Mr. Tony O'Brien:

I thank the committee for the invitation; the Chairman has taken care of the introductions.

The HSE national service plan 2013 was submitted to the Minister for Health on 21 December 2012 and approved on 9 January 2013. On 28 February, the national operational plan, regional service plans and hospital group plans were published to ensure that the HSE has a robust planning framework to support the implementation of the national service plan. These reflect the first full year of implementation of Future Health, a Strategic Framework for Reform of the Health Services 2012-2015, which sets out the Government’s priorities for the health services.

The gross current Estimate for the HSE this year is €13.4 billion, a net increase of €71.5 million on the previous year. However, the reduction required of the HSE in 2013 is €721 million which is a total reduction to HSE budgets since 2008 of €3.3 billion or 22%. In addition, staff levels have reduced by over 10,000 whole-time equivalents since 2009.

The scale of the financial challenge continues to be significant in 2013. Taking account of the budgetary reductions borne by hospitals over the past number of years and the challenge to reduce expenditure at the pace required, the 2013 budgetary allocation process has endeavoured to allocate more realistic hospital budgets with targets that are challenging but attainable. This rebalancing of hospital budgets is made possible by driving changes in policy and driving further cost efficiencies of €383 million in primary care schemes.

The budgetary framework seeks increased income targets of €77 million which requires legislative changes, increased non-pay savings of €43 million and a reduced pay bill of €286 million, primarily linked to measures under the public service agreement. The measures include implementing changes in rosters and skill mix.

The 2013 service plan outlines new expenditure of €90 million in respect of demographic pressures experienced by health services and €390 million to address deficits from 2012. The plan also provides for an investment of an additional 1,025 whole-time equivalents in a number of key prioritised areas. It will be necessary to achieve a reduction of almost 4,000 WTEs or 4% of the workforce. The impact of the staff available to deliver front-line services is critical and will be a key issue that will most directly impact on service levels in 2013. Managing the pay reductions under the public service agreement will also be a primary focus in 2013.

Regarding acute hospitals, fundamental to the reform agenda is the need to reorganise our hospital resources to ensure patients access appropriate treatment in the right setting, receive the best possible clinical outcomes and provide sustainability for hospital services into the future. In 2013, specific targets include over 600,000 inpatient activity and over 830,000 day cases; that no adult will wait more than eight months for an elective procedure, either inpatient or day case, by the end of the year; that no child will wait more than 20 weeks for an elective procedure, either inpatient or day case; no person will wait longer than 52 weeks for an outpatient department appointment by the end of year; and 95% of all attendees at emergency departments will be discharged or admitted within six hours of registration. In addition, when the Government concludes it deliberations and publishes the relevant reports, we will establish hospital groups, implement the small hospitals framework and implement new methods of resourcing in hospitals to drive further efficiencies.

Regarding the ambulance service, a significant reform programme has been under way in recent years to reconfigure totally the way we manage and deliver pre-hospital care services. A further €12 million investment will take place in 2013.

With regard to cancer services, the national cancer control programme will continue to focus on maximising timely access to services and the development of a comprehensive national service. A €17 million additional provision has been made in 2013 for the increased costs of cancer drugs. We will see both the launch, which has already occurred, and the continued development of the national colorectal cancer screening programme and the diabetic retinopathy screening programme during 2013. The latter is not a cancer programme but is managed through the cancer programmes.

The primary care team remains the central point for service delivery in the community. Some €20 million will be invested this year to support the recruitment of prioritised front-line primary care team posts and to further develop community intervention teams. In addition, funding has been provided to continue the implementation of the diabetic retinopathy screening and audiology programmes. Some 17 clinical nurse specialists are in the process of being appointed to support the delivery of the integrated diabetes care model. The total budget for the primary care reimbursement services, PCRS, in 2013 is €2.5 billion. Very substantial cost efficiencies are required to support reduction of €383 million which is outlined in the service plan. Provision has been made for growth of up to 100,000 medical cards and up to an additional 130,000 GP visit cards. Policy changes will reduce eligibility for approximately 40,000 people currently in receipt of medical cards, giving an anticipated net growth of 60,000 cards. Ongoing assessment of eligibility will also continue throughout 2013, with a number of people losing eligibility as a result. These will include individuals in all age categories.

In 2013 we will provide almost 23,000 long-stay residential care places for older persons in line with the funding available under the nursing home support scheme. We will provide home help and home care packages at the levels planned for in 2012. Some 10.3 million hours of home help service and 10,870 people will be in receipt of home care packages.

We have made provision of €1.5 billion for disability services in 2013, a 1.2% reduction from the previous year. We will provide 1.68 million hours of personal assistance, which is the same as committed to in 2012. We will also prepare for the implementation of the national HIQA standards for residential care during the year.

In 2012 an additional €35 million was allocated to mental health services with an associated 414 posts. At the 27 February 2013, 307 of these posts were filled and the remaining posts are in the process of being filled. In addition to the completion of the mental health investment programme for 2012, a further €35 million has been allocated for year two, 2013, of this investment programme. Our priorities in 2013 will be to further develop suicide prevention initiatives, forensics and community mental health teams for adults, children, older persons and mental health intellectual disability and to continue to rationalise adult inpatient and continuing care provision.

Children and families services will be disaggregated from the HSE into a new agency, the Child and Family Support Agency. The main priority for the HSE is to plan for this safe transfer during the year.

Funding of €341 million has been allocated to progress our capital plan. The plan prioritises the development of the National Children's Hospital, the replacement of the Central Mental Hospital, the national programme for radiation oncology and the continued roll-out of primary care infrastructure. The commitment to deliver the mental health investment programme in line with A Vision for Change will continue. Provision is also made for the redevelopment of the National Rehabilitation Hospital and improving long-term care facilities to support services for older people.

The 2013 national service plan sets out a very significant financial challenge. Very substantial savings are required in pay and in the primary care schemes as well as increased collection of income. Managing changes to our staff resource will require a lot of management attention. At the same time a number of critical key areas for investment will take place as I have outlined. A robust process has been put in place to monitor and manage the performance of the plan and any deviations from the plan will be identified early and remedial actions put in place.

I, together with my colleagues, look forward to addressing questions from members.