Matt Shanahan (Waterford, Independent)
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1389. To ask the Minister for Health the location of additional and existing critical care beds, acute beds, subacute beds and community beds provided for in Budget 2021; the administrative process and computational method of allocating the additional beds in tabular form; if the estimates capacity will be at a sufficient level to meet a surge in need which may arise; and if he will make a statement on the matter. [33584/20]

Stephen Donnelly (Wicklow, Fianna Fail)
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The Programme for Government, Our Shared Future, commits to continuing investment in our health care services in line with the recommendations of the Health Service Capacity Review and the commitments in Project Ireland 2040.

The Health Service Capacity Review 2018 found that the net requirement in combination with health system reform is for an additional 2,590 hospital beds by 2031 (2,100 inpatient, 300 day case and 190 critical care). The National Development Plan provides for the addition of the full 2,590 beds by 2027.

This winter is expected to be particularly challenging due to the presence of Covid-19 and the uncertainty around the level of Covid-19 and non-Covid-19 healthcare demands. The Department of Health is working with the HSE to increase acute capacity in hospitals throughout the country to meet this and other health demands. Government allocated €236 million revenue and €40 million capital expenditure as part of Budget 2021 to fund additional acute beds on a permanent basis. This funding will provide, by the end of 2021, an additional 1,146 acute beds.

A proportion of these beds will be funded as part of the HSE’s Winter Plan 2020/21. The Winter Plan aims to provide additional health service capacity across a range of services. Initiatives comprise additional acute and community beds to increase acute capacity, help reduce admissions and facilitate egress.

With regard to critical care beds, at the start of the year, permanent adult critical care capacity in Ireland stood at 255 beds, according to the National Office of Clinical Audit. This included 204 Level 3 ICU beds and 51 Level 2 HDU beds. As part of the initial response to the pandemic, funding was provided for an additional 40 adult critical care beds in March 2020 as well as two paediatric beds. The HSE has advised that between 280 and 285 critical care beds are currently open, with the number open any given day subject to fluctuation in respect of available staff and other operational considerations.

Where necessary, the number of critical care beds can surge beyond the baseline of 280-285 as part of an emergency response. However, it is essential to understand that the use of surge capacity for critical care is necessarily tied to a reduction of services in other areas of the hospital. Moreover, the clinical advice is clear that the greater the reliance on surge ICU capacity, the greater the clinical risk with potential impact on patient outcomes.

Our critical care units have coped well so far, largely due to the fact that the curve was flattened successfully in early stages. As a result, our outcomes for Covid patients in ICU have compared well with other jurisdictions including the UK.

Budget 2021 will allocate funding totalling €52m in 2021 to critical care. This will retain, on a permanent basis, the 42 critical care beds put in place on a temporary basis this year and add significant new capacity. Funded adult critical care beds will increase to 321 by end 2021, an increase of 66 over the baseline number of 255 funded beds in 2020. Funding for 2021 will also include money to allow for the development of a workforce plan as well as education initiatives to grow the critical care workforce.”

In relation to community capacity, a home first approach is being taken founded on a community model of care that puts in place end to end care pathways to deliver care to people at or near home. This will include an integrated a mix of services delivered through Community Health Networks working closely with integrated older person teams, frailty teams, utilisation of new rehabilitation beds and enhanced home care with a new 5 million hours for 2021. The intermediate care beds are intended to enable people to avoid going into acute hospitals or when admitted to acute hospitals to enable to go home more quickly following a period of rehabilitation. These repurposed and additional beds will be located within the 9 Community Healthcare Organisations.

This represents a significant step towards achieving the recommendations in the 2018 Health Service Capacity Review which found that an additional 2,100 inpatient acute beds were required, in a reform scenario, by 2031.

In relation to the particular query raised, as this is a service matter, I have asked the Health Service Executive to respond to the Deputy directly, as soon as possible.