3. Providing health services effectively
The section on PROVIDING HEALTH SERVICES EFFECTIVELY describes approaches for service delivery planning and patient pathways for suspected COVID-19 cases. It also considers efforts by countries to maintain other essential services during periods of excessive demand for health services.
3.1 Planning services
Update 21 May 2021: Reopening plans remain on course as those in their 40’s are given choice of vaccine
Speaking at the weekly HSE press briefing on 20 May 2021, HSE CEO Paul Reid said that more than 2.2 million vaccines were administered up to 19 May. Over 1.6 million people (43% of the adult population) have received their first dose. On 13 May, 56,000 vaccines were administered, the highest number to date. It is estimated that over quarter of a million vaccines were given out the week of 10 May but it is not an accurate total figure as it does not include all data due to the cyberattack on the HSE. The week of 17 May, the HSE is on target to deliver between 260,000 and 280,000 vaccines.
There was some increases in overall cases the week of 17 May but again these figures are not totally reliable due to slowdown in data collection caused by the HSE cyberattack. Although ‘cases seem to be rising again’, Tánaiste Leo Varadkar told the committee on Enterprise, Trade and Employment on 19 May 2021 that Government still plans to introduce indoor dining from ‘early July’, noting that vaccinations were proceeding quickly. The news follows the publication of survey results which found that people in Ireland were the most willing among European Union member states to take the COVID-19 vaccine, with 86.5% stating that they were ‘very likely’ (76.6%) or ‘rather likely’ (9.9%) to get the jab.
On foot of advice from the National Immunisation Advisory Committee (NIAC), this week the HSE announced that people in their 40’s are to have the choice of taking the AstraZeneca and Johnson and Johnson (J&J) vaccines, with the caveat that they will take place under strict conditions. This would include ensuring people are fully informed about any potential risks and assessing whether the two vaccines could be administered to younger people at a quicker pace than Pfizer or Moderna. Those who decline AstraZeneca and J&J will be offered mRNA vaccines as supplies become available.
Update 6 May 2021: One in eight adults are now fully vaccinated
At the HSE press briefing on 6 May 2021, HSE CEO Paul Reid said one-in-eight of the adult population (12%) have been fully vaccinated with a total of 1.7 million Covid-19 vaccine doses administered by Wednesday evening. In the first ten days of May 2021, indicators of the disease are at their lowest levels since October 2020.
The week of 3 May saw the first administration of the Johnson & Johnson Covid-19 vaccine. Some of those who received the vaccine were homeless people in Dublin. People aged 50 and over are now registering online for the vaccine.
Update 28 April 2021: New recommendations agreed for vaccine roll-out
On 27 April 2021, the Irish cabinet approved a series of recommendations from the National Immunisation Advisory Committee (NIAC) including the use of the Johnson and Johnson (J&J) vaccine in Ireland for the over-50s and relaxed its restrictions on the AstraZeneca shot. Healthy under 50s who have had COVID-19 will be considered ‘fully vaccinated’ after one jab. Pregnant women will also be offered faster access to the mRNA vaccine between 14 and 36 weeks gestation, after consulting with their doctor. The decision to prioritise pregnant women for vaccination comes after seven cases of COVID-19 related placentitis were reported in Ireland, six of which led to a stillbirth.
People aged under 50 years, and who are not immunocompromised, and who have had a Covid-19 infection in the last six months, should receive just one dose of a vaccine, at which point they should be considered fully vaccinated. The decision is based on evidence that those with prior COVID-19 infection who subsequently received a single dose of an mRNA vaccine have a similar antibody response to those who have never had Covid-19 and who had received two doses of an mRNA vaccine.
There is some evidence that those aged older than 50 years have a less robust immune response than those under 50 years old. On that basis, NIAC have recommended that, for those individuals who have had a laboratory confirmed Covid-19 infection within the previous six months and who are over 50 years old, should receive a full COVID-19 vaccine schedule. For people under 50 who have had the infection but who are immunocompromised will also receive a full COVID-19 vaccine schedule.
Minister for Health, Stephen Donnelly, said this it was now ‘full steam ahead’ for the vaccination programme. He said Ireland was on course to administer between 160,000 to 180,000 vaccinations this week and more than 700,000 for the month of April.
The Cabinet has also accepted another NIAC’s recommendation that there should no change in the gap between doses of Pfizer or Moderna’s vaccine.
