HSE Winter Plan Update December 28th 2018


Minister for Health Simon Harris and the Taoiseach Leo Varadkar at the winter plan briefing today.

HSE Winter Plan Oversight Group has today (Friday, 28th December) briefed the Taoiseach and Minister for Health on the Winter Plan 2018/19. Implementation of the plan, including the investment of a further €30m, is well underway across our hospitals and community services to manage the expected demand on services including ED attendances, patient admissions, presentations of Older People to ED, managing patients with chronic conditions, trauma, seasonal influenza, winter vomiting and severe winter weather.


Since early December, services have remained very busy with hospitals continuing to report increased patient attendances and patient admissions. Over the past week the number of patients awaiting admission from ED to hospital remained low with many hospitals reporting no waits over the Christmas period.

Yesterday 3,490 patients attended our EDs and 1,054 patients were admitted for further treatment. 684 patients were discharged from hospital yesterday. Today at 8am hospitals recorded 111 patients waiting to be admitted to hospital from ED; representing a 51% decrease in trolley waits versus the same day last year.

The number of delayed discharges (patients whose discharge from hospital has been delayed) remained consistently high in early December but fell sharply in advance of Christmas week and is currently at 483.

GP Out of Hours

Demand for GP out of Hours services remains high, and early indications show it to be in line with 2017 levels. The enhanced measures put in place in GP out of hours services are supporting this service level. The HSE acknowledges the on-going work in this service to support patients over the winter period.

National Ambulance Service

The National Ambulance Service (NAS) reported their call volume as stable over Christmas as expected. This has been helped by good weather and low flu levels. Similar to previous years the NAS dealt with a number of tragic incidents around the country.

Home Care Packages

€10.6 million has been allocated for Home Support Packages to support all hospitals and services. Of these 346 Home Care Packages have been approved and 190 have commenced as of December 23rd. A further 250 packages will be allocated in January.


Flu levels are expected to rise in the coming weeks. More than 60% of people over 50 are living with a chronic condition such as asthma, COPD, diabetes and heart failure. They, along with patients living with cancer and immuno suppression are more vulnerable to infection and need to protect themselves with vaccination against flu and pneumonia. We know that 20% of winter hospital admissions are due to chest infections and prevention is always better than cure. It is really important that all at risk group patients particularly those with chronic conditions get the vaccination. It is still not too late to get vaccinated and this year’s flu vaccine is a good match for the strain of flu circulating.

Winter Planning - 9 Key Sites

Part of the approach to this year’s plan is to focus on 9 key hospital sites and their associated community healthcare organisation over a 4 week period Dec 2018 – Jan 2019.These sites have in previous winters experienced very high patient attendances and waiting times to admit patients from EDs to hospitals wards. Winter Action Teams are managing activity at each of the sites. Key actions include:


  • Providing direct GP access to radiology on a pilot basis over the coming weeks to minimise the number of patients coming to the hospital via the ED for a CT scan or ultrasound.
  • Additional MRI and CTs at weekends on site.
  • Recruiting additional porter staff; to commence first week in January.
  • Extra cardiac investigation sessions to take place in the evenings.
  • Extended opening hours of the Acute Medicine Unit to 10 pm to commence 7th January.
  • Recruiting additional nursing staff to allow the hospital to open escalation beds as necessary.
  • Increase in provision of Community Intervention Teams, to commence in January, current capacity meeting demand.
  • Enhanced Senior Decision makers in ED including ANPs and GPs.
  • Additional home care packages.


  • Winter Clinic for Chronic Diseases in the CUH Campus, COPD and Respiratory Patients, includes assessment, diagnosis , treatment and rehab.
  • Direct Access for GPs for additional MRIs - 10 per week.
  • Additional Private Capacity in Mater Private to commence 28th December 2018.
  • Additional Echos - 25 per week for inpatients.
  • 30 Transitional Care beds available including 14 in the Clonakilty Community Hospital.
  • Reconfiguring of city long term care beds to provide 6 step down beds for CUH in Ballincollig CNU.
  • A Frailty Intervention Therapy Team (FITT) team working in the ED emergency in the CUH, from 2nd January 2019.
  • Additional senior clinicians available in the ED in CUH, in an effort to speed up people’s waiting time in the ED, whether they are admitted, waiting for diagnostic tests or released home.
  • Additional Senior Decision maker at ward Level to increase patient discharges.
  • Opening the Medical Assessment Unit at the CUH 24/7 since 27th December 2018.
  • Suspending some elective surgery.
  • Additional home care packages.

