Mr. Tony O'Brien:

I appreciate the invitation to attend the committee. The other members of my team have already been introduced by the Chairman. I note that the committee requested information and will have received a written response from the HSE and the Department of Health and Children. I will therefore confine my opening statement to updates for the committee.

Members will be aware of last week's television programme on the National Ambulance Service, or NAS, and I would like to clarify a number of points in that regard. The programme placed considerable focus on officer response vehicles, or ORVs. These vehicles and the officers who operate them - all of whom are paramedics or advanced paramedics - are available to respond to emergency calls as and when required. During the period January to March 2014, ORVs carried out 629 emergency call-outs, of which 252 occurred outside the normal working hours of the relevant officers. The NAS has recently commissioned a national capacity review which will utilise a modelling provider with extensive international experience of modelling ambulance operations. The review will analyse current ambulance vehicle numbers, call cycles and response time performances. Additionally, the review will examine current and projected resourcing levels for emergency ambulance cover, intermediate care and ORVs. Overall, the review will determine the level of resource required across the country.

Despite statements in the programme referring to cutbacks in the NAS, it is important to understand that despite cutbacks in other areas of the health services, the budget available for the National Ambulance Service increased by 4.3% between 2012 and 2013. There is a further increase of 2.6% in the 2014 allocation to the service. I note that €9.3 million was spent on NAS vehicle equipment and vehicle replacement in 2013, while a further €7.5 million is set aside for 2014. This has resulted in the purchase of replacement vehicles as part of the fleet modernisation programme, including 27 emergency ambulances, 25 intermediate care ambulances and 27 rapid response vehicles. It is planned to purchase a further 35 emergency ambulances this year. A total of €26.2 million is being invested in the development of a single national control centre which will operate at two sites, one in Tallaght and the other in Ballyshannon. It is also planned to spend €4.6 million on a national defibrillator and mechanical CPR purchase programme in 2014. Since 2008, the number of staff in the NAS has increased by 16%.

This is despite a significant reduction in staff in the wider health services.

At the end of 2014, it is anticipated that the complement of advanced paramedics will be 300, an increase of 400% since 2008. The NAS has also trained approximately 300 paramedics since 2008, as well as recruiting and training approximately 70 emergency medical technicians, EMTs, during 2013 and proceeding to recruit a further 20 paramedics during 2014. In addition, the Emergency Aeromedical Service has completed 556 missions since its inception in June 2012 to February 2014. In 2013, the Irish Coast Guard also performed over 300 helicopter missions in support of the NAS and will continue to do so in 2014. The HSE and the NAS are fully committed to and will continue to invest in services to ensure the best outcome for their patients in addition to the investments towards improvement which are already under way across the service.

On the eight overall recommendations specific to the HSE in the recent report on maternity services at Midland Regional Hospital Portlaoise, I will update the committee on the following key actions that have been undertaken to date. The staff at the hospital have apologised unreservedly to any families who experienced care below the expected standard. On behalf of the HSE, I reiterate that apology. A new management team was appointed on 28 February on an interim basis to run the hospital’s maternity service. Dialogue has already commenced with the Coombe Women and Infants University Hospital to provide support to the Portlaoise maternity unit in a collaborative working arrangement. The HSE is implementing its policy on open disclosure, while a full diagnostics review is under way at the hospital. The HSE has issued a directive to all health care providers requiring them to notify the director of quality and patient safety and HIQA, the Health Information and Quality Authority, of all key risk events.

Other cases that have become known to the HSE since the airing of the television programme where families were not treated in a sufficiently compassionate manner by the hospital’s maternity service are being dealt with by the new management team and the regional director for performance and integration.

The 2014 service plan highlighted that the health service faced a severe financial challenge in 2014. As of the end of January, the HSE is not flagging any new concerns or risks beyond those which were clearly set out in the national service plan. On 31 January, the HSE showed expenditure of €999.5 million against a budget of €975 million, representing a variance of €24.5 million. A material proportion of this variance, €20.2 million, is in the acute hospital sector, with €5.9 million, or 29%, of the acute deficit relating to hospital income generation and €10.1 million, or 50%, relating to agency staffing levels. Up to €4.2 million, or 41%, of the acute variance relating to agency staffing is in the medical category, which relates to the growth in NCHD agency costs. However, it should be noted that there remains a significant issue nationally relating to the recruitment of NCHDs, which is driving agency expenditure in certain hospitals.

