Mr. Robert Watt:

I thank the committee for the invitation to discuss progress with the implementation of reform. I am joined by my colleagues, Mr. Muiris O'Connor, Mr. Jack Nagle and Ms Muriel Farrell. Ms Farrell is an addition to the team and not on the original list the committee received.

We are here today to discuss the Sláintecare progress report for 2021, published by the Department in February. The report sets out progress made against the priorities and actions detailed in the Sláintecare Implementation Strategy and Action Plan 2021-2023. The provision of healthcare radically changed during the pandemic, as we are all aware. As outlined in the end-of-year progress report, significant reform and innovation were delivered throughout our health and social services. The voices of patients highlighted throughout the report reveal the reality of Sláintecare in people’s everyday lives and the outstanding work being done throughout the system to adapt and provide integrated services that put patients first.

I will update the committee on some recent developments this year, specifically on what has been delivered by the Department and the HSE in terms of reform since we last came before the committee in early February. In late February, the Minister for Health launched the 2022 action plan on waiting lists following engagement between the Department, the HSE and the National Treatment Purchase Fund, NTPF. The plan contains 45 actions to reduce and reform waiting lists across four main areas of work. These are delivering capacity, reforming scheduled care, enabling scheduled care reform and addressing community care access and waiting lists. Implementation of the plan is governed by a waiting list task force. This meets regularly and is chaired by me and the CEO of the HSE, Mr. Reid. It is an extension of the approach and structure that we used for the short-term waiting list action plan that ran from September to December last year, and which saw a 5.4% reduction in waiting lists.

Projections for this year suggest that more than 1.5 million patients will be added to active waiting lists for acute scheduled care this year as post-pandemic pent-up demand for health services is released. Through the plan, €350 million has been allocated to the HSE and the NTPF to deliver services to remove more than 1.7 million people from active acute scheduled waiting lists. This will result in a projected reduction in waiting lists of 18%. It is hoped that by the end of 2022, based on implementation of the plans and the progress we would like to see, the number of patients on waiting lists will be at its lowest level in five years. The plan will also make progress towards the achievement of intermediate waiting time targets as set out in the service plan.

Significant reforms are being progressed in tandem with delivering this extra activity. These include modernising care pathways to bring care closer to the community, reduce the pressure on our hospital system and greatly enhance the availability and analysis of data and information.

Progress is largely on track despite the recent surge in both emergency department, ED, attendance and Covid cases. No doubt, what has happened will undoubtedly have had an impact on delivery over the past three to four weeks in particular. As the number of Covid cases comes down and the pressure on the hospital system eases, however, we will hopefully be able to continue to accelerate our progress on waiting lists.

Significant progress has been made with the regional health areas, RHAs, project since I was last before the committee. The Government approved the geographies of the regions in the months preceding the pandemic and directed the Department to explore the organisational design, governance frameworks and funding methods for RHAs via a detailed business case. Substantial work was undertaken by the Department in partnership with the HSE, and with input from the RHA advisory group, in the development of the business case, which was published yesterday. Also yesterday, the Government approved the implementation of RHAs, another important landmark in the reform and modernisation of our health services, as envisioned under Sláintecare. RHAs will provide for the alignment and integration of hospital and community healthcare services at a regional level, based on defined populations and their local needs. This is key to delivering on the Sláintecare vision of an integrated health and social care service.

The allocation of resources by RHAs will also enable better accountability, oversight and evaluation of costs and health outcomes at a regional level. A team of officials including representatives from the Department of Health, the HSE and the Department of Children Equality, Disability, Integration and Youth is on track to produce a detailed implementation plan by the end of this year. I am happy to engage with this committee, and other committees as necessary, to input into that plan. The plan will cover how RHAs will impact on workforce and HR planning, funding allocation, capital infrastructure and governance lines.

Work has started on the development of a population-based approach to service planning and resource allocation. Planning our services in this way will improve our ability to equitably allocate our workforce and capital resources. As part of the Estimates process for 2024, a population-based resource allocation, PBRA, funding model will be used to allocate funding by RHA. A shadow budget cycle is planned for 2023.

In conclusion, the Department will continue to engage with the public and a broad range of stakeholder to increase understanding of how Sláintecare is building a better, more equal health system for all. I am happy to answer any questions from committee.