Ireland’s health system and its staff ‘at the edge of their resilience’

Ireland’s health system and those who work in it are “at the edge of their resilience” as they face into 2021 with increased rates of self-harm a, pressure on cancer services and a possible need for thousands of extra hospital beds, according to an internal analysis for Government.

The examination of the state of the healthcare system, which was written by the HSE and the Department of Health, warns that the system and those who work in it are "at the edge of their resilience."

The report warns that thousands of extra beds will be needed by the end of January if there is even a small increase in the reproductive rate of Covid-19 in the coming weeks, the report warns.

It has found that if coronavirus reproductive number increases to 1.8, there would be a requirement for 610 critical care beds and 3,900 general acute beds by the end of January. The latest estimate of the reproductive rate of the virus was between 0.8 and 1, according to a letter sent by the chief medical officer Tony Holohan to the Minister for Health Stephen Donnelly last week. With the easing of restrictions and increased social contact over Christmas an increased spread of the virus is already expected early in 2021.

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Furthermore, according to the most recent information published by the HSE there are only 268 available general beds across the country and only 28 critical beds available.

The report, which was considered by the National Public Health Emergency Team, also warns that every 2020 target for therapy services is being missed. It further says that there is anecdotal evidence of "increased acuity" in relation to self-harm and reports of increased rates of eating disorder in adolescents. In relation to cancer services, the report finds that surgery is the "area of greatest concern."

“Public patient cancer surgery numbers for the full year to June stand at 70 per cent of 2019 levels. In the early period, many hospitals moved time sensitive and complex surgeries to private hospitals that had the required facilities and support services.

“Overall, the greatest threat to cancer services at this stage is the risk of staff contracting, or being in contact with, Covid-19, giving rise to absences by those staff and their contacts.”

In the first wave of Covid-19, the former government took over 100 per cent capacity of 18 private hospitals at the end of March. However, it decided in May not to extended this arrangement beyond an initial three-month period which expired at the end of June. This came in light of concerns around the €300 million cost of the deal. While talks are ongoing with individual private hospitals to obtain capacity in the event of another wave of infections, the report has warned that “private hospitals are indicating that they are working almost to full capacity mainly to deal with the backlog of private work”.

Discussions are ongoing between the HSE and private hospitals with to create a “safety net” arrangement. There are also warnings about increased pressure on the general practitioners.

The recruitment and development of a “sustainable Covid-19 specific workforce” is “essential if frontline services in the primary sector are to be restored to maximum capacity.”

Throughout both waves of the Covid-19 pandemic, and the ensuing restrictions that followed, fears have been expressed about the toll on the public’s mental health. The report estimated that access to mental health services is between 85-90 per cent of pre-Covid figures.

“Current challenges relate to the need to slightly reduce capacity in inpatient settings to allow for social distancing, and outbreaks of Covid in some approved centres which have affected admissions.”

Current trends will continue in 2021 “leaving the HSE and mental health services with the challenge of addressing the mental health effects of 2020 even if a vaccine is successfully rolled out in 2021.”

Separately, while recent surveillance data indicates no evidence to date of seasonal influenza activity in Ireland, something which the authors of the report describe as "extremely welcome", it "cannot be assumed that such favourable circumstances will persist, and the risk of an influenza outbreak must remain part of consideration as public health guidance is framed for December and beyond."