimated that it will displace up to 100,000 in patients from our total workload of 660,000- cases. The potential impact of HPSC guidance on Nursing Home transfers are extremely significant and the HSE also needs to take into account increased demand due to displaced and deferred activity.

“In the context of COVID-19, Winter 2020/21 will be the most challenging winter for our services in living memory.”

And the HSE is turning to the private sector for help where necessary. Private hospitals will be used to carry out elective work, thus freeing up public hospitals for unscheduled care and to protect services against future COVID-19 outbreaks. It will also procure additional activity from the private sector for specific specialties, including cancer diagnostics and care. This aims to minimise delayed diagnosis and increase provision of cancer care in public hospitals.
It aims to procure 10,000 OPD appointments, 2,879 in-patient procedures, 17,930 day-cases procedures and 2,9351 GI scopes. This is to be done in collaboration with the NTPF. A total of €59 million has been allocated for procuring services from the private sector.

The HSE said it was negotiating a new arrangement with the private hospitals to cover these areas.

Of the additional beds promised in the winter plan, 892 were designated acute (409 already in place and 483 to be provided), at a total cost of €81.5 million – €30.7 million this year and €50.7 million in 2021.

The Plan provides for 484 additional sub-acute beds (395 already in place and 89 to be provided) at a cost of €12.5 million. It proposed to open an additional 251 acute beds and 89 sub-acute beds in the last quarter of 2020 and an additional 232 acute beds in the first quarter of 2021.

The Winter Plan says there will be self-isolation beds capacity of 500 each day.

The Plan said 530 community/new rehabilitation beds were to be repurposed to support the home first pathway at a cost of €87 million. These include 631 rehabilitation outreach places which will be operational up to April 2021, It does not state if these are the same 631 rehabilitation beds mentioned elsewhere in the document. A total of €45 million will be spent on this initiative this year and €42 million next year. The services will need 868 new to staff these services.

Through Pathways of Care, the Plan proposes the expansion of senior decision making and Consultant delivered care, the use of alternative technologies, e.g. Capsule Endoscopy, the development of satellite renal units, and compliance with COVID-19 clinical guidance and staff reduction (e.g.) videoscopes for ENT units).

The HSE Plan includes proposals to improve cancer access/follow up for outpatients(via Telehealth/IT), create resilience within the designated cancer centres/surgery/early diagnosis/diagnostics and streamline the chemotherapy pathway and to provide for the ongoing roll out of the National Cancer Information System (NCIS) to the 26 SACT Units.

The HSE says it is expected that additional resourcing will increase patient attendance across Breast, Lung and Prostate Rapid Access Clinics. It will also assist in addressing the COVID-19 backlog of patients and the impact of COVID-19 restrictions have on capacity across cancer services. It will enable on average an estimated 15% increase in the current maximum capacity (Covid restrictions) for attendances within target access times.

Expansion of non-invasive capsule endoscopy diagnostic services(PillCam) to a further ten hospitals to reduce the lengthening wait list due to a 4 2% reduction in activity due to COVID-19 restrictions.

A total of €4.7 million has been allocated for home support hours by the end of April 2021.

There will be €18.7 million allocated to GP structured access to diagnostics, €56 million for vaccinations and €500 for Telemedicine expansion.

Additional funding of €5.5 million has been allocated to enhance health services for people who are homeless and in addiction.