Ms Laverne McGuinness:

I thank the committee for the invitation to attend the meeting today. The Chairman has already introduced my colleagues.

The committee requested information and replies on a number of specific issues prior to this meeting and the members will have received a written response to these matters. I will therefore confine my opening statement to updating the committee on the following matters.

Quality and patient safety underpins the delivery of our health service and is one of the core values of the HSE. We are therefore striving to improve quality and safety throughout our services. Every month, performance against our service plan targets and deliverables is monitored and measured. The published performance assurance report shows that in April 2014 the health service saw an increase in new emergency department attendances of 3%, or 11,353 people, and the numbers admitted as inpatients from emergency departments has increased by 783 or 1% when compared with the same period last year. Admissions through medical assessment units have risen by 1,101, which is 10% higher than in 2013. Trolley numbers are down 8.8% when compared with the same period last year. The month of April 2014 compared with April 2013 shows a 19.8% reduction in patients waiting for a ward bed. That is an improved quality outcome for patients.

Elective admissions in April 2014 were 5% lower, at 1,771 people, than April 2013 and day care attendances were 2% lower, at 5,644 people. The percentage of patients waiting less than eight months for an inpatient or day case procedure is commensurate with April 2013 values. At the end of April, 90% of all adults were waiting less than eight months for a planned procedure and 10%, or 4,462, were waiting over eight months. Outpatient attendances are 26% ahead of target, with 1,071,808 attendances for the first four months of the year.

During the first three months of the year the ambulance service responded to more than 72,226 emergency calls, AS1 and AS2 categories, which is an increase of 4.5% compared with last year. On average, the national ambulance service, NAS, has received an increase of, and responded to, 1,000 calls per month. The introduction of intermediate care vehicles and operatives in 2013 to manage patient transfers between hospitals continues to have a positive effect on the availability of emergency ambulances. In April, 75% of all transfer calls were handled by an intermediate care vehicle.

With regard to our finances, the net expenditure for the year to date in April 2014 is €3.97 billion. The available budget reported for this period at €3.862 billion has reduced by more than the expenditure, leading to a reported deficit of €107.5 million. The acute hospital sector is reporting a deficit of €80.4 million at the end of April, which represents 74% of the overall deficit. Acute hospital agency costs overall have increased by €25.8 million, up 56%, compared with the same period last year. However, 80.3% of that increase is in the areas of medical and support services staff and this primarily reflects the diminishing capacity to recruit doctors and price increases for agency staff.

The national director of acute hospitals, Dr. Tony O'Connell, has written to all hospital groups setting out clear key messages around the need to reduce costs safely and to submit additional cost containment plans. This was followed up by a series of high level performance assurance meetings.

The board chairs, CEOs and clinical directors of the ten hospital groups with the greatest financial challenges have been met to ensure their financial deficits are discussed at the highest level and highlight the necessity to maintain patient safety and quality at the highest levels. Site visits to most hospitals as part of the assurance process set out within our plan for maximising delivery under the Haddington Road agreement have taken place.

With regard to primary care, there was an overall deficit of €18.8 million in April. The deficit is largely attributable to local demand-led schemes of €14.5 million. Based on the figures for the first four months, the HSE is not flagging new financial risks beyond those set out in the service plan in January. However, it should be noted that the financial risks include a number of items that are not within or are not fully within the control of the HSE. One of these is a €114 million revision by the State Claims Agency.

Members are aware of the Government’s decision on Thursday, 29 May to develop an enhanced policy framework for medical card eligibility to take account of medical conditions, in addition to the undue hardship test. The HSE has established a 23 member expert panel to examine the range of conditions that should be brought into consideration and acknowledges that this process may include the development of a new legislative framework for the operation of the medical card scheme. While the task set for the expert panel is an extremely complex one, it has been requested to furnish a report to the director general by September. The panel includes a range of clinical experts from primary care, specialist services and therapies. It also includes patient representation.

