Mr. Tony O'Brien:

I thank the Chairman and members for the invitation to attend the committee meeting. As this is my first attendance and that of most of my colleagues at this committee since its establishment I take the opportunity to wish the committee well with its work and assure it of our fullest co-operation and assistance. I am joined today by a number of my colleagues, whose names and titles are in the written version of the statement. I will save time by not reading that out.

The committee requested information and replies on a range of specific issues, which have been provided. I will therefore confine my opening remarks to other matters. On income and expenditure, as at 31 August, the latest published figures, the HSE has recorded expenditure of €8.925 billion against a budget of €8.902 billion leading to a deficit of €22.7 million or 0.26%. Pensions and demand-led areas represent two thirds or €15 million of the overall deficit with the remaining one third or €7.7 million arising within operational service areas.

The HSE is in the process of developing the national service plan for 2017. We are in discussion with colleagues in the Department of Health on the development of the plan and we expect to submit it in draft form on 15 November, which is next week.

In emergency department, ED, performance, there were 909,468 emergency presentations up to August, an increase of 6.1% on expected activity. ED patient experience registrations in August 2016 were 4.8% higher than the corresponding period in 2015. Despite this increase, the INMO 30-day moving average for trolleys in August 2016 was lower than the corresponding period in the previous year by up to 5.6%.

The national service plan for this year prioritises a reduction in waiting times for hospital care with a focus on those waiting the longest so that there will be no inpatient or day-case patient waiting more than 36 months by year end. Hospitals are also required to reduce by 50% inpatient and day-case waiting lists for patients waiting 18 months or longer. At the end of August, 89% of the inpatient and day cases were waiting less than 15 months. In addition, 83% of patients on the outpatient waiting list were waiting less than 12 months and 90% were waiting less than 15 months.

The HSE is supported in the implementation of the winter plan this year, with the provision of €40 million, to provide a comprehensive range of actions and measures across community and hospital services to increase the availability of community care, facilitate timely discharge from hospital and increase hospital capacity.

Specifically, the €40 million provides for an additional 950 new home care packages and 58 weekly approvals for transitional care to support discharges from acute hospitals. An additional 55 acute hospital beds are being provided across a range of hospitals as well as 18 step-down beds provided by the Mercy University Hospital in Cork. The funding will support the expansion of minor injury services in Dublin for an additional 100 patients per week.

Community intervention team services will be expanded and there is an increase in funding for aids and appliances specifically to support targeted discharge of patients from hospitals. A targeted waiting list programme for orthopaedics, spinal care and scoliosis care is being implemented in designated sites by the year end.

In summary, the outcomes to be achieved through the implementation of this plan and through integrated working across community health care organisations and hospital groups are the reduction of delayed discharge levels and reduced numbers of patients on trolleys in emergency departments as well as improved patient experience times. In primary care, the HSE is continuing to work on the shift of clinical activity to primary care. Community intervention teams are now operating in 13 areas and expanding further for the coming winter period. Structured chronic illness programmes are underway for Type II diabetes patients and asthma care for children. Improved access to diagnostic tests such as ultrasound is in place for general practitioners and minor surgery is also under way at 20 GP practices around the country. This programme of work is ongoing and scheduled to increase further in 2017, enabled by developments such as the review of the GP contract and ICT enhancements such as Healthlink, eReferral, individual health identifiers, IHI, and the development of a shared electronic health record.

In mental health, the allocation of an additional €15 million to initiate new developments in 2017 with a recurring full year value of up to €35 million will allow for the ongoing development of services in line with A Vision for Change. Approval has been received for the awarding of the contract for the construction of the new national forensic mental health facility at Portrane. This facility, estimated for completion in early 2020, will replace the existing Central Mental Hospital in Dundrum with a modern facility providing 120 Adult forensic beds, a 10-bed forensic child and adolescent mental health Unit and a 10-bed mental health and intellectual disability unit. There is an ongoing need to improve access to psychological therapies for children. Funding is in place to develop this service and approval is now awaited and expected from the Department of Public Expenditure and Reform to recruit in excess of 100 assistant psychologists.

The 2016-17 'flu campaign which was launched as part of this year’s winter planning is well under way. This year’s campaign is targeting the challenges encountered in increasing uptake levels last year with each community health care organisation, CHO, and hospital group required to develop a 'flu plan. Staff are a particular focus this year with staff vaccination clinics being held in CHOs, supported by peer-to-peer vaccination training. In addition, poster campaigns, text messaging, screen saver reminders and other innovative ideas are being utilised to encourage staff, in particular, to get the vaccine.

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