Ms Laura Magahy:

I thank the Chair and the committee for this opportunity to meet them. I will provide an update by way of the opening statement and then we will take questions. We are one year into implementation. I first met the committee a year ago when the office was being set up. I wish to update the committee on what we are doing in terms of the action plan and where that is at. Then I will step back a little, say what we have done and analyse the implementation to date in terms of what are the foundational steps we have taken, what key enablers we have been able to put in place, what the next steps will be and what the dependencies are on that.

The slide shows where we were last year. We very much value the ongoing opportunity to update the committee on a quarterly basis and to get its input. The effort we are making in the Sláintecare implementation office is based on an all-party Oireachtas approach and we cannot do it without the continuing support of the committee, which we welcome.

The implementation advisory council has also met four times so far during the year. That is under the chairmanship of Dr. Tom Keane. We have very good input and advice from the council. We very much appreciate its work. The implementation office was set up in quarter 1 of this year, in January. We published our action plan, which has taken a very programmatic approach to translating the vision of the all-party Oireachtas committee into the first year of its implementation. We are embarking now on the action plan for 2020 to 2022.

In terms of governance we also have the high-level delivery board, comprising the Secretaries Generals of the Departments of the Taoiseach, Public Expenditure and Reform and Health, plus the chief executive of the HSE and me. The board discusses issues of cross-departmental importance to Sláintecare.

I am delighted that Mr. Dean Sullivan is present. Since the advent of the new HSE board, we have put in place oversight taking a joint implementation approach for two key programmes that need to be rolled out in the coming years. We have established a joint implementation approach to that, which feeds through into direct oversight by the Minister. That is the system of governance. It is now well-established and is working well. It gives grounding to a programmatic and systematic implementation.

Our action plan update, as of September, is going to the Government next week. I am pleased to share that we have taken our workstreams approach through the action plan and that we have reported on all of the different elements through the action plan. The summary is that 114 deliverables were due by September and we are 93% on track. As for the eight that are off track; they will be back on track by the end of this year. That is the reason we put them into the orange category.

I acknowledge the work that has been done by colleagues in the Department of Health and the HSE to bring these deliverables to bear. Our office is there to make sure that things happen; we are not doing a lot of the work. Where things go off track, we have an input and we are there to make sure things stay on track. We acknowledge the work that has happened. We are 93% on track and will be there by the end of the year.

I will analyse where we are with the implementation process. I have categorised the process into foundational decisions without which we could not have moved forward. These have all taken place and were deliverables in the action plan. They have all taken place since we came into office. In the past year the decision was made on the six new regional health areas. On the previous occasion I was before the committee I asked if we could please stay with the plan and do it because we knew there was not unanimous agreement on regional health areas but everyone stayed with it. I acknowledge that and thank the committee members and the system for staying with that because it is a foundational piece. That allows us to plan for six integrated regional plans. I will come to that later.

The second foundational decision was to get the new HSE board and CEO in place. That is already putting a discipline around what is happening. We have a very good working relationship with the HSE through the new CEO and with the deputy director general, Mr. Dean Sullivan, who is present. A third foundational piece was the GP contract, again, without which we could not move forward. It was a key enabler especially in the context of chronic disease management and that will be rolled out from next year. Another key enabler is the enhanced nurse contract, which will make sure services can move seamlessly between the hospital and community.

A fifth piece we have been very pleased to see being put in place is through the office of Dr. Colm Henry. He has had a national clinical programmes review and made recommendations on what happens next in regard to them. They are important because if we say we are going to have six regional plans, we need them to be done in a national context. Not every region can go off and design its own way of doing things. It must be done in such a way that we have one national cancer programme, one neurorehabilitation strategy and there are many other strategies that are national and that can be interpreted in a regional way. Putting that foundational piece in place has been extremely good.

We considered the multi-annual commitment to recruiting staff in the community as another important piece that was put in through the budget because it allows us to plan in a multi-annual way. As members are aware, that is unusual because most service plans are done on an annual basis so we are very pleased that we will have visibility into the future for those. We want and need more of that.

In terms of foundational decisions, the dialogue forum has been a critical initiative to strengthen the relationship with voluntary providers. As members are aware, section 38 and 39 organisations are a significant part of the system. Putting the dialogue forum in place following the Catherine Day report is another very important foundational decision. Those are not everything but they are the ones I have picked out for today. There will be more in the action plan that will be released next week.

