Mr. Tony O?Brien:

I thank the committee for the invitation to be present. I am joined by Ms Laverne McGuinness, national director for integrated services, Mr. Liam Woods, national director for finance, and Dr. Philip Crowley, national director, quality and patient safety. We will all do our best to respond to the questions of members.

Before I get into the general details of the opening statement I would like to take this opportunity, in common with members of the committee, to extend my deepest sympathy and condolences, and that of the HSE itself, to Ms Halappanavar’s husband, family and friends on their tragic loss. Yesterday, the HSE set out the details of the investigation into the death of Ms Savita Halappanavar. Professor Sir Aralkumaran, an independent expert in obstetrics and gynaecology, is chairing the investigation team. Professor Sir Aralkumaran is head of obstetrics and gynaecology and deputy head of clinical sciences at St. George’s Hospital, University of London. He is also the president of the International Federation of Obstetrics and Gynaecology with more than 40 years’ experience, 30 of which are in clinical and academic obstetrics and gynaecology. Professor Sir Arulkumaran conducted an inquiry at Northwick Park Hospital following ten maternal deaths at that facility.

It is important that the members of the investigation team comprise expertise in the relevant disciplines of anaesthesia, midwifery, obstetrics and gynaecology to review the full range of clinical care provided to Ms Halappanavar. It is also deemed essential that the team includes an independent patient representative, which it does. The HSE announced such an expert, multidisciplinary team yesterday. However, the HSE is taking into account the concerns of Mr. Halappanavar and in that regard the chairman of the investigation team has sought a meeting with Mr. Halappanavar to discuss his concerns.

The HSE is also currently reviewing the membership of the investigation team and members will be aware that the Galway-based members of the team, as announced yesterday, have stood down in the interests of the investigation. Other appropriate experts will be appointed to the team in due course.

On behalf of the HSE I would like to reassure the public, and in particular Mr. Halappanavar and his family, that we are most anxious to expedite the investigation so that we can establish all of the facts and address any possible safety concerns that may arise as a result of the investigation and that could have implications for women attending at our maternity services.

The financial report for the HSE for September shows a deficit of €399 million, 4.4%, against a spend this year to date of €9.543 billion. The main contributors to this are community schemes at €180 million, hospitals at €207 million and community services at €22 million. There are some minor offsetting balances that give a total deficit of €399 million.

September is the first month this year in which there has been a reduction in the deficit reported, which indicates that the cost containment measures in place are having the effect of reducing spend rates. However, the financial situation of the HSE continues to be extremely challenging. The community-based schemes continue to run significant deficits, which increased by an additional €29 million in the month of September. The HSE has a range of measures in place to reduce the year-end deficit.

Activity continues to grow across the majority of HSE services placing considerable demand on resources. The position, as of September, compared to the same period in 2011 shows that. The Minister has already mentioned the 6% increase in emergency attendances. Emergency admissions have increased by an additional 7,091, or 2.5% in the first nine months of 2012 over 2011. The number of inpatient treatments is up by an additional 2.3% or 10,260, and the number of day case treatments is up by 1.8% or 11,257, giving an overall 2% increase in inpatient and day case activity. GP out-of-hours contacts are up by 3.4%, over 24,000 compared to last year. The number of individuals covered by a medical card as of the end of September was 1,838,603; an additional 144,540 individuals were issued with medical cards since December 2011.

The increased service activity levels place considerable pressure on available resources and capacity within the system. The HSE continues to face significant financial challenges to year-end in areas such as child care, acute hospitals and community drugs schemes based upon the demand for services. Health service staff resources at the end of September stand at 101,743 whole time equivalents, a reduction of 11,028 or 9.78% since staff numbers peaked in the health system in 2007. The organisation is currently operating well within its current approved employment ceiling of 102,936. The recruitment embargo remains in place for funding reasons until the end of December 2012.

In recent weeks the HSE, together with the Department of Health, has been involved in negotiations on private health insurance income, consultant contracts and the cost of drugs. The Minister has spoken about the detail of private health insurance income. In addition to that deal, there are a number of initiatives in train to improve income collection. I have emphasised to all hospitals the importance of addressing the issue of income collection in conjunction with the insurers in order that as many resources as possible will be available to the health system. We have set hospital targets for income collection. Hospitals have been instructed to bring down the value of claims awaiting consultant action, and they will also target the highest value claims. This issue was also addressed by health service employers and the two consultant representative bodies at the Labour Relations Commission.

An important feature of the proposals agreed between the parties was a commitment on the part of all consultants to expeditious processing and signing of claims for submission to private health insurance companies. Consultants will be required to complete fully and sign insurance forms within 14 days of receipt of all relevant documentation and to co-operate with the secondary consultant scheme, whereby a secondary consultant involved in a case can sign the claim form if the primary consultant has not signed within a reasonable timeframe. They will also be required to support the implementation of electronic claim preparation. Health service management is proceeding with implementation of this and other measures, having regard to the relevant provisions of the public sector agreement.

We have awarded the contract for the rolling out of an electronic claims management system on 11 HSE sites to replace the current paper-based system. This system is operational at six sites and a further three are expected to be operational shortly. I expect the range of measures outlined will contribute towards improving the collection of income outstanding to the public hospital system.

On 17 September, following detailed engagement between health service management and the consultants' representative organisations, the Labour Relations Commission issued a comprehensive set of proposals regarding the implementation of the Croke Park agreement by consultants. The consultants' organisations are either balloting or have completed the consultation process on the proposals. Rulings on three outstanding issues have been received from the Labour Court. Management will be meeting the parties concerned to make progress on implementation of the recommendations. In the meantime, the HSE and HSE-funded agencies were advised by the HSE's human resources unit to commence implementation of the full scope of the proposed agreement, with effect from Monday, 5 September, under section 1.23 of the public service agreement which provides for employees and unions to co-operate in implementation during the consultation process.

The Minister has spoken about the cost of drugs. Let me refer to the crisis pregnancy counselling services, particularly the issue that has arisen regarding information provided by these services. We provided members with information last week, as requested, but I will provide a further update. Based on the findings in an internal review carried out by the HSE, I have established an independent investigation which will be chaired by Ms Bridget McManus, former Secretary General of the then Department of Education and Science. The terms of reference are being finalised with the chairperson and I expect that the investigation will be concluded as expeditiously as possible.