Mr. Liam Woods:

I thank the Joint Committee on Health for the invitation to discuss Sláintecare, in particular the specific issues regarding elective hospitals, consultant contracts and the individual health identifier, IHI. The chief executive, Mr. Bernard Gloster, extends his apologies for not being able to attend today. I will confine my opening statement to the three specific topics on the agenda.

The Sláintecare Implementation Strategy and Action Plan 2021-2023, approved by Government in May 2021, set out the priorities and actions for the current time period and is grounded in key reform strategies, policies and initiatives. Significant developments in line with Sláintecare priorities have continued in 2023. These include: the establishment of 96 community health networks and 24 dedicated clinical teams for older persons and those with chronic diseases, operational since 31 October 2023; progressing plans to address waiting lists for scheduled care, including targeted initiatives in each hospital, with €363 million allocated to the HSE and NTPF; the development of new elective hospitals in Cork, Galway and Dublin; and the development of surgical hubs in counties Cork, Galway, Limerick, Waterford, and Dublin. There has also been an increase in bed capacity through the delivery of new and replacement acute and critical care beds, with funded critical care beds due to increase to 331 by year end.

The development of six health regions with the recruitment of the regional executive officer posts is nearing completion. Options for both the health region executive management team and the integrated healthcare area structure have been developed and are under review.

Scheduled care has been reformed through the implementation of modernised care pathways that transition care from the acute setting into the community. Seven priority pathways are currently operational across a number of sites in specialties such as ophthalmology, urology and orthopaedics as part of a detailed implementation plan. The roll-out of Sláintecare integrated innovation fund, SIIF, projects in conjunction with the Department and Pobal continues. SIIF round 3 is at an advanced stage with award offers made to successful projects. A new Sláintecare strategic framework 2024 to 2027 is currently in development with an advanced draft to be presented for discussion at the next meeting of the Sláintecare programme board scheduled for 11 December.

The elective hospitals programme has progressed in 2023 following the Department's conclusion of the gate 1 business case process in December 2022. This includes work to further define the shape and scale of the hospitals and how they will operate and the initiation of procurement, IT and workforce planning. To advance the elective hospital projects in Cork and Galway, the HSE is preparing to develop detailed project briefs, design proposals, related business cases and other material for submission to the Department of Public Expenditure, NDP Delivery and Reform. This is in accordance with the decision gate 2 pre-tender approval of the public spend code, prior to approval to proceed to tender in due course.

The preferred site recommended to be brought forward in Cork is St. Stephen’s Hospital and in Galway Merlin Park University Hospital. The HSE is progressing the procurement of a design team, which will be appointed to provide the full scope of design services for the proposed elective hospitals in Cork and Galway, and the provision of services required to support the HSE with the preliminary business case for the elective hospital in Dublin. The first stage of appointing the design team, which is a preliminary qualification stage, was recently published on the Government's eTenders website. Market response to date has been positive with broad market interest in this competition. Responding to initial feedback, and to encourage optimal interest in participating in the stage 2 tender process, the closing date has been extended to January 2024. This extension will result in the appointment of the successful architect-led design team in April or early May 2024. The appointment of the complementary project control team will be co-ordinated around this timeframe. On the elective hospital or hospitals in Dublin, we are continuing to work with the Department. It is intended to update the Government on progress in Dublin and on the overall electives programme in the near future.

Timelines will be refined as projects develop and evolve, but the overall programme targets for the elective hospitals remain as previously advised, with the hospitals in Cork and Galway planned to receive their first patients in 2027 and to be fully commissioned from 2028 onwards.

Since the introduction of the public-only consultant contract on 8 March this year, 1,129 consultants had taken up the new contract by 23 November 2023, including 255 new consultants and 874 who transitioned from the previous contract. The Sláintecare consultant contract will enable the removal of private practice from the public system on a phased basis, which was a core recommendation in Sláintecare. The consultant contract provides for an extension of consultant core working hours to 10 p.m. Monday to Friday, and Saturdays from 8 a.m. to 6 p.m. This doubles the hours during which consultant-delivered services will be available across many areas of the health service, including emergency departments, and will lead to a significant improvement in the delivery of care. In line with the Government commitment to substantially growing consultant numbers substantially the HSE can report an increase of 914 additional consultants in place since the beginning of 2020.

The IHI legislation was enacted in 2014. During that year the HSE implemented the technical infrastructure required to create the IHI register in parallel with undertaking a public consultation for a data protection impact assessment, which was published in February 2015. In May 2015, a data sharing agreement was signed with the Department of Social Protection for the provision of the PPS number data set, which was required to populate the register. In June 2015, a ministerial commencement order allowed for the population of the IHI register, to commence the creation of IHIs for 4.5 million people, using the PPS number data set provided by the Department of Social Protection. The system went live in September 2015, initially providing IHIs for all electronic referrals from GPs, and then extended to all electronic messages from GPs using Healthlink. In 2018 and 2019, significant work was undertaken with various national systems including the population of IHI into PCRS for all their schemes including medical cards and drug payments. Between 2020 and 2022, the IHI infrastructure was deployed to support the pandemic response. PPS numbers were utilised as part of the primary identification process where they were available. It enabled an IHI to be assigned within various pandemic solutions across the Covid care pathway including referrals, test results, tracking and contact tracing and for Covid vaccinations. The availability of the IHI, in conjunction with eircodes, across the Covid care pathway was vital for providing critical, up to date information to public health and the Government needing to make decisions on their response to the prevalence of Covid within age cohorts and geographical regions.

While work was suspended during the pandemic for deploying the IHI into non-Covid health systems, planning commenced for the 2023 schedule of work to resume rolling out the IHI to more health systems. In 2023, substantial progress has been made. All general practice systems are now populated with the IHI, which is embedded in all messaging between GP’s and Hospitals. All the statutory hospitals, with two exceptions, have also embedded the IHI into their patient administration systems. National screening services, including cervical check, breast check, bowel and retinal screening have also been populated with the IHI. All new patient-focused systems have been IHI populated from the start, including electronic health records, EHRs, in the national forensic hospital, the national rehabilitation hospital and patient billing for the new finance system. All Healthlink messages now have the IHI embedded into them. During 2023 the IHI was provided or validated successfully 88 million times across multiple systems within the health service. This resulted in the IHIs for 5.6 million people being provided to multiple health systems in multiple health settings. During 2024, the IHI will be extended to the last of the statutory hospitals and several of the voluntary hospitals, the National Treatment Purchase Fund and a number of key clinical systems, such as the national integrated medical imaging system, the national cancer system, the new nursing home and support system, the national renal system, the children’s disability network information system and the hospital medicines management system.

The IHI team will also engage with pharmacies and out-of-hours GP services so they can avail of the IHI.

The continued extension and use of IHI is critical for the health service. It is required to bring patient data records together from various disparate systems. It is critical for the success of the new health app due in 2024 and the implementation of the shared care-summary care record, which will complete its procurement process in 2024.

That concludes my opening statement.