Next I wish to focus on some of the key enablers that have been put in place. The forum that has been put in place to look at the oversight implementation of the role of public health doctors, in particular in the context of regional planning, is important. If we are to have population-based planning we need an enhanced public health doctor role. The conversations that are happening at the moment through the office of the chief medical officer in the Department and our HSE colleagues with the public health doctors will be concluded by the end of this year. They are a key enabler.

The postgraduate medical education strategy forum, which is being chaired by Mary Doyle, is another really important initiative. This forum is looking at long-term postgraduate medical education and how it will be planned into the future.

We cannot have a shared care record or an electronic health record unless we have an individual health identifier office, which was put in place this year and is being staffed. The individual health identifier numbers have come across from the Department of Employment Affairs and Social Protection. Again, if this had not happened, we would not be able to roll out our shared records so this was a very important key enabler.

I consider e-pharmacy to be extremely important and one of the first and most important pieces of a shared care record. We have put the governance in place through the HSE to roll that out as urgently as possible. Regarding the joint initiative between the Departments of Housing, Planning and Local Government and Health on housing options for our ageing population, an implementation group chaired by Leo Kearns has been set up. If we are to keep people well and keep them in their own homes for as long as possible, looking at alternatives to nursing homes is critical. This group produced a very good strategy which an implementation group is examining to make sure it is rolled out.

Mr. Sullivan and I put an elective hospital oversight group in place. We know that the Government made the decision to have elective hospitals in Galway, Cork and Dublin but we need to address this issue in a national context in order that everybody in the country is covered for elective care. Those groups are working with us. The timeframe for the group's deliberations is 12 weeks and it is progressing very well. A clinical lead for trauma has been appointed. Mr. Sullivan is leading on this project, which involves naming and rolling out trauma centres in Dublin. A decision will be made on that in the next two months.

I have not addressed every issue but I have highlighted areas that are very important and without which we would not be able to move forward. There is a commitment to have a single assessment tool. The preferred bidder is being selected and that will be rolled out from February. Selecting and rolling out the single assessment tool is a key enabler.

I will now discuss the budget allocation for Sláintecare in 2020. The budget contained many initiatives that are what I would call Sláintecare-friendly but these initiatives specifically come into our section. We are very pleased that we have the enhanced community fund, a multi-annual fund to hire up to up to 1,000 therapists, nurses and other front-line staff to care for people in the community, including advisers for people with dementia. This will allow us to treat people in the community closer to their own homes, thereby reducing community waiting lists. I am happy to discuss how this will be rolled out when we come to questions but it is very important. We cannot move people out of hospital unless we have the capacity in the community to do so. The all-party Oireachtas committee's report was very clear on that. The allocation for the fund will rise to €60 million in 2021.

I will describe a few projects covered by the integration fund of €20 million. There has been a huge response from the system in terms of ideas for doing things better and in a different way and scaling good ideas. The €12 million care redesign fund is about providing care at the least form of complexity, in accordance with the clinical care programmes, to people in the right location. Again, this is very good work that we need to scale. It is all about moving people out of hospital to the place of least complexity, as appropriate.

I am happy for Ms Healy to take more questions on citizen and staff engagement but I will touch on a few matters. We have a very good response from the system, particularly from staff. Everybody is now talking about Sláintecare and how they are doing things in the Sláintecare way. They talk about Sláintecare in action and how they can do things in a more integrated and joined up way. It has become very much a language as well as action across the system. We have been very careful to engage with all the different healthcare professionals, such as nurses and doctors, including at conferences, to hear their suggestions about doing things in a different and more joined up way. We have received a very good response and that this is embedded across the system. More work needs to be done but there has been a very good start.

In respect of wider citizen engagement, we have been carrying out joint initiatives with Healthy Ireland. A very interesting Health Reform Alliance event was held last week and other consultation events with citizens have been held. We have also worked with staff around values in action, conferences and briefings. We welcome our engagement with this committee and elected representatives through the quarterly action plan report, committee attendance and other briefings, as needed. We are always open to discussing any aspect of the process with members or their colleagues.

