Mr. Robert Watt:

It is great to be here. I am joined by my colleagues Louise McGirr, Trevor Moore, who is on my left, Derek Tierney and Siobhán McArdle. I thank the committee for the opportunity to update it on our Sláintecare reform programme. As the committee will be aware, we continue to make progress across the health service. Despite a growing and rapidly ageing population, ever more patients are being seen in shorter timeframes and to high standards of care.

The reform programme covers many different areas. I wish to take some time to touch on a few issues. Capacity is a key issue. A total of nine HSE surgical hubs are at various stages of development nationally. Two hubs are operational, namely the Reeves Day Surgery Centre at Tallaght University Hospital and the HSE surgical hub south Dublin at Mount Carmel Community Hospital. The latter served its 2,000th patient this week. It is great to see the activity ramping up already. The construction of surgical hubs in Dublin north, Galway, Cork, Limerick and Waterford continues, with each of these due to open on a phased basis in 2026. As members will be aware, in July, the Minister announced the further development of elective care capacity in the west and north west, serving Sligo, Letterkenny and the wider Donegal and north-west area.

As part of the joint research programme in healthcare reform, the ESRI developed various projections for various areas of healthcare capacity, including the acute hospital system, GP services and wider older persons' services. These reports were published in May and June of this year and set out the significant increase in capacity required to address the needs of Ireland's growing and ageing population. We are working hard with our colleagues in the HSE, and particularly those in HSE estates, to deliver this much-needed additional capacity.

Of course, capacity is needed, but productivity improvements are a core enabler of Sláintecare implementation as they are central to improving access, quality and efficiency across our service. Our acute hospitals represent €10 billion of the budget for this year, a significant sum of money. While I am conscious that health journeys start in and return to the community setting, we need to make sure that our hospitals are as efficient as possible in order to give every patient the care they need. As of the end of August, 3,090 consultants had signed the public-only consultant contract. That represents 66% of the total consultant workforce. This is made up of 943 new entrants and over 2,000 change-of-contracts.

New software that will allow us to better track consultant working went live in June. This development enables more accurate reporting of five-over-seven working for consultants and service planning and informs medical workforce planning.

Access is a particular challenge, but we are seeing progress. The latest hospital numbers, which were published in August and which members will have seen, show there has been a 40% reduction in people waiting over one year since 2022, the end of the pandemic. Now, 84% of people are waiting less than a year, and 62% of people are waiting less than six months, up from 71% and 51%, respectively, in 2022. These improvements reflect the impact of the multi-annual waiting list action plan, which has been in place since 2021 and which continues to guide our efforts in reducing waiting lists. Of course, waiting times are still too long for many of our citizens. We are not complacent about what we have achieved or the challenges we face. The overall number of patients remains high, and we recognise that further progress is needed, particularly in the context of unmet need and the pressures on the system, which grow each year. This will continue to shape demand for hospital services in the years ahead. Our strategy is focused on improving hospital productivity by targeting key pinch points that affect patient flow. I will touch on one or two issues in this regard.

Emergency departments remain under continued pressure, with attendances increasing year on year. In the 12 months to March, our hospitals treated approximately 1.85 million patients in emergency care. That is 28,000 or 29,000 attendances a week or thereabouts, which is a 10% increase on the previous 12 months. That continues a pattern that we have seen very strongly since the end of Covid whereby we are seeing 10% or so increases in demand in emergency care each year. This is having a significant impact on the system. To address this demand, many issues are being addressed, including expanding the use of acute medical and surgical assessment units. These are spaces where lower acuity patients can be diagnosed, treated and discharged exceptionally quickly, increasing the availability of inpatient ward beds for higher acuity cases and elective surgeries. We are also developing integrated care pathways that allow for direct referrals from GPs and community services, thus reducing unnecessary ED attendances.

