Mr. Dean Sullivan:

Thank you, Chairman. As Ms Magahy said, we are delighted to have this opportunity to engage with the committee and meet the new members. As the committee is aware, during 2020, the Irish health services faced unprecedented pressures as a result of the Covid-19 pandemic. Following NPHET's decision on 27 March regarding the required public health measures, many non-urgent healthcare services were reduced or suspended altogether. In recent months, the HSE has focused on restoring those services as far as possible, which involves delivering care in very different ways and in different settings and maximising opportunities fro technology.

Many of the service changes made this year in the context of Covid-19 align fully with the vision and direction of travel set out in Sláintecare but there remains much to do if we are to effect the complete transformation of healthcare services in Ireland that is required. The OECD's recent country profile for 2019 noted that, in comparison with other countries, Ireland has made good progress on life expectancy but some members of our community still experience worse outcomes than others. We consume too much alcohol and do not maintain healthy weights. Access to services is an issue and we have a lower proportion per head of population of practising doctors than elsewhere. We must seek to achieve better outcomes for everybody, recognising that where we are falling behind, we need to address that and focusing our efforts on reversing those trends and accelerating the digitisation of our health service.

A key principle of Sláintecare, as Ms Magahy outlined, is the right of patients to timely access to all healthcare and social care services according to clinical need. In addition to the recent impact of Covid-19, there were already increasing pressures for a number of years on our scheduled and unscheduled care services as a result of population growth, increasing instances of chronic disease and an aging population. As well as needing the right people and the right infrastructure, including buildings, equipment and technology, to deliver the right services, we need to recalibrate and remodel how we deliver those services. Consistent with Sláintecare, we are seeking to shift the delivery of care from the hospital setting to community settings, with a greater emphasis on prevention and supporting the population to remain healthy and well. Our aim is to sustainably address long waiting times for scheduled care services and in emergency departments, rather than just putting in short-term fixes, particularly for older people and those with more complex needs. In that context, it is crucial that we reduce bed occupancy levels in hospitals and reduce our reliance on community residential models of care by expanding our primary and community care services. We must enable our aging population to maintain their independence and live in the community by delivering care as close as possible to patients' homes.

While we anticipate that the continued management of Covid-19 and the restarting and delivery of core services will be a primary focus for us over the next 12 to 18 months, the wider transformation of services for the long term must occur in parallel in order to ensure we emerge stronger from the pandemic and build on the positive changes we have seen within the service in the past year. The implementation of the recommendations of the 2018 health service capacity review has been agreed by both the Department and the HSE as a starting point for developing our capacity across community and acute services, while also reducing bed demand and improving the health of the population. The capacity review identifies the need for significant increases in capacity across a range of community and acute services. Consistent with that, we have made investments in a range of community and acute services, including additional home support hours and enhanced home support packages. As Ms Magahy said, progress on the community health networks and community specialist teams will very much accelerate in the next year. There will be a focus on ramping up the availability of diagnostics to GPs in the community and other settings and increasing the number of community, step-down and acute beds. The very welcome investment in yesterday's budget for the health service will allow further significant increases in capacity during 2021.

Working closely with Ms Magahy and other departmental colleagues, the implementation of Sláintecare will continue to feature very prominently in the work of the HSE in all our planning processes and also in our operational decision making. It is clear that we will be living with Covid-19 and its impacts for some time to come. Our experience in recent months demonstrates that we are capable of driving positive change and innovating in response to unprecedented challenges. We are living in extraordinary times where, despite the challenges the pandemic presents, there are nonetheless huge opportunities for us to make real changes happen for patients.