Mr. Tony O'Brien:

I thank the Chairman and members for the invitation to attend this meeting. I am joined by my colleagues Ms Laverne McGuinness, chief operating officer and deputy Director General, Mr. Tom Byrne, chief financial officer, Mr. Barry O'Brien, national director, human resources, Mr. Ian Carter, national director, acute hospital services and Dr. Áine Carroll, national director, clinical strategy and programmes. They will assist me in dealing with any questions that arise as we go through. Before the meeting, the committee requested replies on a number of specific issues and will have received a written response to these issues from the HSE and the Department of Health with a detailed report on medical cards and information on NCHDs.

Overall activity remains high across the majority of HSE services within community and acute hospitals. Emergency admissions were up by an additional 7,969, or 4.9% in the first five months of this year over the previous year, and remain 6% over expected levels of activity.

A total of 414,220 elective inpatient and day admissions were carried out in our acute hospitals for the first five months of the year, which is broadly commensurate with the volume recorded for same period in 2012.

GP out-of-hours contacts remain high at almost 420,000 contacts up to the end of May, which again is commensurate with activity in the same period of last year. This service plays a very important role in pre-hospital emergency care.

At the end of May more than 2 million people were covered by either a medical card or GP-visit card, which is a significant milestone in terms of numbers. In May some 22,706 long-term public and private residential places are supported under the nursing home support scheme in the first five months of the year, broadly in line with the figure - different by three - for the same period in 2012.

In setting out the financial situation it is important that it is considered within the following context. As outlined earlier, there were significant pressures on our services. This has had an impact to date on our costs as well as on our ability to fully sustain the very important improvements made last year in areas such as access times to scheduled care. There has been a total reduction to the HSE budgets and costs of €3.3 billion, 22%, since 2008. There has been a reduction in staffing levels of more than 11,320 whole-time equivalents since the peak employment levels in September 2007.

In Vote terms to the end of June there is a cumulative €10 million surplus on net current HSE Vote 39 expenditure. However, it is important to note that the areas which give rise to the surplus are in most cases expected to reverse by year-end and therefore are unlikely to be available to offset other deficits on an ongoing basis. On income and expenditure, the HSE is reporting a year-to-date deficit of €49.34 million to the end of May 2013.

The HSE is not flagging any new concerns or risks beyond those clearly set out within the national service plan for this year as approved by the Minister on 9 January 2013 and within the regional and hospital group service plans which were published in February. Four key risks remain which I will now outline. It should be noted that it is not within the HSE’s sole capacity, within the parameters of service plan, to address all shortfalls that may arise in respect of the following items.

Within PCRS the scale of savings required in the year is €353 million. There has been strong financial performance against this target. The service plan anticipated that regulations under the FEMPI legislation would provide for projected savings on professional fees of approximately €8 million to €9 million per month from May onwards. While the implementation of this legislation was delayed, it is now in place and savings under this heading will be delivered from August.

Achieving the €150 million budget reduction assigned to the HSE within the 2013 service plan is fully reliant on the outcome of the recently published Haddington Road public service agreement. While we are in the process of assessing in detail the potential savings arising from the implementation of the agreement, this validation process is complex. However, we are confident that €420 million will be delivered during the life of the agreement.

Private health insurance income legislation has already been mentioned. That legislation is now in place. We expect to see the full benefit of that in 2014. On private health insurance income - €104 million accelerated income in 2012 - the accelerated income received will need to be sustained this year in order to avoid any adverse effect on the HSE Vote. Of this, €20 million can be achieved through HSE internal processes. Engagement is ongoing with the insurers through the consultative forum on health insurance, seeking to progress this matter.

In terms of direct services, without corrective action within the remainder of our community services and in particular hospital services, there would be a deficit of €104 million, inclusive of €25 million in local schemes based on cumulative data for May 2013. For this reason hospital and community services have been formally requested to identify additional cost containment measures to safely bridge any projected direct services deficit.

Assuming that approval will be given to utilise once-off surpluses, including potential pension and time-related savings, the expectation is that direct services will substantially deliver within the allocated resources.

As members will be aware, in advance of this meeting we submitted a detailed report on medical cards. However, I wish to refer briefly to the issue of discretionary and emergency medical cards which has been the subject of recent publicity and is covered in our submission. The HSE has guidelines in place on the provision of discretionary and emergency medical cards. Medical cards can be provided on discretionary grounds in certain circumstances where an applicant’s income is in excess of the income guidelines. As at 1 June 2013, the number of discretionary medical cards is 59,012 and discretionary GP visit cards is 19,186. The guidelines for the consideration of discretion have not changed in the centralisation of medical card processing.

Since the number of medical cards is higher than ever, it is incorrect to conclude that because discretion has been involved in fewer cases medical cards are harder to get. In the case of emergency medical cards, these are provided to patients who are terminally ill, or are seriously ill, and in urgent need of medical care they cannot afford. Emergency medical cards are issued within 24 hours of receipt of the required patient details and letter of confirmation of condition from a doctor or consultant.

As with discretionary medical cards, the guidelines for the consideration of emergency medical cards have not changed in the centralisation of medical card processing. We have given reassurance to cancer sufferers over the past days that there has been no change to the eligibility criteria for receiving a medical card.

Investment in mental health services is important. There are 123 general adult community mental health teams nationally. In its 2012 service plan, the HSE prioritised €35 million and 414 WTEs for reinvestment in mental health to progress the objectives in the programme for Government. One of these objectives was to enhance general adult, and child and adolescent community mental health teams. In its 2013 service plan, the HSE will build on this investment with a further €35 million to strengthen general adult, and child and adolescent community mental health teams. Of the 414 posts allocated in 2012, 363 posts are in place with a further 23 offered and being processed through Garda clearance, etc. These posts include multidisciplinary team members across all the health professions.

Of the 477 posts approved in 2013, 133 posts have been accepted by candidates. A further 16 offers have been made from existing panels. The HSE is establishing new panels and other arrangements to fill the remaining posts with the intention of filling as many of them as we have candidates for within the current year.

This concludes my opening statement and together with my colleagues we will endeavour to answer any questions members may have.