Mr. Robert Watt:

I thank the Chair and committee members for the invitation to meet again to discuss progress with implementation of our Sláintecare reform. The Chair mentioned the members of the team who are with me - Mr. Tierney, Ms Treleavan, Mr. Patterson and Ms O’Regan.

As we approach the end of the year, I am pleased to say we can report significant progress in the delivery of Sláintecare. One of our key objectives was to increase the volume of activity in our public system and treat more patients in non-acute settings through improved integrated care. In terms of increasing capacity over the last two years, we have seen the largest ever increase in healthcare capacity. Over 900 additional acute beds have been delivered since 1 January 2020, while we have increased our number of critical care beds by 26%. As was discussed with the committee before, we have also increased recruitment significantly. We have recruited more than 15,000 staff over the past two years, including 4,500 nurses and midwives, 2,300 health and social care professionals and over 1,400 doctors and dentists.

Central to delivery of Sláintecare is integrating healthcare delivery between acute and community settings and delivering more care closer to where patients live. This goal is being significantly achieved through the enhanced community care, ECC, programme. Members of the committee will recall the progress outlined previously in establishing the relevant teams which are now substantially operational. The community specialist teams, for example, are providing consultant-led multidisciplinary care to older persons and those with chronic disease. Community intervention teams provide a rapid and integrated response to patients experiencing an acute episode of illness.

Under the chronic disease management programme, to the end of October this year, GPs conducted 333,000 consultations with over 284,000 registered patients, which was a significant amount of activity. The programme engages with patients to encourage a proactive management of chronic conditions. Next year, the hope is the programme will reach full implementation as it is extended down to all patients in the relevant categories aged over 45.

Sláintecare has also delivered GP access to diagnostics for patients, with more than 205,000 diagnostics being provided by the end of October 2022. GP access to diagnostics reduces referral rates to the acute setting and increases flexibility and continuity of care. An encouraging first sign of the impact of this innovation from a recent small study across 16 practices provides positive indications of significant reductions in referrals to emergency departments and outpatient clinics for diagnostics. In this context, the significant investment in the implementation of the ECC programme is being monitored in terms of its activity, outcomes and impacts, and the Department is working with the HSE on the provision of a suite of metrics to better report on its progress. We look forward to updating members in more detail on the outputs of this in 2023. This has been raised previously by the committee so next year we hope to have a fuller assessment of the impacts of the investment to date in this programme.

On affordability, 2022 has seen major developments in making healthcare more affordable for our citizens at a time when families are facing cost-of-living pressures. The drug payment scheme threshold was reduced to €80 in March, while we also saw the abolition of inpatient hospital charges for children aged under 16 years and the introduction of free contraception for women aged 17 to 25. The recent budget included additional funding that will allow the State to expand the free contraception scheme to include 16-year-olds and those aged 26 to 30. Next year will see a significant milestone when we will be able to abolish public inpatient hospital charges for all. We also will be able to extend free GP care to people earning no more than the median household income of €46,000. This will result in more than 400,000 additional GP medical cards.

Another Sláintecare project making impact is the Sláintecare integration innovation fund, SIIF. The aim of the fund is to test innovative care pathways and e-health transformation solutions, informed by front-line staff, which provide the right care in the right place at the right time by the right team. As members will be aware, round one was a success with more than 106 projects now mainstreamed and set to receive recurring funding annually. Key achievements of these projects include an estimated 19,000 inpatient bed days and 3,000 emergency department, ED, attendances avoided. We will have a further funding round to identify further projects and scale up those projects deemed to be successful and effective.

While we have not achieved all that we hoped to in terms of waiting lists in 2022, we have seen particular progress in relation to long waiters, which have reduced significantly from the peaks. The number of patients waiting longer than 12 months for an outpatient appointment has decreased by 35% since March 2021, while the number of patients waiting longer than six months for an inpatient or day-case procedure has decreased by 35% since September 2020. In terms of gastroenterology, GI, scopes, we have seen a 75% reduction since September 2020 in those waiting for these appointments longer than six months. While we are seeing marked progress in many individual hospitals in increasing activity, and thereby in reducing waiting lists, our challenge is now to replicate these success stories across the health system. That is a key goal for the Department and our colleagues in the HSE for 2023.

The Department and HSE continue to work in developing the new RHA structures for integrated care. I have updated the committee previously on the detailed approach taken to date. As the committee will know, an implementation plan is being prepared to set out the organisation and governance of RHAs and the relative roles of the regions, HSE national and the Department of Health. This plan will set out a critical path for implementation through 2023 and 2024.

The committee may have noted the Health in Ireland – Key Trends 2022 report which was published by the Department last week. The report sets out some of the progress we have made over the last decade in terms of life expectancy and overall health and well-being. While we now have the highest life expectancy at birth in Europe, which has been a very significant development over time, these welcome developments also show the scale of the challenge we now face as a health service in terms of increasing and growing demand. Over the last ten years, for example, the number of over-65s in our population has increased by 35% and these increases will continue as we progress and demographic changes impact our society. The number of people in this category is expected to double in the next 20 years, with a particular increase in the over-85 category. As our population grows and gets older, which of course is a positive element, it provides enormous challenges for our health service and how its structures are organised and deliver care to our citizens.

In conclusion, while 2022 has seen increased capacity and improved affordability, we must continue our efforts and accelerate the pace of reform in future years. Next year will see the highest ever level of expenditure on health in Ireland. We must continue to demonstrate progress toward our goal of transforming our health service in order to meet the ever-increasing demands of our population.

Our challenge continues to be to implement foundational system change through innovation and the delivery of integrated services by investing in people, new care pathways, new technologies and new ways of working that will enable us to better respond to the growing health needs of our population. This ultimately is the motivation behind the Sláintecare programme.