Mr. Bernard Gloster:

I thank the committee for the invitation to meet with it today. I welcome the opportunity to engage with the committee on the two items listed for discussion today: namely, the HSE's 2023 National Service Plan and community neurorehabilitation services.

I am joined by my colleagues, as outlined by the Chair, and I am also supported by senior staff: Ms Sara Maxwell and Ms Niamh Doody. The 2023 National Service Plan comes against the backdrop of the drive to return to the normal functioning of services, at the best of times complex in themselves, following the sustained impact of the pandemic since early 2020. The winter period of 2022 into 2023 saw unprecedented demand in a range of critical services, including emergency departments, general practice, social care, mental health, and new outpatient referrals.

The 2023 National Service Plan seeks to achieve two headline objectives. These are the restoration of health and personal social services in the first full year post the pandemic and the advancement of the programme for Government and Sláintecare in achieving universal healthcare.

The 2023 core revenue budget on which the national service plan is based is 5.7% higher than the opening position in the previous year. When some further once-off Covid funding is included, the total revenue for the plan is €21.7 billion. This includes the provision of additionality in existing levels of service of €900 million and €240 million for new service developments. The NSP is supported by a capital plan of almost €1.2 billion. This takes account of previously agreed projects and is aligned to both the programme for Government and the strategic priorities of the HSE, supporting the mitigation of infrastructural risk and the delivery of safe and quality healthcare.

The year 2022 saw the introduction of a targeted waiting list action plan. In view of the significant demands and the need to continuously reduce waiting times, the 2023 National Service Plan is supported by a separate waiting list action plan for the year. The national service plan and the waiting list action plan, in addition to the National Treatment Purchase Fund, NTPF, activity, will again ensure record numbers of people are seen and treated this year. While improving waiting times, we will continue to see high volume lists overall as the numbers of new referrals are at an all-time high, an experience not unique to Ireland.

To give the committee an understanding of the scale of our acute activity, the most recently available 12 months of data show there were 3.4 million outpatient and 1.7 million inpatient and day case attendances. In addition to this planned or scheduled care, our hospital system also treated 1.6 million patients during this same period in emergency or unscheduled care. That represents a 10% increase on 2019, the pre-pandemic level measure year, and reflects the ongoing pressure on hospitals from viral surges and increased emergency department attendances. The 2023 National Service Plan will also see the advancement of new structures for the health service as the regional health area, RHA, concept is advanced.

In February 2019, the National Strategy and Policy for the Provision of Neurorehabilitation Services in Ireland – Implementation Framework was published. The strategy aims to integrate neurorehabilitation services, offering care in specialist centres where needed or as close to the patient's home as possible. To achieve this, the strategy outlines the configuration of what are referred to as managed clinical rehabilitation networks, MCRNs, at a population-based level. Following the transfer of functions in the programme for Government, this matter is now led by the Department of Children, Equality, Disability, Integration and Youth in its disability function and the HSE is directly engaged with the unit there on the implementation of this strategy. The managed clinical network model consists of a multi-tiered system of neurorehabilitation services, which includes the following. Tier 1 is the national neurorehabilitation inpatient facility. Tier 2 refers to the regional neurorehabilitation inpatient facilities. The aim is to have four to six facilities of approximately 20 beds per 1 million population. Tier 3 covers local community-based neurorehabilitation teams, CNRTs, which is the interest of the committee today. The progress and next steps in regard to each of the managed networks for neurorehabilitation services is listed in the presentation. I will move to Tier 3, which is what interests the committee today. The objective is to establish nine community-based neurorehabilitation teams. They will include approximately 13 professionals, comprising a wide range of therapy services, led by a consultant in rehabilitation.

In 2023, full local community-based neurorehabilitation teams will be place in CHO 2, CHO 4, CHO 6 and CHO 7. We note the dependency on the availability of staff for recruitment to complete the teams. The impact of these teams will vary in 2023 due to the recruitment processes, but they are intended to be fully functional by early 2024. The 2024 Estimates will include the remaining CHO areas, recognising that in CHO 1 and CHO 3 there are partial teams in place which predate the strategy. These will provide a good foundation to bring those areas into line with the strategy. That concludes my opening remarks. I am happy to assist the committee.