Plan to boost critical care capacity tendered

A proposal to build a hub and spoke model for critical care to bring the capacity to a higher and more sustainable baseline has been submitted to the Department of Health.

The plan, developed by the Critical Care National Clinical Programme, led by Dr Michael Power, has the agreement of the Health Service Executive (HSE) and the seven Hospital Groups, according to Chief Clinical officer, Dr Colm Henry.

This proposal would see “consolidation of what is a very specialist resource, into the hospitals which could provide the greatest reserve of expertise, and have the greatest complexity of services which feed into critical care,” Dr Henry told this morning’s (June 12) coronavirus update from the HSE.

He underlined the surge capacity was unsustainable long-term and the need to go to a higher baseline.

The plan was focusing on future needs, including new builds in some sites, so the health service did not have to rely on temporary resources and designated areas.

“We need to double our intensive care unit [ICU] capacity,” added Dr Catherine Motherway, President of the Intensive Care Society.

She said the service had old infrastructure, the plans for permanent new ICU capacity needed to be accelerated, isolation facilities increased and the aim should be for an occupancy rate of 70 per cent to be able to cope with local surges.

She acknowledged this could not be done overnight but stressed the surge capacity was temporary, and redeployed staff had to return to their normal duties, and there was need for facilities to get back to providing care to elective patients.

Dr Motherway offered a number of positives in that “we did not exceed capacity”.

The crude mortality rate of about 20 per cent (crude data) and outcomes appeared good and compared well internationally. Dr Motherway cautioned that the mortality data were crude at this point and required further investigation.

Additionally, the World Health Organization had advised innovating and Ireland had become involved in international collaboration on research.

Demographics and information from 600 patients’ data had been entered on to the severe acute respiratory infections (SPRINT-SARI) database in a bid to learn more about this disease, “remembering it’s only about five months since we discovered its existence,” added Dr Motherway.

Over 30 patients had also been recruited into clinical trials of various drugs and treatments.

She offered her condolences to all those families of people who had died of Covid-19 disease and with Covid-19 at this time.

Chief Executive of the HSE, Paul Reid, outlined that a new service plan for 2021, and a new winter plan 2020/21, were to be developed by the HSE, taking cognisance of delivering services in a Covid-19 environment.

Dialogue was continuing with the Department of Health on the framework the HSE had submitted for the delivery of services “in a very new way”.

Building sustainable models of primary care was to be a core priority.

In strengthening and scaling up capacity, “The private hospital agreement is going to be key for us. We are going to have to have a very agile system in our health service during the winter period, that is a process that is ongoing,” Reid said at this morning’s operational briefing.

Discussions were underway on the next arrangements to be put in place with the private hospitals.

Bed occupancy was at 48 per cent for inpatient services, and 139 per cent for day case procedures.

HSE Chief Operations Officer Anne O’Connor acknowledged significant work carried out by the private hospitals, where the larger private hospitals had delivered high-end complex care to patients with different types of cancer — oesophaegeal, head and neck cancers — and complex cardiovascular procedures.

The angiogram waiting list in Galway had been eliminated and they were addressing the gynaecology waiting list in Cork.

Valerie.ryan@imt.ie