Mr. Stephen Mulvany:

I thank the Chairman and members of the committee for the invitation to attend today's meeting. I am joined by my colleagues, Mr. Damien McCallion, chief operations officer; Ms Mary Day, national Director, acute operations; Ms Yvonne O’Neill, national director, community operations; and Dr. Mike O Connor, national clinical lead, acute operations.

Significant investment has been received for the winter plans and national service plans, NSPs, over the past three years. This investment has enabled the Health Service Executive to respond to the immediate demands of the Covid-19 pandemic, and to enhance health and social care services.

The winter plan for 2022-2023 includes national and local initiatives which have been developed in an integrated manner to target hospital admission avoidance, facilitate patient flow through hospitals and discharge back to home and community. The plan details leadership, governance and accountability structures at both national and local levels which are providing monitoring and reporting to support effective timely implementation over the winter period. The plan aims to prepare services and mitigate the additional risks posed by winter pressures.

There are a number of key challenges contributing to increased pressures at an earlier point in the winter period which is resulting in a high level of unscheduled care activity with a significant sustained increase particularly in attendances and admissions for those patients aged over 75 years.

There are particular demands for our primary and community care services in responding to and supporting the health needs of those seeking international protection. These increasing demands are compounded by a shortage of healthcare workers both nationally and internationally to address and deliver the staffing capacity required for core and new service developments. Issues are being faced in maintaining and opening additional bed capacity related to infection prevention and control requirements, recruitment and staff retention challenges.

While currently Covid-19 hospitalised cases are stable at 317 patients, including 11 patients in intensive care units, ICUs, there remains the potential for a high incidence of seasonal illnesses this winter. The numbers of Covid-19 patients still present a significant demand on acute hospitals in terms of bed capacity and increased length of stay.

The Health Protection and Surveillance Centre, HPSC, has advised of increasing notifications and hospitalisations of influenza and respiratory syncytial virus, RSV, cases at an earlier point in the winter period than previous pre-pandemic winters. The incidence rates of such seasonal illness are likely to increase with the colder weather during the winter period. The HSE anticipates these seasonal illnesses, Covid-19, influenza and RSV, coupled with other challenges, will result in high pressures in the demand and delivery of health and social services this winter.

In the week ending 5 November, there were 117 influenza cases and 439 RSV cases notified. As of 6 November 2022, 1.2 million patients have attended our emergency departments, EDs, in the year to date. This equates to an additional 77,000 patients, which is an increase of approximately 7% compared with the same period in 2019. For patients older than 75 years, the total number of ED attendances for the year to date is almost 161,000. This represents an increase of approximately 14% on the same period in 2019. ED admissions have also increased, with approximately 305,000 patients admitted from our emergency departments in the year to date. This represents an increase of slightly more than 3% compared with the same period in 2019. However, for patients aged over 75 years, ED admissions in the year to date are 10% higher than the same period in 2019.

In line with previous years and in response to these demands, the Winter Plan 2022-23 national initiatives have focused on delivering additional capacity, improving pathways of care and rolling out the vaccination programme for flu and Covid-19. Funding has been allocated for the delivery of additional capacity in both acute and community services. Within our emergency departments, staffing capacity is being increased through the recruitment of additional nursing staff in line with phase 2 of the safe staffing and skill mix framework. All hospital sites and associated community healthcare organisations will implement an integrated process for patients with a hospital stay of more than 14 days to improve integrated communication, patient flow and discharge to home or community. Alternative patient pathways are being implemented during the winter period to support admission avoidance, patient flow and discharge. Examples include €6.8 million allocated to the National Ambulance Service for winter initiatives, including deploying rapid handover teams; funding of €500,000 to provide 1,340 nights of palliative care nursing; €16 million allocated for transitional care beds to support the discharge of patients from acute hospitals; €4 million allocated to the provision of short-stay respite services, providing important supports for both patients and their caregivers; €4 million allocated to complex care packages to facilitate discharge and maintain patients with highly complex care needs at home; €5.1 million to provide 18 residential packages to people with a disability; €3 million allocated to mental health placements to assist discharge from acute hospitals; €4.5 million allocated to provide aids and appliances; €10 million allocated to GP supports, including GP access to diagnostics and out-of-hours supports, which are ongoing; €2 million for the expansion of community intervention teams, with a particular focus on the mid-west and north west; and enhanced community care pathways and supports to target those at risk of hospital admission this year including the provision of ring-fenced community bed capacity and home supports for older people.

In addition to the outlined national initiatives, since April 2022, individual integrated bespoke winter plans were developed for acute hospital sites and associated community healthcare organisations. A total of 447 whole-time equivalent posts and funding of more than €54.8 million is associated with these local plans. In total, a funding requirement of more than €169 million has been approved to implement these measures in 2022-2023, including the recruitment of 608 whole-time equivalent posts across a range of services.

The chief operations officer is responsible for the Winter Plan 2022-23. A performance unit monitors and reports on an agreed suite of targeted key performance indicators, KPIs, and winter plan implementation. To ensure oversight at a local level, each area has local integrated implementation teams that are jointly chaired by hospital groups’ chief executive officers and community healthcare organisations’ chief officers.

I acknowledge and thank all healthcare staff for all their efforts during the past two and a half years as we have combated both Covid-19 and the cyberattack. I include in that acknowledgement our private hospital and private nursing home colleagues, our primary care colleagues, including GPs and pharmacists, and, importantly, our section 39 and section 38 voluntary partners.