Mr. Jim Breslin:

I thank the Chair and members of the committee for the opportunity to discuss the arrangement made with private hospitals in response to the Covid-19 pandemic. I note that the committee, in its invitation, indicated it was particularly interested in the use of the capacity of the private hospitals and the impact on continuity of care and treatment of private patients. Before I address these specific issues, I remind members of the context within which the arrangement was rapidly put in place.

The arrangement was concluded at the end of March, at a time when epidemiological projections for the disease indicated we faced a surge in cases with the potential to overwhelm our health system. The European Centre for Disease Prevention and Control, ECDC, was clear that all European health systems faced such a risk at the time as we watched regions and countries struggling to manage. It was recognised that the HSE urgently needed additional acute hospital capacity to deal with the anticipated crisis and to protect other urgent time-critical emergency services.

On 16 March, the Government's action plan in response to Covid-19 identified the need to increase acute hospital capacity and so, on 30 March, following intense negotiation by the HSE and the Department, we reached agreement with the private hospitals. On that day, there were 111 patients with Covid-19 in intensive care units in our public hospitals. The figure had more than doubled over the previous week. The agreement, which has been laid before the Houses of the Oireachtas, gave the HSE immediate access to an additional 2,500 beds, over 100 of which were critical care beds, on a cost-only, open-book basis.

Thankfully, the public health measures adopted so assiduously by the public have meant that, so far, we have managed to suppress the virus and the anticipated surge has not occurred in the manner we all feared.

On 27 March, NPHET recommended a pause in all non-essential health services. This was for the purpose of freeing up capacity and reducing opportunity for the spread of the disease. As a result, during April there were up to 2,000 public beds vacant at any one time, which is unprecedented. The level of patients in private hospitals was initially modest. However, the arrangement allowed the HSE to transfer and thereby maintain critical essential services, such as cancer surgery and chemotherapy, cardiothoracic surgery and urgent cardiology procedures, as well as providing the assurance that extra capacity was available in the event that it was needed, which was the main objective of the arrangement initially. Since then, local co-operation between the public and private hospitals has supported an increase in utilisation and the latest figures show that inpatient bed utilisation across private hospitals is now at 48% capacity and 56% of critical care capacity. The resumption of routine scheduled care has commenced and the HSE is continuing to increase its utilisation of private hospitals for the remainder of the period of the current arrangement.

The committee has also highlighted the issue of continuity of care. Faced with the immediate prospect of a major peak in demand for hospital care, the Government mandated the HSE and the Department to procure 100% of the available private capacity for public patients. The agreement provided that all patients treated under the arrangement would be treated as public patients, with care provided based on clinical priority. The arrangement made explicit provision for continuity of care for patients who were either in the hospital at the inception of the arrangement or who required treatment during the course of the arrangement. Full-time private consultants were offered locum public-only contracts for the duration of the arrangement. Where a consultant accepted the contract, he or she would continue to treat the patient but as a public patient. Where the consultant did not accept the contract offered, the transfer of the care of that patient to another consultant at the point in his or her treatment plan he or she reached was to be facilitated. Implementation issues were encountered and more generally, the pause in non-essential health services, which was only lifted by NPHET on 5 May, has affected private patients as well as public.

The Department worked with the State Claims Agency to make available clinical indemnity to those consultants who have not agreed to the contract, such as those providing care for continuity of care reasons to private patients on a pro bonobasis, subject to the agreement of the hospital concerned.

The arrangement with private hospitals was developed in very quick order in exceptional circumstances. It met its urgent objective of ensuring additional capacity was available in the event that the public system was overwhelmed and supported the maintenance of other urgent critical care such as cancer services. The public system faces ongoing challenges as we endeavour to resume operations in the context of Covid-19. The capacity within the private sector is an important feature of Ireland's healthcare infrastructure. It has a role to play in meeting the challenges we face in continuing to be prepared for any subsequent wave of the disease and for meeting ongoing healthcare needs. The Government is currently reviewing the current arrangement and as Deputies will be aware, on Friday, it announced that the current arrangement would cease at the end of June, and the Department and HSE were mandated to open negotiations with private hospitals to put an alternative arrangement in place.