Mr. John Connaghan:

I thank the committee for the invitation to attend today's meeting. I am joined by my colleagues as previously introduced by the Chairman. In preparation for the meeting, committee members requested information and replies to a number of specific questions and they will by now have received the written response to them. I will therefore confine my opening remarks to the following issues.

First, I welcome the announcement by the Minister for Finance and Minister for Public Expenditure and Reform, Deputy Donohoe, that it is intended to allocate an additional €700 million to the health service in 2018 by way of Supplementary Estimate, which now brings the 2018 net revenue budget of the HSE to €15.2 billion. I know that this was the subject of the Joint Committee on Health meeting of 24 October so I will confine my remarks to welcoming the fact that this will be included in the base funding of 2019.

The HSE is currently finalising an implementation delivery plan in response to the Scally review recommendations. This is a considerable piece of work ranging from procurement to open disclosure and from governance to risk management. While our focus will be on early implementation, our concern will be to ensure that plans are solid and sustainable in the future.

We are continuing to support the international expert panel RCOG review, which was commissioned by the Minister for women who were diagnosed with cervical cancer. This work will continue through 2018 and into 2019.

A key risk to enable cervical screening to continue in Ireland was the extension of the laboratory contracts. We have secured agreements to enable continuity of the service and are currently finalising contracts with service providers. The new model will ultimately see a more balanced model of public and private provision in Ireland. We are also carrying out an extensive worldwide exercise to secure additional capacity, given current demands leading to extended reporting time for women.

We are progressing plans to introduce primary HPV screening, with a focus on international best practice to ensure we have a successful deployment. At the present moment, until we complete our planning work and finalise on current laboratory provision, we are not in a position to provide a critical path or timetable for the introduction of HPV testing.

We are continuing to provide supports to the women and their families impacted by the crisis. We are also strengthening the role of patients in the CervicalCheck programme with the establishment of a public patient involvement panel and patient representation on key groups.

Turning to other matters , I advise the committee that planning for winter 2018-19 is well advanced in respect of planning and escalation, the operational management of patient flow and maintaining public health in place at hospital group and community healthcare organisation, CHO, level. There are five priorities for this winter in the following broad categories: ensuring integrated working between acute hospitals and the community; ensuring robust preparedness plans that optimise our existing resource; ensuring de-escalation pre-Christmas, maintaining demand and capacity balance between Christmas and the new year and ensuring the provision of enhanced measures for the new year surge; a focus on ambulatory patients and on older persons with emphasis on admission avoidance, enablement and community supports; and strengthened working arrangements with GPs, nursing homes and the HSE. We can provide more detail on this as we carry out this engagement with the committee.

We are grateful for the €10 million once-off funding allocated by the Department of Health for winter. It is intended to utilise this additional funding to increase the provision of community supports pre-Christmas and open additional capacity in January.

Since the last Joint Committee on Health update, we have made some progress on key performance indicators such as trolley count, with each month since the end of quarter one 2018 recording a decrease over the same period in 2017. Inpatient and day case waiting lists have decreased by over 5,000, from 78,000 in June to 72,700 in September 2018. That is down from a peak a year ago of 86,000.

In the national ambulance service, incidents responded to by patient-carrying vehicles in 18 minutes and 59 seconds or less is above target at 81%, noting a performance improvement month on month in the last quarter.

On our community services, the Health Information and Quality Authority, HIQA, has advised the HSE that all 1,149 disability centres are now registered as of 31 October 2018 under the national standards for residential services for children and adults with disabilities. This has been a substantial achievement for the sector. It is a very positive indication regarding our investment in quality improvement through dedicated professional programmes and additional financial resources for providers.

However, notwithstanding all of the above, we still have significant pressure on acute, community and social care services. There are too many people waiting on outpatient waiting lists and there is also a significant increase in the numbers of people attending emergency departments and increasing unmet demand for home care support with over 6,000 people now awaiting home support across the nine community healthcare organisations. All of these are the subject of detailed planning in our national service plan for 2019.

As we move into 2019 we also need to prepare for the introduction of a board to the HSE. This is a welcome and necessary step for the appropriate governance of the largest organisation in Ireland. I would particularly like to welcome Mr. Ciarán Devane to the post of chairman. I know from my early discussions with Mr. Devane that a focus on patient safety and quality and culture and values will be early agenda items for the board.

Consideration of how the HSE responds to recommendations on audit, risk, governance and accountability arising from the Scally report will also be an important aspect of the early work of the board.

I take this opportunity to look forward into 2019 and highlight some of the HSE's other key strategic objectives. Sláintecare has provided a framework within which the HSE will focus on transforming healthcare services over the coming decades. New services will be progressed in line with Government policy and care closer to home will be improved through further investments in primary care services, including GP services, the extension of eligibility and reductions in prescription charges and drug payment scheme limits. The HSE will also focus on a number of key organisational objectives in 2019, including a designation of the major trauma centre and trauma units in Dublin, commencement of the nine learning sites focused on a new networked operating model for community health networks, which will lead to a full-scale national implementation, further development of maternity services and continued investment in ehealth with a specific focus on electronic health records. My colleagues and I will endeavour to answer any questions members have.