Mr. Tony O'Brien:

I will touch on a couple of areas. In terms of the financial position, the draft 2016 financial outturn figures for the health service indicate net expenditure of €13.528 billion against an available budget of €13.514 billion giving rise to a small adverse variance of €14 million. The delivery of a €14 million or 0.11% in-year variance represents practical financial break-even, given the scale of the health services overall resources, and means the HSE is not starting a new financial year in 2017 with a very significant incoming deficit. It clearly shows the benefit of receiving sufficient funding early in the year, including the €500 million received mid-year, to set achievable financial targets for health service managers, clinicians and staff. It also demonstrates the health services ability to deliver when set achievable targets and, in that regard, I thank all of our management and staff for their hard work and efforts. I also acknowledge the support received from the Department of Health, including its assistance with meeting excess costs associated with the State Claims Agency.

The Minister has already outlined issues to do with the winter initiative and, in the interest of time, I will take those as read.

On the issue of acute hospital waiting lists, I will take this opportunity on behalf of the HSE to apologise once again to all patients who have had a poor experience either in terms of waiting times or communications with our services. A key priority for the HSE is tackling long patient waiting times and ensuring timely access to treatment and care. We fully acknowledge that patient waiting times are unacceptably long in certain specialties and this, to some extent, reflects the need for greater capacity and staffing in certain specialties within our services. It is also essential that we fully optimise our public capacity.

Each year in our hospitals more than 3.3 million patients attend outpatient services, while one million have a planned day case procedure and approximately 100,000 people have an elective inpatient procedure. Between January and November 2016, more than 1.5 million inpatient and day cases were completed in our acute hospitals representing an increase of almost 30,000 when compared to the same period in 2015. It is fully acknowledged that waiting lists in certain specialties including ophthalmology; ear, nose and throat, ENT; orthopaedics, urology; and general surgery have seen significant increases in the number of patients waiting for treatment. It must be noted that both the challenge of availability of consultants in these specialties as well as hospital capacity have contributed to this increase.

The key issue for patients is how long they are waiting and based on national treatment purchase fund, NTPF, figures published in January, 36% of patients are waiting less than three months for an inpatient day case procedure, IPDC, 58% are waiting less than six months and 2% are waiting over 18 months; 93% of adult patients were treated within the national target time of 15 months for IPDC; 69% of patients were treated within the eight-month national target; and the proportion of patients waiting over 18 months fell from 4.5% to 2% at the end of December. A key focus of the HSE waiting list action plan 2016 was to reduce the number of patients waiting the longest length of times for inpatient and day case procedures. The HSE's target, approved by the Minister, was that we would reduce the number of patients waiting over 18 months by 50% and that there would be no more than 1,800 patients waiting for more than 18 months. We exceeded this target and the number of patients was reduced to 1,738 due to the treatment-removal of over 11,500 people from the waiting list.

An important feature of the 2016 waiting list was optimising our public capacity as well as outsourcing activity. For example, 200 cases were undertaken by Cappagh National Orthopaedic Hospital for other hospitals, the Mater Hospital undertook 24 spinal and scoliosis cases on behalf of Tallaght Hospital. University Hospital Limerick carried out work for the Saolta group and Kilkcreene Orthopaedic Hospital carried out work for Midland Regional Hospital in Tullamore. We will build on this approach in 2017 with particular reference to orthopaedics, scoliosis, ophthalmology, vascular and ENT services.

In 2017, the HSE is working with the NTPF to develop an action plan for inpatient day case and outpatient waiting lists to deliver on the 2017 target that no patient would be waiting longer than 15 months by the end of October. It will set out specific actions by groups aiming to optimise existing public capacity within hospitals and groups and targeted outsourcing for those specialties where there are known capacity challenges. The approach outlined will be underpinned by strong oversight and governance by hospitals and groups and at national level. With specific reference to scoliosis, the HSE has set a target of four months for treatment of scoliosis and is finalising a comprehensive plan in this regard. This will require a range of solutions given the capacity challenges in the Irish public and private system.

The eHealth Ireland programme within the HSE has had some success in 2016 creating the first digital hospital in Ireland delivering the infrastructure for an individual health identifier to be "turned on", completing the implementation of e-referral into every acute hospital and beginning the implementation of e-prescribing in the community. In 2017, the eHealth Ireland programme will continue to move towards an electronic health record, EHR, for Ireland. While the full EHR business case is being considered, the programme is working to put in place foundations that enable an innovative and yet considered progression to delivering a digital fabric for the way in which health care is delivered. As well as these foundational programmes of work, the eHealth Ireland team will continue its work in new and innovative arenas. Genomic sequencing for epilepsy patients will continue, the implementation of an artificial intelligence mobile "friend" for patients with bipolar disorder will be piloted and digital supply chain management to the door of patients with haemophilia will be delivered. All of this will be achieved within the current HSE IT budget. If we were to invest even 1% more in this area, the team is confident that it could deliver striking benefits to the system and 1% more would still be 1% less than the average EU country. This concludes my opening statement.