Mr. Liam Woods:

I thank the committee for the invitation to attend this meeting. I am joined by colleagues, Ms Angela Fitzgerald, Dr. Vida Hamilton and Mr. Ray Mitchell. I intend to go through a summary of the statement to allow time for questions. In March 2020, the Government approved a proposal from the Department of Health to allow for a formal partnership with private hospitals, which would make their facilities and capacity available to meet the challenges of the Covid-19 pandemic. This put more than 2,200 beds, approximately 8,000 staff, and a range of clinical facilities at the disposal of the public health service. A number of other countries have made similar arrangements, for example, the UK, Australia and Spain. By decision of the Government, the arrangement is now ending with a view to negotiating a new one going forward from the end of June.

The Government’s decision to acquire access to the total resources of the private hospital sector included a number of key principles. The private hospitals would operate on the basis of public-only work. The basis for funding the hospitals was to be through a cost recovery model. Private hospitals would focus initially, at least, on delivering time-dependent care. Private-only consultants associated with the 18 private hospitals were to be offered temporary consultant contracts for exclusively public work. The public hospital system will continue to operate under existing eligibility rules.

Clinical modelling exercises undertaken within the HSE in March 2020 regarding the expected demand for acute and critical care arising from the pandemic indicated that by mid-April we might possibly require up to 1,000 critical care beds and 2,000 additional inpatient beds to match peak demand. Existing public sector capacity was 250 critical care beds and 11,000 inpatient beds operating at close to 100% occupancy, with 650 unavailable due to delayed transfers of care. The timeline was pressing and the options available to ramp up short-term capability were limited. As a consequence, we secured the Government decision and agreement outlined above. On 27 March 2020, NPHET directed that "all non-essential surgery, health procedures and other non-essential services be postponed". As a result, all public and private hospitals curtailed their elective activity during April in the interests of patient safety and protecting capacity for surge requirements.

Approaches to boosting acute activity included stopping all non-urgent elective work, growing critical care capacity and acquiring private hospital capability. The experience to date has shown that private hospitals do not, generally speaking, employ the consultant specialists who work with them. They are served by either public appointment holders with private practice rights or by a group of "private-only" consultants who do not have public appointments. The number of private-only consultants is in the region of 550 and of these, 291 have taken up the offer of a public patient-only contract from HSE, a type A contract, and are treating public patients on the private sites.

A key concern identified was the imperative to ensure continuity of care for private patients. The HSE fully acknowledges this requirement and where there is a justifiable case based on continuity of care needs, we have agreed that private-only consultant rooms can be included in the initiative as a recoverable cost. The HSE agreed a range of measures to ensure continuity of care, including private patients who were in a course of treatment at the date of the arrangement commencing continuing in care; patients who were booked for procedures based upon clinical priority being admitted as public patients without charge; some consultants offering to provide care pro bonoto ensure continuity of care; and both the HSE and individual consultants having a duty to ensure care continuity, which has occurred. Additionally, consultants from public hospitals provided care in the private hospital setting and indemnity was provided.

Until such time as there is a vaccine or cure for Covid-19, 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. This is amplified by the need to manage in a Covid environment. The private hospital system is not the sole solution for the safe delivery of care in the Covid environment but 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.

Against this backdrop, our objectives remain as set out earlier. These are to provide a capacity reserve against surge pressures, to maintain essential service to non-Covid but time-dependent surgery and treatments, to ensure safe environments for both patients and staff and to address the extensive build-up of displaced work as soon as possible. Some of the innovation undertaken in the past two months will need to stay in place. Virtual clinics can support the delivery of up to 50% of outpatient appointments in some specialties, reducing the requirement for face-to-face appointments.

In summary, all the indications are that the pandemic will remain a significant shaper of health services in the medium term. The basic shortfall in acute capacity is a matter we must address, along with Covid-19.