Update 27 April 2021: Vaccine shipping shortfall but targets still achievable
Deliveries of the Johnson and Johnson (J&J) vaccine will be halved this week after a shipment of around 26,000 doses of the vaccine for the Republic was caught up in the fallout from an incident at a US factory producing the vaccine. The delivery shortfalls arise from an audit by the US regulator, the Food and Drug Administration (FDA), of a factory where 15 million doses of the vaccine were ruined due to a production error earlier this year. As a result, Ireland’s second delivery of this vaccine, due this week, will be reduced to around 12,000 doses.
Taoiseach Micheál Martin said ‘there has been some reduction in the J&J 12,000 shipment. But the bulk of the Johnson and Johnson vaccine was due in late May and June. The bulk of it is still to come. We already have some in the country… The key for the Johnson & Johnson is the 600,000 (figure) over the quarter two period, which gives us well in excess of four million vaccines due in that period.’
Mr Martin also said that progress was going well with the vaccination program, although some time has been lost in between the various changes made to the use of vaccines and scheduling. Meanwhile, the chairman of the Irish Medical Organisation’s GP Committee believes the Government’s vaccination targets of having more than 80 per cent of adults vaccinated with at least one shot by the end of June are still achievable, following NIAC’s recommendation. Dr Denis McCauley was optimistic that 80% of adults could be vaccinated by the end of June.
Update 20 April 2021: Impact of vaccination changes and supply issues on national roll-out remains unclear
A briefing note supplied to the Oireachtas health committee by the Health Service Executive (HSE) on Tuesday 20 April 2021 warned that uncertainty over supplies for all four vaccines remains a significant ‘programme risk’. In a week that also saw cut-backs to the AstraZeneca delivery schedule to Ireland and ‘a small number’ of serious blood clotting incidences in people who received the vaccine, the document detailed how the decision to restrict the use of AstraZeneca to those aged over 60 has necessitated ‘a major reorganisation of the vaccination programme’.
While this has had a ‘significant impact on the vaccination programme’, the HSE added that efforts will be made to ‘minimise the impact of this’ by targeting mRNA vaccines to people in high priority cohorts aged under 60.
The news comes as pharmaceutical company Johnson & Johnson are set to resume vaccine deliveries to the European Union. This follows the European Medicines Agency (EMA) ruling that the overall benefits of the J&J vaccine outweigh the risk of blood clotting events as a very rare side effect. At the NPHET briefing held on 22 April 2021, CMO Dr Tony Holohan said he expected the National Immunisation Advisory Committee (NIAC) to provide its advice on the use of the over the coming days and that there would not be unnecessary delays to the vaccination roll-out.
However, speaking on the topic earlier, HSE Chief Executive Paul Reid had said that if NIAC restricted the use of the J&J vaccine it would ‘significantly’ affect the rollout of the State programme.
Ireland expects to receive 600,000 doses of the J&J vaccine before the end of June and 2.1 million before the end of the year. On 22 April 2021, NIAC deferred any decision on the use of J&J until next week. There is increasing frustration with NIAC’s ‘abundance of caution’, the many changes to and the slow pace of vaccination roll-out from the public and politicians.
Update 16 April 2021: Online vaccine portal opens for those aged 65 and over with 30,000 people registering in one day
The HSE’s online vaccine portal went live on Thursday 15 April 2021, with 30,000 69-years olds signing up within 24 hours. The system will be open to 68 year-olds on 16 April, then to 67 year-olds on 17 April, and so forth. Speaking at the weekly HSE COVID-19 briefing, Chief Executive Officer Paul Reid said people aged 60 to 64 will be able to register for vaccines ‘well before the end of April’.
People who want to register online require their Personal Public Service (PPS) number, Eircode (equivalent to postcode or zip code) and email address; however it has been noted that the 39-step registration process may prove cumbersome for some signatories. Those unable to provide this information are advised to register by phone.
Speaking on RTÉ's Morning Ireland, Damien McCallion, the HSE's National Clinical Lead for the Vaccine Programme, said there will be up to 37 centres opened on a phased basis to facilitate vaccine administration. He said those who had their vaccines cancelled last week will be ‘prioritised’, but that it may take several weeks to have their vaccine appointments rescheduled.
The HSE is due to reveal how it has reorganised the vaccine roll out following the decision to only use AstraZeneca with 60-69 years olds and the pause put on exports of J&J by the USA, both of which emerged the week of 11 April 2021. A new plan in light of the changes governing the availability and distribution of vaccines will be submitted to Government shortly.