Outpatient activity has also increased, with over 4 million attendances recorded in the last 12-month period for which we have data. Again, this is a significant increase, a 9% rise compared with the previous year. We are working on enhancing productivity and increasing output. We have piloted an outpatient optimisation pilot at two sites, Naas General Hospital and the Mercy Hospital in Cork, which have produced very positive preliminary results. We are now considering how to fast-track the roll-out of these initiatives at other sites. We see this outpatient department, OPD, optimisation tool, on which we may, if the Chair wishes, give the committee a more detailed briefing at a future meeting, as a key part of the productivity improvements we hope to see over the next few years. The early results are very positive.

I am conscious that faster access to outpatients will necessarily increase the demand for diagnostic tests. We are working to improve access to diagnostics, particularly out of hours and at the weekend, in line with programme for Government commitments. We have already made diagnostics more accessible in the community through GPs. These initiatives are helping to reduce delays and support earlier clinical decision-making.

Efficient use of theatre capacity is essential to reducing waiting times for elective procedures. There is a programme being led by Dr. Colm Henry where we are supporting hospitals to improve scheduling, reduce cancellations and extend operating hours. A theatre utilisation tool has been implemented in 50% of hospitals across 22 sites over five regions with significant potential for improvement in productivity identified within existing resources. Importantly, the flexibility provided through the public-only contract must be implemented in full to ensure the transition to a more complete seven-day service and to fully utilise the theatre capacity we have.

Timely discharge is critical to maintaining patient flow. We are investing in enhanced discharge planning, community supports and step-down facilities to ensure patients can leave hospital safely and promptly. The roll-out of integrated care programmes for older persons and chronic disease - Mr. Pat Healy, who is leading the charge on these programmes, is here and can talk in more detail about this - is enabling more patients to be discharged home with appropriate supports, while transitional care beds provide a vital bridge between hospital and home. This way, patients can spend the last leg of their health journey closer to home, where they want to be, and inpatient beds are freed up faster for new patients.

At the heart of our productivity agenda is a commitment to improving the patient experience and outcomes. Ultimately, that is the goal of improving our health system. Every efficiency gained in the system translates into tangible benefits for those who rely on our services. It is not as if there is money being remitted back to the Exchequer, which then makes savings. The money is being reinvested in improving services for patients who have access issues. This translates into the following. Shorter waiting times mean patients are seen faster, diagnosed earlier and treated sooner, improving health outcomes and reducing anxiety. Faster access to emergency and acute care ensures patients presenting with urgent needs are triaged and treated quickly, improving safety and reducing overcrowding. Better use of diagnostic and theatre resources leads to quicker diagnoses, faster recovery and fewer cancellations or delays for procedures. Timely and safe discharge supports recovery in familiar environments for patients and reduces the risk of hospital-acquired complications. Consistency and equity across the system ensure that patients receive high-quality care regardless of location, while underperformance is addressed to improve fairness.

Ultimately, productivity is not about doing more with less; it is about doing better for patients we serve. It is about ensuring that every resource, every minute and every decision contributes to timely, effective and compassionate care for our citizens.

Our approach is grounded in identifying best practice and ensuring it is adopted across the system. As a service we need to become even more agile, learning and improving at pace. We are now using real-time data to monitor performance, developing hospital-level improvement plans and targeting areas of underperformance with tailored supports. We are also strengthening clinical leadership, which is critical, and operational management and engaging with front-line staff to ensure that reforms are practical, sustainable and informed by experience.

While the reduction in long waits is encouraging, we know that many patients are still waiting too long for care. The increase in referrals is a sign that more people are accessing the care they need. Our challenge is to ensure that this care is delivered in a timely, efficient and equitable manner.

We remain committed to achieving the Sláintecare targets of ten weeks for outpatient appointments and 12 weeks for inpatient and day case procedures. These are ambitious goals but they are achievable with sustained investment, ambitious system reform and a relentless focus on productivity and patient flow.

I look forward to engaging with the committee.