Mr. Stephen Mulvany:

Good morning Chair and members. I thank the committee for the invitation to meet it to discuss the current challenges facing public hospitals. This winter continues to be a particularly challenging period for our entire health system, both in our acute hospitals and across our primary and social care services. This is a situation that is being experienced by almost all health systems in western Europe. Attendances and admissions at emergency departments, EDs, throughout the country were higher in 2022 than ever before.

Levels of infectious respiratory diseases are exceptional with sustained peaks when compared with the past five seasons.

Health and social care professionals across the entire health system have responded to this sustained pressure and have acted to mitigate the impact on patients and service users. It is important to recognise the enormous effort and professionalism of our staff in what are extremely difficult circumstances. On behalf of the HSE, I would like to thank all of our staff and our colleagues in the wider health system for their continued work and dedication.

In respect of the epidemiological situation, influenza is already at levels that make this an exceptional season when compared to previous years. Respiratory syncytial virus, RSV, continues to be challenging and, along with influenza, is placing significant pressure on general practice and hospitals. In addition, Covid-19 levels have been higher in recent weeks.

On the operational impact, there are significant pressures on the system generally, particularly on the parts of it most impacted by the very significant level of respiratory viruses. This includes general practice. This winter, GP out-of-hours services are seeing nearly 39,000 patients a week on average. Attendance at EDs for the full year 2022 was up by 14.8% over 2021. Across the winter months, attendance levels reached the highest ever recorded by the HSE, at over 31,000 attendances in week 44. Admissions from EDs were also up across all age cohorts in 2022, with an increase of 11.2% over 2021 levels and, importantly, the level of increase of admissions of patients over 75 years of age was 15% in 2022. Patients over 75 years of age present to ED more acutely unwell and stay, on average, twice as long in hospital as patients from younger age groups. The impact on our EDs has resulted in increasing numbers of patients waiting on trolleys for admission to a bed, to a daily high of 772 patients awaiting admission on trolleys on Tuesday, 3 January. National Ambulance Service, NAS, demand increased by 15% between January 2022 and November 2022. Over the past two weeks, there have been nine days on which the NAS has received more than 2,000 calls a day, which represents a new record high. While every effort is made to minimise the impact of winter season factors on our patients' experience, the combination of the baseline increase in activity across the year and the severity of respiratory viruses this winter has resulted in increased numbers of patients waiting on trolleys and in surge facilities for longer periods. The HSE regrets that this has been the case. Our staff do not believe this is acceptable and neither do we.

In terms of the HSE response, we have previously briefed this committee on the winter plan measures, which remain in place. The current epidemiological situation surpassed the most pessimistic modelling and in response to the increasing pressure on the system, I convened the national crisis management team, NCMT, on 22 December. The purpose of this team, working in co-ordination with the integrated operations winter oversight group, is to ensure that all measures are being taken alleviate pressure and manage patient risk as effectively as possible. There continue to be regular meetings of the NCMT and the winter oversight group to analyse current performance, aid decision-making and facilitate rapid implementation of actions. Escalation actions and arrangements include additional seven-day working across both acute and community services since 5 January. Such arrangements include additional staffing support for patient flow, additional rostering of senior decision-makers, increased access to acute and community diagnostics and therapies and increased availability of community staff to enable discharging and admission to community beds. Through agreement with the Irish Medical Organisation, IMO, participating general practitioners have extended their clinic hours by up to eight hours per week per GP. Enhanced funding has been provided to GP out-of-hours services to enable them to roster additional GPs. The National Ambulance Service has engaged private capacity and voluntary ambulance services to support hospital discharges. Community first responder schemes are responding to elderly patients and doing welfare checks on patients waiting for emergency ambulances. The NAS has also put in place hospital liaison personnel to expedite turnarounds and co-ordinate care handovers. Some 180 beds have been accessed from private hospital and liaison is ongoing with private hospitals to secure additional private capacity and to ensure that all available contracted private beds are utilised. Available nursing home capacity continues to be identified and aligned with hospital need. Ongoing regular engagements continue with key internal and external stakeholders, with the staff organisations and unions, the Private Hospitals Association, PHA, Nursing Homes Ireland, NHI, private and voluntary home care providers, HIQA and GPs. Members of the national management team, including me, continue to visit acute sites across the country.

The purpose of these visits is to listen and observe the experience on the ground, offer visible support to local staff and assist with problem solving those issues that can be resolved at national level. The effectiveness of the existing winter plan measures previously discussed with members of the committee and these escalation actions continue to be monitored and evaluated to inform lessons learned and the ongoing responses. Variation in emergency department performance can in many cases be explained by variations in demand, complexity of patients or capacity. As with every health service, however, significant systemic improvements are also required in processes, clinical pathways and whole-system integrated working, and this will directly benefit patient safety and care.

Thanks to the significant efforts of our teams on the ground, supported by the measures I have outlined, there has been a substantial improvement in the situation over the past couple of weeks, with a significant reduction in the numbers of patients on trolleys awaiting hospital beds. We continue to work to drive these numbers down further in a safe and sustained way. While we will have to put all of our energy into managing the current crisis for the coming weeks, we have agreed that we will keep track of what has worked well and consider the lessons learned from this period. This will be factored into future planning. That future planning will commence as soon as we are over the worst of the current crisis and will include planning for both next winter and the longer term.

Alongside a review of capacity being conducted by the Department, the HSE will bring forward in 2023 a three-year unscheduled care improvement plan that will contain a combination of process improvement, expedited infrastructural investment and learning from sites performing well. That concludes my opening statement.