Mr. Robert Watt:

I wish the Chairman and members a good morning. I thank the committee for the invitation to meet it to discuss progress on the implementation of Sláintecare. As the Chair mentioned, I am joined today by my colleagues Mr. Muiris O’Connor, Ms Caroline Pigott, Mr. Jack Nagle and Mr. Bob Patterson.

The Oireachtas all-party Sláintecare report sets out the Sláintecare vision for a universal health and social care system, where everyone has equal access to services based on need, and not ability to pay. I am happy to report today that alongside my colleague and the CEO of the HSE, Mr. Paul Reid; the Minister for Health, Deputy Stephen Donnelly; and the Government, we are making significant progress in delivering on this reform agenda.

Of course, the background to this discussion is the Covid pandemic. This took up much of our management time over the past two years which, unfortunately, slowed down several reforms, but it also demonstrated the benefits of a universal approach and the capacity of the system to change and respond. The Covid response, by necessity, accelerated many positive aspects of the Sláintecare vision. This included fast-tracking service innovation, new pathways of care, new ways of working and changes implemented rapidly in line with the Sláintecare vision and principle. In effect, these changes accelerated the move from a hospital-centric system to one where more services are provided in the community and near a person’s home. With the unprecedented funding support from the Government over the past number of years and again this year, it is now our challenge to galvanise a system to build on these reforms.

The context for healthcare reform is the need, which I believe is generally accepted, to change a system that is not structured around the new and emerging needs of our population. Our population is aging rapidly. By 2028 there will be more people aged over 65 than under 14. We are living longer, thankfully, but many of us will be living with one or more chronic illness. The health service capacity review, which was prepared in 2018, projected that the demand for healthcare to 2031 will grow significantly. For example, it projected increases in demand of 46% for primary care, of 39% for long-term residential care and of 20% for home care. These increases are clearly not sustainable and we need to continue to develop a more efficient integrated healthcare system that can meet these growing patient needs.

There are many aspects of Sláintecare and I would like to focus on a number of aspects today: enhancing public capacity; improving care at primary and community level; encouraging innovation; and the multi-annual waiting list plan.

First, a critical aspect of Sláintecare is to enhance the capacity of the public health system. Significant investment has been made by the Government and this is delivering additional staff, more hospital infrastructure and capacity and unprecedented levels of activity. For 2021, the Government has allocated almost €21 billion to core health spending. This is an extra €6 billion over the original allocation in the budget for 2018, four years ago, and an increase of over 40%. Priority investments include funding to reduce waiting lists, additional staff and more bed capacity. The CEO of the HSE will touch on this in more detail, so I will just be very brief and give some of the highlights. For example, additional critical care, acute and sub-acute beds were fully funded and opened in 2020 and 2021. Staffing in 2020 experienced the largest increase since the foundation of the HSE and 2021 has seen that trend continue with more than 6,000 whole-time equivalent staff members recruited across all service numbers. There are now over 12,500 more staff working in our health service than there were at the beginning of 2020. That is the most rapid increase in staffing numbers over any two-year period since the HSE was established. As colleagues know, a further significant increase in staffing numbers is planned this year. Specifically, there have been improvements in staffing in our acute services, which increased by almost 4,000 in 2020 and by another significant number, 3,690, in 2021.

Second, significant investment has been made to enhance community care capacity and to affect the shift from a hospital-centric model of care to delivering more care in the community. For example, an additional 837 community beds were delivered in 2020-21. To date, 51 healthcare networks, 15 specialist teams for older persons and two chronic disease management teams have been established, as well as national coverage of community intervention teams, which are all targeted at reducing dependence on the current hospital-based model of care. Each community specialist for older people will see between 6,000 and 7,000 people per year, which equates, in total, to over 210,000 patient contacts a year overall. When the chronic disease management teams are fully established, they will have approximately 30,000 patient contacts a year, which represents more than 900,000 contacts a year on a full basis of implementation. Almost 21 million hours of home care support were delivered in 2021, with over 55,000 people in receipt of the service by the end of last year. This is about 2.9 million or 17% more hours compared to 2020, with increased funding maintained for this year. Over 85% of GPs are registered with the GP chronic disease management programme and nearly 220,000 consultations were delivered in 2021. GP direct access to diagnostics, which is another key element of Sláintecare that has been debated and discussed for many years, has resulted in over 138,000 radiology tests being accessed by GPs in the community. I understand that a further 17,000 tests were undertaken last month alone. On the basis of that rate, we will be close to, if not above, 200,000 for the year as a whole. Thanks to the efforts of the HSE, these resources not only enhance community care but avoid unnecessary trips to hospital, thereby freeing up bed capacity for more complex and urgent cases.

Third, we are fostering a culture of innovation through the Sláintecare integration fund. This involves investing in new care pathways, new technologies and new ways of working and eventually shifting care to the left and directly engaging with front-line staff. Specifically, the fund facilitates the testing and evaluation of innovative models of care, with 105 out of 123 projects being mainstreamed through the HSE.

