Mr. Bernard Gloster:

I thank the committee for the invitation to meet to discuss the arrangements for the funding of health services in 2024, the services and the workforce matters. I am joined by my colleagues Dr. Colm Henry, chief clinical officer and Ms Anne Marie Hoey, national director of HR, and I am supported by Ms Sara Maxwell.

In respect of the funded position for the HSE for 2024, my comments and extensive detail are a matter of public record, including that as recorded on the “This Week” programme on RTÉ Radio One on Sunday, 15 October last, following the budget announcement.

The next stage of the process is for the HSE to receive the letter of determination from the Minister and his Department and thereafter to prepare a service plan for 2024 for submission and consideration by the Minister. In respect of the funding for health services for 2024, the position has not changed since my comments of 15 October, other than to note that details of any supplementary allocation in respect of 2023 and the possible implications of that for 2024 remain to be decided.

As noted in my comments of 15 October, the health service has a very significant allocation, much increased in previous years, and this has allowed for extensive progress and growth in many areas of service provision. Coupled with this and notwithstanding the impact of the pandemic, the health service is also experiencing record levels of demand for various clinical and social care services. Until such time as the HSE receives the letter of determination, we are not in a position to elaborate further on the 2024 outlook other than in the comments I have made and widely reported in recent days. The matter of the overall vote for the Department of Health, including its non-HSE activities, is referred to by my colleague, the Secretary General.

I want to turn to two particular issues in my opening remarks that I know are of concern to the committee. The first is in respect of services for 2024. As per my public comments, I anticipate services will continue in 2024. We will see significant focus on two critical areas, which I have emphasised since taking up post and as requested by the Minister and the Department. Those are unscheduled emergency care and access to care and the waiting list action plan. Both of these and the initiatives associated with them are well funded in 2023 and this will continue in 2024. These two areas of service, together with a number of preplanned commitments or new developments arising from beds and capital infrastructure due to be opened, will see an additional workforce of approximately 2,200 whole-time equivalent, WTE, and these cover many of the essential areas of service to be continued.

Committee members will be aware of many new national strategies and programmes developed and commenced in recent years. While in the main these will not see growth in 2024, significant work can be done with the existing resources within these programmes.

It is fair to say overall that 2024 will see these services continue with a focus on consolidation rather than growth. While this will be in the context of a very constrained and challenging financial position, based on all that is known at this time, I assure the committee of the full focus of the board and myself as the CEO in delivering the best level of service possible to those in need of same.

I also want to comment on the issues associated with workforce that I know are of concern to the committee and particularly in respect of the recent recruitment pause, which was extended by me earlier this month. Our workforce has grown considerably as has been previously reported. It was 23,000 additional at the end of September since 2019. This has allowed for significant responses and developments. The HSE will reach, if not exceed, its funded additional net target for 2023 by the end of this year. That is the reason and the sole reason for the pause in respect of certain grades. It is my intention for 2024 that budget holding areas will have a full pay and numbers strategy and allocation within which to work and within which the targets will be very clear. An improved control environment will allow for these targets to be met and maintained on the one hand but not exceeded on the other. This will require a particular co-ordinated focus on existing staff, the management of new posts, the management of the use of agency and overtime and conversion from agency staff to direct employment, where appropriate and possible.

The HSE intends to agree with the Department of Health a clear budget and staffing numbers position in respect of employment costs and management for 2024 and this will have to be managed very carefully. I am aware of the disappointment of many, both in the workforce and externally to the HSE regarding recent decisions associated with staffing controls. I assure the committee and all concerned of my commitment to a continuously improving workforce position, capable of responding to a whole range of needs but also as clearly required within the limitation of the available funded workforce position.

That concludes my opening remarks and I am happy to assist the committee.