Mr. Paul Reid:

I am pleased to present at the committee today, along with Mr. Watt and his colleagues and our colleagues from the Department of Health. I thank the committee for its invitation to meet with it to discuss the implementation of Sláintecare. I am joined by my colleagues Ms Anne O’Connor, chief operations officer; Ms Yvonne O’Neill, national director of community operations; Mr. Liam Woods, national director of acute operations; and Ms Yvonne Goff, national director of change and innovation. Sláintecare provides us with an unprecedented opportunity to bring about sustained improvements in the quality and capacity of our health system. The reform agenda we are now pursuing has the full support of the HSE board, which will have oversight of our progress in accordance with its statutory governance role. Our primary focus will be to improve access across community and acute services, to increase bed capacity, to address health inequalities and to enhance patient experience. As members will be aware, the HSE corporate plan 2021-24 details a transformation agenda for health and social care. It was developed to align with the Sláintecare objectives.

In quite an organic way, our response to the pandemic has accelerated many service changes that would ordinarily have required lengthy planning processes. I mention, for example, as Mr. Watt has done, e-health, community healthcare and service integration. These innovations are both enduring and system-wide. They were driven largely from the front line, which ensured successful implementation. Models of care were developed in line with one of the principal objectives of the Sláintecare strategy, which is to provide care in a location that meets patients’ and clients’ needs. The pandemic has therefore provided invaluable insights into how we can embed these ways of working. I am keen to ensure we use all that we have learned to the fullest extent. A key example of such progress last year was direct GP access to radiology services, with five external providers seeing just under 140,000 referrals by the end of the year, thereby materially reducing the demand on hospitals.

Between 2019 and 2022, €210 million has been made available through the 2019 GP agreement in support of modernisation initiatives, the e-health agenda and the roll-out of the chronic disease management programme to over 430,000 people. The enhanced community care programme was allocated €240 million for the establishment of 96 community health networks and 30 community specialist teams for older people and for those with chronic diseases to provide integrated services locally. Some 1,400 staff have been recruited, with over 2,000 additional posts to be recruited in 2022. To date, 51 community health networks, 15 community specialist teams for older persons and two chronic disease specialist teams have been established. Separately, the targeted 91 disability network teams are in place. These developments are being delivered collaboratively with voluntary providers to deliver enhanced care across general and specialist services.

Expanded community intervention teams were further developed in 2021, with five additional teams and three enhanced teams, which means that we now have 21 community intervention teams in operation. Immediate measures were also taken to introduce hospital and critical care pressures by permanently increasing surge capacity by 324 additional inpatient beds, along with 42 additional critical care beds. Additional capacity was also contracted from the private hospitals to support demand.

We continue to work with the private sector to rapidly reduce waiting list numbers. A further 314 public community beds and 498 private intermediate care beds were introduced as part of our Covid-19 response. During the pandemic, ambulance services moved away from an emergency medical service to a Sláintecare-aligned model reorientating healthcare from the traditional hospital-centric model by bringing care to patients rather than patients to care. Such developments were planned pre-Covid to manage the impacts of an ageing population, chronic disease and the growth in our population more generally. As a consequence of the pandemic, this was accelerated.

Sláintecare integration fund projects have been established in more than 100 locations nationally with project partners from acute, community and academic settings. Many of these projects have already been mainstreamed - primarily through the enhanced community care fund and the HSE welcomes the €4 million provided to support 29 more projects this year.

Although the HSE delivers approximately 3.3 million outpatient appointments, over 1 million day cases and 82,000 elective discharges each year, demand continues to exceed capacity in many specialties and I fully accept that patients are waiting too long to be seen. During the pandemic, outpatients waiting lists grew by 98,000, or 18%, inpatient-day cases waiting lists grew by 9,000 and endoscopy waiting lists grew by 10,000. Working with the HSE and the NTPF, the Department of Health published a waiting list action plan in October 2021 focused of providing additional procedures through public and private hospitals by the end of 2021 to reduce waiting lists. By the end of December, the outpatient waiting list decreased by 35,000, or 5%, with a 21% reduction in those waiting 18 months or over. There was only a slight decrease in the inpatient-day case waiting list due to the significant effect of the cancellation of elective surgeries due to Covid-19 and emergency department pressures and a decrease of 5,400 in the endoscopy waiting list. A plan to improve waiting lists and achieve Sláintecare access targets is being developed with Department of Health, clinical and managerial colleagues. Essential to the reform of scheduled care is the concurrent redesign of care in the community. We are also aiming to redesign acute care pathways by engaging wherever possible new technologies and innovative service delivery models. Significant progress has been made to modernise and implement over 70 clinical pathways within 16 clinical specialties. A waiting list plan for 2022 is currently in development and the HSE welcomes the additional funding of €200 million, which will be focused on delivering additional capacity to support this work.

The implementation of RHAs using a population health management approach will significantly impact our health system. Working with the Department, we expect to scope out design and development of RHAs and to finalise an implementation plan that is consistent with the Government's decision to establish RHAs. It is anticipated that by the end of the year, corporate and clinical governance frameworks will be completed. Aligned to Sláintecare, RHAs will support population-based service planning and funding.

The scale and challenge of Sláintecare's implementation should not be underestimated and methods of implementation and detailed planning will be important to ensuring our success. Collaboration was paramount in 2021 and it strengthened relationships greatly with healthcare providers right across the public, voluntary and private acute and community settings. This coalition allowed us to meet the relentless demands of the pandemic. Given what our health service has faced in the last 23 months, the almost instinctive alignment of the system to Sláintecare principles demonstrates the commitment of our staff and their belief in this hugely important national strategy. I have no doubt that this spirit of collaboration is the key to unlocking the full potential and the delivery of Sláintecare. I assure the committee that the HSE will devote the whole of its efforts to ensuring that we deliver on Sláintecare. Achieving this would be a fitting reward for the public and also for our healthcare staff, who have given so much over the past two years. I also acknowledge the significant commitment and sacrifices made by our teams over the past two years. Not many organisations could sustain five waves of Covid and a cyberattack.