A public consultation process has commenced to seek the views of the public, including patients, patient representative groups and professional bodies. Approximately 3,143 public submissions have been received by the HSE which is also putting in place a consultative forum of representative patient groups to support and enable them to feed into the process in a structured fashion. In the meantime, the HSE has suspended reviews of existing medical cards granted on a discretionary basis and no further reviews for this category of medical card will commence pending the outcome of the new policy framework. Arrangements are also under way to restore medical cards withdrawn during the period of July 2011, subject to three conditions specified in the memo to the Government. It is anticipated that up to 15,000 medical and GP visit cards will be issued to people with serious medical conditions as part of this process. The HSE is analysing its databases to identify the people concerned and intends to have the bulk of the medical cards issued by mid-July. We hope to have 10,000 concluded by the end of this week. It is important to note that reviews of general medical cards and medical cards held by those over 70 years of age continue.

In terms of current activity, at the end of April 1.8 million people, or 39.2% of the population, held medical cards. Included in these are 50,375 medical cards granted on a discretionary basis. Some 125,166 people held GP visit cards, including 29,841 granted on discretionary grounds.

The National Ambulance Service, NAS, serves a population of 4.6 million and employs over 1,600 staff across 98 ambulance stations. It is serviced by a fleet of 523 vehicles. Its budget is €138 million and the budget available increased by 4.3% between 2012 and 2013, with a further increase of 2.35% in the 2014 allocation. The NAS is one of the few services in the health sector that has seen increased investment in recent years. This investment has been made as part of a strategic programme to develop a modern, high quality national ambulance service that is safe, responsive and fit for purpose.

Between 2013 and 2014, €26.2 million has been invested in the development of the national control centre, of which €14.2 million relates to capital, including €7.6 million invested in ICT for a digital voice recognition and computer-aided dispatch system. Since 2012, the National Ambulance Service has been on a journey of significant reform. A major reconfiguration of the way in which it manages and delivers pre-hospital emergency care services is under way. The reform programme reflects many of the strategic changes under way in ambulance services internationally as they strive for efficiency and increasing specialisation. The NAS control centre reconfiguration project is a significant and complex multi-year national change project aimed at reducing the number of command and control centres from 11 originally to six at present, with one national centre on two sites. This key project will deliver a single state-of-the-art national emergency control operation centre for Ireland on two sites, at Tallaght and Ballyshannon, which are almost complete.

In the last quarter of 2013 a decision to procure a formal capacity review was taken. The purpose of the review is to independently assess the required resources and the optimal deployment of these resources to meet the needs of a modern ambulance service. The company selected to undertake the review has extensive international experience of modelling ambulance operations. It will complete a detailed technical analysis of computer aided dispatch data, coupled with data for ambulance deployment and rostering arrangements. It will then use advanced modelling techniques designed to determine the ability of current resources to meet existing and anticipated demand and identify any gaps in provision. A component of the work will include Dublin fire brigade activity. It is expected that the capacity review will be completed in the third quarter of 2014.

The committee specifically asked for my opening statement to address the issue of adrenaline pens. On behalf of the HSE, I extend my deepest sympathy to Ms Sloan and her family on the loss of their daughter, Emma, who suffered an anaphylactic reaction last December. The Minister has covered some of this topic. Persons with a confirmed diagnosis of anaphylaxis are prescribed adrenaline pens and shown how and when to use them. The current recommendation is that two pens should be carried with the individual at all times. Those identified as being at risk may also be prescribed adrenaline pens. Patients who experience an allergic reaction are advised to keep the injections to hand and sufficient quantities are reimbursed under the community drugs schemes to enable them to be kept at multiple locations such as at school, at home and in child-minding facilities, etc. The HSE has published guidelines on its website. Extending the availability of adrenaline pens is a complex matter and under consideration with the Department of Health, as outlined by the Minister. The medication is available only on prescription and an alternative would require amending legislation.

The committee also asked that I address the INMO and the Haddington Road agreement as part of the update. The HSE notes the engagement on 17 June between the INMO and the Joint Committee on Health and Children. The planned meeting between the INMO and HSE management referenced in the transcript of the meeting on 17 June has been rescheduled owing to diary issues. Our HR director is on leave. The Haddington Road agreement has been designed to provide significant enablers and provisions to extract costs and reduce the overall cost base in health service delivery, while radically reviewing and changing work practices, rosters and work patterns in the context of the reform and reorganisation of the health service. All areas of employment within the public health sector are being examined to see how they can best contribute to this cost extraction challenge as required by the Government, while minimising the impact on front-line services, patients and clients.

That concludes my opening statement. Together with my colleagues, I will endeavour to answer questions committee members may have.