Mr. Robert Watt:

I thank the committee for the invitation to discuss progress in the implementation of Sláintecare, the programme to improve our health service. As was mentioned, I am joined today by my colleagues, Mr. Muiris O’Connor and Ms Sarah Treleaven.

As committee members will be aware, last week, the Minister for Health published the 2022 action plan, the Sláintecare Implementation Strategy and Action Plan 2021-2023, which sets out the ongoing priorities to improve our health and social care services. This report contains many different elements, but this year, the main focus of the reform involves addressing waiting lists and the very significant waiting list plan that we discussed on the previous occasion. It is now being implemented across different aspects of the service. It also includes further developments in shifting care to the community through our enhanced community care programme, significant recruitment and establishment of various teams in providing care outside of a hospital setting, which is a key element of the Sláintecare programme. There is also further investment in innovation and enhanced capacity in terms of additional employees into the service, as well as additional beds and access to care. Implementing digitally held solutions aligns with the Government's recently published strategy. It also introduces the Sláintecare consultant contract.

In this respect, we hope to engage with the representative bodies over the next week or so on finalising the new contract. We are focused on progressing the national elective ambulatory strategy through the provision of new elective capacity in Cork, Dublin and Galway, which is important for increasing the overall capacity of the system to provide more elective procedures for our citizens. We are also focused on the realignment of acute and community services via regional health areas, RHAs, which we discussed at our previous meeting. We can briefly set out the progress in this programme.

The 2022 waiting list action plan was launched on 25 February. The plan allocates €350 million to the HSE and the National Treatment Purchase Fund, NTPF, and details 45 actions to reduce and reform waiting lists. The immediate focus of the plan is to reduce active waiting lists for acute scheduled care by 18% this year. If we can meet this projection, it will bring the number of people waiting to its lowest point in five years.

A waiting list task force has been established and is chaired by Mr. Reid and me. We meet fortnightly. A working group, comprising colleagues from the Department, the NTPF and the HSE, meets weekly to monitor progress and variance against waiting list plans, consider actions and identify issues to be elevated to the task force.

Overall, waiting lists are performing slightly ahead of the targets set out in the waiting action plan. The first three or four months of the year were difficult due to Covid, the impact of which on the system was profound and reduced the amount of care that could be provided. As of the end of April, both the outpatient and gastrointestinal, GI, scope waiting lists were performing ahead of target while inpatient day case waiting lists were marginally ahead.

We are maintaining the momentum behind the development and roll-out of the enhanced community care programme. Mr. Reid will touch on this in some detail. I will list the key achievements: 81 of 96 community health networks, CHNs, are now established; 21 of the 30 planned community specialist teams, CSTs, for older persons are established; 11 of the 30 CSTs for chronic disease management are established; 21 community intervention teams are now operational, with national coverage secured for the first time; and 139,000 diagnostic scans of various modalities were provided last year. Regarding that last, significant progress has been made this year, with more than 75,000 scans by the end of April and a further 20,000 or so by the end of May. We are on target for providing many more diagnostics in the community than we did last year, with a likely total of 200,000. More than 1,200 whole-time equivalent staff have commenced their roles and a further 650 are at an advanced stage of recruitment.

The significant advance in GP access to diagnostics is an impressive performance from a standing start. Every week, large numbers of people who would have turned up for hospital appointments are now receiving that care in the community setting through our older persons and chronic disease pathways. This is real reform happening in practice on the ground for patients.

An individual population health profile has been created for each of the 96 CHNs, each containing standardised data on the demographics and health status of the relevant CHN. This supports the identification of service needs down to a local level. This profiling is an ongoing process and will lead to much better planning. Initial external evaluations of the nine learning sites have highlighted a significant appetite for change among staff as well as positive feedback, particularly about the role played by GPs.

The Department of Health is progressing RHA implementation in partnership with the HSE and the Department of Children, Equality, Disability, Integration and Youth. We are designing six regions around the country where, rather than the system being funded on a siloed basis that separates community care and hospital care, health services will be co-ordinated around the needs of patients across all care settings. This means that RHAs will serve one population in one region with one budget. By aligning the services that we provide in each region, we will have the ability to see more clearly how a patient moves through our system from GP to hospital and back again.

The Government decision on RHA implementation, approved on 5 April, provides policy direction and a clear mandate for the RHA work programme. Given that stakeholder consultation is critical for the success of this reform, regional workshops and other engagements are planned to input into the development of the implementation plan. As was mentioned at our previous meeting, we are interested in receiving input from this committee and anyone else who wants to engage in the process. We have an open mind about where we are going with the design. There are many questions and we do not have a fixed view on them. With our colleagues in the HSE and elsewhere, we are trying to figure out exactly how to implement the plan.

The Government remains committed to introducing the Sláintecare consultant contract to hospital consultants as soon as possible. The contract remains the subject of engagement with consultants' representative bodies.

The Government decision in December to implement a national strategy of elective care centres was shared with the hospital groups and individual hospitals and a programme business case has been developed for the elective centres in line with it. The Government decision is to progress development of dedicated elective centres in Cork, Galway and Dublin and will provide elective care services for all of the population of Ireland. Work has been continuing on the development of project-level preliminary business cases for Cork and Galway, including public spending code compliant analysis, to support the delivery of care centres in an agile manner. These are expected to be finalised first, with the Dublin project business case being progressed in parallel.

The Department will continue to engage with the public and a range of stakeholders to further the goals of Sláintecare in building a better, more equal healthcare system for our citizens. These reforms build on one another and are progressing in tandem. I am happy to engage with committee members on this matter.