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AS THE GOVERNMENT considers NPHET’s advice to move the entire country to Level 5 restrictions, there is concern that the HSE Winter Plan came too late and that it will have difficulty hiring the necessary staff for the significant amount of additional beds you have promised.
The National Public Health Emergency Team met yesterday and recommended that the entire country be moved to the highest level of the government plan ‘Living with Covid-19’.
This would mean, similar to the national lockdown, that everyone would be asked to stay home, except to exercise within 5 km of their homes. Gatherings of any size other than small amounts would not be allowed at weddings and funerals.
Health officials, and those working on the front lines, have been concerned in recent weeks not only about the increase in the number of daily cases, but also about the increase in hospitalizations for Covid-19.
Yesterday there were 134 confirmed cases in the hospital, with 21 of those patients in ICU.
‘Ambitious’
In the recent launch of the HSE Winter Plan, Chief Operating Officer Anne O’Connor said she had set an “ambitious goal” of 12,500 additional employees.
He said the goal is to recruit 4,987 of them in 2020 and 2,760 of them will be core personnel, with the rest focusing on testing and tracking. This recruitment plan includes doctors, nurses, but also home support staff and caregivers.
An additional 251 acute beds will be opened in the last three months of 2020 and there is a commitment to create 17 additional ICU beds in the system during the winter.
The HSE has not specified how many ICU beds will open this year, nor how many employees will be hired for those beds.
People Before Profit TD Richard Boyd Barrett has raised concerns about the capacity of the UCI as we move into winter. In the Oireachtas Covid-19 committee last week he noted that temporary emergency beds during the pandemic had increased ICU capacity to 354. There are now 280 ICU beds across the country.
Talking to TheJournal.ie, Boyd Barrett said the HSE needs to make changes to make these roles attractive to healthcare workers.
“They have to immediately eliminate the pay gap for new entrants, which is a huge barrier to hiring nurses and health workers in general. They have to drastically change their attitude and value the nurses and health workers by paying them properly.
He said that even with the 17 additional ICU beds promised in the Winter Plan, the health service has fewer critical care beds than in April, because the increased capacity has been exhausted.
“That is concerning when it looks like we are heading into a second wave.”
Retention of personnel
Talking to TheJournal.ieDr Motherway, an intensive care consultant at Limerick University Hospital, said providing beds for acute patients and staffing those beds will be important for ICUs.
“We need to expand the number of hospital beds so that when we have a patient ready for discharge from the ICU, they have a bed to go to and their ICU bed can go to another patient.
“Both intensive care beds and general ward beds need to be expanded, and while there is a commitment to do so, there are broad features in the document. I am not aware of the complexities of where they will go and how they will go. “
She said that recruiting “cannot be done in one go.”
“It can be difficult to hire nurses, especially to work in Dublin, which is where I imagine a lot of the extra ICU beds will be. The cost of living in Dublin is very high for people with an average salary.
“The work at the UCIs in Dublin is satisfying because it is complex work, but there is a challenge there and also a challenge in terms of retaining the UCI staff.”
Dr. Motherway has previously said that the health service needs to double the current number of ICU beds in the system.
“Staffing the beds is expensive and in the long run the temporary beds don’t work. If we are going to double the capacity, it will take three or four years and it is expensive: around 1 million euros per bed.
“One of the reasons we had to close is that we realized, and the HSE has several reports where this has been said, that for years it had been necessary to increase capacity, but the funding for it was never there. . And there are some funded beds that they couldn’t recruit for. “
The HSE National Intensive Care Capacity Plan for 2019 noted that nineteen adult ICU beds remained “ commissioned and non-operational intensive care beds ” with allocated funds.
“Although every hospital / group is enabled with the critical care nursing career path to recruit Irish nursing graduates immediately upon graduation, sadly there is currently a hiatus in HSE employment,” the plan read .
Dr. Motherway said she feels “hopeful but a little anxious” as the number of cases increases. She said keeping the numbers low will require “significant participation” from people during the winter.
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Indefinite contracts
Sinn Féin health spokesman David Cullinane said the Winter Plan “came too late” and is concerned that the HSE may not be able to deliver the additional beds this year.
“They have not given figures in the staffing plan and we know that the cost of staffing ICU Beds is close to 1 million euros per year. They require a lot of specialized personnel to keep them open.
“I think recruiting and delivering the number of emergency beds needed will be the biggest challenge. They say they will deliver 220 before the end of the year, but they will only be temporarily available until the end of April.
“The HSE has also said that hospitals have to reduce capacity to 85% for infection control, most are operating at 95% and I do not see that being able to go down, it will be a difficult winter.”
He criticized the ‘Be On Call for Ireland’ recruitment campaign, to which tens of thousands of people applied. Some 2,300 people were deemed eligible to work in the health service after the interview process and 240 were offered jobs.
However, Cullinane noted that these staff were not offered permanent contracts.
“Giving them permanent contracts, that means there is a better chance that they will stay and it would send the message that the health service is really serious about hiring,” he said.
‘A challenge’
Speaking last week on RTÉ’s Today with Claire Byrne, HSE CEO Paul Reid acknowledged that it will be “challenging” to recruit the number of people HSE plans to hire as part of the winter plan. He said that since the beginning of the pandemic, 150 additional consultants and 1,500 nurses have been hired, but this is “still very short.”
“It will be a difficult challenge, and I fully accept it in terms of nursing. We are setting up a wide range of processes to help us do that, we are working with universities on a strategic level to help with the numbers coming in.
“We have some panels that we will call, we are working with agencies to recruit, but also entering the payroll of the health service, but through agencies.
“We are talking to the public dating service so they can help us, we are analyzing some of the limitations; It can take a long time, and I know, for public service contracting and we are talking to the civil service and civil service public appointment about how we can accelerate that in a time of particular need.
Reid also said he wants to use full-time employees and strengthen HSE’s full-time capacity. However, he said that “it is not always possible to do that ignition.”
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