Mr. Paul Reid:

I am joined by my colleagues, Ms Anne O’Connor, deputy director general, Mr. Liam Woods, national director of acute services, Dr. Colm Henry, chief clinical officer, and Ms Grace Rothwell, general manager of University Hospital Waterford. I commenced my role as the HSE director general last Tuesday, 14 May 2019. Prior to this I was chief executive of Fingal County Council for the past five years. Before that I was the chief operations officer in the Department of Public Expenditure and Reform. Most of my previous career has been in the private sector, mainly as an executive director with Eir. During my time in Fingal County Council I worked closely with community healthcare organisations, primary care centres and, indeed, many community-based projects and Healthy Ireland initiatives. In 2017, I was invited by former Minister of State, Deputy McEntee, to be vice chair of the national task force on youth mental health. I was also a member of the advisory council on Sláintecare.

As a committed public servant, there is no greater role than to be working with a dedicated and valued workforce, striving to make people’s lives better. I have set out three immediate priorities for the organisation and, indeed, for the new chairman and board. These are the delivery of quality and safe services to the public, including patients and service users; transitioning to a new model of integrated care; and strengthening the confidence and trust in the organisation from many of our stakeholders, including the public and patients. I look forward to working with the chairman and members of the HSE board, together with health services staff throughout the country, to achieve these important priorities. I also look forward to working with the Chair and the members of this committee and commit to providing them with the information they need to carry out their important role.

The Sláintecare report for 2017 signalled a new direction for the delivery of health and social care services in Ireland. It sets out a new model of regional and integrated care to deliver quality and safe services to our patients and service users.

As mentioned by the Minister, to support early implementation, in budget 2019, €20 million was provided for the establishment of a Sláintecare integration fund to test and determine how services could best be delivered. I have been really impressed by how the system has responded overwhelmingly to date, from the bottom up, with initiatives that will ensure the integration fund will support reform in front-line services where we can make the greatest impact.

On financial matters which are very challenging for the organisation overall, I issued a memo within the organisation on 14 May. I understand it has been made available to the committee. It highlights the need to break even financially, while prioritising the safety of services. In the next week or so the chief financial officer, CFO, of the organisation and I will be meeting senior management to review plans and assess how we might be able to achieve this outcome.

Notwithstanding the strengthened controls, it is a fact that the health service is dealing with increased demands. This process is internded, therefore, to ensure we will commit resources, where required, within the available resources. It is a very challenging process, but we must build a culture where we deliver within the budget allocated to us by the Oireachtas and the State. We will be in a stronger position in the future to invest in the new models of care.

On scheduled care, it is a fact that waiting times remain too long. Notwithstanding this, there has been considerable progress made in reducing the numbers waiting for access to surgery. The figures published for April show that the number of patients waiting for inpatient/day case procedures was 70,295. This represents a decrease of over 9,000, when compared to the figure for April in the previous year. The investment made by the Government is greatly welcomed and supported by collaboration between the HSE, the Department of Health and the National Treatment Purchase Fund, NTPF.

Outpatient waiting lists remain too high, with 551,965 waiting for an appointment. The numbers waiting were adversely impacted on in the early part of the year as a result of strike action. To ensure a consistent approach to the validation of waiting lists, the HSE and the NTPF have worked closely to establish a central validation office which is supporting the adoption of a consistent approach to the validation of waiting lists across all of the acute hospitals.

On unscheduled care, the demand for emergency care continues to grow year on year. The figure for the first quarter of the showed a 7.6% increase, at over 23,700 patients, compared to the figure for the same period last year. I fully acknowledge that there is a need for a significant improvement in waiting times for patients. It is a key area on which we will focus.

We have initiated a review of the winter planning process in 2018 and 2019. With the agreement of the Minister, the HSE is extending the review to include the commissioning of an independent expert group to carry out a review of emergency department performance and activity over the winter period on nine individual hospital sites and in their associated community healthcare organisation, CHO, areas. The expert group will examine emergency department performance, but in so doing will have regard to capacity, bed utilisation, internal capability, including consultant manpower, medical, nursing and overall staffing levels. It will report its findings and recommendations as part of the winter review report for 2018 and 2019. It is expected that it will be completed within a three month period. We believe it can result in some good evaluations and learnings, not just from the winter planning process but also overall as to what is best practice across the various hospitals and groups.

On the subject of mortuaries, the mortuary at University Hospital Waterford, UHW, is the south-east regional centre for autopsies. I recognise that the current facilities are not compliant with contemporary requirements. On my second day in this role in the HSE I visited the hospital and the mortuary and spoke to local management, staff, consultants and a pathologist. Interim control measures are now in place and additional refrigeration capacity is also being made available. In acknowledging the issues raised and concerns expressed by staff at University Hospital Waterford, a review of mortuary services is planned. It will include a review of existing mortuary facilities. The terms of reference for the review are being finalised and it is hoped the final report will be available in September. Mortuary capital development is included in the HSE's plan and has been approved since March, with approval to go to tender in May. The expectation is a new building will be in place within two years.

On HPV vaccination, provisional uptake of the girls' programme is at 70% in respect of the first dose in 2018-19, which represents an increase of 60% on the figure for the school year 2017-18. Older girls are coming forward to receive the vaccine where they had previously refused. This has to be welcomed by everybody. The second dose is being delivered in the period March to May and final figures will be available later in the year. Ongoing concerted efforts are required to be made by all healthcare professionals and opinion leaders to improve and maintain the level of confidence in the HPV and all other vaccines.

Ireland’s first gender neutral HPV vaccination programme is due to be rolled out from September. and a communications plan is in development. The vaccine to be used is HPV9 which offers protection against an additional five cancer causing strains of HPV compared to Gardasil4 which is currently being used.

A key message from the national patient experience survey from our reviews of adverse incidents and complaints concerns the critical importance of listening and responding to patients. The national patient experience survey is under way for the third consecutive year. During the month of May 28,000 patients who have had an inpatient stay in hospital will be invited to give feedback on their experiences. Over 84% of respondents rated their experience of hospital care as either very good or excellent. I look forward to engaging directly on the surveys with patients in the coming weeks. Some 83% of respondents stated they had been treated with dignity and respect and that they had full confidence and trust in the staff providing care. Some 96% of respondents rated their hospital room or ward as being very clean. This year the survey programme will be extended to maternity services. In February 2020, 11,000 women will be invited to give feedback on their experiences. I personally intend to visit a number of hospitals in the coming weeks to promote the patient experience survey and thank staff for all of their valued hard work and commitment to the programme.