Ms Laura Magahy:

I want to introduce myself and my colleague, Dean Sullivan, who we work with closely in the HSE. Ciara Mellett is the new head of Healthy Ireland, which is a key part of Sláintecare. Caroline Pigott is our head of resources in the Sláintecare office and Grainne Healy is our head of citizen engagement. If the members have any particular questions on those areas they can address them to those colleagues.

As most of the members know, the Sláintecare report emanated from the all-party Committee on the Future of Healthcare. It is a ten-year healthcare reform. We translated that into an implementation strategy, an action plan and, this year, a joint action programme. We are taking a programmatic approach to the implementation of this vast and exciting programme.

The key principles are delivering the right care in the right place at the right time and given by the right team; promoting health and well-being and preventing illness; bringing the majority of care into the community; creating an integrated system of care that is provided on the basis of need and not ability to pay; and moving from long waiting times to a timely service, with accountability and performance at the heart of it. Fundamentally, it is about trying to deliver a health service that has the capability and capacity to manage changing needs. This will be done through a population-based planning approach with clear pathways between GPs, community and social care services and hospitals and empowerment of front-line staff, with one budget per region. It was a decision by Government last year that we would be moving to this regional implementation. Fundamentally, it is about many parts of the system working together in terms of community healthcare workers, occupational health, dental services, GPs etc. and all of the HSE colleagues across the system.

We are in year two of implementation. Our job in the implementation office, which is based in the Department of Health, is to ensure that all parts of the system are following the strategy, to work collaboratively and to report on progress. This year, it is also about learning the lessons from Covid-19.

I will not go through them but we have a variety of implementation work streams. It is a vast programme with many moving cogs that all need to work together, and there is a strategy behind that. Fundamental to it, and it was very much addressed in the budget, is the capacity and access programme, which is about making sure we have enough access so that people can hit the Sláintecare target waiting times for inpatient, outpatient, diagnostics, emergency department, ED, and community care and that we have enough human and infrastructural capacity after reforms in line with the health capacity review. These are divided into three big pillars. One is about healthy living, which is our Healthy Ireland programme. Another is about enhanced community care, which I will talk about, and the other is about hospital productivity improvements.

Regarding progress to date on healthy living, we have our Healthy Ireland strategy, which rolls out the obesity policy, physical health and sexual health strategies and a focus on prevention and citizen engagement. We have many initiatives with partners across the country to roll that out, including with Healthy Cities and Counties, the Healthy Ireland charter network, the warmth and well-being scheme and the Making Every Contact Count initiative through GPs.

Interestingly, in the budget for next year we have a new area-based health and well-being initiative in disadvantaged areas with a ring-fenced additional €20 million for Healthy Ireland this year, which we very much welcome.

In terms of enhanced community care, the focus is on rolling out community healthcare networks with a basis of population for 50,000 in a group. There will be 96 of those across the country,with chronic disease and older persons specialist hubs, integrated care, GPs, community and hospitals. This will be enabled through healthcare pathways, and I would be very interested in elaborating on that if we get the opportunity to do so. The approach is to help these mini-communities of approximately 50,000 across the country.

The impact of this community care initiative will be to move patients with ambulatory-care-sensitive conditions from hospitals into the community. The funding in yesterday's budget and through last year is very welcome and will mean these 96 area-based services can be rolled out and we can start to give the care in the community that is absolutely needed. The provision will be based around the older persons and chronic disease service model, moving between the hospital, community and GPs and making sure we can treat people and keep them living well at home as long as possible.

Throughout this year we have had some very interesting innovation funds, with 122 different projects all around the country represented by the little red dots members can see on the screen. These projects are about encouraging innovation, shifting care to the community and scaling and sharing examples of best practice and processes for chronic disease management. There are some lovely examples of this happening throughout the country and fantastic learnings coming through from these projects, which will be scaled into next year. I have set out the details of the different projects in my opening statement but I will not go through them now. Fundamentally, they are about providing services for people and making sure they get the right care in the right place.

In terms of hospital productivity, we are looking at streamlining ways of working. There have been great innovations such as the ambulance service's hear and treat initiative, pathways to treat people outside of hospital, virtual clinics and trauma centres and hospital avoidance measures. An example is the virtual clinics for heart failure which have moved outpatient department treatment into the community. This has meant fewer people going to hospital, with 90% of treatment now being delivered in the community. We are making great progress on our elective hospitals development project and hope to have a business case ready before the end of the year. The oversight group is being chaired by Professor Frank Keane.

Regarding the implementation status, we have had, through 2020, a quarter of the funding needed for community services. That allocation is massively augmented in the budget for 2021. Our e-health priorities are agreed and capital funded, we have a business case for elective hospitals and there are innovative care re-design initiatives addressing waiting lists. We were very pleased that the programme for Government reaffirmed the commitment to Sláintecare and we are very grateful for the support of this committee in keeping an all-party focus on its implementation.

I do not have time to go through the many learnings from Covid. Many things were fast-tracked during the pandemic, particularly e-health and new ways of working. People showed they could adapt and were up for a change and looking for new ways of doing things. We see this in the use of e-health video consultations, the deployment of the individual health identifier, the attend anywhere booking system and Healthlink, which gathers information back to GPs. We have a superb programme of e-health initiatives which is now fully funded in the budget and we will be able to implement it with speed over the next two years. Huge progress was made on the individual health identifier initiative this year. Everybody in the country now has an identifier and we are moving towards a shared care record in the coming years.

Our priorities for 2020 to 2023 are, first, to keep people well at home or near home, out of hospital and living independent lives. That will be worked on through a series of initiatives which I do not have time to go through today but are based around health pathways, enhanced community funding, scaling integration funds and implementing related projects. Our second priority is to achieve the waiting list targets through implementing the capacity and access programme, devising a multi-annual waiting list plan and commissioning the ambulatory elective centres. The third priority is around standing back and looking at things from the perspective of a citizen care master plan, working towards universal eligibility and multi-annual funding.

The budget has provided a huge investment in Sláintecare, amounting to approximately €1.34 billion. It will provide permanent funding for initiatives that have sometimes only had part-time funding. It is a really welcome initiative. The challenges and implementation risks for our implementation office are around ensuring there is a co-ordination of effort moving in the direction in which Sláintecare was set by the Oireachtas committee. The recruitment at scale is going to be a big issue. A huge investment in people is required in terms of getting the right personnel in place. The ongoing Covid impact on non-Covid services is something we all must live with and adapt to over time.

I thank the Chairman and members for the opportunity to discuss these matters with the committee. I am very happy to continue the discussion.