Mr. Bernard Gloster:

I thank the Chair and members for the invitation to meet with the joint committee to discuss Sláintecare reforms, the capital expenditure programme, the public-only consultant contract and practices and standards in nursing homes. I am informed that members also wish to discuss maternity service in Portiuncula. My statement in that regard is accompanied by an appendix that comprises a briefing to me on that service from the regional executive officer of HSE west and north west and our national women and infants health programme, NWIHP.

I am joined by: Ms Kate Killeen White, the regional executive officer for Dublin and the midlands; Dr. Colm Henry, chief clinical officer; Mr. Brian O'Connell, our head of strategic health infrastructure and capital delivery; Mr. Pat Healy, national director of national services and schemes; and Ms Amanda Casey, chief social worker. I am supported by Ms Sara Maxwell and Ms Niamh Doody from my office.

I am conscious that since the HSE last appeared before this committee, the passing of Harvey Morrison Sherratt has taken place. To Harvey's parents, Gillian and Stephen, and to all who are affected by his passing, I want to publicly record my sincere condolences. I have reached out to the family. At a time of their choosing, I am anxious to hear from them in order to discuss the most appropriate way in which Harvey's care can be reviewed. The Minister is due to meet Gillian and Stephen, and I will await the outcome of that to inform any next steps. Notwithstanding any review, I can clearly see from the accounts given by Harvey's parents that they have a lived experience of him being let down by the healthcare system. That is something I, as head of the health service, very much regret and for which I want to apologise to them.

Together with my colleague, the Secretary General, I am pleased to report to the committee a continued focus on actions and progress under several headings aligned to the Sláintecare policy framework.

We continue to work on four key strategic priorities of implementation in the HSE. They are improving access, enhancing service quality, expanding capacity and enabling reform.

Relating to access, I want to note more than 33%, 251,000 people, on the standard measured waiting lists are inside the Sláintecare target times at the end of July 2025. Despite three years of unprecedented growth in demand on these lists, we have seen enormous progress tackling those waiting longest as well as improving the response to new patients. Some 83% of patients, 511,000 people, on outpatient, OPD, lists are now waiting less than 12 months. Longest waiters - those greater than 24 months - have reduced on the outpatient list by almost 55% this year, down now to 39,000, the lowest ever. Inpatient day cases, IPDC, have reduced by 42%, down to 7,500 and scopes are almost practically down to the lowest figure of 100. That relates to those waiting over 24 months. We continue to tackle the longest waiters and I have emphasised to this committee before that the volume on waiting lists have no bearing on outcome but the time on waiting lists do.

I am aware of concerns regarding the waiting times for a number of services in primary care. We are working with the Minister and her Department to finalise an additional programme of work to alleviate some of those pressures. Regarding enhancing service quality,I will be happy to respond to Members' questions on the range of issues under this heading, including improvement methods in patient safety and health protection. For now, I want to highlight our progress on patient participation. Our six regions now have full-time patient service user leads and patient service user councils are emerging, populated by and chaired by patients to support developments in their local area. Several hundred patient partners gathered last week for their third annual meeting and it is heartening to see this level of inclusiveness which is making a remarkable difference. The national director for patient and service user engagement is also responsible for our culture change programme and reports directly to me. It is essential we are influenced in our planning and implementation by the people we serve. Patient involvement is now at its most advanced level.

With regard to expanding capacity, the commitment to expanding beds in recent years has been of great assistance. The developments in other capacity and infrastructure are also essential as new ways of providing care become the norm, such as things like day procedures. Within the capital programme, 286 acute beds will be delivered this year, with 124 of those to date. The overall number will include a new 96-bed block at UHL, which the Minister will open in October. This will bring the total new beds on the UHL site alone to 128 since last December. Through separate works and programmes we will also see this year replacement NICU neonatal cots added to our system and open. Works on critical care capacity at St. Vincent’s are progressing, as are the enabling works there for the planned national maternity hospital. Some 615 combined replacement or new beds in community nursing units are also advancing, with 75 of those completed to date this year. Planned surgical hubs are progressing in south Dublin which are open and in north Dublin to open in early 2026. Further sites are well under construction at Galway, Cork, Waterford and Limerick. The programme was added this year by the Minister’s approval for surgical hubs in Sligo and Letterkenny.

Supply of graduates is a critical part of expanding capacity and it has long been a challenge in the health service. This month has seen the expansion of 500 new health training places for health and social care professionals and nurses combined. The HSE will continue to prioritise clinical training placements to meet the increased supply. The increase in GP training places is a major step and we are now seeing the second intake of the revised number, 350 in both years one and two of the programme, and by 2027 there will be 350 in each of the four years of the training scheme.

