Surgical operations on patients will be cut by a third between now and the end of the year and some health services will only operate at half the level they were at pre-Covid-19.
The devastating impact of living with Covid-19, and the limitations infection control imposes on some of the sickest patients, was outlined by the HSE yesterday.
HSE chief Paul Reid said that he was now drawing up a "winter plan like no other" as the threat of Covid-19, flu and patient demand looms.
He was speaking as the HSE's phased plan for a 'Safe Return to Health Services' until the end of 2020 highlights the huge obstacles posed by infection risk, which are resulting in less patients being seen.
The plan warns that "theatre and procedure room activity may remain reduced by up to 30pc depending on the type of procedures being undertaken and extra safety requirements, PPE and infection control".
Patients also need to be tested for the coronavirus in advance .
It says that procedures known as scopes are only operating at 50pc capacity.
Outpatient clinics are now running at 50pc to 60pc of their normal capacity. This should be increased to 70pc by September and be at this level until the end of the year.
Patients can expect less face-to-face consultations with doctors and instead half of these will take place over the phone or via video call.
"We know we have to operate within reduced capacity all across our systems which will make things slower in how we deliver services. Services will take longer to complete," said Mr Reid.
The plan to restore non-Covid-19 services is being carried out with a very uncertain lens and the risk of another surge in infection.
He asked people to "continue to stick with us".
"We never said this was going to be a short game. It was always going to be a long haul," he said.
Meanwhile, Ireland should look at moving away from nursing homes as it is difficult to protect older people from Covid-19 in congregated settings. It follows the damning Hiqa report showing many nursing homes hit by Covid-19 had poor infection control and governance.
Mr Reid said: "This is not a time for any one sector blaming the other.
"We all have to put up our hands and take really big learnings around how nursing homes are overseen and what learnings we have seen throughout the pandemic so far.
"The first learning is the obvious one, nursing homes and particularly congregated settings are not the environment in which you can protect people in a pandemic," he told Newstalk FM.
Nursing homes have been at the epicentre of a disease outbreak which has proven most deadly for the frail and elderly.
Mr Reid said the health service needed to look at how they care for older people in the future. "It can't be in congregated settings," he said.
"If you look at Denmark, they stopped building nursing homes a few years ago and I think that is lesson number one for Ireland.
"I do believe there is a gap when it comes to nursing homes and that is an issue we have to address, whether it is clinical oversight or governance. I am wide open as CEO of the HSE, to any learning that people believe we can make."