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Health Minister warned of staff shortages by HSE in pre-Christmas message

Dr Lorraine Doherty wrote on 21 December that the Covid-19 situation was “deteriorating”.

File image of Stephen Donnelly in December.
File image of Stephen Donnelly in December.
Image: Leah Farrell

HEALTH MINISTER STEPHEN Donnelly was told that not a single public health department in the country was sufficiently staffed for response to the Covid-19 pandemic.

He was also warned that the department in the North West of the country was “critically understaffed” and that Dublin’s public health team had a major gap at “clinical leadership level”.

The warnings came in a stark pre-Christmas message from the HSE cautioning that there was little “resilience” in operational plans for testing over the holiday period.

The document was sent on December 21 and within a fortnight, testing of close contacts had to be suspended because of a massive upsurge in confirmed Covid-19 cases.

The briefing was written by Dr Lorraine Doherty, the National Clinical Director for Health Protection, who warned the situation was “deteriorating”.

She wrote: “While it is challenging to accurately predict Covid-19 demand and population behaviours, the current projections over the Christmas and New Year’s period highlight challenges for the service.”

They said plans had been prepared to ensure staffing was available and that many had “volunteered to be contacted during the Christmas or New Year weekends if necessary”.

However, it warned of particular challenges in Dublin and also in the North West where Covid-19 outbreaks were highest at the time.

Dr Doherty said: “The North West department is critically understaffed at senior clinical leadership level and will provide weekend cover and OOH [out of hours] service during Christmas and New Year.

“By international comparison, Dublin would also be understaffed per population for health protection at clinical leadership level.”

A chart also warned that there would be “no surveillance cover” in the North East of the country over the holiday period.

This was simply infeasible due to “medical staffing issues”. It was also not possible to get cover for two days on the out of hours rota in the south east of the country.

It also warned of the risk of key staff becoming ill, piling further pressure on the operational plan.

“Combined with increasingly complex cases, this would likely require deployments of previously redeployed staff to public health departments,” said Dr Doherty.

Separately, the HSE chief executive Paul Reid rejected Department suggestions of introducing self-referrals for Covid-19 testing in a letter from December 23.

In a letter to Minister Stephen Donnelly, he said the current system of using GPs to recommend testing was “the optimal model for referrals”.

He said introducing an alternative model would not be consistent with public health advice.

Reid wrote: “It is also untested and therefore carries what we consider to be inordinate risk to the testing and tracing programme capacity, particularly given the current resurgence in infections.”

He also said creating a self-referral system would require significant resources at a time when the testing system was already “being stretched”.

“This is not feasible within the timeframes suggested,” he said.

Other records released under FOI show how the department was also warned as early as December 15 that testing was unlikely to cope with modelled infection numbers.

A briefing said: “Some days exceed 29,000 overall for swabbing and laboratory demand and over 13,000 contact tracing calls.

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“These are well in excess of demand to date. The highest daily totals for swabbing and labs are circa 20,000 and contact tracing circa 6,000.”

It said predictions of several days in a row where demand exceeded resources would likely prolong the period “before equilibrium is restored”.

In a statement, a department spokeswoman said the third wave of Covid-19 infection had put considerable pressure on public health teams as well as testing and tracing.

She said: “However, systems put in place by the HSE showed that they were able to respond quickly to the significant shift in demand, and by invoking surge plans in the period immediately post-Christmas it was possible to meet demand, with over 175,000 tests per week being completed.”

The spokeswoman said the department had committed to significant investment in public health this year with plans to double the current workforce at an annual cost of €17 million.

She added: “This is not only a response to the current pandemic but is an investment in the future development of our public health function. Recruitment for these positions is underway and is progressing well.”

About the author:

Ken Foxe

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