A Winter Plan like no other

When the HSE’s Winter Plan 2019/20 was published, our editorial at the time asked if the name was appropriate anymore. Was it, in management speak, ‘fit for purpose’? Although these plans acknowledge the additional pressure on health services during the winter months, most of the initiatives they contain could apply any time throughout the year due to the chronic problems of emergency department overcrowding and long inpatient and outpatient waiting lists.

This year’s Winter Plan is essentially a Covid-19 plan, at least in terms of how the pandemic impacts upon health services. The HSE has strong influence over pandemic policy, being represented on the national public health emergency team (NPHET) and holding important responsibilities in terms of Covid-19 testing and contact tracing. However, it is outside the Executive’s remit to decide whether to impose ‘lockdowns’ or social restrictions to limit the spread of Covid-19. It must have faith in (the increasingly uncertain) Government strategy that the numbers contracting the novel coronavirus can be reduced as much as possible, so as not to overburden our very fragile health service.

The Winter Plan is dependent on the Government in that Exchequer funding is required to finance the measures it contains. The HSE has received an allocation of an additional €600 million to support the plan. For context, last year’s plan received an additional €26 million. This huge increase is an acknowledgement of the scale of Covid-19, which, as we hear so often, is a once-in-a-lifetime event. Last year’s plan was announced in November, in the depths of winter; the 2020/21 iteration has been published earlier, again as a response to the current crisis.

Will the increase in funding, as significant as it is, be enough? Under the plan, 892 acute beds; 484 sub-acute beds; and 631 rehabilitation beds are promised. The document states that 409 of the acute beds and 395 of the sub-acute beds are already in place, leading bodies such as the IHCA to question the real capacity gain over the coming months.

The IMO points out that the ‘new’ beds announced are temporary beds in the system. In a statement responding to the publication of the plan, the Organisation stated there is no funding for additional sustained long-term beds in acute and other sectors. While additional beds are welcome, the IMO said they are simply insufficient given the long-term capacity deficit; the emerging needs of the population; and the expected Covid-19 surge.
“The proposed increase in intensive care beds is woefully inadequate given the circumstances we face,” according to the IMO.

The Winter Plan promises a “recruitment campaign, both domestic and international, of a scale that has not been done before”. However, both the IMO and the IHCA criticise the lack of detail regarding the appointment of new consultants and frontline healthcare workers.

The ongoing provision of Covid-19 community assessment hubs and the extension of these to incorporate the treatment of acute respiratory illness through acute respiratory assessment and treatment hubs is also referred to in the Winter Plan.

There are currently seven community assessment hubs in operation. The plan is to have 20 hubs in total available from January to March of next year.

It is too soon to tell whether the plan is sufficient to cope with the current crisis. At the time of writing, Covid-19 cases are on the rise. The capacity deficits in the Irish acute system make it very vulnerable to a second surge. The HSE must do all in its power to cope with what has been termed ‘a winter like no other’, but will also have to hope that Government policies to curb the spread of Covid-19 are a success.