These projects resulted in over 15,000 reduced referrals, more than 18,000 acute beds avoided and over 8,000 patients off waiting lists. More details are included in the Sláintecare implementation report, which the Minister published yesterday evening. It sets out some of the numbers in more detail, as well as some of the significant benefits of these changes.

The National Ambulance Service, NAS, has successfully continued the development and implementation of alternative care pathways, with the aim of hospital avoidance and of an improved use of healthcare resources. The total number of patients treated by the NAS alternative service was over 18,000, with 44.3% being treated at home or in the community.

Various e-solutions and e-changes have been brought about which are improving the overall efficiency of the system, freeing up staff time and reducing the administrative burden. We have just mentioned two of them. Some 14 million prescriptions were transferred electronically in 2021. There was an enormous amount of activity in the community. It enabled a much more efficient administrative management of that issue. Some 333,000 video consultations were delivered based on our estimates. Clearly, now that we see that video consultations can work, they will have a role to play in the future.

A critical objective of Sláintecare is to reduce waiting lists. The short-term waiting list plan, which was published by the Government in October 2021, resulted in a 5.4% reduction in overall waiting lists, which was in line with the target reduction. The 2022 waiting list action plan is being finalised by colleagues in the Department and the HSE and it will be brought to the Government next week. This plan will set out actions to deliver further reductions in waiting lists, address backlogs, stem future growth and lay the foundations for future reform actions. It will set out how and where additional funding will be allocated. As members will know, €350 million has been committed to support this plan. Some €200 million is to support waiting list initiatives and €150 million has been allocated to the National Treatment Purchase Fund, NTPF. This is an increase of €50 million on last year’s allocation. Each year, the number of new additions to waiting lists increases significantly. The challenge is to increase activity, both to reduce the stock of people waiting too long and address the new additions. In 2022, it is estimated that over 1.5 million people will be added to the waiting lists. This reflects normal additions and an acceleration in presentations due to deferrals caused by Covid-19. Under the proposed plan, which it is hoped the Minister and the Government will publish next week, the HSE and the NTPF propose to deliver services to remove many more patients from active waiting lists. We estimate that this will be the largest level of activity ever delivered and that it will result in a significant reduction in these waiting lists. It is hoped that by the end of this year, the number of patients on active waiting lists will be at its lowest point since the beginning of Covid-19.

Reducing waiting lists will also require further capacity enhancements. Ultimately, plans are progressing for new elective hospitals in Cork, Dublin and Galway which will cater for up to 940,000 planned procedures and operations every year. This is a critical short- to medium-term change in the configuration of the system and it will increase capacity to enable us to increase the number of elective procedures. Of course, reducing lists will also require ongoing change and reform in productivity, as well as improvements in pathways and other issues that Mr. Reid and his team will no doubt touch on later. Increasing productivity is a key part of the response to this challenge. In addition, it will require progress on ensuring all patients are treated in public hospitals on the basis of need and not on the basis of their insurance status. This will free up capacity in public hospitals but it will also ensure a more equitable system. Removing private income from public hospitals is a key Government objective and a key objective of Sláintecare. It will require legislation and further discussions with the representative bodies. Members will be aware that talks have been ongoing with representative bodies on the implementation of a Sláintecare contract, which will pave the way for the removal of private care from public hospitals. We look forward to further engagement on those talks.

I will turn now to Sláintecare governance and oversight. A new Sláintecare programme board, which is co-chaired by Mr. Reid and me, has been established to drive the implementation of Sláintecare reforms. The Sláintecare board, which will report directly to the Minister, Deputy Stephen Donnelly, will ensure enhanced co-ordination on delivering key reform priorities. The board has met twice since December. It will meet every second month going forward. Responsibility for the overall project management office has been assigned to the leadership of an assistant secretary, Mr. Derek Tierney.

As this committee is aware, our hospital groups and community healthcare organisations are not aligned geographically, nor do they overlap on management, clinical oversight or budgets. The Sláintecare report identified that regional health areas, RHAs, are essential for the proper and improved integration of health services and for population-based planning in Ireland. The allocation of resources will also enable better oversight and evaluation of costs and health outcome benefits. RHAs will ensure the alignment and integration of hospital and community services at a regional level, based on defined populations and local needs. The Government approved the geographies of the regions in the months preceding the pandemic. The Government decision directed the Department to explore the organisational design, governance frameworks and funding methods via a business case. A memo for the Government decision is being drafted, and the Minister for Health will bring it to the Government in the next few weeks. A detailed implementation plan is being developed by the Department and the HSE, with input from the newly established RHA advisory group. This will cover how RHAs will impact on workforce and HR planning, funding allocations, capital infrastructure and governance lines. Our high-level timeframe is for design detail for this year, with implementation beginning in 2023.

With the unprecedented funding and support of the Government, we now have a real opportunity to build on recent progress, to continue to implement Sláintecare at pace and to continue to translate the Sláintecare report from shared vision to reality. I would like to take this opportunity to again thank all of our colleagues in the Department of Health and in the HSE for their continuing work and dedication in delivering on this agenda for the Minister, for the Government and for the citizens of Ireland. I look forward to working with the committee and to answering any questions.