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The Stark reality of winter plans — fact can be more harsh than fiction

f the HSE is ever in need of a new slogan, it could do worse than use one of the most famous lines from the TV series Game of Thrones, which came to an end earlier this year. The phrase ‘Winter is coming’ is by now familiar even to those who never watched the show. It was the motto of the House of Stark, one of the foremost families in the mythical land of Westeros and was the title of the first episode. The line was repeated frequently throughout the series, usually with faux-Shakespearian intonation and ominous portent. According to the Game of Thrones fandom wiki, “the meaning behind these words is one of warning and constant vigilance”.

‘Winter is coming’ and its metaphorical implications surely resonate with the occupants of Dr Steevens Hospital. The characters in Game of Thrones even had their own winter plan of sorts, although this mainly involved battling ice zombies. The HSE’s plan, which was launched on 14 November, confined itself to tackling hospital overcrowding. A further parallel is worth making, if I am not pushing the comparison to breaking point. In the series, the protagonists were fighting off an existential threat; if the white walkers (ice zombies) won the battle, Westeros would have been consigned to an endless winter. In a way, this is the current reality for the HSE.

The Executive’s winter planning process is designed for the health service to cope with the higher rate of attendances hospitals face over the winter period. But as everybody knows, in Ireland, hospital overcrowding is not limited to winter. Instead, it has become a ‘crisis’ afflicting the health service all year round. Likewise, stretched community services require support constantly, not just between November and February. Speaking about the winter planning process last year, RCSI Hospitals CEO Mr Ian Carter stated “short-term reactive planning to specific periods of the year cannot continue to be the solution”.

To be fair to the HSE, this is something that the Executive has acknowledged. The National HSE Winter Plan 2018/2019 focused on nine hospital sites, with associated Community Healthcare Organisations (CHO). An integrated winter action team (WAT) was established on each site that reported to the national winter oversight group.

“The approach taken by WATs should be maintained throughout the year, with a targeted focus on the full winter period,” according to the Winter Plan 2019/2020.

The 2019/20 plan will see €26 million in funding go towards: The Nursing Home Support Scheme; transitional care; home support packages; and WAT initiatives. Is there a value in the winter plan if ‘winter’, in the sense of emergency department overcrowding, at least, is never-ending? Evidence shows that there are higher rates of respiratory viruses circulating at this time, including seasonal influenza, norovirus and healthcare-associated infections, which all put greater pressure on health services. It is only sensible to plan for these eventualities. But any illusion that overcrowding is a seasonal occurrence has long since been dispelled.



Rather than the Starks, others may prefer that the HSE adopt the philosophy of another prominent family in Westeros, the Lannisters. According to their unofficial motto: “A Lannister always pays his debts.”  Such a focus on balancing expenditure would no doubt be welcomed by the Department of Public Expenditure and Reform in light of the HSE’s constant budgetary problems.

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