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Over the last two weeks, there have been nine days where the National Ambulance Service has received more than 2,000 calls a day. Shutterstock
Trolley crisis

HSE boss: Flu, RSV and Covid figures at levels above Govt's 'most pessimistic modelling' for winter

Planning for next winter to begin early when health system is ‘over the worst’, says Stephen Mulvaney.

LAST UPDATE | Jan 17th 2023, 12:47 PM

THE CURRENT EPIDEMIOLOGICAL situation surpassed the most pessimistic modelling contained in the government’s Winter Plan, according to interim HSE boss Stephen Mulvaney. 

The interim CEO of the HSE appeared before the Oireachtas Health Committee today where he told TDs that flu is already at levels that make this an exceptional season when compared to previous years.

RSV, along with influenza, continues to place significant pressure on GPs and hospitals, while Covid-19 levels have risen in recent weeks, he says in his opening statement to the committee. 

Outlining the operational impact such illnesses have had on the health system, Mulvaney says that this winter, GP Out of Hours services are seeing nearly 39,000 patients a week on average, while attendance at EDs for the full year 2022 were up by 14.8% over 2021.

Over the last two weeks, there have been nine days where the National Ambulance Service has received more than 2,000 calls a day, which represents a new record high, according to Mulvaney. 

Under questioning from People Before Profit TD Gino Kenny, Mulvaney said that the level of flu has appeared to have peaked, but that it would still be another week until the HSE can be certain.

Trolley crisis

Acknowledging the trolley crisis, and the daily high of 772 patients waiting on trolleys on 3 January, he told the committee that every effort is being made to minimise the impact of winter season factors on patients’ experience.

He said the HSE regrets the numbers that have been forced to wait on trolleys, stating: “Our staff do not believe this is acceptable and neither do we.”

However, Mulvaney rejected assertions that there had been a “failure of leadership” within the HSE in the response to the overcrowding crisis, following criticism from Sinn Féin’s health spokesperson David Cullinane.

Cullinane said that the HSE had failed to deliver the Winter Plan, while questioning why a multi-annual plan had not been put in place several years ago.

Mulvaney reiterated that the levels of flu, RSV and Covid-19 had been beyond their modelling and that the significant surge had not been predicted.

All measures are being taken alleviate pressure and manage patient risk as effectively as possible, he says in his opening statement, saying that there continues to be regular meetings of the National Crisis Management Team and the Winter Oversight Group to analyse current performance and to aid decision-making.

The National Crisis Management Team is set to continue meeting until at least the end of February.

Pointing to specific measures that have been rolled out, he said additional seven-day working rosters have been in place across both acute and community services since 5 January.

More consultants and senior decision makers were deployed in hospitals over the weekends to ensure a more consistent flow of discharges across Saturday and Sunday.

Through agreement with the IMO, participating GPs have extended their clinic hours by up to eight hours per week per GP and enhanced funding has been provided to GP Out of Hours services to enable them to roster additional GPs.

The National Ambulance Service has engaged private capacity and voluntary ambulance services to support hospital discharges, he states, adding that 180 beds have been accessed from private hospitals.

Work is ongoing with private hospitals to secure additional private capacity and ensure that all available contracted private beds are utilised, he adds. 

Through these measures and the effort of staff, Mulvaney says in his statement that there has been a substantial improvement in the situation over the past week, with a significant decrease in the numbers of patients on a trolley awaiting a hospital bed.

“We continue to work to drive these numbers down further, in a safe and sustained way,” he states. 

The HSE boss also indicates that work on the Winter Plan for 2023 will begin earlier than usual this year. 

“While we will have to put all of our energy into managing the current crisis for the coming weeks, we have agreed that we will be keeping track of what has worked well and considering lessons learned from this period to factor into future planning – that will commence as soon as we are over the worst, both planning for next winter and for the longer term,” he told TDs.

A review of capacity is being conducted by the Department, and the HSE will bring forward a three-year unscheduled care improvement plan this year which will look at process improvement, expedited infrastructural investment and learning from sites performing well.

HSE apology

When asked by Fine Gael Senator Martin Conway whether or not the HSE would apologise for the number of people on trolleys over the last several weeks, Mulvaney said that “we absolutely do apologise”.

However, he rejected Conway’s assertions that the response to the crisis was “lacklustre” and said that “no response is perfect”.

When asked if the increased trolley counts lead to a higher patient mortality level, Mulvaney said that he “cannot guarantee” that patients have not died due to the overcrowding in hospitals.

However, he said that there was a direct link between delays in patient admission and a higher level of excess mortality.

The appearance of the HSE boss and officials before the health committee comes ahead of a Sinn Féin motion on Wednesday on hospital capacity. 

Cullinane told The Journal that he believes the Health Minister Stephen Donnelly and the HSE have both failed to heed warnings about the level of virus circulation that were coming over the winter. 

“There has been numerous reports into hospital overcrowding including from HIQA. The warnings were ignored and front line staff and patients are now paying the price.

“We know what needs to be done. There are no shortcuts. We need to increase hospital capacity with more beds, surgical theatre and diagnostic capacity and more staff to speed up admission to hospital, to reduce wait times in Emergency Depts and to tackle waiting lists,” said Cullinane. 

He added that there is a need for more community step down and recovery beds to speed up hospital discharges and more GPs, community pharmacists and community intervention teams to ensure patients get the right care in the right place at the right time.

“We also need strong accountability and delivery from a reformed HSE with less management layers and greater autonomy at local and regional level.

“More short term plans and window dressing will not address the crises in health. We need investment and root and branch reform,” he said.

Last week, Cullinane stopped short of stating that his party would put down a motion of no confidence in the health minister, suggesting that people instead wanted solutions to the health crisis. 

- Additional reporting by Tadgh McNally

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