AS THE GOVERNMENT considers NPHET advice to move the whole country to Level 5 restrictions, there is concern that the HSE’s Winter Plan came too late and that it will struggle to recruit the staff require for the significant number of additional beds it has promised.

The National Public Health Emergency Team yesterday met and recommended the whole country should be moved to the highest level of the government’s ‘Living with Covid-19′ plan. 

This would mean, similar to the nationwide lockdown, everyone would be asked to stay at home, other than for exercise within 5km of their homes. No gatherings of any size would be allowed other than small numbers at weddings and funerals. 

Health officials – and those working on the frontline – have been concerned in recent weeks at not only the rising daily case numbers but also the increase in Covid-19 hospitalisations. 

Yesterday there were 134 confirmed cases in hospital, with 21 of those patients in ICU. 

‘Ambitious’

At the recent launch of the HSE’s Winter Plan, Chief Operations Officer Anne O’Connor said an “ambitious target” of 12,500 extra staff had been set.

She said the aim is to recruit 4,987 of those in 2020 and 2,760 of those will be core staff, with the rest focused on testing and tracing. Included in this recruitment plan is doctors, nurses but also home support staff and carers.

An additional 251 acute beds are to be opened in the last three months of 2020 and there is a commitment to creating 17 additional ICU beds in the system over the winter.

The HSE has not specified how many ICU beds will be opened this year, or how many staff for those beds will be recruited.

People Before Profit TD Richard Boyd Barrett has expressed concern about the ICU capacity as we move into the winter. At the Oireachtas Covid-19 committee last week he pointed out that the temporary surge beds during the pandemic had brought ICU capacity to 354. There are now 280 ICU beds across the country. 

Speaking to TheJournal.ie, Boyd Barrett said the HSE needs to make changes so that these roles are attractive for healthcare workers.

“They have to immediately eliminate pay inequality for new entrants, that is a huge barrier to recruitment of nurses and healthcare workers generally. They have to dramatically change their attitude and value nurses and healthcare workers by paying them properly.

He said even with the additional 17 ICU beds promised in the Winter Plan, the health service has fewer critical care beds than it did in April, because the surge capacity is gone. 

“That’s concerning when it looks as though we’re heading into a second wave.”

Staff retention

Speaking to TheJournal.ie, intensive care consultant at University Hospital Limerick Dr Motherway said the delivery of acute beds – and the staffing for those beds – will be important for ICUs.

“We need hospital bed numbers to expand so that when we have a patient ready for discharge from the ICU, they have a bed to go to and their ICU bed can go to another patient. 

“Both the critical care beds and the general ward beds need to be expanded and while there is a commitment to do that, it’s broad strokes in the document. I’m not privy to the intricacies of where they’ll go and how they’ll do it.”

She said the recruitment “can’t be done in one fell swoop”.

“It can be difficult to recruit nurses particularly to work in Dublin, which is where I imagine many of the additional ICU beds will be. The cost of living in Dublin is so high for people on an average wage.

“The work in Dublin ICUs is satisfying because it’s complex work, but there is a challenge there and a challenge in terms of retention of ICU staff too.”

Dr Motherway has previously said that the health service needs to double the current number of ICU beds in the system.

“The staffing of beds is expensive and in the longterm temporary beds don’t work. If we are to double the capacity it’ll take three or four years and it’s expensive – about €1 million per bed.

“One reason we had to lock down is that there was a realisation – and the HSE has a number of reports in which this has been stated – that there had been a need for years to increase capacity but the funding for it was never there. And there are some funded beds that they weren’t able to recruit for.”

The HSE’s National critical care capacity plan for 2019 noted that nineteen adult ICU beds remained ‘non-operational, commissioned critical care beds’ with funding allocated.

“Although each hospital/group is enabled with the critical care nursing career pathway to recruit Ireland’s nursing graduates immediately on graduation, regrettably, currently, there is a HSE employment pause,” the plan stated.

Dr Motherway said she is feeling “hopeful but a little bit anxious” as the case numbers rise. She said keeping numbers down will require “a significant buy-in” from people over the winter.

Permanent contracts

David Cullinane, Sinn Féin’s spokesperson on health, said the Winter Plan has “come too late” and he is concerned the HSE will not be able to deliver the additional beds this year.

“They haven’t given numbers in the plan for staffing and we know that the cost of staffing ICU Beds is close to €1 million per year. They require a lot of specialist staff to keep them open. 

“I think recruiting for and delivering the number of acute beds required will be the biggest challenge. They’re saying they’ll delivery 220 before the end of the year, but they’re just coming on stream temporarily until the end of April.

“The HSE has also said hospitals have to reduce capacity to 85% for infection control, most are operating at 95% and I don’t see that being able to come down, it’ll be a difficult winter.”

He criticised the ‘Be On Call for Ireland’ recruitment campaign, which tens of thousands of people applied to. Some 2,300 people were deemed eligible to work in the health service after the interview process and 240 were offered jobs. 

However Cullinane pointed out that these staff were not offered permanent contracts. 

“Give them permanent contracts, that means there’s a better chance of them staying and it would send the message that the health service is actually serious about recruiting,” he said.

‘A challenge’

Speaking last week to RTÉ’s Today with Claire Byrne, CEO of the HSE Paul Reid acknowledged that it will be “a challenge” to recruit the number of people the HSE plans to hire as part of the winter plan. He said since the beginning of the pandemic, an extra 150 consultants and 1,500 nurses have been recruited but this is “still very short”.

“It will be a difficult challenge, and I fully accept that in terms of nursing. We’re setting up a whole range of processes to help us do it, we’re working with the colleges on a strategic level to help with the numbers coming through.

“We have some panels which we will be calling on, we’re working with agencies to recruit for it but equally coming onto the health service payroll, but through agencies.

“We’re talking with the public appointments service so they can help us, we’re looking at some of the constraints – it can take a long time, and I knowledge that, for public service recruitment and we are talking with the public appointment service and civil service about how we can accelerate that at a time of particular need.”

Reid also said he wants to use fulltime employees and strengthen the HSE’s fulltime capacity. However he said it is “not always possible to just make that switch on”.