Mr. Bernard Gloster:

I wish the Chair and members of the committee a good morning. I thank them for the invitation to meet the committee today to discuss the progress in respect of the 2024 focus on productivity in our health service. I am delighted to attend with the Secretary General of the Department of Health and his team. I am joined by my colleagues, who have already been introduced. I am supported by Mr. Ray Mitchell from the parliamentary affairs division and Ms Sara Maxwell. The committee will be aware that in approaching this and the coming years, the Minister requested a specific focus on the issue of productivity at both Department and HSE levels. The following are now in place: the group referred to by the Secretary General, which we jointly chair, and a small dedicated unit in the HSE reporting directly to me. This will remain in place for the next two years. It is essentially the entire driving force between designing and monitoring multiple measures across the HSE aimed at ensuring the best use of the resource we have in the public interest.

It is clear and well set out that demand for services is only going in one direction and in many cases at a faster rate than had been predicted prior to the pandemic. Demand is not only increasing in the number of people seeking services but also in the range of conditions and the ever-growing options for responding, be that in diagnostics, procedures or therapeutics. The work of the task force and the unit is seen in the context of productivity and savings. I will turn to the financial element of that discussion shortly, but it is important to outline what we mean by productivity and savings.

Earlier this month I addressed delegates at the HSE’s integrated care conference, advising those in attendance that productivity and savings in healthcare are about our greatest resource, which is time - a focus not only on staff time but also patients' time as an increasingly supported concept in the emerging literature. The impact of productivity on patients is what this is all about. Increased productivity means getting more out of the time we put in and more activity out of the resources we have, leading to more access. More access not only improves quality of care but it is also safer. The combined efforts of more resources and productivity will enable us to respond to demand, whereas more resource on its own or the corresponding waiting times pending that additional resource, are unsustainable.

The impact to date on waiting times through this combined resource and efficiency can be seen in significant examples. The first is in waiting lists for outpatients, inpatient day cases, and GI Scopes. In 2023 we removed 180,000 people more than in the previous year. The weighted average waiting time for outpatient services has gone from ten to 7.5 months at the start of this year and despite continued unprecedented growth in demand to 7.2 months at the end of August. In our overall policy direction and target, some 30% of people are now waiting inside the Sláintecare timeframe for targets. In unscheduled care, which is trolleys, since the second half of 2023 we have seen improvements in this challenge, which is tracked daily. While 10% more people are turning up in emergency departments this year to date, there is a corresponding decrease in trolleys of up to 20%. Delayed transfers of care, previously discussed at this committee, which is the delay in people waiting to get out of hospitals who are finished the acute episode, has reduced from a running average of 550 to 600 a day to 350 to 400. It is clear that we must continue to adapt our ways of working to build on these improvements and to broaden the focus of productivity to all of the services we have, including both health and social care in the community.

The committee will be aware of the challenges we face as an organisation in managing significant demand for our services and in controlling such a large and at times disparate organisation. The revised structure of the HSE with six new regions and new regional executive officers puts us in a much stronger position to manage our considerable budget, with the ability to make funding and activity decisions much closer to the patient, where they are best informed. In June of this year with the agreement of both the Department of Health and the Department of public expenditure and reform, we have achieved a very strong and certain position for our cash budget that enables us to plan to the end of 2025. Introducing a new control environment for both pay, referred to as the pay and numbers strategy, and non-pay is a critical factor in an overall productivity-centred approach. By the end of 2025, that control environment will have fundamentally altered in its impact and the certainty regarding the resources we have and the value the public gain from them.

Finally, I want to make a note of thanks, if I may. The HSE will be 20 years in existence this coming January. For the majority of that time, our engagement with the Oireachtas, both at committees and with individual Members, through parliamentary questions and representations, has been extensive. There is no doubt that an enormous amount of work goes on behind the scenes to keep that process well oiled. The stand-out name for most of that time has been our head of parliamentary affairs, Ray Mitchell. He joins me today in the last few weeks leading up to his retirement. Owing to his unique relationship with the Houses of the Oireachtas, I thank the committee for affording me the time to pay tribute to him, to thank him for his work, to wish him and his family all the very best into the future and to wish him good health and happiness. That concludes my statement.