Mr. Bernard Gloster:

I thank the Chair for the invitation to meet with the joint committee to discuss the National Service Plan 2024. I am joined by my colleagues Dr. Henry, Mr. Mulvany, Ms Hoey, Ms Queally and Ms Killeen White. I am supported by senior colleagues, Mr. Ray Mitchell and Ms. Niamh Doody.

The national service plan sets out a significant plan for our statutory health and personal social services in response to the needs of the public for services and the requirement to advance many new ways of provision to ensure sustainability into the future. This is my first full year of a national service plan. It is also the first in which the HSE has two line Departments following the transfer of functions relating to disability services to the Department of Children, Equality, Disability, Integration and Youth in March 2023. The board and executive have worked with the Departments led by the Minister for Health, Deputy Stephen Donnelly, and the Minister for Children, Equality, Disability, Integration and Youth, Deputy Roderic O’Gorman, to produce one national service plan reflective of the need for continued pursuit of integration as core to service provision.

The overall allocation of €23.5 billion for health represents an increase of 4.6% on the opening position in 2023. Some €20.7 billion relates to the health Vote and €2.8 billion to the Department of Children, Equality, Disability, Integration and Youth's Vote. There is provision of €162.8 million for new developments this year. Of that, €64.1 million relates to disabilities. A further welcome €90 million is expected to be allocated shortly in respect of new health developments.

Access and capacity will be enhanced, with €56 million in new investment in acute beds, diagnostics and the waiting list action plan. Service improvements will continue, with €13.6 million in new investment in child and adolescent mental health services, CAMHS, enhanced community care, ECC, and health promotion. Workforce and reform will see progress. Some €29.1 million of new investment is being allocated in respect of GP places, non-consultant hospital doctor, NCHD, training, nursing and midwifery and health and social care professionals, with a focus on student practice. New surgical hubs and digital reform will all aid improved ways of working and provide more convenience for the public. Disability services will continue to develop, with €64.1 million in new investment to support school leavers, residential care and the ever-increasing demand for respite care. Across health and disabilities, we have existing level of service support with a combined €834.7 million and additional support recognising the challenges that arose in late 2023, with a once-off allocation of €918.7 million for 2024.

It is obvious from all of the evidence that in what is clearly identified as a challenging year we need to continue to invest in new developments. Correspondingly, we are also obliged to demonstrate the best use of what we have and the advancement of new ways of working. To this effect. there is now a joint Department of Health HSE productivity task force, and this will assist in guiding further efficiency over the coming years. In simple terms, the productivity focus should allow us to generate more activity with broadly the same resources to respond to public need, in particular access. The new consultant contract and the public sector pay agreement are central to this focus.

I am acutely aware of the challenges and concerns regarding the pause on aspects of recruitment over the past number of months. It is clear that control within and the best use of the staff we employ is central to our responsibilities to the public, not only in respect of the services we provide but also the management of the allocation we receive from Government. It was clear in the latter part of 2023 that recruitment was running at a rate that was not sustainable. The highest ever net growth in the health service occurred in 2023, with an increase of 8,239 bringing the number of whole-time equivalents to 145,985 across the HSE and section 38 agencies. The growth is in contrast with an average increase of 4,690 in the previous five years and well exceeds even the highest most recent year driven by Covid-19 of 6,361 in 2020.

In December, even at the height of the pause, employment numbers grew by 933. We have again seen that continue, albeit less net growth in January, particularly in nursing. Turnover has improved, in that it decreased in 2023 by 1.3%, which is significant for the size of our workforce and the upward trend of the preceding years. Despite the need to get to grips with our affordable numbers and the challenges in this process, we have the largest workforce in the history of the Irish health service. That workforce has expanded by 21.8% since the end of 2019.

Notwithstanding control measures and affordability actions, we will this year see recruitment of new development posts at a minimum of 2,268 in our health portfolio and 683 in disability services. Supported by the board of the HSE, I am determined to ensure that our management of approved workforce levels brings us to a point where arbitrary measures at national level, such as a pause, will not be necessary and the best productivity possible in the public interest is achieved through our most valued asset, namely our workforce.

When I took up this post a year ago this month, I committed to expediting the introduction not only of new regions as set out in the programme for Government and the Sláintecare policy platform, but also to fundamentally reorganise the centre of the HSE in its role, purpose, function and performance. I am pleased to report to the committee that as of 11 March, five of the six new regional executive officers are now in place, two of whom are with me today, with the remaining regional executive officer due to start on 15 April. Reporting directly to me, this represents a significant move towards the integration of services and delayering of decision-making processes in the HSE. I welcome the new executives who, together with redefined roles for people at the centre, will be the mechanism and structure through which we will deliver this service plan, one which aims to improve services for the people we serve, continue to reduce waiting times in all forms and increase the quality of outcome at every point at which the public engage with us.

I am conscious that many people remain challenged in the context of their confidence in us as an organisation. This is in part because there are times when we simply come up short for them. While the evidence shows a lot of improvement, it is clear there is a significant way to go and the national service plan further facilitates that journey.