Mr. Bernard Gloster:

I thank the Chair and members for the invitation to meet the committee today and to join with colleagues from the Department of Health in providing an update on our work arising from the Sláintecare policy framework. I note that in the invitation members have also indicated their wish to discuss access criteria for medical cards and associated issues. I am happy to address both topics.

I am joined today by my colleagues: Mr. Pat Healy, national director, with responsibility for the enhanced community care, ECC, programme; Ms Mary Day, national director of acute operations, with responsibility for the waiting list action plan; Ms Anne Marie Hoey, national director of HR, with responsibility for workforce; and Mr. Shaun Flanagan, assistant national director of the primary care reimbursement service, PCRS, with responsibility for the medical cards system. I am supported by senior staff, Ms Sara Maxwell and Ms Niamh Doody.

With regard to Sláintecare, as indicated when I last appeared before the committee, I would like to draw attention to the significant progress made in the development of primary and community care services. These services are essential to allow us to move away from an acute-centric model to the delivery of care at the lowest possible level of complexity. Primary and community care are also developing to meet the needs of our ageing demographic and to facilitate the change in the management of chronic disease. In recent days, the committee will have received a detailed briefing on this work, ECC and the substantial progress that has been made despite the influence of the pandemic.

ECC has had substantial investment and is now starting to yield results. The investment in clinical front-line staff is unprecedented. At this point, in summary: 2,643 whole-time equivalents, WTEs, are secured, representing 76% of the overall 3,500 posts approved for the programme; and 94 of the 96 community healthcare networks, CHNs, and 47 of 60 community specialist teams, CSTs, for older people and chronic disease are operational, with the balance to be in place by year-end. The 21 community intervention teams, CITs, are operational, with nationwide coverage now secured. The technical briefing sets out further detail and it is instructive to note the success rates being achieved. There were 22,266 patient contacts by the integrated care programme for older persons, ICPOP, community specialist teams, and that is in the first four months of 2023. Some 64% of those people were discharged home, 6% were admitted to acute hospital, 1% were admitted to long-term care and 29% remain engaged with the teams. Those are very significant indicators of success, given what was originally planned.

Some 91% of patients with chronic disease are now fully managed routinely in primary care and are not attending hospital for ongoing management of their chronic condition. GPs are referring any patients who cannot be managed within general practice to the community specialist teams for chronic disease, and 28,362 patient contacts were in this context from January to April 2023. Our community healthcare networks provided over 460,000 therapy services patient contacts between January and April 2023. Community diagnostics provided 136,852 radiology scans between January and May 2023 and just over 253,000 in 2022, which is reflected in significant reductions in referrals to hospital services.

I have set a specific requirement for this September to flex the ECC model to provide an interface with both public and private nursing homes to improve hospital avoidance and to support post-hospital discharge. This will be a new departure for primary care services. This high-level view of the ECC programme demonstrates a significant opportunity for the future and we are focused on ensuring this valuable resource has both short-term and long-term benefit to the reform of health care delivery.

With regard to medical cards, anyone who is ordinarily resident in the Republic of Ireland can apply for a medical card or GP visit card. This includes families and single people, including those working full-time, part-time or not at all. “Ordinarily resident” is defined as a person who is living in Ireland and intends to live in Ireland for at least one year. Individuals will receive a medical card or GP visit card in the following situations: when their finances - their income and outgoings - are assessed and they meet the income requirements; or when they do not meet the income requirements but they have a medical condition or conditions that make paying for healthcare difficult. The national medical card unit has well-developed processes for looking at hardship, and this is often called a discretionary card. Individuals who automatically qualify may not have to do a means test, and I have included a list of those at appendix 1 of my statement.

The HSE advises the public that the most efficient way for individuals to apply for a medical card is online. However, the national medical card unit processes both manual and online applications. There is no expectation that a fully online system could be achieved. Currently, the majority of medical card and GP visit card processing is completed within four working days of receipt of a fully completed application, albeit the printing and posting of a medical card may take a further number of days. During the month of May 2023, 99% of completed medical card applications were processed within 15 working days.

If an individual does not qualify for a medical card based on means, the national medical card unit can consider whether the cost of meeting his or her or his or her family’s medical and other health needs is fair and reasonable, despite the person's income. This is often called a discretionary card and an individual would usually only apply for same after his or her application has been turned down on income grounds alone.

Between December 2022 and the end of May 2023, there was a net overall increase of 22,994 medical cards, bringing the total to 1,591,373 persons at the end of May 2023. Between December 2022 and the end of May 2023, there was a net overall increase of 10,229 GP visit cards, bringing the total to 545,970 persons at the end of May 2023. At the end of April 2023, there were 183,354 medical cards and 39,324 GP visit cards in existence which had been awarded solely on a discretionary basis.

With regard to the workforce, at the end of March 2023, the HSE and section 38 agencies had 139,838 whole-time equivalents populated by 158,582 people employed, and the Secretary General has already expanded on that point. This is an increase of 20,020, or 16.7%, on 2019 levels. This week, we are commencing a major international recruitment campaign associated with the public-only consultant contract, which is commencing in the UK and Australia before progressing on to the rest of Europe and Canada. As far as we believe, the investment in our recruitment drive is merited.

Other matters relevant to Sláintecare have been addressed by the Secretary General and have previously and recently been briefed to the committee, including the implementation of regional health areas and also waiting lists. I am happy, with my colleagues, to address those matters further with the committee.