Dr. Ambrose McLoughlin:

I thank the Chairman and members for welcoming me to this committee. I welcome this opportunity to appear before them to discuss the Department's Statement of Strategy 2011-2014. I am joined by colleagues from the Department - Dr. Fergal Lynch, deputy secretary general, Ms Bairbre Nic Aongusa, assistant secretary and Mr Tony O'Brien, director general designate of the HSE and also a member of the MAC at the Department.

The statement of strategy 2011-14 sets out the high level aims and objectives of the health system for that period. It also states the Department's functions and responsibilities in leading health service reform and identifies our strategic goals and programmes for improving health outcomes. This three-year period will be a time of very significant change for the health services. The programme for Government commits to the development of a universal single-tier health service, supported by universal health insurance, providing access to health services based on need rather than income. We must ensure that patients access care in an appropriate setting, which will require the improvement and development of community-based services through the primary care system. New models of care will be introduced across all services which will treat patients at the lowest level of complexity and provide quality services at the lowest cost. These ongoing initiatives will inform the most appropriate structure, staffing and organisation of services and also deliver greater productivity. Increasing efficiency and productivity will require changes in how, where and when people work. It will require greater flexibility in work practices and rosters to maximise the efficient delivery of services. This scale of reform combined with our financial and economic circumstances will present many and difficult challenges for the health services in the years ahead.

The statement of strategy sets out the process by which the Department will deliver on its role and strategic goals within this context. Total current expenditure for the public health service is being reduced by nearly €1.1 billion over the period 2011-2014 under the national recovery plan. However, in order to meet unavoidable pressures and Government commitments, in excess of €2 billion will have to be taken out of the health budget over the same period. The number of health service staff has been reduced from a peak of 111,000 in 2007 to fewer than 102,000 now, with a further 6,500 to depart by 2014. While this scale of financial and staff reductions has put pressure on the health system, the system has responded by delivering more with less.

With regard to delivery on the programme for Government, significant progress is being made on the implementation of the health integrated reform plan. Legislation is being progressed in regard to HSE governance, extending free GP care, risk equalisation and reference pricing. Reports have been published in regard to the disability value for money and policy review and the review of the Mental Health Act 2001. The special delivery unit continues its support to hospitals to maintain the downward trend in regard to numbers waiting in emergency departments. Implementation plans have been agreed for a number of clinical care programmes which will improve the quality of patient care, improve access and save money. Work is ongoing on the completion of the framework for smaller hospitals and on the development of hospital groups. The national carers' strategy has recently been published, the national positive ageing strategy is nearing completion and the national strategy on dementia will be developed by 2013. The reform of mental health services continues to progress in line with A Vision for Change and 13 of the old psychiatric hospitals have closed completely or have closed to new admissions. The policy framework for the future of public health 2012-20, Your Health is Your Wealth, is nearing completion. The report of the national substance misuse strategy was launched in February 2012 and an action plan to implement its recommendations is being developed. The special action group on obesity is progressing cross-sectoral measures to help halt the rise in obesity. Discussions are ongoing with a view to achieving further reductions in pharmaceutical costs and the use of generic alternatives. The health sector action plan continues to be implemented across the health sector. Key commitments include reviewing rosters, skill mix and staffing levels, increased use of redeployment and changing work practices.

These and related follow-on initiatives will form the Department's work programme for the coming years.

The Department's statement of strategy sets out what we want to achieve over this timeframe, how we intend to make it happen and how we will know, and to what extent, we have succeeded. We have organised our goals and actions by strategic programme areas. Programme 1 relates to fair access and sustainability. Programme 2 relates to patient safety and quality. Programme 3 relates to health and well-being. Programme 4 relates to primary care. Programme 5 relates to acute hospitals and programme 6 relates to specialised care services. However, it should be emphasised that four elements underpin and inform all of the strategic programmes: keeping people healthy; providing the health care people need; delivering high quality services; and getting the best value from the health system resources. The overall performance framework for the health system and the performance indicators developed under the framework will be used to assess the health system's progress in regard to its core objectives and will be reported on annually. That concludes my statement. Together with my colleagues I look forward to our discussion on the statement of strategy and related issues. We will take questions from members.