Mr. Paul Reid:

I thank the Chair and members of the committee for the invitation to update them on the HSE’s winter plan. As this is my first time attending before this committee of the Thirty-third Dáil, I would like, on behalf of the HSE, to wish the Chair and the members of the committee well with their important work. I assure the committee that the HSE will assist it in every way we can. Colleagues joining me today are Ms Anne O’Connor, chief operations officer; Dr. Colm Henry, chief clinical officer; and Mr. Liam Woods, national director of acute operations.

On 27 March 2020, just as we were emerging from last year’s winter season, a decision was taken by NPHET to postpone all non-essential surgery, health procedures and other non-essential services on account of Covid-19. This necessary decision led to a near standstill of scheduled healthcare activity. Although activity has resumed, there have been enduring consequences for our health services. In the knowledge that we would be delivering services within a Covid-19 environment until after the development of a vaccine or cure, we published a strategic framework for service continuity. The framework outlines our key objectives, including the resumption of services, the retention of surge capacity and the adoption of new technologies. Our winter plan builds on this framework and aims to ensure that we are as prepared as possible for the anticipated seasonal pressures, which this year will be more challenging than ever.

We have been entrusted with €600 million in order to achieve these objectives which is the biggest allocation ever made for a winter plan. We are committed to investing this money in the places where it will have maximum impact.

Our core objectives can be succinctly summarised. First, we aim to avoid congestion in our hospitals. Second, we will resource community services to deliver more care than ever before. Third, we will ensure that lines of communication between these two pillars of our health system, acute and community, are seamless. Integration of services has always been problematic in practice. However, one of the few positive things to emerge from the pandemic is our capacity to operate as a whole system when the circumstances require it. Additional key priorities include supporting nursing homes, strengthening public health capacity and minimising the impacts of Covid-19 on our cancer services, including screening services.

Winter funding will only get us so far. Our success is also heavily predicated on the public continuing to take the necessary precautions as per public health advice and continuing the downward trend in community transmission of Covid-19.

A community first approach to the delivery of care will be central to delivering safe, efficient and effective services through winter and beyond. We are making substantial investment in reorienting our services into the community through: 4.7 million additional home support hours; enhanced home support packages; community specialist teams in 11 centres focused on older persons and chronic disease care; 530 community intermediate care and 631 enhanced community rehabilitation beds; GP access to more than 79,000 diagnostic procedures; enhanced homelessness supports; and making the flu vaccine available to staff and to the public.

With regard to our acute capacity, at the end of 2019, we had 10,988 inpatient beds, including 255 critical care beds.

The 2021 Estimates provide funding for the following beds on an ongoing basis: 1,146 incremental beds in acute hospitals; 66 critical care beds; and 135 sub-acute beds. The arrangement with private hospitals will also allow us to augment our existing approaches to Covid-19 and non-Covid pathways, particularly in the event of a surge in hospitalisations. Provision is also being made for additional consultants, the extension of renal dialysis satellite stations and home dialysis projects and for the use of new technologies in endoscopy. The waiting lists have stabilised, albeit at a much higher level. Extra resources for the National Treatment Purchase Fund, NTPF, will allow for additional insourced and outsourced activities to tackle waiting lists. Steady progress is also being made in the resumption of elective activity and the latest data show that we are almost in an equivalent position to the corresponding period in 2019.

I will inform the committee of the financial position. The HSE received its annual letter of determination 2021 on 4 November and is now engaged in the finalisation of the 2021 national service plan. In summary terms, the scale of the additional investment in the health service in 2021 is unprecedented when viewed in the context of any previous single year. Including moneys held back initially by the Department of Health, the national service plan 2021 revenue net expenditure allocation is €3,534 million or 21% above the national service plan 2020 allocation of just over €17 billion. The 2021 capital allocation is also more than 20% ahead of the 2020 level. This investment reflects a strengthened trust and confidence in the HSE and how our staff have mobilised and responded to the many challenges of this pandemic to date. We want to build on this response so far, so it becomes the foundation of a sustained and lasting improvement in our health and social care services of which we can all be proud.