Update 12 March 2021: Frustration with delays in vaccination roll-out
Speaking on national radio on the morning of 12 March 2021, health minister Stephen Donnelly acknowledged that there have been difficulties and delays with the delivery of doses of the vaccine to GPs around the country and that this causes anxiety for patients. He said the Health Service Executive (HSE) is making ‘significant changes’ to address these issues but pointed out that 99% of the target for the vaccination of the over-85 age group has been met.
Minister Donnelly also said he was talking to the AstraZeneca representative for Ireland to convey the Government’s frustration with the revised volumes and delivery dates.
Minister Donnelly also outlined how the National Immunisation Advisory Committee (NIAC) has updated its advice and is recommending that the AstraZeneca vaccine can be used for people aged 70 years and older. This will mean that the AstraZeneca vaccine can be used for this older age group. To date, over 100,000 of people over 70 have been given a first dose, mainly the Pfizer vaccine. There are nearly half a million people aged 70 and older. The new advice updates the original advice from NIAC on 2 February 2021. NIAC issues its advice to the CMO on vaccines, and the CMO then advises the Government.
At the HSE briefing on 10 March, HSE chief Paul Reid outlined that there has been 536,617 vaccinations carried out by 8 March 2021, with 382,528 of these being dose one and 154,089 of dose two. Speaking at the parliamentary health committee on 9 March 2021, Mr Reid acknowledged that Ireland will only receive 1.1 million vaccine doses in the first three months of this year. Originally, there was a target of 1.7 million doses based on advance purchase agreements with manufacturers. This was then adjusted to a target of 1.4 million and then lowered again to 1.24 million. He explained the shortfall is due to slower-than-expected delivery of doses by the three companies with authorised vaccines: Pfizer/BioNTech, Moderna and AstraZeneca, how delivery dates for shipments of the vaccines have changed on more than 20 occasions in the past two months.
Update 24 February 2021: Vaccination strategy
The vaccine allocation strategy first announced in December 2020 was amended and a new priority list published on 24 February based on new clinical and medical advice with the aim of vaccinating first those who are more likely to suffer severe disease or death should they contract COVID-19.
The vaccine programme has been scaling up week on week according to Paul Reid, CEO of the Health Service Executive. Reid said that the week of 22 February would see over 100,000 vaccines administered: “This week gone, we will have done probably very close to 80,000 and next week, we will be well over 100,000. So, we are beginning to see the scaling up and certainly, as we get into April, we are getting to levels of about one million a month as we reach into April and May.”
Frontline healthcare workers and people who are over the age of 65 and live in long-term care facilities have already been vaccinated and currently the third vaccine group comprising of adults over the age of 70 is being vaccinate. The next vaccine group under the initial plan was to be non-frontline healthcare workers, followed by people aged 65-69, workers key to the vaccination programme, and then people aged 18-64 with certain medical conditions.
However, with the change announced this week by the Minister for Health Stephen Donnelly, vaccines will instead go next to people aged 16 and 69 who are considered at very high risk of developing severe Covid-19. This group includes people who are severely immunocompromised, who have obesity with BMI over 40, have uncontrolled diabetes, undergoing certain treatments for cancer, and/or are living with certain chronic illnesses including chronic neurological conditions, certain inherited metabolic diseases, Down Syndrome, and sickle cell disease and chronic severe respiratory disease.
At the weekly briefing of the National Public Health Emergency Team on 25 February 2021, Professor Philip Nolan, Chair of the NPHET Irish Epidemiological Modelling Advisory Group, said: ‘We are making continued and significant progress, albeit more slowly. The reproduction number remains below 1, between 0.6 and 0.9, which is a real achievement’. He also noted the significant reduction in cases amongst both health care workers and people who live and work in nursing homes explained by vaccination and how this is a reason for hope.
Update 11 February 2021: Vaccine roll-out slows this week as centres put in place to vaccinate older people with the Pfizer BNT vaccine
Speaking at HSE briefing on 11 February, HSE Chief Executive Paul Reid said that 243,353 vaccine doses have been administered, with 88,453 people having received two doses. He said this puts Ireland third in the EU in terms of doses per 100 of the population, behind Malta and Denmark, but ‘well above the EU average’. Mr Reid outlined how 12,000 people over the age of 85 will receive their first dose of a COVID-19 vaccine next week while 25,000 healthcare workers will be vaccinated with the Astrazenca vaccine.
At the HSE briefing, it was detailed that 91,548 vaccines have been administered in long-term health care facilities and 150,789 to healthcare workers. They said that in the next week 79,500 vaccines will be given, with just 12,000 of those for the over-70s, starting with those who are over 85 years of age.
