Mr. Paul Reid:

I thank the Chairman and members for inviting us to attend this meeting of the committee. I am joined by my colleagues, Ms Anne O'Connor, chief operations officer; Dr. Colm Henry, chief clinical officer; and Mr. Liam Woods, national director of acute operations. The Health Service Executive (Governance) Act 2019 commenced on 28 June 2019. On that date, the newly established board of the HSE met, with the Minister in attendance. Under the Act, the board is now the governing body of the HSE, accountable to the Minister. I look forward to working with the board and providing every support and assistance to the members in their work.

A key priority for the HSE is to maximise the provision of safe services, within the funding with which we are provided. This is a significant challenge for the HSE in the context of the increasing level of demand for our services. Demand is rising due to an aging demographic, more complex service demands and ongoing societal and economic change. The latest reported financial position, as at July 2019, shows a deficit of €281 million, or 3.1%, with 43% of that relating to operational service areas and 57% relating to pensions and other demand-led areas. The comparable figure for the same period in 2018 was 72% higher at €485 million, or 5.8% of the budget, with 80% of the deficit in the operational service areas. The greatest cost pressures within our operational services are in respect of providing residential placements to service users with an intellectual disability and the provision of specialist emergency care within the acute hospital setting to a growing population of older and frailer patients.

Costs in respect of pensions, the State Claims Agency, the primary care reimbursement service and overseas treatment are largely driven by policy, legislation, demographics and the macroeconomic situation and are not generally amenable to normal in-year financial management. I have directed relevant national directors, community healthcare organisation chief officers and hospital group CEOs to identify and put in place additional measures to limit, to the greatest extent practicable, any overruns within operational services.

The measures to limit overruns include greater emphasis on controls around agency spend, overtime and staffing levels. Monthly expenditure limits have been agreed and are being monitored closely, including at a monthly financial management meeting which I chair and all the community healthcare organisation chief officers and hospital group CEOs attend. This is a challenging process but we are committed to embedding an improved culture of delivering within the budget allocated to us by the State. Doing so will put us in a stronger position to secure investment for the future, which is in the best interests of patients, service users and their families.

The 2019 HSE capital plan, which was recently launched, forms part of a rolling ten-year investment plan for health. Modern infrastructure and equipment are a crucial part of the provision of a quality health service and, ultimately, a positive patient experience. An allocation of €642 million was allocated this year to continue the delivery of more than 91 projects across the country and initiate another 73 projects for acute and non-acute services. Fifty-eight community nursing units, CNUs, are at planning and design stage and €85 million has been allocated to deal with infrastructural risk, replacement of equipment and replacement of ambulances. This investment will provide increased capacity across the health service and support the delivery of Sláintecare.

Budget 2019 provided for the establishment of the Sláintecare programme implementation office at the Department of Health, with €20 million allocated for the establishment of a ring-fenced Sláintecare integration fund. This fund will test new ways in which we can bring care closer to home, including putting the patient and client at the centre of service design and delivery. Across the country, 122 projects have been selected for funding. A total of these are from HSE or HSE-funded services and include projects supporting individuals to prevent and manage their chronic conditions and projects to enhance community care services and mental health support services. These projects will run for a period of 12 months from initiation and processes will be put in place to enable successful projects to be scaled for national implementation over time.

The HSE and the Sláintecare programme implementation office are working to progress the full range of Sláintecare reform programme actions and projects. We have also been working to establish higher-order priority work programmes over the next two years, which have the potential to transform the way care is delivered and experienced in Ireland. These programmes will be jointly led and implemented by the Department of Health and HSE and will cover the design and implementation of regional health areas. This is essential in ensuring we have better enabled delivery organisations fully focused on delivering services that meet the needs of the local population. In addition, the priority programmes will deal with service capacity and service access. This will address the implementation of the health service capacity review recommendations across acute hospital and community care services, while also reducing the inevitable demand for beds in the coming years.

Winter preparedness planning is a core component of annual operational planning in the health service. It is essential to ensure service provider organisations are prepared for the additional seasonal pressures associated with the winter period. Analysis has shown significant levels of growth in emergency department attendance and admissions over the past winter seasons, outstripping population growth by more than 2.75%. The winter preparedness plan was developed by the HSE through a collaborative process across all key services, including community operations, acute hospital operations and the national ambulance service. The plan sets out the core components of an integrated winter plan and seeks to guide those developing their local plans in terms of essentials that must be considered. Through this proactive planning and action, combined with the assistance of the public in following winter season guidance from the HSE, including availing of the flu vaccine programme, we will endeavour to provide safe and efficient services.

In August of this year, the HSE launched the new gender neutral human papilloma virus, HPV, vaccine programme for girls and boys in their first year of second level. Information packs for parents are being provided through schools by the local school vaccination teams, which have now started to give the first dose of the vaccine. The implementation of this new programme is backed up by campaign materials including videos, social media posts, radio advertisements and the hpv.iewebsite. The provisional uptake of the HPV girls' programme is approximately 70% for 2018 to 2019, which is an increase from 64.1% in the previous school year. It is important to acknowledge the powerful work of the late Laura Brennan in promoting the HPV programme. She made an enormous impact in communicating the benefits of this important life-saving vaccine and encouraging parents to get informed via the Get the Facts resource.

The new paediatric outpatient and urgent care centre, Children's Health Ireland, at Connolly Hospital Blanchardstown opened in July.

This opening is a major milestone in the new children's hospital project. Since opening, the latest available figures indicate that 645 children presented to the urgent care centre at Connolly Hospital and 94% of children were discharged home. The average time spent by patients in the urgent care centre is 112 minutes. The urgent care centre will continue to extend the hours of operation on a phased basis. It is expected that 25,000 children and young people will visit the urgent care centre every year, leading to a reduction in emergency department attendance for children.

Since opening, the latest available figures indicate there were 514 attendances to the Connolly Children's Health Ireland outpatients department. When fully operational, this new facility will provide 17,000 outpatient appointment attendances annually. This new facility and service is a welcome development and will contribute to significant reductions in general paediatric outpatient waiting times for patients and their families. I thank Children's Health Ireland and all concerned for their work and commitment in getting this facility operational.