Mr. Bernard Gloster:

I will certainly do my best. I am joined by my colleagues. They have already been introduced so, in the interests of time, I will not repeat that introduction. We serve a population of 5.5 million people. The life expectancy in Ireland for 2025 is projected to be approximately 82.7 years, with a slight gender divide. This represents a slight increase from previous years, which is driven by factors like falling mortality rates for major diseases and a growing population. Life expectancy has been steadily increasing and we now rank among the highest in Europe in that regard. For two decades prior to the pandemic, life expectancy here grew faster than the EU average. There are many contributing factors to this outcome.

In more recent decades there have been significant improvements in some of the major determinants of health such as housing quality, education, air quality, diet, smoking cessation and physical activity.

A broad range of social, environmental and economic factors are substantial determinants of health. Within healthcare, significant improvements in provision of and access to healthcare, advances in diagnostics and therapeutics, research, and workforce growth by specialty have all contributed to our overall health status. We have seen improvements in health outcomes for older people, a high rate of self-perceived good health, and decreasing mortality rates from diseases like some cancers and particularly circulatory problems.

Despite many successes and improvements, we know from analysis of demographic trends, prevalence of chronic disease and the traditional inpatient centric model of healthcare we have relied on that planning for healthcare can no longer be viewed through the single lens of just increased investment for more of the same. There are many factors but two are critical to planning at this point. First, the ESRI and others report that the population aged 65 and over is projected to grow from 0.78 million in 2022 to an estimated 1.3 million in 2040, increasing their share of the total population from 15% to 21%. Within that we can see clearly that the over-85 age group at circa 85,000 is likely to quadruple over the next 30 years and this is a particular marker for healthcare planning. We have also seen the general population numbers substantially altered due to global movement and unprecedented geopolitical factors.

Secondly, with a population with an expected prevalence of chronic diseases of 53.8% among adults aged over 50, the number of people with chronic diseases in Ireland could increase from 778,000 people in 2016 to an estimated 1.08 million by 2030. The term chronic diseases refers to long-term health conditions which are slow to progress and require ongoing management. Behavioural and metabolic risk factors for these conditions remain substantial: 17% of adults are current smokers, 60% are overweight or obese, and less than half meet physical activity recommendations. According to 2023 figures, chronic diseases account for approximately 40% of hospital admissions and, within that, 75% of bed days.

Ireland's acute bed occupancy rates remain among the highest in the OECD, measured in recent years as approximately 95%, leaving little capacity to absorb demand shocks. This is particularly relevant during the winter season when emergency respiratory admissions have been shown to increase, thus reducing capacity for overall chronic disease management in the population, particularly patients with co-existing or underlying chronic conditions.

The HSE focus on future planning, consistent with Government policy, direction and investment, is focused primarily on the following areas: healthy lifestyle, which is an attempt to improve the health status of the population and thereby reduce traditional demand; clinical excellence, right across social care to primary care, and right up to the tertiary care parts of the spectrum; and, most importantly, accessible, affordable and safe care. The approach this year and for the years ahead is to achieve improvements in all these areas through sustainable foundations. These include a combination of financial resource and using it more efficiently; workforce resource and using it more productively; infrastructure with capacity reflective of new methodologies, such as surgical hubs, chronic disease hubs, primary care centres, and, of course, bed stock; and finally, technology and digital resource systems, such as the electronic health record, EHR, and virtual care.

On the financial position in respect of Ireland's health services, the 2026 health budget, excluding disability services in the HSE, is €25.2 billion, with an additional capital allowance of €1.5 billion, increasing on the 2025 opening positions of €23.7 billion and €1.3 billion respectively. Having worked to improve control and reduce dependency on supplementary health funding, with continued focus required in this area, the next phase of emphasis will be on maximum efficiency and productivity. Budget 2026 provides for an additional 3,300 whole-time equivalents to the workforce. What will be different is the allocation methodology for those.

The contrasts in service performance across regions show that excellence is possible but not yet consistent. The regional model of Sláintecare must be about aligning the performance of every service to the standards already achieved in our best-performing areas. It is only in this context that we achieve comprehensive balance across regions. The Minister's clear instructions for 2026 are to use existing and new resources combined to enable regions to focus on their areas of challenge and underperformance, thereby bringing us closer to national equity. This approach, a first, sets the basis for longer-term planning, with the possibility of moving closer to population-based resource allocation and further efficiency in strategies such as activity-based funding. We must however get to the point where we experience more uniformity across the country; hence the 2026 approach by the Minister is very welcome. After 2026, a next obvious step is multi-annual funding linked to multi-annual planning.

The health workforce will continue to need to grow to meet demand. However, planning is now taking account of the unprecedented growth to date. In 2026, the Department of Health-funded part of the HSE will have an opening allowance of 133,300 whole-time equivalents, rising by the end of the year to 136,600. This is up from 101,000, excluding disabilities, again at the start of 2020. These are enormous numbers requiring major permanent financial underpinning. This rate of growth is not sustainable for our economy and the focus for the future has to be beyond the traditional view of additional workforce.

