Mr. Liam Woods:

I thank the Chairman for the invitation to appear before the committee. I am joined by my colleagues Ms Angela Fitzgerald, deputy national director of acute operations, and Dr. Vida Hamilton, national clinical adviser and group lead for acute operations. Dr. Hamilton is also an intensivist working in Waterford hospital. We understand that the committee wishes us to address capacity in our hospital system and the general demand, particularly relating to Covid patients, and to talk about the private hospitals and increased capacity available to us under the private hospital arrangements recently put in place. As the Chairman noted, the vaccine is subject to further separate dialogue next week.

As for managing demand, the experience of the pandemic over the past ten months, moving towards a year, has taught us a number of lessons. In March and April, the number of emergency department, ED, attendances fell sharply. Non-urgent routine care was suspended, in line with the NPHET guidance in late March, and we acquired capability of 18 private hospitals to provide assurance of protected space in which to provide non-Covid care. The private hospital capacity at that stage was proactively used for significant volumes of non-Covid care, namely, 60,000 day cases and 10,000 inpatients. Extraordinary measures were taken to deal with an extraordinary and unprecedented challenge at that time.

During the first surge, 2,200 beds were vacant to support anticipated need, although there were staffing challenges with that, and Covid patient numbers peaked at 825. The plan worked for two reasons, namely, the extraordinary efforts of staff and carers throughout the health system and the magnificent response of the public in reducing transmission. The lessons learned at that stage were how to manage care of all acute patients, Covid and non-Covid alike, the extension of telemedicine, which very much supported care outside of the hospital environment, community care being brought closer to individuals' homes, the use of remote monitoring for people at home, which is ongoing, and the increased delivery of home dialysis to keep patients away from hospital space where feasible.

In regard to additional bed capacity, by the end of 2019 there were 10,988 inpatient beds, including 255 critical care beds in the system nationally. In response to Covid, we opened an additional 426 beds and, based on the Estimates for 2021, we will open a further 720 beds during the course of this year. The additional capacity from the start of last year, therefore, will be 1,146 beds in total. The intention is that will allow us to operate at 85% occupancy, which is the international norm. In addition, the Estimates for 2021 provide for the opening of 66 critical care beds by the end of 2021, which includes permanent funding for 40 beds, funded temporarily in response to surge. To date, 33 of these beds have been opened, with a further seven expected to do so in the coming weeks.

As for the preparation for 2021, the circumstances we face now are very different from those of March, and in many ways more challenging. The disease is much more transmissible.

Backlogs have built up in scheduled care. Social distancing and increased infection control measures mean our existing capacity cannot deliver at previous levels and overcrowding in emergency departments has been reduced significantly. We cannot tolerate high trolley numbers due to the risk of infection.

Significant numbers of healthcare workers are absent due to infection, close contact or the need to care for others. In the acute hospitals alone, we have more than 6,000 workers on sick leave at present. Almost half of them are nurses. On a positive front, the availability of early roll-out of a vaccine will be a key factor in mitigating risk in the future relating to our staff.

We are currently in a new pandemic surge. Numbers infected and hospitalised on either wards or in ICU are at levels not seen before. The number of measures already invoked include strong guidance from our chief clinical officer, all non-urgent and non-time-dependent cases in the public sector have been paused in public hospitals and surge plans have been activated across the entire public hospital system, increasing surge capacity by 400 beds. For critical care, our surge plans aim to deliver 350 ICU beds. Derogation measures are in place to maximise available staff. Safety net arrangements have been agreed with 18 private hospitals and more than 800 patients have already been treated.

The private hospital support in 2020 provided access to their entire capacity for three months in the earlier part of 2020. Temporary mechanisms beyond that period saw private hospitals provide care right though to the year end. The new safety net arrangement, which will be in place for up to 12 months, allows us to trigger capacity by prior arrangement in the event of need associated with surge, which we are now in, and guarantees access to a maximum of 30% capacity and beyond by agreement with private hospitals. The HSE is paying commercial rates for activity already carried out. The focus for private hospitals is on delivering urgent, time-dependent elective care and unscheduled care. Continuity of care concerns are being addressed in two ways. Public hospitals will determine the patient profile that will transfer and private hospitals can continue to deliver care for their patients in the remaining capacity, much of which will be urgent and necessary.

In conclusion, I would like to stress two points. We need people to continue to use the health services during this time. We are alert to the fact that in the first phase of this, there was the risk of patients not attending emergency departments for strokes and heart attacks in particular. Meeting the exceptional challenges which present to acute care depends heavily on the public response and the management of the infection in the community. That concludes my opening statement. I thank the Chairman.