The over-70s will be administered in 84 GP practices across the State and in three large centres in Dublin City University’s Helix Theatre, the Munster Technological University in Cork and another location yet to be named in Galway city.It is planned that the first dose of the vaccines to the over-85s will be completed by the end of February when they will begin to vaccinate the age cohort between 80 and 85 in early March. It is expected that all over 70s will be vaccinated by May.
Update 04 February 2021: Decision made to give Pfizer and Moderna vaccines to over 70’s
On 4 February, the National Immunisation Advisory Committee (NIAC) and the Chief Medical Officer recommended that mRNA vaccines (Pfizer BioNTech and Moderna) should be used for the over 70’s where practicable and timely. These recommendations were accepted by the health minister and the HSE is revising plans for the roll-out of vaccines for this age group.
The Chair of the National Immunisation Advisory Group, Professor Karina Butler, said the decision was due to a low amount of data on the efficacy of the AstraZeneca vaccine in older age groups and that it will not lead to untimely delays in rolling out all types of the vaccines to get the most people vaccinated as soon as possible.
The AstraZeneca vaccine will be reserved for younger cohorts. The first AstraZeneca vaccines in Ireland are due in Ireland this week, with 400,000 doses expected to be delivered by the end of March.
Up to 4 February, it was expected that the AstraZeneca vaccines would be given to over 70s through their GPs, beginning with those aged 85 and older from mid-February. Under the revised plan, GPs with smaller numbers of clients will travel to larger practices because of the challenges in transporting the mRNA vaccines. Large GP practices, primary care centres and dedicated vaccination facilities will be used from the middle of February under the new revised ‘total re-tooling’ plans for vaccinations in older people.
Speaking on the matter, the Taoiseach Michael Martin said the decision to prioritise the Pfizer-BioNTech and Moderna COVID-19 vaccines for people aged over 70 will create significant ‘logistical challenges because this changes the model that the Health Service Executive and the Task Force were working on’. He added that the AstraZeneca vaccine will be used for cohorts four, five, six and seven on the vaccination priority list, which he said ‘will bring those somewhat forward’.
Tánaiste Leo Varadkar told the Dáil on 4 February that the decision not to give AstraZeneca to over 70s, the vaccine rollout for people for the over 70s group ‘may well be slower’. He added that this meant the roll-out for healthcare workers would be faster and that the same total number of vaccines would be administered. The Tánaiste said that vaccinating between 70% and 80% of adults by September is still attainable, despite changes to the roll-out plan.
Update 28 January 2021: Vaccine programme making progress
As of 28 January, 161,500 vaccinations have been administered in Ireland. Of those, 89,900 were given to healthcare workers, some of whom (76,100) have received a first vaccine while others (13,800) have had their second dose, with further 45,000 second dose vaccinations planned for frontline healthcare workers by Sunday 31 January. Additionally, 71,600 vaccines were administered to people in long-term residential care facilities.
Minister for Health Stephen Donnelly TD confirmed that a programme to vaccinate individuals in the community will commence in February 2021 but has flagged concerns about the supply of vaccine doses. He said: ‘Today we have confirmed that the community vaccination programme will begin in February, subject to regulatory approval of the AstraZeneca vaccine. Despite anticipated disruption to deliveries, which was announced on Friday 22 January, Ireland will receive a delivery of AstraZeneca vaccine within the expected range for February, although at the lower end of that range. Delivery in March is likely to be more impacted and considerably lower than what was originally stated by the company. We continue to prioritise those most vulnerable to COVID-19 in our society against the backdrop of limited supply of vaccines’.
According to the Health Service Executive (HSE) CEO Paul Reid, the rollout of the AstraZeneca vaccine for those aged 70 will commence in the middle of February as planned with over-85s receiving the vaccine first.
Meanwhile, the HSE is introducing antigen tests for COVID-19 for use in hospitals. Antigen testing is faster than laboratory-based PCR testing and the Irish Nurses and Midwives Organisation (INMO) have called for the provision of the antigen tests as a screening tool for all frontline healthcare staff in addition to ongoing PCR testing.
However, a health technology assessment carried out by the Health Information and Quality Authority (HIQA), found that antigen tests to date showed reduced diagnostic accuracy compared with laboratory-based real-time reverse-transcription PCR tests. According to the HSE, it will be left up to each hospital to decide when and where these tests would be used.