I mentioned the integration fund because it was a highlight during the year when so many interesting projects applied for funding. A total of 477 applications were received, of which 122 projects were successful. They are found all around the country. The little dots in the slide represent the locations around the country. The goal was to promote the engagement and empowerment of citizens in the care of their own health, to scale and share examples of best practice and processes for chronic disease management and care of older people in particular, and to encourage innovations in the shift of care to the community or provide hospital avoidance measures. We received very interesting ideas, some of which involved scaling existing things while others proposed new initiatives.

I will discuss some sample projects. Jigsaw Online is an e-mental health platform. Jigsaw is very engaged and involved in youth mental health and the e-mental health platform the organisation is setting up for young people is a very interesting project. Other examples of projects include one by Epilepsy Ireland and Alone's BConnect project. Alone's project is very innovative. It is talking about linking healthcare, social care and community care using technology and services. Other projects include Beating Breathlessness by the Asthma Society; Croí, West of Ireland Cardiac Foundation's MySláinte community lifestyle programme; and Diabetes care in the mid-west. The latter project was a very interesting one that involved a podiatry-led pathway for timely provision of footwear and orthotics in the community. Basically, it was about preventing amputations through early intervention. It is a critical project. Another project involves rolling out FIT teams in Mullingar, Wexford and west Wicklow. We know the FIT teams have been proven to work in Limerick and other places. These teams go into hospitals, identify people in the emergency department and try to get early interventions so they stop older people in particular from having to be admitted to hospital and wrap the services around them. It is a very good project. There are around 300 staff within the integration fund projects. As we know, the staff are the core of services and health and social care is all about services.

We have work to do on eligibility and entitlement. We are submitting a memorandum to Government on the de Buitléir report, developing a roadmap for universal access and establishing an interdepartmental group on eligibility and entitlement. We would love to discuss with the committee whether there should be a citizens assembly on the issue of eligibility and entitlement.

Regarding access and capacity, I mentioned that two key programmes are being rolled out using a joint integration approach. The left hand side of the slide details the regional integrated care areas, RICA, programme while the right hand side details the capacity-access programme. We know we need to create more capacity in the system. We know we need 2,600 more beds and more staff and that we must shift care from hospitals to the community and focus on prevention. This framework provides an interesting way of approaching how we will do that and names projects to achieve this. Some of the key ones to pull out are healthy living to scale patient empowerment integration fund programmes. An awful lot of programmes in there involve patient empowerment, social inclusion and social prescribing. We need to implement housing options for our ageing population. They are just two initiatives. With regard to enhanced community care, we need to recruit 1,000 new front-line community staff, implement alternative paths for unscheduled care and diagnostics and procure the shared care record.

On hospital productivity, we need to optimise usage of existing hospital beds and decide locations of elective hospitals and procure design teams for them. These are the projects for next year and the year after in the context of the capacity plan. It is very important that they are put in the right sequence and that decisions are made in the right order.

I shall now turn to regional integrated care areas. We had a very good meeting with the chief executive officers of the hospital groups and the community organisations two weeks ago and we asked them if they would be willing, able and up for doing joint planning from the bottom up for each of the six regions. They have come back and have nominated people they would like to be involved. We also want to get patient representatives and representation from the section 38 and section 39 organisations, and from the public health doctors, in order that we can begin in earnest the regional planning for each of those six areas. The approach we are taking is to: look at the population mapping and then to look at population needs; decide capacity planning requirements for each region; look at the enablers that need to be rolled out for the regions; and - critically - looking at the pathways of care per region. In the next two weeks, we will have an interesting opportunity when Carolyn Gullery from Canterbury, which is often quoted as a very successful region, will come over to share her experience with and meet each of the six groups we have set up in order to look at these six integrated regional plans. It will be very interesting and I am excited about that. It is a great opportunity to get our regional planning right.

Deputy Shortall is interested in population profiling and how it is done. Through the health intelligence section of the HSE we have done the population profiling for each of the six regions. The profile is based on age and so on. We can then plan what the services are that each of the regions has. We have done that for each of the regions as a first step.

All of this work we are doing involves a number of dependencies. We are quite clear about the steps we want to take and how we can roll it out, but we need to maintain the momentum that has been put down during this year, to continue the stakeholder buy-in and to ensure that we have the members' support. If we do not have that support, if there is anything we can do better, we would be very open to that. We also need the Government to continue to take key strategic decisions - because there are a number that need to be taken in the next short while - and to resource those decisions. Depending on all of that, we are up for it, we are able and we have all of the structures and governance in place. I thank the committee for its continued support.