As well as the wider performance management of the acute system in 2014, a more targeted approach with individual poorer performing hospitals is now being undertaken. The acute system is facing a challenging year, with legacy deficit issues to be addressed and with hospitals expected to meet the full value of cost containment plans unachieved in 2013 of €56.5 million. This is in addition to the full value of savings measures that are to be delivered in 2014.

There is an emerging issue with private health insurance income, and the HSE has identified an increase in claims being pended for payment by insurers. This issue has been highlighted to insurers and the HSE is actively engaging with them to reduce the lead time from submission to payment of claims. This will improve the overall cash position.

Overall in January, the data with regard to activity against the service plan shows that the health service has seen an increase in new emergency department attendances of 3%, or 2,261 people, and a 3% increase in emergency admissions in January of 2014; a 34% reduction was achieved in the number of emergency department patients waiting on trolleys for ward-bed accommodation between January 2011 and 2014; and day care attendances were 2% lower, at 1,100, than in January 2013.

The health service saw an overall improvement in adult waiting lists in January 2014. At the end of the month, 96% of those on waiting lists, or 41,251 adults, were waiting less than eight months for a planned procedure, as compared with 94% in the same period in 2013. There were 1,764 adults waiting over eight months at the end of the month compared to 3,073 in the same period in 2013.

During the 12 months of 2013, the ambulance service responded to more than 281,000 emergency calls in the AS1 and AS2 categories, a significant increase of 14,000 over 2012. The number of people covered by medical cards as of January 2014 was 1,840,760, or 40.1% of the population. Included in these numbers are 50,505 medical cards granted on discretionary grounds. The total number of general practitioner visit cards as of January 2014 was 125,930, including 27,204 cards granted on discretionary grounds. There are 46,513 clients in receipt of a home help service and 11,969 clients in receipt of home care packages. There are 22,959 clients supported by the nursing home support scheme, NHSS, with 4.1% of the population, or 21,880 people aged over 65 years, supported in either NHSS or saver beds.

The process which has been ongoing with the section 38 agencies to reach compliance with the Government’s pay policy is nearing completion. Since the beginning of the year the regional directors for performance and integration, with support from regional human resources, have been working with each agency through a further process of verification and clarification where a deviance from pay policy was previously recorded to ensure full implementation of the provisions of the pay policy and assist the agencies in reaching compliance. In line with the pay policy, and as part of the ongoing process of reaching compliance, organisations seeking to make a business case for the continuation of an unapproved allowance were invited to submit their business cases for consideration by the HSE. Business cases were also required for the continued payment of allowances which are not encompassed by or in line with the Department’s consolidated salary scales but may have been sanctioned in the past. A total of 202 business cases have now been received. An internal review panel, comprising nominated members of the HSE leadership team, has reviewed each business case in detail and is in the process of making a decision on each case. A report will be published shortly. Up to 143 business cases were received in respect of senior managers - those at a salary level of grade VIII and above - for consideration by the panel. In addition, 59 business cases in respect of salary levels below grade VIII have been reviewed at operational level by the regional directors for performance and integration. The process is nearing completion, following which we will be in a position to provide a full report on the outcome of the compliance process. It is important to note that as a result of the co-operation received in reaching compliance with the pay policy, no agency received a reduction in cash funding.

Turning to section 39 agencies, since the introduction of the national standard governance framework with the non-statutory sector, the HSE has been continuously reviewing and strengthening these arrangements in accordance with the requirements of sound governance and accountability and to ensure they are aligned with the ever-changing exigencies of our health and personal social services. One such enhancement was the introduction in 2013 of a requirement for all agencies covered by a service arrangement, under either section 38 or section 39, to complete a template setting out details of the remunerative arrangements for senior managers - grade VIII and above. The HSE is close to completing a template for verification and validation of service managers’ remuneration in the larger section 39 agencies - namely, those which receive in excess of €5 million in funding annually from the HSE. A report will be finalised by week commencing 14 April, which will be available to the committee.