Update 20 January 2021: Continued roll-out of vaccinations
Up to the 20 January 2021, 121,900 vaccinations had been carried out, 48,800 of them in nursing homes and over 73,100 to health care workers. The weekend of 14/15 there was three temporary centres set up to administer vaccinations to GPs and GP practice nurses.
Vaccinating the priority group – those in long-term residential settings – has been delayed due to the high number of outbreaks in these settings. Speaking in the Dáil on 21 January 2021, Minister Stephen Donnelly said it is hoped that all citizens will be offered a vaccine by the end of September.
In a European survey presented at the HSE briefing on 21 January 2021, 37% of Irish adults declared they would wish to get the COVID-19 vaccine ‘as soon as possible’ second only to Malta in the EU 27, considerably higher than the EU average of 23%.
Update 18 January 2021: Vaccine programme steadily moving forward
After early critique of the COVID-10 vaccine roll out as slow, the vaccination programme has gained some momentum. As of 13 January, when last figures were made available, a total of 77,303 people have received their first dose of either the Pfizer or Moderna vaccines.
By 24 January, all residents and staff in nursing homes are to be vaccinated. Vaccinations have also been widespread among healthcare workers. The programme will next move on to immunising older people living in the community who are most at risk of serious illness. Together these three strands will meet twin goals of protecting the most vulnerable and ease pressure on the health system.
Update 11 January 2021: Vaccination roll-out
The first COVID-19 vaccines were administered on 29 December 2020. The roll-out began in hospitals and healthcare facilities. All clinical guidance, policies, protocols and procedures to enable the safe, effective and efficient administration of the vaccine have been published in the first week of January, over 2,000 healthcare professionals have been trained to safely administer the vaccine.
In line with recommendations from the National Immunisation Advisory Committee (NIAC), which was ratified by Government, vaccinations are starting with those:
• aged 65 and older living in long-term care facilities at highest risk of morbidity and mortality
• healthcare workers at significant risk of disease exposure such as doctors, nurses, healthcare assistance, health and social care professional, porters and administrative support staff.
Having reviewed the scientific data, NIAC is currently recommending that the second dose of the vaccine is to be given at 21 days and if a 6th dose remains in a single vial, it is safely administered.
Up to 11 January, 40,000 nursing home residents and healthcare staff have been vaccinated. On 8 January 2021, the Minister for Health announced an accelerated vaccination programme. He said that they had planned to vaccinate all 75,000 residents and staff in long-term residential care units with the first dose by the end of January but that this will now happen by 22 January. He said ‘We’re mobilising 65 vaccination teams including hospital vaccinators, community vaccinators, school vaccinators and the National Ambulance Service. Vaccinations will take place seven days a week’.
There have been public concerns over the perceived slowness of the vaccine roll-out in Ireland however health officials insist that the only constraints on vaccination roll-out is supply which is currently running at 40,000 doses a week. Health leaders have also said that when the Moderna vaccine is available they will be able to provide more than the current 40,000 a week and that the potential availability of the Astra Zenica vaccine will facilitate mass community roll-out of the vaccine.
A body representing private sector doctors and dentists – the Medical and Dental Consultants’ Association - said there was no sign of vaccination of staff in the private sector in Dublin or Galway as of yet. It warned that if staff in private hospitals got COVID-19, it would put the new HSE agreement with the HSE in jeopardy.
Update 15 December 2020: Vaccination strategy and implementation plan launched
The health minister Stephen Donnelly launched the Irish National COVID-19 Vaccination Strategy and Implementation Plan on 15 December 2020. The launch was on the same day that the European Medicines Agency (EMA) announced it would bring forward its final assessment of the Pfizer/BioNTech vaccine to the 21 December. If and when the EMA authorises the vaccine, the European Commission will approve its use in Europe within days. It can then be distributed in Ireland so there may be some vaccinations in Ireland before year-end in line with roll-out across Europe.
The strategy details the high-level plan for the safe, effective and efficient vaccination of the population. There will be a three phased roll-out of vaccinations – initial rollout for targeted groups, a mass ramp-up and finally open access. There are no dates for the phases due to uncertainties in the authorisation process and the supply and logistical challenges for each vaccine that is ultimately authorized and distributed.
As detailed previously by the health minister, under the vaccination plans, the highest priority groups – those over 65 in long-term care facilities, and healthcare workers in direct contact with patients – will receive the vaccine first. Firstly, vaccines will be administered in hospitals, long-term care facilities and other healthcare sites followed by mass vaccination clinics, GP surgeries and community pharmacies in the second and third phases.