For reform, there are many strands to the health reform agenda and all of these are aimed at either increasing use of existing capacity to enable greater access or improving quality of care from safety to outcome. Some of the key areas to be noted in terms of the Slaintecare implementation policy are: The HSE app and the next phase of development towards a shared care record as key milestones to electronic health record, EHR, system; the introduction in a small number of test sites of a new outpatient department, OPD, toolkit which increases the use of existing capacity to reduce waiting lists. Very positive outcomes in sites such as Naas and the Mercy Hospital Cork have led to the decision for rapid nationwide roll-out of this in 2026. A similar approach to theatre utilisation is already established and will become the next focus of productivity for full roll-out after OPD; The expansion of the public only consultant contract, POCC, and five out of seven options together took shape over the recent weeks and evidence is showing the benefits realised here and the opportunities for more. The Minister led a nationwide workshop on this progress and the follow-up in January 2026 will see the embedding of five out of seven working as a mainstay of the HSE way of working. Following testing of the acute virtual ward concept at UHL and St. Vincent’s - we have seen wards often cater for 25 people on a day - a further five sites have been approved for this development at Mercy, Galway, Tullamore, Drogheda and Kilkenny. The development of a total community wide ICT system ‘Community Connect’ is at an advanced stage and this will help alleviate some of the difficulty for those accessing services where the true status of waiting times and volumes is hard to define at present.

With regard to the public only consultant contract,the introduction of the POCC in March 2023 saw 3,864 whole time equivalents, WTE, employed at consultant level and working in our health service. The total number of consultants employed as of July this year is 4,670 WTEs. Of that number, there are 3,090 on the POCC and are comprised of 2,147 consultants who converted from previous contracts to POCC and 943 new recruits who entered straight into the contract. The utilisation of this workforce is key to the overall progression of service over six days for all services and over seven days for patient flow.

Regarding practice and standards in services for older people and nursing homes,there are 24,150 people supported by the nursing home support scheme, NHSS, or fair deal as it is colloquially known, in July this year. This is the highest number of people supported by the scheme since it commenced in 2009. There are others cared for in short-stay and various other arrangements. All these people are entitled to have and feel safe in the knowledge that their care is not only safe but of a high standard against modern-day benchmarks. I am conscious of reports and events earlier this year in respect of care provided in nursing homes and I am aware this committee has held meetings in that regard with the Minister of State, Deputy O’Donnell, his officials and HIQA. We are working closely with the Minister of State on those issues and with the Ministers, Deputies Carroll MacNeill and Foley, on the wider context of adult safeguarding.

In speaking to issues of standards in nursing homes, I would like to reflect briefly on the public provision, which similar to the private provision, is subject to inspection and registration by HIQA. There are currently 127 community nursing units and these have a bed stock of 4,818 long-stay beds and 1,519 short-stay beds. A total of 355 beds are temporarily closed. These closures across public facilities are mainly attributed to capital works to ensure compliance with regulation, staffing availability, turnover and infection prevention and control.

As regards compliance with regulations as of June this year, overall, our HSE designated centres are deemed by HIQA to be 72.8% fully compliant, 19.7% are deemed to be substantially compliant and 7.5% are deemed to be not compliant. Areas of non-compliance include governance and management, residents' rights, fire precautions and premises. Not all those apply to all the centres. There are different levels of non-compliance. In all cases where there is an element of non-compliance, there is a programme of improvement agreed with HIQA and this ensures that there is as balance between maintaining service levels - some in very old buildings - safely and bringing those services up to full or substantial compliance.

There can be little doubt that there is more to do in this area but I am pleased to report to the committee that public unit care has substantially improved in both standards and safeguarding. The initial onset of regulation saw heavy focus on buildings and space whereas now there is a more mature understanding of and focus on the quality of care, relationships, daily living and safeguarding.

Any deviation from this pursuit is totally unacceptable to the HSE and we are encouraging the public and staff to always highlight concerns and shortcomings. It is only in a continuous improvement process of feedback and responsiveness that we can be assured of the care people receive when they are unable to live at home.

I would like to conclude by noting we are entering the respiratory illness season and I take this opportunity to request the support of this committee and everybody in highlighting that as the respiratory illness season commences the demand for healthcare, from GPs to emergency departments, will surge. We urge the public to heed all protection advice, to explore the options to ensure the right one meets their needs and to help them, their family, their colleagues, their community and their health service by availing of and updating participation in all vaccination and immunisation programmes. I thank the Chairman.