Mr. Dean Sullivan:

I thank the committee for the invitation to attend its meeting this morning. I am joined by my colleagues, Ms Anne O'Connor, national director of community operations, Ms Angela Fitzgerald, deputy national director, acute hospital services, and Mr. Damien McCallion, national director for national screening services. Mr. Killian McGrane from the women and infants programme is also here. The director general is sitting to my right.

I am very pleased to be here today on what is my first appearance before the committee. In preparation for this meeting, the committee requested information and replies to a number of specific questions and it will have received a written response to them. I will therefore confine my opening remarks to the following issues.

First is an update on CervicalCheck. As the committee is aware, there are a number of strands to the work of the serious incident management team which has been working solidly over the past 12 days with the aim of addressing and allaying the concerns that women and the wider public have about CervicalCheck and its audit process.

Regarding our work to make contact with women directly affected by the failure of CervicalCheck to inform all women of the audit process and its findings in relation to their smears, I can confirm that hospitals have been working since the serious incident management team was established to contact all the women affected and to discuss the audit findings with them. To date, 201 women and their families have been contacted. I understand it has not been possible to contact the remaining eight people and their families to date, as some women are not in the country because they are travelling or living abroad, or are uncontactable for other reasons. All 201 women or their families have been offered a meeting at the earliest opportunity with their doctor at a time that is suitable and convenient to them.

I can confirm the National Cancer Registry Ireland, NCRI, is working with the CervicalCheck programme to carefully reconcile data held by the registry and CervicalCheck to ensure that we have identified all women diagnosed with cervical cancer since 2008 who had a screening history with CervicalCheck. We expect to conclude this data reconciliation process over the coming days. The establishment of an expert international review panel, led by the Royal College of Obstetricians and Gynaecologists and the British Society of Colposcopy and Cervical Pathology, will review the results of screening tests of all women, including any additional women identified by the NCRI and CervicalCheck data reconciliation process, who have developed cervical cancer and who participated in the screening programme since it was established in 2008. This will provide independent clinical assurance to all women about the timing of their diagnosis and any issues relating to treatment and outcome.

As members will be aware from the daily reports published by the serious incident management team, we are working to provide call backs as quickly as possible to concerned women who have rung the information line. As of yesterday, 11,982 women have called the line. Of these, 8,150 women have requested a call back, and of these 3,649 calls have been returned. As members will appreciate, the call backs take a period of time, as in those cases where the person has a history of referral for colposcopy treatment or a history of cancer, we are providing a clinical consultation with a clinical staff member with expertise in colposcopy or cancer treatment. Return calls to women have been made throughout the weekend and will continue through this week, with support from staff in health facilities around the country. The clinical advice is that women who have had normal test results in the past can continue to participate in the cervical screening programme according to their normal schedule. We are working to provide information to women across a range of channels to assist those whose query can be answered without the need for them to call the CervicalCheck information line. Since we began measures to provide public information across a range of channels, the proportion of callers having their information needs met and therefore not requesting a call back has dropped significantly.

I would like to put on record my personal apology at the concern and anxiety that has been caused to women and their families and the wider public as a result of the CervicalCheck controversy. It is essential that we learn lessons and re-establish confidence in the screening programme, as the Minister said, which was and is a public health initiative saving literally hundreds of lives. In this regard, I very much welcome the decision announced yesterday by the Cabinet to establish a scoping inquiry into the issues which have recently come to light. I assure members, the women and families affected and the public at large that the HSE will participate and co-operate fully with this process and with the work of the external expert panel to ensure all of the facts surrounding what has occurred will be known, that we can learn from this and importantly that trust and confidence in our national screening programmes will be rebuilt.

Turning to the Portiuncula Hospital report, last week the Saolta University Health Care Group published the report of the External Independent Clinical Review of Maternity Services at Portiuncula University Hospital. The review examined 18 cases from the period 2008 to 2014. I wish to make the following comments in light of the publication of the review. There have been a number of important developments since the initial review into the therapeutic hypothermia cases in Portiuncula in 2014. There is now a strong policy framework in place, with the development of the national maternity strategy in January 2016, the development of the national bereavement standards in August 2016, and the launch of HIQA’s national standards for safer better maternity services in December 2016.

Following on from the policy framework, the national women and infants’ health programme was established in 2017 to implement the strategy, and to provide leadership and governance for maternity, neonatology and benign gynaecology services. During 2017, the programme visited all 19 maternity hospitals and units at least twice; supported the hospital groups to develop maternity networks, and launched the implementation plan for the national maternity strategy. In 2018, an additional €4.55 million in development funding was allocated to maternity services. The key priorities for that include the introduction of foetal anomaly scanning and the appointment of 28 additional sonographers has been approved; and the supporting of new models of care, particularly the supported care pathway, which is a midwifery delivered approach and is a key focus for 2018. To support this, 52 additional midwives have been approved to take forward the pathway in each maternity hospital or unit. A national implementation group has been established to oversee the development.