The vaccine will be available to the whole population free of charge. Chairman of the vaccination taskforce, Prof Brian MacCraith, said at the launch, the challenge of rolling out a Covid-19 vaccination programme is ‘unparalleled’ due to the ‘scale, complexity and desire for speed’ involved. Earlier in the week, Deputy Chief Medical Officer, Dr Ronan Glynn issued a statement on the vaccine being on the horizon, explaining why the vaccine has happened so quickly.
While there is unanimous support for the plan, there were some concerns over the absence of details in the plan, in particular in relation to workforce capacity to deliver mass vaccinations and the IT system needed to support its roll-out.
Update 11 December 2020: COVID-19 vaccine rollout in Ireland
A plan will be published the week of 14 December for the roll-out of the COVID-19 vaccine in Ireland. Considerations regarding the distribution, storage and phased administering of the vaccine are included. Nine ultra-low temperature freezer lorries have been acquired for the distribution effort. In the community, GPs and pharmacists are likely to play a large role in carrying out immunisations but mass vaccination clinics may also be required. It is expected that there will be no cost to any person taking up the vaccine. Government is working on a communications plan to deal with people's concerns and to combat misinformation.
The vaccine will be available to people on a phased basis in order of the relative risk of severity of illness in case of infection. The initial allocation strategy will be adapted as more data and evidence emerges over time on vaccine effectiveness and the epidemiology of the disease.
A provisional order of allocation was published this week with more details to follow:
1. People aged 65 years and older who are residents of long-term care facilities (likely to include all staff and residents on site)
2. Frontline healthcare workers
3. People aged 70 and older
4. Other healthcare workers not in direct patient contact
5. People aged 65-69
6. Key workers
7. People aged 18-64 with certain medical conditions
8. Residents of long-term care facilities aged 18-64
9. People aged 18-64 living or working in crowded settings
10. Key workers in essential jobs who cannot avoid a high risk of exposure
11. People working in education sector
12. People aged 55-64
13. Other workers in occupations important to the functioning of society
14. Other people aged 18-54
15. People aged under 18 and pregnant women
Meanwhile, vaccinations against COVID-19 began in Northern Ireland on Tuesday 8 December.
Update 02 December 2020: Vaccine distribution in Ireland may begin in early January
The Minister for Health Stephen Donnelly has said that pending the final review by the European Medicines Agency (EMA) of the Pfizer/BioNTech vaccine due on the 29 December, Ireland may begin distributing the vaccine in early January. The Moderna vaccine will be reviewed by the EMA on 12 January and credentials of other vaccines will also be considered. Mr Donnelly said that it was his ‘unambiguous view’ that the vaccine should be provided free of charge but that no final decision had yet been made. The estimated cost of universal COVID-29 vaccine provision is €117.6 million. The government plans to purchase from a number of different pharmaceutical companies and has agreements in place to purchase 15.6 million doses of vaccine. The decision on which groups will be the first to receive the vaccine will be decided next week and is likely include healthcare staff, older people and those working in meat plants.
Speaking in the Dáil on 2 December, Taoiseach Michael Martin said the work of the Covid-19 task force is ‘proceeding at pace’. He said that the infrastructure to store the vaccine at minus 70 degree was already being set up and that the equipment would be commissioned by the middle of next week. There were calls from opposition parties, including Labour leader Alan Kelly that a ministry be created to deal with the roll-out of Covid-19 vaccines and a permanent taskforce set up.
Taoiseach Micheal Martin also defended the EU decision that national governments would indemnify companies producing the vaccines as the vaccine supply ‘would simply not have happened’ without pre-purchase agreements.
Update 11 November 2020: Task force established to manage roll-out of Covid-19 vaccine
Speaking at the Oireachtas Health Committee on 11 November, HSE chief executive Paul Reid said that a new high level government task force to manage the roll-out of Covid-19 vaccine held its first meeting that morning. The taskforce will be chaired by Professor Brian MacCraith with other members including Chief Medical Officer, Dr Tony Holohan, Paul Reid, chair of the senior officials group on Covid-19 Liz Canavan, Government chief information officer Barry Lowry and Government chief procurement officer Paul Quinn. There will also be officials from the Department of Business, along with a logistics cold chain expert and project management expert.
Speaking in the Dáil in the same day, Taoiseach, Micheál Martin said that Ireland will receive about 1% of the vaccines made available through the EU collective purchase scheme. The EU will buy approx 300 million units of vaccine. People vulnerable to Covid-19 will prioritised once safe vaccines to prevent the virus are approved and ready.
