Mr. Robert Watt:

Good morning, Chairman and members. I thank the Chairman once again for the invitation to join the committee to discuss progress in the implementation of Sláintecare. As he mentioned, I am joined by Ms Rachel Kenna, chief nursing officer, Ms Margaret Campbell, principal officer in the strategic workforce planning area and Mr. Bob Patterson and Ms Grace O’Regan, who work in the Sláintecare implementation division.

We have discussed previously our progress in meeting the challenge of Sláintecare in terms of integrating health responses between the acute and community, and in delivering more care close to where patients live.

I am happy to report we are making progress. Our enhanced community care programme continues to expand and develop as planned. Ninety of the planned 96 community health networks are now established, as are 21 of 30 community specialist teams for older persons and 17 of 30 community specialist teams for chronic disease management, while 21 community intervention teams are now operational and securing national coverage. One of the things we discussed previously was GP diagnostics. Some 170,452 scans have been provided to end August 2022, which is a significant advance on the number provided last year. We plan to expand this service further next year.

We remain on target in enhanced community care, ECC, recruitment. Of the total target of 3,500, almost 1,900 have already commenced their roles, with a further 420 at an advanced stage of recruitment.

As the committee is aware, we are currently at phase one of the regional health area, RHA implementation, which is focused on the high-level design of the service delivery model for the health and social care service - the organisational arrangements needed to deliver integrated models of care. Six RHA streams have been established, focusing on clinical governance and accountability; finance, inclusive of population based resource allocation; digital and capital infrastructure; people and development; change, communications and culture; and programme co-ordination. The work of the workstream groups will feed into an implementation plan that will be finalised by the end of the year. Work has started on the development of a population-based approach to service planning and resource allocation. A population-based resource allocation funding model will be part of the Estimates for 2024. My Department recently published a spending review paper which provides an analysis across six countries to establish international best practice in this area to see how they can best inform our approach going forward.

The transition to RHAs will continue next year, with recruitment for senior posts starting as early as possible. The Minister, Deputy Donnelly, has established an advisory group of patient and staff representatives from across the health and social care sector who continue to engage and contribute to the development of this implementation plan.

Stakeholder consultation is key in developing the new structures for integrated care. Several events have been held with health sector stakeholders to make sure what we are designing better enables integrated, patient-centred care. This has included engagement with the HSE board and senior leaders within community healthcare organisations and hospital groups. The Departments and the HSE are also involved in detailed engagement on regional health areas with the dialogue forum for voluntary organisations, and the engagement will continue. Six regional events for employees are being held in September and October to gain input from staff in terms of this reform.

As regards the specific item on the agenda for this morning, and Mr. Reid will speak about this in a moment, we expect at this stage the increase in whole-time equivalents to be approximately 4,600 this year. By the end of August, staffing levels show a growth of 2,600. All staff categories are showing growth in the year to date with the largest increase seen in nursing and midwifery. All nursing and midwifery graduates in the class of 2022 have been or are being offered permanent opportunities within our health system.

To supplement the national pool, the HSE has implemented a drive to source nurses and midwives from the international market. As the committee will have seen from recent research published by the Department of Health, we must dramatically increase the numbers of nurses we train to reduce our reliance on such international recruitment. This increase began over recent years, and we will have in place an additional 344 undergraduate training places for nurses and midwives.

The HSE has similarly directly targeted all the health and social care professional, HSCP, graduates from Irish colleges, and these applicants are being interviewed and will be offered jobs from October onwards. To supplement the pool, international campaigns have been launched in a number of different areas, and the Department of Health is working with the Department of Further and Higher Education, Research, Innovation and Science to increase the number of HSCP students in Irish colleges over the years ahead.

Our capacity to recruit people is also an issue and significant activity is taking place. Recruitment capacity has increased within the Public Appointments Service, particularly for the recruitment of medical consultants. The HSE is also developing targeted initiatives to enhance the candidate pool, focusing especially on hard-to-fill posts. In recognition of the scale of global competition for health care talent, the HSE has developed and implemented a globally competitive relocation package to attract international recruits to our service.

Working with the Department of Further and Higher Education, Research, Innovation and Science, we have succeeded in securing an extra 60 places on medical courses for Irish and EU students this year, with agreement to increase this by a total of 200 over the next four years, but even that announcement will not be sufficient.

We will have to increase the numbers much more and probably double the places we make available in the quickest timeframe possible. We will need to look at different ways such as expanding or creating new schools, and all options we can to provide more opportunities for people who want to join this important profession. As I say there is agreement to increase the places but I think we will need to go much further than that. In common with other healthcare professions, the numbers of Irish and EU medical graduates we are producing is far short of the numbers we need to meet the healthcare needs of the service, as discussed before. The demographic challenge is increasing demand all the time and we need to increase our workforce and train more people to participate into the future. Clearly a big issue for us is to look at all opportunities to increase the number of graduates we produce domestically. We are making progress on recruitment and reform, but obviously we need to accelerate this and I am very happy to take questions from members of the committee.