On quality and safety, the women and infants programme will be supporting maternity networks to develop a serious incident management forum dedicated specifically for maternity services within each maternity network. A key focus of the national infants' and women’s programme will be to develop these new tools with the services and to improve learning outcomes. Finally, on maternity networks, as the Minister noted, effective governance is a core recommendation in the maternity strategy and more generally in the planning and delivery of health and social care services. Managed clinical networks, called maternity networks, are being progressed and should provide the necessary governance, and ensure that smaller units work closely with tertiary units in ensuring that the provision of consistent, high quality, safe care to women and their infants.

The Sláintecare report provides an ambitious vision of a different kind of healthcare system. It signals a new direction of travel in relation to eligibility, delivery, and funding of health and social care in Ireland into the future. It presents an opportunity and, appropriately resourced and governed, it has the potential to transform the health and well-being of the population, and how and where they access services.

As stated in the HSE national service plan 2018, a key priority for the health service this year is to develop an agreed strategic position with the Department, in the interests of building a safer, more sustainable health service, designed to meet the needs of our population. An opportunity to achieve this is presented in the detail of the implementation of Sláintecare. We will continue to work closely with the Department to ensure that we realise this opportunity.

Integrated health and social care is at the heart of the report which would see healthcare delivered at the lowest appropriate level of complexity through a health service that is well organised and managed to enable comprehensive care pathways that patients can easily access and service providers can easily deliver. As members will be aware, the consultation on integrated health and social care, and alignment of CHOs and hospital groups, is currently under way, with a closing date of 23 May. This is an important engagement and we look forward to learning the outcome and participating in consideration of all of the factors involved in any proposals around integration and alignment, as optimised health service delivery is at all levels of delivery is a common aim.

In the national service plan 2018, we highlight four key reform themes; first, improving population health; second, delivering care closer to home; third, developing specialist hospital care networks; and fourth, improving quality, safety and value. These themes line up fully with key strategic actions within Sláintecare and provide the basis of a phased shift within the way we deliver our services, commencing in 2018, which lays a foundation to build on through specific actions which support the implementation of Sláintecare.

We are also enhancing our planning, delivery and our accountability roles to support change so that it results in service improvements and better experience and outcomes for people. I very much look forward to the upcoming publication of the Sláintecare implementation plan which will inform our corporate plan for the next three years and be visible in the actions planned through our annual planning process for 2019.

The €10.9 billion capital investment in healthcare infrastructure announced in the recently published Government’s national development plan 2018-2027 is very welcome. It represents a significant increase in capital investment over the next decade compared to the past ten years. This increased allocation will allow the HSE to address the areas of greatest clinical and infrastructural risk including the equipment replacement programme in addition to enabling the HSE to deliver on the current capital programme. This allocation will also allow the HSE to plan, develop and commence a construction programme to meet the additional capacity demands outlined in the recently published health service capacity review 2018. As the Minister noted, the allocation will also allow demonstrable progress to be made with the e-health agenda over the next ten years.

The committee’s invitation letter made specific reference to the availability of Versatis, and a more detailed briefing note on the up to date position has been provided for members. For the purpose of the opening statement, I would just like to reiterate that prescribing patterns for this medication had become grossly out of line with expectations for its licensed indications and usage, and access control measures were necessary to address this for patient safety and cost reasons. Members will note from the details circulated that the medication continues to be available for licensed indications, that is, for nerve pain after a previous shingles infection in adults, and a quick turnaround application and appeals system is operational for unlicensed or exceptional access for individual patients. Latest figures indicate that the medication continues to be reimbursed by the HSE for approximately 3,000 patients.

I would like to make a few brief comments on Storm Emma, which was one of the worst storms to hit the country and severely challenged all front-line services. At this time, when the service is making many headlines for the wrong reasons, and the public's trust is reasonably undermined, it is important to acknowledge when the service gets things right. I am sure committee members will join me in recognising the huge efforts of staff across the service, supported by staff from other sectors, who went way beyond the call of duty in the face of almost impossible conditions to ensure all essential health and social care services continued to operate during that period of particularly severe weather. The values and commitment of healthcare workers were particularly demonstrated during this very testing time.

This concludes my opening statement and my colleagues and I will endeavour to answer any questions committee members may have.