Update 24 September 2020: HSE winter plan published
On 24 September, the HSE published its Winter Plan (https://www.hse.ie/eng/services/publications/winter-planning-within-the-covid19-pandemic-october-2020-april-2021.pdf). This year’s plan was developed with the intent of delivering essential healthcare in a COVID-19 environment. It details a range of initiatives to enhance community capacity and access and decrease acute hospital demand. The plan prioritises primary and community care, which if delivered will advance the goals of Sláintecare and mitigate the impact of COVID-19.
There is a budget allocation of €600million to support the implementation of the Winter Plan. Key initiatives include additional:
• acute bed capacity;
• home support packages;
• HSE procured private bed capacity;
• intermediate care beds, proposals for acute hospital egress; and
• Community Healthcare Networks, Community Specialist Teams in the areas of Older Persons and Chronic Disease.
Speaking at the launch of the plan, Anne O Connor, HSE Chief Operations Officer said; ‘For the forthcoming winter period, we are focusing on the resumption of health services, while preparing for the expected pressures associated with winter and delivering services in the context of the continuing presence of COVID-19. Guidance, new processes, and infrastructure, will be critical to supporting the resumption of service delivery. In addition, a Community First approach to the delivery of care will be central to delivering safe, efficient and effective services through winter and beyond. Service delivery will be re-oriented towards general practice, primary care and community-based services.’
Key initiatives within The Winter Plan are:
• to open an additional 251 acute beds and 89 Sub Acute beds in Q4 2020 and an additional 232 acute beds in Q1 2021;
• The ongoing provision of COVID-19 Community Assessment Hubs and the extension of these to incorporate the treatment of acute respiratory illness via Acute Respiratory Assessment & Treatment Hubs;
• There are currently seven Community Assessment Hubs operation within 5 Community Healthcare Organisations with a further three on standby to open should demand increase. The plan is to have 20 hubs in total available from January to March
• Three categories of technology solutions encompass 28, large individual projects within the overall programme.
The plan envisages the recruitment of an additional 12,500 staff, however it does not specify which staff types and by when. Other objectives include a 30% reduction in trolley numbers and quicker treatment of patients in Emergency Departments, the completion of 20,000 plus additional elective procedures and a maximum of 450 delayed transfers of care for patients who are well enough to leave hospital.
A new arrangement is being negotiated with private hospitals, so that the HSE has access to capacity in the event of a surge in Covid-19 cases as well as the provision of elective care for public patients experiencing delays given the growth in waiting list during the pandemic.
The 2018 Department of Health Capacity Review and Sláintecare acknowledge the appropriate capacity of the health service in terms of both beds and community based services. This plan is not intended to achieve that level but is intended to be the first major steps towards achieving such a level.
Update 22 July 2020: Plan for return to non-COVID health services
On 22 July 2020, the Health Service Executive (HSE) published a plan outlining the return to health service and social care provision called ‘A Safe Return to Health Services: Restoring health and social care services in a COVID environment’ (https://www.hse.ie/eng/services/news/newsfeatures/covid19-updates/a-safe-return-to-health-services.pdf). The plan outlines a strategic framework for the delivery of services from now until February 2021.
Strict infection prevention measures, including physical distancing, are being implemented across the services resulting in reduced capacity and services being delivered in different ways.
As a result various surgeries, procedures, health screening programmes and outpatient clinics are planned to be running at 50-70 percent of their usual capacity (https://www.independent.ie/irish-news/health/some-services-to-operate-at-half-capacity-as-hse-plans-for-winter-like-no-other-39390013.html). Capacity is envisaged to go up over three phases as outlined in the plan while also allowing for extra capacity potentially needed during the winter months. The main assumption underpinning the plan is the level of illness and health service pressure caused by COVID-19. If later surges present a change, the timelines will change accordingly. The schedule will be regularly monitored and updated as appropriate, dependent on public health guidance and healthcare capacity.
Update 12 June 2020: Waiting lists for hospital treatments growing during COVID-19
Waiting lists in Ireland were long compared to its European counterparts before the COVID-19 crisis but have grown since the virus arrived as hospitals have limited elective care and redeployed staff and resources.
On 12 June 2020, the Irish Hospital Consultants Association (IHCA) warned of unprecedented challenges in the months ahead unless realistic practical plans are developed and implemented urgently to expand public hospital capacity and community step down services to provide care to non-COVID and COVID-19 patients (https://www.irishexaminer.com/breakingnews/ireland/leading-consultant-warns-covid-19-could-push-waiting-lists-up-to-a-million-by-years-end-1003013.html).
