LAST UPDATE | 2 Jun 2020

THE HSE has told the Dáil Covid-19 committee that the cost of taking over the private hospitals will be roughly €300 million.

The deal, which saw the State renting 19 private hospitals during the pandemic, was estimated to cost €115 million per month.

The arrangement is due to conclude at the end of the month, following a Cabinet decision last week.

The Irish Hospital Consultants Association told the committee earlier today that the deal was poor value for money. 

Sinn Féin’s David Cullinane agreed with the statement, particularly when less than half the capacity was used.

No cost-benefit analysis was conducted, according to the Department of Health’s Secretary General Jim Breslin.

He said the deal was negotiated over the period of one weekend, and was agreed on the basis the State might need the entirety of the private capacity.

Breslin said the department wanted to have all capacity at the ready, stating there were no other beds on the island the State could get access to.

Facing critism from Culllinane in relation to the cost, Breslin said: 

“A fire alarm went off and we sent four fire tenders to put out the fire, and people are saying now we should only have sent three… What if it needed more than three?”

‘Very poor value for money’ 

The consultants group said earlier today that the test of time has confirmed that the private hospital agreement, which is costing around €115 million per month, “represents very poor value for money from patient care and taxpayer perspectives”.

“The experience is that of very low private hospital bed capacity occupancy at around one third on average and low utilisation of theatre and other ancillary facilities.

“Furthermore, the private hospital contract is prohibiting the provision of urgent care required by patients with non-Covid-19 illnesses. This is leading to the accumulation on waiting lists of a large number of patients who require urgent care.

“There is now the additional risk that these patients will deteriorate clinically and will increasingly evolve into emergency cases if they are not treated without delay. All patients deserve timely access to quality care.”

Social distancing

The HSE also told the Dáil Covid-19 committee today that most of Ireland’s existing public hospitals will not be fit for purpose in terms of meeting the requirements of safe distancing.

In his statement to the committee, which is again being held in the Dáil chamber, Liam Woods, national director of acute operations, stated that even a relatively modest increase in the reproductive rate to 1.2 or 1.3 “would have very significant impact on both specialist critical care beds and the wider hospital system.”

“Our existing infrastructure in many of our public hospitals is not fit for purpose in terms of meeting the emerging requirements in terms of safe distancing,” Woods said.

In the last week, there has been increased pressure to reduce the social distancing rule from two metres to one metre by a number of sectors. 

Last week, Labour’s Alan Kelly said that the rule was hindering the reopening of the health service and screening programmes.

The committee was also told that until such time as there is a vaccine or cure for the virus, healthcare delivery will occur in a higher risk environment where outbreak and surge could occur at any time.

The underlying capacity issue remains in the acute system, the members were told, with the issues only being amplified by the need to manage Covid-19.

While the private hospital system is “not the sole solution for the safe delivery of care in the Covid-19 environment” it is the only immediate acute option that can help provide an occupancy of 80% delivering on the twin requirements of matching non-Covid demand and providing surge capacity for Covid-19, the committee heard.

As winter approaches this year there will be the additional challenge of Covid-19 patients on trolleys in emergency department awaiting admission to hospital wards, the HSE warned.

Speaking about the suspension of non-Covid care, the committee will be told of a build-up of waiting lists.

Areas of immediate priority include endoscopy, cardiology, cardiovascular, urology, orthopaedics.

The numbers waiting for more than three months for endoscopy at end February have gone from 11,801 to 17,664 at end April.

Equivalent waiting list figures for orthopaedic procedures go from 6,134 waiting more than 3 months in February to 8,672 by end April, 2020.

Similarly, all four national screening programmes have been suspended under clinical advice since March and can only recommence when certain safety conditions can be met, according to the HSE.

The committee will be told that virtual clinics could support the delivery of up to 50% of out-patient appointments in some specialties, and would reduce the requirement for face to face appointments.

On the private hospital deal, the HSE says that Ireland has a low number of ICU beds per head of population.

Clinical modelling exercises undertaken within the HSE in March regarding the expected demand for acute care and critical arising from the pandemic indicated that by mid-April, 1,000 critical care beds and 2,000 additional inpatient beds might be needed to match peak demand.

Existing and usual public sector capacity was 250 critical care beds.

The Irish Hospital Consultants Association said the predicted steep surge did not occur because of mitigating actions that were taken, adding “at this time it appears it is unlikely to occur in the months ahead given the success of the public health measures implemented thus far”.

Need for ongoing capacity 

The Irish Nurses and Midwives Organisation will also address the committee today and raise the issue of capacity and how it put the Irish health service on the back foot from the beginning.

Its statement states that due to government neglect over the years, the Irish health system has huge deficits in terms of bed capacity which urgently need to be addressed if it is to continue to deal with the Covid-19 crisis.

The INMO has called on the HSE to publish its clinical roadmap for the reopening of services, stating that it must allow for a “gradual reopening” of both public and private care in tandem with prioritising patients based on clinical need.