Mr. Ian Carter:

I thank the Chairman and members for the opportunity to appear before the committee. As requested I will be brief and stick to the five minutes allocation.

The RCSI Hospital Group comprises seven hospitals, Beaumont hospital, Cavan hospital, Monaghan hospital, Rotunda hospital, Louth hospital, Connolly hospital and Our Lady of Lourdes hospital. It is a single governance construct with five HSE hospitals and two voluntary hospitals incorporated. The position of the chief executive officer of the hospital group and the chief executive officer of Beaumont hospital are both held simultaneously by me.

The RCSI Hospital Group serves a population base of 800,000. In terms of service provision, the group provides all secondary care services, a designated cancer centre and is also the national centre for neurosurgery and renal transplantation.

I will not dwell on the performance metrics as they are self evident but every single patient modality in terms of activity is increasing. On every single metric we are looking at about a 10% increase in activity on last year's figures across both inpatients and the emergency department. The focus for the group this year has been on trying to secure performance improvements in respect of access to the emergency departments. The metrics are very clear and to date this year we have been able to secure an overall significant volume reduction in the number of patients presenting to emergency departments waiting for beds. That is continuing as we speak.

In terms of elective access, as our emergency department performance has improved, we are in a position as a group to increase the number of patients waiting for elective treatment to be brought in and treated and the figures to date compared with those for last year, show an increase of 2,500 in the number of elective treatments.

Our core budget is €676 million and we have a workforce of just over 8,000. We will break even in terms of our budget. Our workforce is broadly static in comparison to the end of last year.

We have six key objectives as a group. We want to improve access performance in terms of both emergency and elective access, doing no preventable harm to patients. We want to operate fiscal prudence and to work in terms of integration in two paradigms - the concept of a single control hospital facility spread across six sites, migrating the capability and capacity demands across the six sites and working strongly to integrate with the community, with particular focus on chronic disease.

The main action of the group beyond improving access has been its ability to treat more patients. This year the group has been able to treat more patients across the six sites. We are matching capability with capacity. A series of initiatives whereby patients waiting in Beaumont hospital for elective surgery are now routinely being treated in Cavan hospital. Patients waiting for endoscopy are routinely treated in Cavan or Connolly hospitals. With an ambulatory gynaecology unit on the Connolly campus, there is no longer a need to require patients to attend Beaumont or the Rotunda hospitals. With the creation of plastic surgery services on Connolly hospital campus, patients therefore do not need to attend Beaumont hospital. The concept is to provide an integrated site, whereby Beaumont's role is as a complex provider and Connolly is able to provide a stronger service in terms of simple or non-cancerous surgery.

Likewise we have migrated services to the Louth campus. The aim is similar to the role of the small hospitals, to ensure we have productive units that are able to undertake simple surgery. On the flipside, we have moved complex upper gastrointestinal surgery to Beaumont, following in line with the national cancer strategy. The idea is to transfer patients requiring complex upper gastrointestinal, GI, surgery or cancer treatments to the level 4 hospitals.

I will outline the key challenges for the group as we face into 2017. We face the ongoing difficulty of recruiting and retaining nursing staff. We have a workforce of just under 3,000 nurses and on average the vacancy rate is 16%. We have a less than optimal reliance on agency staff. Also, for the smaller hospitals we have difficulty retaining or recruiting consultant and junior hospital staff, particularly for levels 2 and 3 hospitals.

In terms of integration, we are working in a very hospital centric model. One broadly has two ports of call for a hospital, either through the outpatient department or the accident and emergency department. If we look at the fact that of the patients presenting to a hospital, 85% of them will have some form of exacerbation of chronic disease. We have an overly hospital centric model, whereby more care could be delivered in the community, but the current structure means more care is delivered in the hospital.

While there is a good working relationship with community services in terms of the integrated pathway, we have a mismatch in terms of supply and demand, particularly when it comes to community support, which means that at any one time across the whole group, between 10% to 15% of our bed occupancy will be filled by elderly patients predominantly who are waiting discharge to either community homes or needing home care support. At present about 170 beds are inappropriately occupied.

In terms of funding we face challenges in meeting the income target set by the HSE which will not be achievable.