Mr. Bernard Gloster:

I thank the Chair and members for the opportunity to appear before the Joint Committee on Health to discuss the preparedness of the healthcare system for the expected seasonal increase in respiratory and other illnesses this winter. The Chair has already welcomed my colleagues. I am also supported by Mr. Ray Mitchell and Ms. Sara Maxwell.

When I took up my post and first attended this committee in March this year I indicated my intention, with the agreement of the Minister, to move away from the annual cycle of winter plans. In this context the HSE has prepared and commenced an in-year unscheduled care management plan which will run for the coming period. In addition, a more sustainable three-year plan has been drafted and I anticipate its approval as we approach 2024. Both plans are based on four points of emphasis towards which I have directed all HSE services in recent months.

The first of those is avoidance operations, which is heavily led by community services in conjunction with hospitals and is aimed at hospital avoidance where appropriate. Emergency department operations is led within those departments and is aimed at maximising flow at that point of the patient journey and, equally important, the experience of people while waiting admission. In hospital operations the point of focus is on all aspects of processes within hospitals to ensure that decisions regarding patient care are made in the timeliest fashion and the mechanisms are there to give effect to those decisions, for example, diagnostics. The fourth category is discharge operations. Again, this is predominantly the function of community and primary care services working with hospitals to reduce the length of time a patient spends in hospital after the acute phase of care has been determined as concluded.

There is little doubt, as we face this coming period, that trolley waits and pressures will be a feature of our services. The focus of the HSE is to ensure not only that these are kept to the minimum extent possible but also that there is a pathway to continuous improvement. I repeat our sincere regret to any person who has a bad experience while waiting to access our services, including those who have to wait in emergency departments beyond an acceptable timeframe. I particularly recognise older people and those who find themselves in vulnerable situations. I restate our commitment that their care and comfort will be a priority even when some waiting is unavoidable.

Some recent information helps to contextualise the position. Year on year trolley waits have dropped by an average of 21 per day, or 6.5%. While recognising some individual site variations and challenges, this is to be welcomed. More focused counting methodologies will assist a detailed daily understanding of the position. In recent months, delayed transfers of care, DTOCs, have moved from an early year challenge of 600 to 550, and in the past month improved further to 474. Again, more focused counting methodology will assist in understanding the problems and informing responses. Year-on-year breaches of the nine-hour limit for those ages over 75 have, on average, decreased by 15 per day, reflecting a 25% improvement. Work is now focused on maintaining substantial reductions in both the 24-hour and nine-hour breaches. We have seen some positive indications of that in recent weeks. These are to be welcomed but are not something to be complacent about.

Attendances remain on a par with last year. Within this, however, a greater number of patients have been admitted, resulting in 40 more patients per day needing an acute bed, which is a 4.4% increase year on year. Improvements in trolley waits and delayed transfer are of particular significance in this context. I assure members and the public that a full system-wide management and clinical leadership hands-on approach is being taken to exploiting every opportunity to respond to the public need, particularly as it manifests in the emergency department context.

I am aware of recent commentary in respect of communications regarding discharge and options for people, for whom it has already been decided that alternative care is a requirement.

It is regrettable that some of this narrative has emerged, particularly for older people and their families, when it is abundantly clear that the measures are appropriate, sensitive and, most importantly, a response to patient safety issues. There is a clear and unambiguous connection between delayed transfers of care and the pressures in EDs in several hospitals. It is of course accepted there are also other contributory factors.

I have made it a clear priority of this year’s focus that older and more frail people are to be the most urgent focus of all of our services, including where necessary their care experience in EDs while awaiting admission. There is no doubt we can do better and recent indications are proof of this. We have and continue to have significant support from the Minister and his Department and I am satisfied this will continue into 2024. I previously advised the committee of a new framework for private hospital use and despite much criticism at the time, this has been well responded to. This will be used appropriately in the weeks ahead.

I have advices from the chief clinical officer in respect of respiratory syncytial virus, RSV, seasonal Influenza and Covid-19, all of which continue to be monitored and feature in our plans, which are adjustable to the circumstances to the greatest degree possible. Communication with the public on options for care and regular proactive reporting on the patient flow data, such as trolleys and DTOC, will feature more strongly in the coming weeks and months. I believe it is important that the HSE continues to increase its publication of data in real time for the public to see.

In conclusion, I want to thank our staff across the entire HSE and funded agencies who participate in our response to unscheduled and emergency care pressures and challenges. There is little doubt but that their flexibility and innovation contributes significantly to our response. I thank the public for their ongoing co-operation with measures and advices and I urge all relevant groups to please take up the option of flu and Covid-19 vaccinations and boosters as a means of protection for all. This concludes my opening statement. I thank the Chair.