A total of 9,137 individuals were added to the public outpatient and inpatient/day case waiting lists in May which now stands at a total of 808,447 meaning around 1 in 5 of the Irish population are currently waiting for public hospital care (https://www.ihca.ie/news-and-publications/ntpf-waiting-lists-could-reach-1-million-as-latest-figures-show-an-additional-11844-people-added-in-may).
Up to early April, GPs are the primary detectors and treaters of COVID-19, linking to hospitals as necessary. While GPs continue to see sick patients, since 16 March, the vast majority of consultations are via telephone, video or other alternative consultation methods.
All Hospitals are to have a COVID-19 plan in place. Measures included in the COVID-19 action plan are:
• Maximise patient flow through hospitals and ensure the most efficient use of existing resources.
• Hospitals receiving infected patients will have a multidisciplinary COVID-19 preparedness committee in place.
• Facilitate patients suitable for discharge who are currently delayed in acute hospitals.
• On an ongoing basis, accelerate appropriate discharge of patients to appropriate facilities, or with homecare support.
• Source and deploy additional step-down beds in nursing homes, hotels etc. to facilitate early discharge. Enhance Minor Injury Unit service provision to reduce pressure on EDs.
• Implement major surge plan.
• Restrict elective & OPD activity, essential clinical services will be maintained.
• Provide telephone triage and support to patients in the community to avoid healthcare attendance.
• Transfer certain essential hospital activity to private hospitals; move certain essential OPD activity to community settings where feasible; source additional step-down beds in nursing homes, hotels etc.
• Reconfigure physical infrastructure in acute hospitals to facilitate separate treatment pathways for COVID-19
• Expand capacity at National Isolation Unit in Mater Hospital
• Maximise single room usage for essential treatment of patients at higher risk, such as immunosuppressed, CF etc
• Use certain specialist non-ED hospitals and/or private hospitals for treating infected patients
• Facilitate National Ambulance Service (NAS) to provide home / community testing services
• Harness additional clinical support from the Defence Forces, voluntary and private ambulance providers
• Expand NAS clinical hub, COVID-19 and mental health support desks i.e. significantly expand staff, including clinical advisors, retired GPs and others to provide clinical advice at the support desks within the National Emergency Operations Centre of NAS
• Continue to enhance paramedic led mobile medical services
• Provide accommodation for patients receiving daily treatment (e.g. Radiotherapy) to minimise risk of infection
• Expand acute & critical care bed capacity
• Expand community care capacity
• Supporting wider capacity
• ICT support: Support for home/self-management for diagnosed well patients and remote management of diagnosed patients who become unwell
• Provide additional beds for patients with moderate, acute and critical care needs
• Open all available beds in acute hospitals, maintain additional beds opened for Winter Action Plan, commission additional critical care and isolation beds
• Secure additional beds in private hospitals
• Maintain current level of short term, transitional and long stay beds
• Continue to deliver additional short term, transitional and long stay beds and training for care staff
• Progress cocooning and cohorting of at risk patients and vulnerable people in accordance with evolving public health advice
• Increase and deliver short term, transitional and long stay beds to manage patient impacted by COVID-19.
By 05/04/2020, figures released at the HSE briefing outlined the increase in hospital beds (from approximately 10,000 hospital beds) by 7,500; this included 2,500 from the private sector, 1,100 isolation beds in a new facility in City West Dublin, 450 overflow beds in same facility, and other increases in beds in health and other facilities around the country. The critical care capacity has increased from approximately 225 ICU beds pre-crisis to 800 critical care beds the week of 05/04/2020. New ventilators are arriving which will increase the numbers of ventilators from 1,100 to 2,400 across the system. HSE CEO Paul Reid outlined how the key issue with delivering critical care is having the skilled staff to provide the care, not the physical capacity that is escalating.
There are plans for up to 40 clinical community assessment hubs are to be put in place, these will start the week of 06/04/2020. They will take referrals from GPs for the treatment of COVID-19 patients or those suspected with COVID-19 outside of hospital. New models of care are being put in place for these community hubs. There are also plans for telehealth so that people can manage their mild COVID-19 symptoms and others at home.
Press releases, Agendas and minutes of the meetings of the National Public Health Emergency Team: https://www.gov.ie/en/collection/691330-national-public-health-emergency-team-covid-19-coronavirus/
Government of Ireland. COVID-19 Action plan for Ireland: https://www.gov.ie/en/publication/47b727-government-publishes-national-action-plan-on-covid-19/