Mr. Paul Bolger:

Deputy Kelly asked about the plan for this year, whether the Department thinks changes at the structural level are having an impact and asked a final question about elderly care. I will answer the first two and pass the question about elderly care to my colleague, Ms Scally, who is leading a review of delayed discharges and that area.

The Deputy asked what the plan is and what we are doing differently. One of the key things we have done this year is to establish a new unit within the Department which has a clear focus on scheduled and unscheduled care. This is my unit, and these are some of the members of the unit. This is our clear focus and this is what we are interested in: driving improvement in scheduled care, which concerns waiting lists, and unscheduled care, which concerns trolleys. To talk about how we are working, I will focus on three areas: what we are doing in terms of activity, what we are doing about finances and what we are doing to bring forward improvements.

We have sought to address activity by setting out and agreeing clear targets with the HSE and the NTPF, particularly in respect of inpatient and day-case activity. We publish these figures with a very clear and, I think, very understandable target for the end of the year, which is 70,000 people. We do not just say, "We will see you in December" and hope to be successful in meeting that target; we actually monitor the target every month. We have trajectories that we expect the HSE and the NTPF to deliver each month and we monitor these. The benefit of the monitoring is that, by working collectively with the HSE and the NTPF - we meet fortnightly at official level and meet with the Minister every month or six weeks on this issue - we are able to address or overcome any administrative challenges or any other challenges that arise. There have been some examples of issues that we have been able to address. Second, and more important, we are in a position, as I outlined in my statement, to introduce remedial plans when we are not making progress in line with the trajectory.

This year, at the end of April, we were able to sit down following the winter and say: "This is where we expected you to be in terms of your activity to meet the 70,000 target and this is where you are." At that time there was a shortfall of between 2,000 and 2,500 procedures. We were then in a position to go back to the NTPF through the HSE and say what types of steps could be taken to address that. The plan that has been agreed, to which I referred, is that there will be an additional 2,300 procedures for which the NTPF will be able to offer treatment this year.

The second element is finances, and it links into that area in terms of remedial plans. This year we have held back all the new funding relating to activity. All the new development is held in the Department and it is released when we are satisfied the measures that were introduced have been delivered. This brings an additional level of control to the process from our perspective. It ensures that the priorities the Government has set out and funded are delivered. Second, it gives the opportunity to avail of new opportunities as they may arise. The best example we have this year is that there were certain projects that were not progressing fast and were not going to draw down funding this year. They were the modular build in Clonmel, a delay in opening beds in Kilkenny and a centralised validation function we established. By having greater control we were able to address that finance and then reallocate the money that was allocated for those to open the cataract theatre in Nenagh from July. That is an example of how we are actively monitoring the finances and making changes mid-year to deliver.

The third piece is improvement. We are taking an evidence based approach and we are fortunate that we are able to build upon the work of colleagues that was undertaken last year relating to the capacity plan. That sets out the clear challenge the system is facing. One of the big tasks of Susan Scally and her team for the first six months of the year was working with the HSE to develop proposals for where additional capacity could be introduced into the system. We have also established a centralised validation function within the NTPF. This is a very important function. At one level it will ensure that the waiting lists and the challenges we are addressing are accurate. It will also offer consistency to patients throughout the country in terms of communications and timelines. A great deal of work has been done by the Department, the NTPF and the HSE to simplify communications with patients and to send out clear letters of one page that make it very clear what the person has to read, what the person has to do and what the person has to return. We have trialled that with a number of groups and it has had an impact.

The next matter is working on the basis of the lessons learned process for next year. In the context of planning for the coming winter, the key question is what lessons we can learn from last year. It is not so much what happened last year, but the question we are engaging with the HSE on is what happened over and above what it had planned to happen. We have had much discussion about this. Liam Woods referred to influenza and we referred to some other issues. It is not so much that we had a longer influenza season; it is about what was being planned, what happened and what lessons we can learn from that as we plan for next year. To bring that together on what we are trying to do in terms of the improvement aspect, the ED task force is now in place and what is planned for September this year is an unscheduled care forum that will bring together members of the ED task force and, more importantly, people from around the hospital system and perhaps internationally to look at what processes worked-----