Mr. Damien McCallion:

I thank the Chair and members for the invitation. My colleagues have been listed, so I will not repeat that.

The recent publication of the Sláintecare progress report highlighted the significant progress being made in many areas but substantial more work is still to be done. Implementation of Sláintecare is the top priority for the HSE, alongside delivery of our core services. We continue to work closely with colleagues in the Department of Health.

On our integrated model of care, the implementation of the HSE's health regions involves the internal reorganisation of the HSE into six organisational regions with responsibility for the planning and co-ordinated delivery of health and social care services within their respective geographies. The six new regional executive officers, REOs, were appointed and took up position recently. They are now accountable and responsible for regional health and social care services. The REOs report directly to the HSE chief executive officer on the operation and management of the health regions and are part of the national leadership team. This is being followed on 1 June by implementation of a new centre to support the regions, which will transition over the summer, concluding in September 2024. The HSE centre will be focused on activities that are best performed at national level, rather than operational matters. This means the centre will devolve responsibility and authority for delivering the vast majority of services to the six regions.

As the Secretary General mentioned, in 2023, despite continued increases in demand for urgent and emergency care, we saw some improvement in key performance metrics, such as patients delayed waiting for admission, patients delayed waiting for transfer of their care to the community, and patient experience times for people aged over 75 in our emergency departments. We continue to see an increased demand for urgent and emergency care, with a 11.5% increase in attendances year to date and a 15.8% increase for older people aged over 75 attending EDs. Despite this, in that period we have managed to achieve a 10% decrease in the number of patients delayed on trolleys, a 16% reduction in patients aged over 75 delayed more than 24 hours, and a 46% decrease in patients delayed in hospital waiting for their care to be transferred to the community.

However, despite these overall productivity improvements, we continue to see some sites with particular challenges. These remain a key focus for the HSE in order to ensure we improve the experience for patients in those sites. This includes implementation of specific short- and medium-term actions as part of a site improvement plan, with supports for those sites where necessary. In addition, we established an academy in 2023, which is focused on ensuring that learning is transferred from those sites that are working well to support sites under more pressure.

Waiting lists reduced in 2023 following similar progress in 2022. As the Secretary General mentioned, waiting times were reduced by 32% for those waiting more than 12 months and the average waiting time reduced from 9.2 months to 7.2 months. We continue to increase our activity in 2024, with, for example, 4.2% more outpatient appointments delivered in the first quarter than were delivered in 2023. However, we face a significant challenge in that referrals for acute hospital services continue to rise post pandemic at a much higher rate than was previously the case. In order to mitigate this demand, we continue to work closely with the National Treatment Purchase Fund, NTPF, and to focus on modernising the waiting list process through implementation of initiatives such as centralised referrals, productivity improvements, a theatre usage improvement programme, modernised care pathways and robotics. Separate initiatives seek to improve access in our community services, including mental health and disability services. Particular focus is being paid to improving our response to children’s services.

A very substantial elective care programme has been put in place, which brings together key projects to increase our surgical capacity, to address inpatient and day-case waiting lists and future elective demand. These include the development of surgical hubs and elective hospitals, which are designed to separate elective and emergency care. The first surgical hub opened in west Dublin with two further surgical hubs due to open in south Dublin and north Dublin before the end of this year. In addition, work is progressing on opening hubs in counties Galway, Waterford, Cork and Limerick, while considering other geographical areas. These will use rapid-build construction, where possible. At full capacity, each hub will work from 8 a.m. to 8 p.m. six days per week and ultimately cater for 5,000 day procedures and 12,000 outpatient appointments related to those procedures per annum. Significant work has taken place over the past few months in defining the size and scope of the elective hospitals based on updated demand and clinical models. While the building planning phase is ongoing, we continue in parallel to develop the operating model, workforce requirements, diagnostics and digital requirements for the new elective hospitals. A request for tender submission was published on 24 April on eTenders for phase 1 of Cork and Galway.

On our enhanced community care programme, one of the key aims of Sláintecare is to shift towards provision of care in the community, where possible, and away from hospitals.

We have seen significant investment in our community care services with the establishment of community diagnostic services, community health networks based around local populations and the introduction of community specialist teams, such as teams for older people and chronic diseases. The Secretary General has referred to some of those advantages in terms of reductions so I will not repeat them.

The introduction of the public-only consultant contract on 8 March 2023 was a priority aimed at improving patient care with the removal of private care within public hospitals. As of 2 May 2024, 2,229 consultants have signed the new contract. An immediate benefit is that all new contract holders provide their full contracted hours to public-only work. In addition, we are placing a particular emphasis on supporting emergency care at weekends and on additional outpatient activity as further private work ceases under the new contract.

With regard to capacity and productivity, the Health Capacity Plan 2018 identified a series of capacity increases required to meet demand. We have grown our acute and critical care bed capacity with the opening of 1,126 acute care and 71 critical care beds - now 320 in total - since 2020. The number of primary care centres has also grown from 138 in 2020 to 176, thereby improving access to care in the community. We are currently updating our capacity plan in regard to other services, such as mental health.

Another key part of the reform area is improving productivity. The Minister has established the joint task force to which the Secretary General referred. We are continuing to see rising demand in line with other healthcare systems following the pandemic. It is critical that we focus on extending services into the evenings and weekends to maximise the use of our infrastructure. This productivity area will be a priority for our new health regions and overseen by the joint task force.

Regarding digital health, the HSE and the Department of Health have worked together to finalise a digital health and social care framework that will guide priorities, development and investment. This is underpinned by a more detailed roadmap which sets down a clear path for the integration of digital technologies in the healthcare system and marks a crucial step in the journey towards a patient-centred and digitally-enabled health and social care environment. Through this framework, we are advancing the implementation of a new patient app in 2024, the development of electronic patient records in key areas, such as the children’s hospital, and the development of a national electronic health record. In addition, we continue to implement solutions to support hospital and community services in their day-to-day operations across services such as laboratories, mental health, disabilities, older persons, primary care and palliative care. This includes the innovative use of robotics and exploring the use of artificial intelligence.

In conclusion, significant progress has been made in the implementation of Sláintecare in our health and social care services. This is underpinned by strong governance and delivery structures between the Department and the HSE to ensure successful implementation. Our focus continues to be on investing in our workforce, underpinned by new facilities, new technologies and new ways of working.