The Winter Initiative 2016 - 2017

The Winter Initiative 2016 – 2017 aims to manage the expected increase in demand for health services during the winter and to improve patient experience. We want to reduce the numbers of people waiting to be discharged from hospital, keep as many people at home as comfortable as possible, and to make it easier for those who have to attend our hospitals.

The plan sets out a comprehensive range of actions and measures, across community and hospital services, to increase the availability of community care, facilitate timely discharge from hospital and increase hospital capacity.

Key targets

Reduce the number of delayed discharge patients

A key objective of the Winter Initiative is to reduce the number of patients waiting to be discharged from hospitals by providing the specific supports to allow patients to move home or to an alternative suitable community setting which meets their needs.

The target was to reduce the number of patients to no more than 500 by end December 2016.
This target has been reached with 436 delayed discharge patients recorded in hospitals on 28th December 2016, reducing from a high of 659 patients in September 2016.

Provide Additional Home Care Measures

Home Care Packages

An additional 10 million in funding is provided under the Winter Initiative Plan for homecare measures to help patients to leave hospital or to avoid hospital admission.

The plan is delivering an additional 950 Home Care Packages (HCPs) targeting 10 specific hospitals from September 2016 to February 2017 including Our Lady of Lourdes Hospital Drogheda, Mullingar Hospital, Cork University Hospital, South Tipperary Hospital, Waterford University Hospital, University Hospital Limerick, Galway University Hospital, Tallaght Hospital & St. James’s Hospital and Beaumont Hospital.

Home Help Services

More than 48,000 people are being supported through Home Help Services at any one time. This enables people to continue living in their own homes or to facilitate their discharge from hospital.

10.5 million home help hours were provided in 2016– 100,000 hours more than the target provided for in 2015.

Nursing Home Support Scheme (NHSS) or Fair Deal

For those waiting for long stay care, the Social Care Division is supporting hospital discharges by maintaining the NHSS (also known as Fair Deal) waiting times at no greater than 4 weeks.

Read our Key facts on home support services.

Reduce Patient Waiting Times in ED

The HSE has set targets for the length of time patients wait in ED before they are either discharged or admitted to hospital. These targets are known as Patient Experience Times (PET). The Winter Initiative aims to improve compliance with PET targets for the categories listed in the table below.

Winter Initiative – PET Target % compliance at the end of December 2016
Patients waiting less than 24 hours 98% 97%
Patients aged 75 and over waiting less than 9 hours 75% 59%
Patients waiting less than 6 hours 75% 64%

Reduce the number of patients awaiting hospital admission

  • Three times daily at 8 a.m., 2 p.m. and 8 p.m. acute hospitals report the number of patients awaiting admission to an inpatient hospital bed.
  • The system known as TrolleyGAR enables daily monitoring of ED performance and helps trigger the hospitals’ response during busy periods.
  • The Winter Initiative target is that all hospitals will meet their 8 a.m. TrolleyGAR threshold which is 236 on a national basis.
  • For further details see TrolleyGAR website.

Open additional hospital beds

Additional acute beds are being provided in some hospitals including Beaumont Hospital,the Midlands Regional Hospital Mullingar, Galway University Hospital, the Mater Hospital and the Midlands Regional Hospital Tullamore. 18 additional step down beds have opened in the Mercy University Hospital Cork.

Orthopaedics, spinal and scoliosis waiting list initiative

Additional funding was provided to address orthopaedic and scoliosis waiting lists in Cappagh National Orthopaedic Hospital, Our Lady’s Hospital for Sick Children, Crumlin and Tallaght Hospital. By the end of November 2016, 540 patients had their procedure completed, were scheduled for treatment or had been clinically reviewed and taken off the waiting list.

Improve minor injury services

Injury units can treat broken bones, dislocations, sprains, strains, wounds, scalds and minor burns that are unlikely to need admission to hospital. Find out more on our Injury Units page.

There are now 11 Injury Units across the country in Smithfield Dublin, St Columcille’s (Loughlinstown Dublin), Mercy Injury Unit ( Gurranabraher, Cork), Bantry, Mallow, Ennis , Nenagh , St John’s Injury Unit (Limerick), Roscommon , Dundalk and Monaghan.

The Mater Smithfield Rapid Injury Clinic was allocated additional funding to treat more patients over the Winter period. The service was expanded to provide for an additional 100 patients each week, with patients being seen in a more timely way, to include a Saturday service.

Read our Key facts on Emergency Departments this winter.

Expand Community Intervention Teams and Services

A key development for the winter plan is the expansion of community intervention teams (CIT). A Community Intervention Team (CIT) is a specialist team which provides rapid and integrated care to a patient for a defined short period of time. This includes: IV antibiotics (detailed below); wound dressings; acute anticoagulation management; Supra-Pubic Catheter / Ostomy Care; Medication Management; Enhanced Nurse Monitoring; Care of patients with respiratory illness.

Winter Plan funding 2016/17 was used to extend the CIT service. This has enabled the development of two new teams in South Tipperary and Roscommon bringing the number up from 11 CITs to 13, the teams in place are as follows:Dublin North, Dublin South,Kildare, Louth, Meath, Wicklow ,Carlow/ Kilkenny ,Midwest (Limerick, North Tipperary, Clare) ,Cork,Galway and Waterford.

A limited service is available in Sligo which operates a shorter working day; South Tipperary became operational in December 2016.

The Winter Plan 2016/17 funding also enabled the Primary Care Division to expand the service in existing CITs in Dublin North, Louth/ Meath, Galway and Cork. There has been a significant increase in the number of referrals to CIT in the past year, however, there is capacity for additional referrals, particularly in the areas above which have expanded their service. Activity increased to 27,000 interventions in 2016 and an anticipated growth in 2017 to provide 32,000 interventions.

Increase funding for Aids & Appliances

Additional funding was received in 2016 for aids and appliances to support discharge of patients from hospitals as well as facilitating hospital avoidance. €5m has been spent in full, with over 3,400 patients benefiting from provision of these aids and appliances to facilitate hospital avoidance/ hospital discharge since 1/10/2016. A significant amount of stock has been purchased and is available for supply to patients.

Transitional Care Beds

An additional 58 Transitional Care beds will be approved weekly and made available to all acute hospitals, in addition to the funded level of service of 109 per week.

Expand medical service to homeless people in the Dublin City

The HSE has funded additional GP and nursing services to provide an expanded medical service to homeless people in the Dublin city area. The funding will enable the provision of seven clinics and follow up services every week from Monday to Thursday.

Find out more about Primary Care.

Read our key facts on Primary Care this winter.

Flu Vaccination Campaign

By end of November over 400,000 flu vaccines had been provided by GPs and pharmacies since the commencement of the campaign in September for the community at large and health care staff.

Read more about our flu vaccination campaign.

HSE urges at-risk people to get flu vaccination

Big increase in at risk groups getting flu vaccine this season

5th Jan 2017 HSE Flu Update

12th Jan 2017 HSE Flu Update

26th Jan 2017 HSE Flu Update

Get advice on fighting flu and other bugs on undertheweather.ie

Progress updates

The Implementation and delivery of the Winter Initiative Plan against the set target is carefully monitored and reported.Each month we'll be publishing updates online to show how we're progressing against our key targets. You can access them at the links below:

Dec 2016: December progress update

Jan 2017: HSE announces enhanced Winter Plan measures

Norovirus reports

Read the latest reports of Norovirus (also known as winter vomiting bug) here.