Mr. Paul Bolger:

I thank the Chairman and the members of the joint committee for the invitation to attend today's meeting. My colleagues in the scheduled and unscheduled care performance unit and I are pleased to be in attendance. I am the director of the unit, which was established in the Department of Health at the end of last year. The core objective of the unit is to improve access for patients to acute hospital services and to reduce waiting times for scheduled and unscheduled care. I am joined by Ms Susan Scally, who is a principal officer with responsibility for unscheduled care, and Ms Linda O’Rourke, who is an assistant principal officer with responsibility for scheduled care. Ms Mary McCarthy, who is sitting behind me, recently joined the unit as a principal officer with responsibility for scheduled care.

I propose to focus briefly on the current position with regard to waiting lists for inpatient day case procedures and outpatient procedures. I will outline the actions taken to date to improve performance and the plans for the remainder of 2018. If it is okay, I will update the committee on the waiting list figures to the end of June, which I received after I submitted my opening statement yesterday evening. I will provide a brief overview on the work that is under way to increase the number of beds in the system in response to the health service capacity review. My team and I fully recognise the impact on patients of long waiting times to access hospital services and the need to make real improvements. The health service will treat 3.3 million people as outpatients this year. It will deliver 1.7 million hospital operations or procedures outside of the additional work of the National Treatment Purchase Fund, NTPF. It is estimated that 435,000 of these 1.7 million hospital procedures, or just more than 25%, are from the waiting lists.

While this level of activity is not fully meeting the demand, progress is being made in improving access. The investment that has been made in this area of health care is delivering better results for patients. If we are to match the increase in demand for services and to reduce waiting times substantially and sustainably, the reform programme set out in Sláintecare needs to be implemented.

The actions outlined to reduce waiting times, improve the accuracy of waiting lists and invest in additional capacity are, nonetheless, important and will improve access for patients.

The programme for Government contains specific commitments to improve waiting times for hospital procedures. In total in 2017, €17.5 million was provided to the NTPF to purchase treatment for long waiting patients and in budget 2018 this investment was increased to €50 million. NTPF activity recommenced in April 2017 and, in July 2017, the number of patients waiting for such a procedure stood at a high of 86,100. By the end of 2017, the numbers waiting had reduced to just under 81,500. Inpatient figures at the end of June stood at 78,000, that is, patients waiting for a hospital inpatient or day case procedure, IPDC. This represents a drop of 8,100 or 9.4% in the 11 months since July last year.

In April this year, the Minister for Health published the inpatient and day case action plan 2018, a joint initiative of the Department of Health, the NTPF and the HSE. Under this plan, the number of patients waiting for an inpatient or day case treatment is targeted to fall below 70,000. It is estimated that during 2018, approximately 133,100 patients will be added to the published waiting list. To achieve the target of under 70,000, the IPDC action plan commits to remove approximately 145,000 patients from the waiting list this year through a combination of HSE and NTPF activity. The NTPF accounts for 20,000 procedures.

Several factors, including the cancellation of elective treatment and the increase in emergency procedures due to significant emergency department, ED, pressures, have resulted in fewer procedures for patients on waiting lists in our public hospitals. However, through the active monitoring of the action plan and the close collaboration with the HSE and the NTPF, it has been agreed that the NTPF will now target an additional 2,300 procedures in 2018, or a total of 22,300, to ensure targets are met. This level of activity represents a significant increase on 2017, where some 8,200 patients were removed from the IPDC list arising from NTPF activity.

The NTPF, working closely with the HSE, has invited all hospital groups to develop proposals to maximise the use of existing facilities and capacity. The NTPF advises that it has received 70 different proposals across all hospital groups. Arising from this, from January to June this year, more than 3,500 offers for treatment in a public hospital have been accepted and 2,400 patients have been treated.

The outpatient waiting list remains a significant challenge to be addressed in 2018. At the end of May there were 511,000 waiting for an outpatient appointment but this was reduced by the end of June. To address the issue of increasing outpatient waiting list numbers, the Department of Health, the HSE and the NTPF are finalising an outpatient action plan for 2018, which is due to be published shortly. This plan will support the HSE’s compliance with its national service plan targets, reduce the growth in the number of patients waiting for outpatient services, improve the accuracy of the waiting list, and trial a number of NTPF-funded interventions, including weekend and out-of-hours clinics. The validation of waiting lists is an important part of the successful management of waiting lists and clinics. Since the end of 2017, the HSE and individual hospitals have undertaken validation of waiting lists. To build on this momentum, last month the Minister approved the establishment of a central validation function in the NTPF to centralise the validation of all waiting lists across the HSE. The fund envisages being in a position to commence validation of patient files from September of this year.

Work on the development of an integrated waiting list solution, tailored specifically to meet the needs of our health system, is being advanced this year. The NTPF has examined the feasibility to progressing to an integrated system. This report is being reviewed by my unit with a view to establishing a high-level governance structure at system level to lead on implementation.

Ireland is experiencing a growing demand for health care services, which is evident in the increasing number of patients being added to waiting lists and the increased pressure on our hospital EDs. Increasing capacity is therefore central to improve access, both through our emergency departments and for scheduled care and waiting lists. As part of budget 2018, the Government provided an extra €30 million in 2017 and a further €40 million in 2018 to alleviate pressure on our EDs last winter. To the end of May 2018, total attendances were up 3.5% and admissions up 2.2%, compared to the same period in 2017. For those aged over 75, in the first five months of the year attendances rose by 5% and admissions by 5.5%, compared to the same period in 2017. This increased demand has contributed to an 11% increase in the number of patients on trolleys, compared with the same period in 2017. Delayed discharges also remained elevated during the winter period. The trolley figures during April and May began to stabilise relative to the preceding months in 2018. The national daily average 8 a.m. trolley count has been falling since March, with 340 in March, 297 in April, 251 in May and 224 in June.

The health service capacity review indicates that Ireland has among the highest acute bed occupancy rates in the developed world at 94%, significantly ahead of the OECD average of 77%. The national development plan provides for a major increase in capacity across the health system, including the development of new dedicated elective-only hospitals in Dublin, Galway and Cork. The aim of these hospitals is to both increase capacity and provide for a better separation of scheduled and unscheduled care.

Increasing capacity alone will not address the challenges faced, but on the basis of significant reform over the next decade, the report recommends an additional 2,600 acute beds by 2031. The NDP provides for the full complement of beds by 2028, three years ahead of schedule. As a first step toward implementing the health service capacity review recommendations, the Minister asked the Department to work with the HSE to identify the location and mix of beds which could be front-loaded in 2018 and into 2019 and 2020 to alleviate overcrowding. This proposal will seek to increase capacity in both acute hospitals and community settings. The implementation of this proposal will require a mix of capital investment, including a programme of modular builds. A key element of the proposal is the identification of the workforce requirement and the development of plans to meet these requirements. These proposals are currently under consideration by the Department and the Minister.

I thank the committee for the opportunity to provide a summary of activity under way. My team and I will endeavour to answer, to the best of our knowledge, any questions from the members.