Dublin- Mater Misericordaie University Hospital and St Vincent’s University Hospital

  • Additional diagnostics have been scheduled throughout the weekend in both hospitals to free up additional capacity during the week. These include CT, MRI, Ultrasound, and Cardiac Diagnostics.
  • St Columcille’s Hospital will be opening an additional 8 beds in January.
  • Hospitals are also working closely with their Community Intervention Teams (CIT) and OPAT.
  • Additional private capacity in private facilities.
  • Frailty FIT teams in both hospitals. Geriatric Emergency Medicine and FIT teams in all of the Ireland East Hospital Group’s Model 3 hospitals actively working with their patients and community partners.
  • Senior Decision Makers in each of the Model 3 and 4 hospitals in the Ireland East Hospital Group throughout the Winter peak periods.
  • Additional Healthcare Attendants to augment the nursing service teams and palliative care services.
  • Expanded discharge lounge St Vincent’s University Hospital 7 days a week.
  • Additional home care packages.

Tallaght University Hospital/Naas and Tullamore

  • Extended opening hours for Out of Hours (OOH) services in Tallaght Cross. Extended rostering for weekend days and evening and midweek evenings for GP OOH services TLC and KDoc including 1 mobile unit for KDOC.
  • Opening 6 beds in both Tullamore and Tallaght Hospitals.
  • 15 Nursing Home beds in Belvilla Nursing Home allocated to Tallaght University Hospital.
  • 3 additional beds available in Abbeyleix Community Nursing Unit.
  • Increased capacity for GP OOH (TLC, KDoc and Midoc).
  • Enhanced Rapid Access Frailty Teams at Tallaght, Naas and Tullamore hospitals supported by community partners.
  • Integrated care team for older persons supported by Tallaght University Hospital and Community Healthcare Dublin South, Kildare & West Wicklow.
  • Increase in diagnostics, both an increase on site and out sourcing which will provide additional CTs , MRIs, U/S and Cardiac Echos.
  • Infection Control nurse rostered at weekends.
  • Additional home care packages.


  • Opening an Acute Medical Assessment Unit (AMAU) at UHL 24/7 in a new 19-bay unit in January. This will provide an alternative referral option to ED for GPs.
  • FIT team to operate from AMAU.
  • The old AMAU (17 bays) will be opened as an Acute Surgical Short Stay Unit on a phased basis in January and will facilitate additional emergency procedures during the winter period.
  • Additional emergency theatre lists will also run during the focus period.
  • Increased access to diagnostics (MRI) three evenings a week.
  • Additional Medical Registrar in ED.
  • Increased access to Ultrasound for inpatients.
  • Additional transport facilities to ensure no delays in discharges.
  • Focus on use of CIT & OPAT, fast access to community based beds for transition care.
  • Community staff on-site in University Hospital Limerick, Dooradoyle.
  • Additional home care packages.

University Hospital Waterford

  • Winter clinic for Chronic Diseases - Respiratory COPD / Breathlessness assessment, diagnosis and management in primary are including treatment and rehabilitation benefitting 75 patients in total. Direct access to GPs to avoid presentation to the ED
    to commence 2nd January.
  • Direct access for GPs to Ultrasound, 100 additional per week.
  • Additional access to GPs for x rays in Dungarvan Community Hospital.
  • Additional private capacity.
  • Additional Cardiac Echos for four weeks to commence 2nd January 2019.
  • Extended Hours of Registrars and/ or GPs in ED.
  • Community Intervention Teams will increase from 24 to 30 interventions over the 4 week period.
  • Additional home care packages.

See www.hse.ie/winter for more information.

Last updated on: 28 / 12 / 2018