The focus on planning for the short and medium to long term is best viewed through two lenses. First, we are now pursuing greater flexibility in how we prioritise and change use of existing workforce resources to improve responsiveness and productivity. Contractual methods such as public pay agreements are significant enablers here. Second, generating workforce supply through targeted third level training programmes and new methods, such as apprenticeship, and increased higher education pipeline in the programme for Government will lead to a better balance between how we use what we have and how we target the generation of the most critical supply.

Our core focus on future planning for infrastructure is again not to rely solely or exclusively on traditional models. By OECD standards, we are still very high in our dependency on traditional inpatient and older person bed models. While we need bed capacity to catch up with demand and underinvestment in the years of financial downturn, we also need to build infrastructure that reflects new ways of responding to demand. These include surgical hubs, with five to open in 2026, and general elective reform, chronic disease hubs in the community, primary care centres, and local injury units, together with new beds where we are increasing our specialty focus in 2026, with critical care, maternity care, and, of course, the new children's hospital.

Our only likely possibility of meeting future demand is to arrive at a better balance between these new configurations and traditional beds. Targeted investment will be the only effective response rather than the approaches of the past. Linking revenue to the opening time of new infrastructure is now the priority of the Minister, as endorsed in major reviews such as the Frank Clarke report and proven to have worked in the opening of the recent 96-bed block in University Hospital Limerick. There is now a specified requirement by the Minister that Government investment in 2026 must include the outcomes of concluding and commissioning new infrastructure. Finally, infrastructure need will need to be matched with virtual care methodologies which also have proven to be effective.

In digital care and technology, I believe we are much better positioned than ever before to now exploit the benefits that are available. The Minister is currently finalising her approach to the full EHR business case and we anticipate hearing from Government very shortly. Subject to approval, I believe Ireland can obtain substantial utilisation of EHR as routine practice in a relatively short few years. We are not waiting for all of a system to arrive before progressing. In 2025 we developed our HSE health app. In 2026, we will develop our shared care record. Throughout 2025 and 2026, we will bring segments of the service into EHR mode, most notably our maternity units and of course the children's hospital, followed by others. All these together with the new approval will lead to a place of bringing one full region to EHR in 2027-28, thereby enabling national roll-out to be standardised thereafter.

All of our developing systems such as laboratory and the national integrated medical imaging system, NIMIS, which we will mandate in all services and be the only systems we fund, will position us strongly for the implementation of EHR. Reflecting on attempts over many years in the health service in this area, I firmly believe that the direction of travel now being undertaken is as good as it can be and is achievable for a lasting difference for generations to come.

We are separately pursuing a range of virtual care constructs, including wards and virtual care methods in the community. Next year will see further development of these virtual acute wards. They were first introduced in 2024 at St. Vincent's University Hospital and University Hospital Limerick. A total of 1,937 patients have been onboarded in these wards since July 2024, equating to 18,100 patient active days. These virtual wards are now fully operational, with an average of 25 to 30 patients per day. Both sites expect greater occupancy, going up to 40, in line with the expected surge this winter.

Phase 2 sites, originally identified as Our Lady of Lourdes in Drogheda, Tullamore and Mercy University Hospital in Cork, will go live this November. I have recently added Kilkenny to the list, which will also go live this year, and Galway early next year. This will bring enough evidence to make any adjustments to the methodology and thereafter introduce virtual wards as common practice for additional capacity to hospitals.

Virtual care is also being used in the non-acute settings. There are notable projects using remote health monitoring to support patients with chronic conditions. The community acute respiratory excellence, CARE, project in Letterkenny is a 20-bed COPD remote virtual care model, resulting in a 20% drop in COPD admissions, a 50% drop in readmissions of patients with COPD, and saving €4.2 million. On maternity hypertension, a cohort of 113 patients have been seen to date. This suggests a greater than 50% reduction in admission rates can be made from this model. There are others that I have listed in my statement, including the supporting multimorbidity self-care through integration, learning and ehealth, SMILE, project and the national telehealth roadmap where we have projects running right across our various teams in the community based on a model that a patient can attend anywhere, meaning it is a virtual attendance.

Remote health monitoring to support clinical care in the ambulatory setting tender is due for publication in the next two weeks. This will enable the scaling of many of these projects.

We are using technology to improve our resource management systems with both IFMS and NiSRP. In 2025, these were effectively completed in HSE, and we are now moving to full implementation in the section 38 hospital sector followed by the section 38 disability sector. Adoption of these systems by these funded organisations will be mandatory in 2026 service arrangements. I have included further details in the briefing.

There can be no doubting that demand for healthcare is both growing and changing. That should be no surprise to anyone. The complexity of planning for the future is not in formulating the plans themselves, but in understanding that new and different approaches are the only means by which we can meet future demand, as opposed to just the simple strategies of the past where we always needed more to do new or different. We have improved access and outcomes from healthcare, but I recognise we have a distance to go. I am confident that the plans in place are increasingly more realistic, achievable and, critically, supported by the Minister and the programme for Government.