HOSPITAL BEDS WHAT OUR HEALTH SYSTEM REALLY LOOKS LIKE
RISING patient numbers and a health service bursting at the seams have sparked concern over how the country will cope with Covid-19 this winter.
The next two weeks will be crucial in terms of getting our Covid-19 hospitalised cases under control, according to HSE chief Paul Reid, as he said the system is now ‘challenged but not overwhelmed at this point’.
The health service’s plan to see us through the winter to April is focused on building capacity.
But one of our main issues is that our ICU bed numbers should have been double what they were prior to Covid-19. However, Mr Reid insists: ‘If building ICU capacity is our first line of defence, we’ve lost it completely.’
Here, the Irish Mail on Sunday breaks down in numbers how prepared the health service is for the coming surge of Covid.
ICU BEDS
As of October 9, we have 282 open and staffed ICU beds, 31 of those are occupied by Covid-19 patients and only 39 are free. The HSE is aiming to bring its current ICU (intensive care unit) bed capacity from 280 to 300 by the end of the year.
However, in an internal HSE document reported on by this newspaper in April, the HSE said it had 428 ICU beds open and staffed, and ‘access to’ 528 in total.
This is significantly higher than the 300 currently being targeted.
The HSE did not respond to repeated requests for clarification of the figures and how many of them came as part of the multimillion-euro deal done with private hospitals to provide extra capacity earlier this year.
In addition to the conflicting figures above, in an Oireachtas committee hearing on September 29, Mr Reid said we had 354 ICU beds at the peak of the pandemic.
When asked if it would be possible to scale up to this level again and how long it would take, the HSE said each individual hospital has its own individual surge plan and that ‘in the event of such a surge, critical care capacity may be scaled up as needed’.
The ICU beds are also not equally distributed – eight hospitals have no free ICU beds, six have just one ICU bed free, two hospitals have three, Drogheda hospital has four and Beaumont has the most with seven.
The reason we no longer have access to the higher number of beds is because they were temporarily taken from other departments to cope with the surge previously.
These high-dependency unit beds, pre-operative and postoperative theatre beds are back in service.
There is particular concern over the lack of planning around ICU bed numbers, with the Irish Hospitals Association calling for a doubling of ICU bed capacity.
The increase of 300 by the end of 2020 will only bring us 118 off what was required prior to what we needed 10 years ago.
As far back as 2009, a report published by the HSE recommended bringing the number of ICU beds to 418, and then to 579 in 2020: ‘The number of critical care beds should be increased by 45% from 289 to 418 beds. This will need to increase sequentially to 579 over the period
2010 to 2020.’
We have 274 general hospital beds free excluding critical care in our system as of October 8, according to the HSE. However, these are not evenly dispersed. Most major hospitals have under 10 free general beds. Beaumont Hospital has the highest number of free beds, currently at 69, followed by St James’s at 35.
Over the summer, the HSE said it increased acute hospital bed capacity by 409 beds and 400 subacute (community hospital) beds. According to the winter plan for 2020 to April 2021, we can expect 483 more acute beds and 89 more sub-acute beds.
However, numbers on trolleys are steadily rising and there is concern amongst healthcare professionals that that will continue to rise significantly into winter.
The HSE hopes to reduce the trolley count this year by 30% but numbers of patients on trolleys in September rose on average to 209
and to date in October rose to an average of 223.
HOSPITAL STAFF
Since the beginning of the pandemic, the HSE has said there has been an increase of 4,800 people on its payroll – including 152 consultants, 840 doctors, 1,607 nurses and midwives and 620 social-care professionals. For public health teams, staffing has increased by almost 80% on the pre-Covid numbers, mainly through temporary deployments, and 255 permanent staff across all public health departments, the HSE says.
In its winter plan, the HSE says ‘a major national and international plan to attract talent will be implemented’.
It is foreseeing that 2,000 of its current staff members, per month will require Covid assessment, testing and contact tracing. It is also foreseeing increased absenteeism due to ‘Covid fatigue’ and ‘exhaustion’.
According to Mr Reid, 2,000 staff members were trained up to manage surge capacity.
The INMO’s Phil Ní Sheaghdha told the MoS that more staffing and planning is required to get through the winter.
