Ms Anne O'Connor:

I thank the chairman and members of the committee for inviting us. I am joined by my colleagues Mr. Liam Woods, deputy director general and chief operations officer; Mr. Dean Sullivan, deputy director general and chief strategy and planning Officer; and Dr. Peter McKenna, clinical director, national women and infants health programme.

I would like to update the members on a number of issues. On the winter plan, the HSE commenced winter planning for 2018-19 in May 2018. The planning process focused on three main areas: emphasis on providing community based care options to prevent emergency department, ED, attendance and expedite discharge from acute hospitals to either a patient’s home or a community-based care alternative; close integrated working between acute hospitals and community services through local winter action teams with national oversight; and increasing specific measures in nine sites over a peak four-week focus period between 17 December and 30January.

Some €30 million was provided in winter funding - €10 million once-off in quarter 4 of 2018 and €20 million in 2019. The emphasis on community-based services saw two thirds of the available funding directed towards primary and social care services - €10.6 million to home support packages, €4 million to the provision of aids and appliances, €1.5 million to transitional care and more than €4 million allocated to community beds and initiatives.

Due to increasing system pressures towards the end of the focus period, the national oversight group agreed to extend the enhanced measures by an additional two weeks to support unscheduled care at the nine sites. Unscheduled care performance improved significantly in quarter 4 2018 compared to quarter 4 2017 where the 8 a.m. trolley count was 4.2% lower than the same period last year. This was despite ED presentations increasing at a rate higher than expected at 3.3% for the same period.

This trend has continued and increased into January 2019. Analysis of performance for the period 1 January to 27 January 2019 recorded ED attendances at 98,797, an increase of 9.2% on the same period in 2018. ED admissions in this period were 27,319, an increase of 6.3% on the same period in 2018. Despite such increases, the 8 a.m. trolley count for the same period in 2019 was 8,732, representing a 14.8% decrease in trolleys on the same period in 2018.

It should be noted that the flu season in 2018-19, while not yet over, appears to have been shorter and less intense than that in 2017-18. However, the high ED attendances this year have included significant levels of respiratory cases that are non-flu related.

Regarding service improvements and achievements in 2018, during the year there were significant achievements and improvements across the range of health and social care services and I would like to highlight some of these to the committee. Our acute hospital services continue to demonstrate improvements in the inpatient day case waiting list, which reduced to almost 70,000 at the end of 2018 from 86,100 in 2017 or a reduction of 18%. This ambitious target was achieved as a result of the continuous focused efforts in collaboration with the National Treatment Purchase Fund, NTPF, and the Department of Health. Last year saw considerable improvements in a number of other targets as follows: the number of patients waiting over nine months has almost halved since July 2017 from 28,100 to 14,900; the number waiting over nine months for a cataract procedure has fallen by 87% since July 2017; the number waiting nine months for a tonsillectomy has fallen by 84% in the same period, with the number for angiograms falling by 88%. Over the course of last year, 418 spinal surgeries were completed, including 201 spinal fusions, and the number of children waiting longer than four months reduced to 35 at the end of 2018. Cancer key performance indicators, KPI, continued to improve in services such as symptomatic breast, lung and prostate cancer in 2018 with all sites showing sustained improvement over the year.

In 2018, primary care services expanded with the opening of 13 new primary care centres. Within the primary care services, 743,000 people were seen by community nursing services; 1.5 million people were treated by health and social care professionals; and in excess of 1 million contacts were made with GP out-of-hours services in the year.

A significant milestone was achieved when all of our 1,149 disability centres were registered by the Health Information and Quality Authority, HIQA, as of 31 October 2018 under the national standards for residential services for children and adults with disabilities. This has been a substantial achievement for the sector.

More than 53,000 people benefitted from home support in 2018 and 15.7 million hours of support were provided. The percentage of persons over the age of 65 in long-term care has fallen to 3.4% against a target of 4%. This is assisted by the ongoing investment in home support.

In our mental health services, 10,734 children and adolescents were seen by child and adolescent mental health services, CAMHS; 203 children and adolescents were admitted to CAMHS acute inpatient units; and 27,124 adults were seen by mental health services.

However, notwithstanding that progress and achievements, we still have significant pressure on acute and community services with high numbers of people on outpatient waiting lists, a significant increase in the numbers of people attending EDs and increasing unmet demand for home care support. Our service plan for 2019 will focus on bringing about further improvements and increased capacity across the health services, particularly in those areas where we are experiencing ongoing service pressures.

The Sláintecare implementation strategy was published last year. A detailed action plan is in development, led by the executive director of the Sláintecare programme office that will set out a series of work streams and designated actions, with associated measures to be delivered in 2019. The HSE is committed to working with the Sláintecare programme office and all stakeholders to play our part in successfully bridging the gap between the vision for health service transformation in Ireland and delivery of that change at the front line.

In respect of termination of pregnancy services, following last year’s referendum and subsequent legislative change, abortion services are now being provided by the HSE through GPs or family planning services and in maternity units and hospitals across the country. People can now access an abortion in Ireland under specific circumstances. Some 259 GPs have signed the contract and each day more GPs are signing up as the service evolves. Of the 259 GPs, 128 consented to having their details shared by My Options. There is a good geographic spread of GPs taking part, enough to meet the needs of people who may need to access the service. The Well Woman and Irish Family Planning Association, IFPA, clinics are now well established in the provision of services in the greater Dublin area. All maternity hospitals are providing the following services: managing complications arising from termination; providing appropriate care and supervision for women following a diagnosis of fatal foetal abnormality, and referral to the appropriate tertiary unit; and providing appropriate care and supervision in cases where maternal health or life is at risk, and referral to an appropriate tertiary hospital, as appropriate.

Nine maternity hospitals are providing the full range of termination of pregnancy services. The number of sites providing these services will increase during the remainder of 2019. My Options, the HSE’s unplanned pregnancy service, is the first point of contact, providing free and confidential information and non-directive counselling to people experiencing an unplanned pregnancy. The My Options helpline has seen a steady number of calls each day since it went live on 1 January 2019. Since the myoptions.iewebsite information went live on 21 December after the legislation was enacted, there have been more than 80,000 visits and almost 300,000 page views to the website.

I will give an update on the nurses' strike action. Within the HSE, we have put in place a governance structure to oversee preparedness for the series of nurses strikes and for the co-ordination and implementation of system-wide contingency plans. During the recent strike days the ongoing interaction between local management and strike committees proved to be effective. As the strike continues, there is increased risk for patients and clients along with increasing disruption. We estimate that in excess of 40,000 patients and service users are impacted on each strike day. The HSE continues to seek full derogation for cancer surgery and services while the action continues. There is ongoing engagement with community health organisations, CHOs, hospital groups and all front-line services to seek to manage this difficult situation. We are acutely aware of the significant impact of patient appointment cancellations and the cumulative impact on access to services, and we are advising the public to stay tuned to media reports and adverts as well as to contacts from local services to those affected.

In addition to this week's strike days, the Irish Nurses and Midwives Organisation, INMO, has notified further strike dates next week from 12 to 14 February, inclusive, and 19 and 21 February. The overriding objective remains that the dispute be resolved given the number of patients and clients affected. The HSE remains open to be part of any talks to achieve that objective.

That concludes my opening statement and, together with my colleagues, we will endeavour to answer any questions members may wish to ask.