Mr. Stephen Mulvany:

I thank the committee for the invitation to attend today’s meeting to examine emergency care, waiting lists, disability services, including the provision of disability services by outside agencies, and MIDOC GP out-of-hours service in the context of the financial statements 2021.

At previous meetings in 2022 I have provided an overview of the annual financial statements of 2021 and, therefore, I will confine my remarks to the current financial position for 2022. The HSE has received a revised letter of determination for 2022 from the Minister for Health in December, which provides additional funding for 2022 for revenue and capital expenditure of €22,457.8 million and €1,159.9 million, respectively. This additional funding is welcomed noting that a significant element of the increased funding relates to Covid-19 expenditure incurred in 2022. The HSE is currently working to complete a first draft of the annual financial statements, AFS, for 2022 which will be presented to the Minister and to the Comptroller and Auditor General by 28 February 2023, in line with normal requirements.

The 2022 financial position cannot be viewed as finalised until the completion of the AFS and its audit by the Comptroller and Auditor General, however, it is expected that this additional funding will allow the HSE to achieve to a substantial break-even position for last year.

The committee asked the HSE to provide briefing information on a number of specific focus areas and these were submitted in advance of today’s meeting. These areas included emergency care. All across Europe health systems came under sustained pressure with even the most developed systems struggling to cope with demand on their services in the post-Christmas period due to the high rate of multiple viruses and their impact on the population. These high activity levels have occurred in the context of an earlier than usual influenza and respiratory syncytial virus, RSV, season alongside record hospitalisations of influenza and RSV cases. There was also a surge in Covid-19 hospitalised patients in December 2022. While this surge of respiratory infections was predicted and planned for, the observed levels have been in line with the more pessimistic of the projected models. The briefing note submitted outlines progress of funded initiatives through the current winter plan, previous national service plan 2022 and the additional escalation actions put in place. It also outlines our emergency response measures agreed by our national crisis management team, which I chair as CEO.

On hospital waiting lists, significant progress was made in reducing the time people were waiting for services. The number of outpatients waiting longer than 18 months decreased by 38.5%, that is, by 59,000 patients; the number of patients waiting longer than 12 months for an inpatient or day-case procedure decreased by 22.6%, or 3,800 patients; and the number of patients waiting longer than 12 months for a GI-scope decreased by 86.5%, or 3,500 patients. To be clear, this was below our target, which was severely impacted by Covid-19 in 2022, but we saw significant progress in the latter part of 2022. The HSE has also set challenging targets in 2023 to further reduce the time people are waiting for outpatient appointments so that 90% of people are waiting no longer than 15 months, 90% of inpatient or day case are waiting no longer than nine months and 95% of patients for a GI-scope are waiting no longer than nine months. Given the impact of Covid-19 and the ongoing recruitment challenges, not all waiting list funding was spent in 2022. We are currently finalising the hospital group and community healthcare organisation, CHO, waiting list plans for 2023. Where practical and appropriate, initiatives that were in place at the end of 2022 are being continued, to ensure that the momentum created in the latter part of 2022 is maintained and built upon in the first half of 2023.

On disability services, the briefing that was submitted outlines the governance arrangements for disability services, regional distinctions and the criteria being used in respect of the level of services provided as well as disability services for children and related respite care.

On GP out-of-hours services, the committee specifically asked for a briefing note on the expenditure and function of MIDOC out-of-hours GP services, which has also been circulated in advance. This outlines GP out-of-hours services to the public in the MIDOC area have continued to be provided, with increased support from the local community health care area, despite the challenges the service faced.

I have confined my opening statement to the key points relating to the 2022 accounts and the specific focus areas requested by the committee in the context of the 2021 financial statements. We will be happy to take any questions the committee has regarding these matters. This concludes my opening statement.

The Chairman mentioned repayments. The Health Act 2006 set out who was eligible for what repayments. It dealt with the fact that residents in nursing homes had been inappropriately - unlawfully - charged under two or three specific sets of regulations going back over a number of years. It provided a scheme of repayment, which has been properly set out in our accounts over the years, as the Comptroller and Auditor General indicated, which saw more than €450 million paid directly to those clients. To be eligible you had to be either a medical card holder in a public community nursing unit or a medical card holder in a publicly-funded contracted bed in a private nursing home. As far as we are concerned, the accounts have properly reflected that. It is a separate matter regarding patients who were in private nursing homes who were not charged under those subsequently determined to be unlawful charging regulations. They had contracts with their private nursing homes and, where they qualified for a means-tested scheme, they received a subvention from the State towards the cost of those. If they did not qualify under that, they could qualify for tax relief. Whether that was sufficient is a different matter.