‘The annual winter surge and Covid together make a toxic combination,’ she said.
‘Patients who are critically ill simply need more care.
‘Each ICU bed needs more than six specially trained nurses to staff it. If we’re going to save lives this winter, we will need to ensure that safe staffing levels are rolled out not only in ICU, but across our health services.
‘We’ve been calling for a funded workforce plan for many years. Without a plan there will be a heavy price to pay in terms of the safety of staff and patients this winter.’
VENTILATORS
Earlier this week, Mr Reid said that pre-Covid we had access to 750 ventilators across ICU and transport vehicles. The HSE procured an additional 1,026 ventilators over the summer months.
In early May, a HSE spokesperson told the MoS: ‘Through multiple sourcing channels, we have had access to more than 2,000 ventilator units. The total quantity of ventilators procured is 1,158 – which we consider to be adequate in the current circumstances.
‘In March, we had access to 500 ventilators, and 900 machines to support breathing.’
The MoS sought clarity from the HSE on the difference in figures issued, but none was forthcoming.
PPE
At the beginning of the crisis, access to appropriate Personal Protective Equipment was a major issue. Mr Reid insisted earlier this week that the HSE’s focus hasn’t been taken off this issue. Launching the Winter Plan, he said: ‘We continue to add some more to build our stock for protections this winter. We’ve received over 515 million items of PPE, and we’re currently distributing 16 million items of PPE to 3,000 locations per week.’
In terms of cost for PPE to come, a forecasting algorithm is being developed by the HSE in conjunction with the Department of Health. At pandemic pricing levels, this algorithm calculates that an additional requirement to the value of €415m PPE-related funding will be required by yearend, with a further amount to the value of €1.55bn for the full year of 2021. It is expected that the HSE will realise some price reductions as markets soften.
The HSE did not answer our questions on how long current stocks of PPE would last, but frontline workers have told the MoS they have not had any issues with accessing PPE in recent times.
TESTING AND TRACING
We now have lab capacity in Ireland for 100,000 tests a week and 5,000 tests a day in acute hospitals. We have 38 community assessment hubs and 35 community testing centres.
Last week the median turnaround time for testing was 1.9 days, and from swab to return of the completed test was 27 hours. A total 90,000 tests were carried out, 89,500 swabs were taken and 18,000 calls were made as part of contact tracing. The positivity rate for the past seven days was 3.9%.
In terms of serial testing, in a total of 287 schools, our testing is currently completed, or ongoing. A total 6,741 staff and students are being identified and are on either day zero or day seven testing. There have been 122 detected cases, which is a positively ratio of 1.8%.
On serial testing in nursing homes and long-term care facilities for older people, we are now on the third cycle of serial testing and 200,000 tests have been carried out to date. Tests were carried out in 568 facilities with a positivity ratio of 0.32%, at our meat processing plants with a total 81 facilities completed.
According to the HSE, 100 swabbers will be starting between now and early next week. A total 600 are being processed. Meanwhile, 65 tracers start this week, and 75 will start next week.
It said that prior to September, testing and tracing was carried out by redeployed staff within the health service and volunteers. This model can be expected to change fully by November with new trained staff in testing and tracing and redeployed staff returning to their roles.
As reported in this paper last week, specialists such as audiologists and speech and language therapists are still being seconded to contact tracing duties, adding to already long waiting times for patients to be seen.
PRIVATE HOSPITALS
The Winter Plan is also relying on co-operation from private hospitals to provide capacity. Unlike the arrangement made with private hospitals earlier this year, which cost €115m a month from March to June – most of which lay idle during those months – a total of €59m has been budgeted for 2021 to be spent on gaining additional capacity to cope with the pandemic.
This will be a tender process where private hospitals with capacity to support the HSE can apply directly to be on a panel of hospitals to be used when needed. Negotiations between the HSE and individual private hospitals are still ongoing.
From March to June this year, 13,000 inpatient discharges, 54,000 day cases, 86,000 diagnostics, and 52,000 OPD attendances were carried out in private hospitals.
The HSE is looking for private hospitals to provide the following - 10,000 outpatient appointments, 2,879 in-patient procedures, 17,930 day case procedures, and 2,935 gastrointestinal scopes.