Mr. Robert Watt:

I thank committee members for the invitation to discuss progress of the implementation of our Sláintecare reforms. I am joined today by my colleagues Mr. Muiris O’Connor, Ms Louise McGirr and Ms Rachel Kenna who will be familiar to the committee from previous engagements.

The committee will know from previous discussions that Ireland’s health services are undergoing a most significant programme of reform and expansion. There has been an unprecedented level of investment to support that expansion and reform. There is continued investment in our workforce, in delivering new care pathways, new facilities, new technologies and creating new ways of working that is enabling our health service to respond to the growing health needs of our population.

We are increasingly seeing the patient impacts of this investment. The enhanced community care programme, for example, continues to deliver increased levels of healthcare through general practice, primary care and community care closer to people's homes and away from the acute hospital system. The Minister published a three-year progress report covering the period of 2021 to 2023 in April showing the extensive progress made over this period in respect of that programme.

Work has continued through this year and significant reform programmes continue to build on progress across the service. This is particularly so in areas highlighted in the programme for Government, such as waiting lists, women’s health and digital health. These reforms will aid in our goal of achieving the highest possible standards of affordable, quality health and social care for the people of Ireland when they need it and where they need it. Making this vision a reality for the patient is at the core of our collective efforts in the Department and in the HSE, and we will continue to improve health and social care services to optimise patient outcomes and be responsive to their needs.

Our driving objective remains, as ever, to increase the volume of public activity and to treat more people in the community through improved integrated care. In addition, as I have said here before, healthcare productivity is key to achieving this goal - the more productive we are, the more patients we treat, the less time they must wait and the better health outcomes we can achieve.

As members of the committee are aware, significant investment has been made over the last number of years. To give some examples, staff numbers have risen by almost 40% from 2016 and we have added more than 1,100 acute beds.

As the committee is aware, we are continuing to build more physical beds and we are also putting in place a virtual beds programme. We have invested significant resources in shifting care to the community in line with the recommendations of the Sláintecare report.

We now have in excess of 430,000 people registered with the chronic disease management programme, 91% of whom now have their care fully managed in primary care settings. We have presented various data to the committee in respect of that programme. A recent audit of a sample of such patients revealed a reduction of more than 31% in emergency department attendance, a 25% decrease in inpatient admission and a 33% reduction in the use of GP out-of-hours services. This is a significant programme that focuses on people with particular conditions. The progress we have made is really impacting on the overall efficiency of the system. There is obviously more we need to do and we need to build on it in future years.

The investment we have made has yielded not just better care but also more care. This year, the HSE expects to deliver almost 4 million outpatient appointments, up from 3.2 million in 2021. Emergency department presentations are up by 29% over the period. Day cases are up by 20% and inpatient discharges are up by 17% over the past four years. This year, we are once again likely to see the highest level of activity ever within the public health system. We are doing much more because of the investment we have received and the reforms that have been undertaken. It is a critical message that these things need to go hand in hand.

That said, we need to do more. The demographic challenge we face cannot be underestimated. We have seen growth of 11.4% in our population since 2016. There has been a 20% growth in the population over 37, with this cohort now making up more than 53% of the population. The population ageing is a significant factor. Within 30 years, our population over the age of 65 will grow by more than 1 million. The number of over-85s will almost quadruple. This committee is aware of the challenges this will bring to providing more care to more people over much longer periods. One interesting statistic is that, since 2016, 67% of the increase in inpatient discharges is accounted for by people over 70.

While we continue to expand our service to meet growing demand, we must change how we work in order to deliver ever more care. We are seeing signs of what is possible. I will touch on a few of these data points. This year, we have seen a decrease in the number of patients waiting on trolleys. This is despite an increase in demand of more than 10%. We have seen an improvement in the percentage of people who are waiting less than six months on our waiting lists for scheduled care. This has increased from 41% in 2021 to 62% this year. Some 82% of people are now waiting less than 12 months and the number of those waiting more than 12 months has been reduced significantly. Overall, the average wait for people on the list for outpatient care has fallen from 13.2 months in July 2021 to 7.2 months now. While we are not saying that these improvements necessarily mean the end of our ambition - of course, people are waiting too long - they do show significant progress on waiting lists.

The productivity and savings task force was set up in March and is co-chaired by Bernard Gloster of the HSE and myself. This endeavours to bring a sharp focus and leadership to how our system can respond to ever-increasing demands. We have taken advantage of the digital opportunities available, analytics and the use of data and insight to effect real change for patients. New clinical pathways, moving services to the community, as I have mentioned, and focusing more of our efforts on prevention is yielding results. The task force prioritises both savings in cash terms and productivity measures that can deliver real improvements in services. Cost-cutting is not the overall objective of this group. We are making the budget go further and maximising resources to deliver more with what we have. We are seeking savings across the management consulting budgets, medicine spend and non-pay expenditures. While this is challenging against a backdrop of high demand, these targets are intended to focus the service on where we are spending more in a cost-effective manner. We need to continue to challenge ourselves. There are a number of key questions for us. Are we carrying out procedures across all the regions and sites at the same and best value? Are we ensuring that all diagnostics and tests ordered are needed and not duplicated? Are we maximising our procurement strength as a major purchaser of health goods and services?

It is clear that it is not sustainable over the long term to continue to increase health expenditure in line with demand each year. That is not sustainable from the Exchequer's perspective so we must meet the increase levels of demand in health by reforming how we do things and availing of opportunities to maximise existing infrastructure and resources to meet demand and reduce waiting lists, such as introducing new models of care, care in the community and virtual wards. As the Chair knows, we have introduced two virtual wards at St. Vincent's and Limerick. The early results as to the impact they are having are very positive. We have made good progress and we will continue to focus on these areas. We are very happy to engage with the committee as required.