HSE OFFICIALS HAVE said a “very significant redesign” of the health service will be needed for the next 18 months and beyond as the country lives with a continuing threat of a resurgence of Covid-19.
Speaking at the HSE’s weekly update, CEO Paul Reid said there has been engagement this week about how to return to the delivery of non-Covid services.
Building capacity both in terms of general beds in hospitals and critical care units will be a priority. He said part of the new strategy will involve building sustainable models of primary care to reduce the number of people entering the hospital system.
“We’re going to have to re-calibrate our time frames and our plans and we can’t be talking about ten year time frames anymore. We have to look with a very new tightened lens over the next 18 months and three years,” he said.
I know there’s a sense as we get to much better measures at the minute, and we’re getting back to non-Covid services, there’s equally a risk that we forget about the absolute real risk of this in the coming weeks, months, but particularly in the winter period. And I am duly concerned about our winter period and I’m duly concerned about our capacity for that period.
Reid said we will need extra capacity this winter “in a way we hadn’t got it last year”.
“This winter has to be different, we’re going to have to have the agility to step up capacity and we’re going to have to do that before we hit the peak of winter.”
Step-down capacity like the field hospital on the grounds of the University of Limerick will play a role this winter, providing care for non-Covid patients who are fit for discharge but require further rehabilitation or are waiting for a nursing home place. The isolation facility at Citywest may be used for similar purposes as demand for isolation spaces drops.
Intensive care
Dr Catherine Motherway, President of the Intensive Care Society said the winter period is always difficult in Ireland with an increase in respiratory disease.
“We always have difficulty with capacity, we see it in the trolley figures and those of us who work in critical care see it when we have to cancel elective surgery.”
She said the hope going forward is that critical care nurses can be recruited and trained and plans are being discussed not to create permanent new ICU capacity. Current ICU capacity needs to be doubled permanently, Motherway said.
“That won’t happen overnight, but it needs to start and it needs to start happening soon.”
She said we should aim for an occupancy figure of 70% in ICU so we can cope with localised surges which may happen over the winter months.
“We have created surge capacity and that is temporary because those staff have to return to what they were doing as we go back to providing routine elective care which has been deferred as a result of the pandemic and we’re keen to get that care back up and going.”
Motherway also said much of our infrastructure is old and new build will be needed as well as increased bed capacity.
Testing
The testing and tracing programme will continue to play a vital role. Currently the end-to-end process from the time symptoms are reported to the time a person’s contacts are traced takes three days in 86% of cases.
“When I reference a new testing strategy for the future, it’s largely around what is the model,” Reid said today.
“It’s an absolute requirement for Ireland to have a testing and tracing capability for the future to deal with pandemics.”
He said the HSE will look at whether testing should be carried out in a combined, concentrated setting rather than split between labs and also how to manage a flexible and sustainable contact tracing workforce, which currently relies on volunteers from the public service.
Reid said he expects plans will be brought to the HSE board and to the government on how to go about this in the future.
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