Mr. Ciar?n Devane:

I thank the committee for inviting me on the occasion of the proposal by the Minister for Health and the Minister for Children, Equality, Disability, Integration and Youth to reappoint me as chair of the HSE. In June 2019, the Minister for Health re-established the board to oversee the HSE. He is now calling on me, as it happens. This was an important step in improving governance and was one of the key recommendations of Sláintecare. When I came before the committee in my first week as chairperson, I said what excited me was turning the pages of the Sláintecare report, the fact it has cross-party support and the fact that it set a direction of travel which, when implemented, will give us universal healthcare and a service fit for the future. That excitement remains with me and my fellow board members.

I will speak a little bit on governance. For the last five years, we have focused on the delivery of the policy framework - for example, national clinical strategies. There is no point having them if we do not implement them and have them funded. We have focused on Sláintecare itself and the health priorities of the Government. To do this, the board put in place a corporate plan which set out our three-year objectives. I have attached a summary of that to this statement.

Every year we have the national service plan, which needs to match the ministerial priorities and the corporate plan. We also have an audit plan, a scorecard and a risk register. We have a new transformation roadmap outlining the journey, so that we have a control environment which ensures we cover compliance and performance issues and the risks we see, as well as the priorities for change.

To support the board, we have five committees which report into us: audit and risk; people and culture; planning performance; safety and quality; and a new one, technology and transformation. In our five years, we have had 104 board meetings and 235 committee meetings. We use that committee and board structure to push the priorities, find new ways of working, ensure better use of data, support cultural change and enhance productivity. There is a lot still to do but that is a necessary foundation for the transformation that we all say we need.

The pandemic tested that governance as much as it tested the rest of the health system to its limits. I have to acknowledge the tireless work of all staff across the health service and the health system, in the HSE, in sections 38 and 39 partners, in the Department and across Government. Truly, the commitment, endurance and dedication was outstanding and should never be forgotten. When I look back on that period, I think we should all be rightly proud of how Ireland handled the pandemic. We had one of the best mortality outcomes of any country. This should not be a total surprise. Ireland's health system continues to have outcomes that in many cases are among the best in Europe and, indeed, in the world.

The quality of care in the community and hospital care is recognised by the public, with Ireland reporting the highest self-perceived health status in the European Union. Ireland is also among a small group of seven EU countries where life expectancy is above 82.4 years, two years above the average in the EU. There have been significant improvements in mortality for many of the common causes of death, which shows the benefits of those clinical strategies when well implemented over time. The fact that we sustained that through the pandemic is encouraging for the resilience of the health system, even in the face of the ransomware attack which made a really tough job much harder.

Since the pandemic, the focus has been on transformation. Some of this is structural, with Bernard Gloster, as our new chief executive, progressing the health regions and devolving decision-making out of the centre wherever possible. The regions are going to be critical to the implementation of Sláintecare on the ground and putting it into action. The committee knows well that the hospital groups and community healthcare organisations, CHOs, served different populations and did it in different ways and covered different geographies with separately managed services. Now, with the regional executive officers being in place, the new approach will allow us to integrate the services, clarify the care paths and allow the services to truly be based on the evidence about the population they serve.

Much is going well but I want to talk about the strategic priorities of concern to us, as the board. Our urgent care services are delivering more care to more people each year but the demographics mean we have services under pressure almost all year round. We have done away with the winter plan idea and moved to a year round approach. We are always seeing the implementation of the multi-annual, if not multi-funded, urgent emergency care plan. We still have too many patients on trolleys. Significant progress has been made and they are 12% down this year. We recognise the intense effort it has taken to do that.

Looking at the second six months of 2023, the number of patients on trolleys was down 22% compared with the same six months in 2022.

However, we see some hospitals with particular challenges and, as we have seen, this can have tragic consequences. All patients using health and social care services should consistently receive the safest care. Failures are a matter of great regret to us as a board and to all in the HSE. It is a matter of great concern to all of us, whether we are on the board or part of the wider system. When something goes wrong, the board expects that open disclosure as a principle is applied across the HSE and our partners. We also expect that the appropriate lessons are learned and applied to ensure these events become ever less frequent. We expect senior colleagues to use the tools available to mitigate risk and to follow guidance. It is the only way the frequency of those rare events will become lower. This is true in emergency care but it is also true of safeguarding in residential settings, in maternity care and across the entire system. These are awful events. We have to learn and act to make sure they are not repeated.

Elective care is a second area that needs transformation. A programme is currently being put together to increase surgical capacity, address waiting lists and get ahead of and anticipate future demand. These include the development of surgical hubs and elective hospitals, which are designed to separate elective and emergency care.

The board of the HSE is overseeing the implementation of the multi-annual waiting list action plan, which spans acute and community settings beyond urgent and emergency care. It has to build on the progress of 2021 and 2022 as part of the multiannual approach to sustainably reduce waiting lists and waiting times and move towards the maximum targets in Sláintecare.

On enhanced community care, one of the key aims in Sláintecare is the shift left, as we call it, towards provision of care in the community. There has been significant investment in those community services, with their own diagnostics, community health network teams based around local populations, and new community specialist teams, such as teams for older people and chronic disease management. These are all helping significantly with hospital admission and readmission rates. For example, we have seen that admission rates between 2019 and 2023 are down 16%; 30-day readmissions are down 24%; and 91% of patients with chronic disease are now routinely managed in primary care. However, we have to ensure that the infrastructure is invested in to support this increased workload in the community so that staff have the right tools in the right environment.

We have seen significant growth in staffing, with the highest workforce number since the formation of the HSE in 2005. In 2023, there were just under 146,000 whole-time equivalents compared with December 2019, when there were just under 120,000 whole-time equivalents. This is up 22% over four years. Of course, that is great news but there is now a requirement in 2024 to show we are using that investment well and making sure the money the taxpayer and the public have given us increases activity and improves outcomes through using that increased workforce. We also need to stick to the limit of what is allocated. Specifically, the impact of recruitment beyond available funding during 2023 will need careful management over the next number of months, as we need to move to a fully understood, agreed and compliant pay and numbers strategy. This does not mean that there will not be recruitment in 2024. Approximately 2,200 additional staff are provided for in the NSP on the health side. Another just under 700 staff are provided for on the disability side so it is 2,900 in total. However, it is fair to say that 2024 will be a year of consolidation, lower growth in staff numbers, and better control, with some critical posts open to recruitment and others filled by moving staff into more important vacancies from less immediately critical roles.

I particularly welcome the adoption of the public-only consultant contract. Along with the increase in consultant numbers overall, this means significant new senior medical capacity across our services. Our management and clinical leadership will work to make full use of the potential this provides in hospitals and across all settings to make sure patients experience the full benefit of having senior decision-makers rostered on site for greater proportions of the day, including at weekends.

The board completely supports Sharing the Vision, which is a mental health policy that envisions a mental health system designed around the requirements of the individual. Of concern to us were the findings of the look-back review into child and adolescent mental health services, or the Maskey report, and the Mental Health Commission report into CAMHS. We will continue to prioritise the implementation of those recommendations.

Specialist community-based disability services transferred to the Department of Children, Equality, Disability, Integration and Youth in March last year. That Department secured Government approval for the action plan for disability servicesin July 2023, which along with the Roadmap for Service Improvement 2023-2026: Disability Services for Children and Young People, has to be a focus for 2024. Making that real will be an important challenge for all of us.

The funding allocated for 2024 will progress many acute and community projects throughout the country. The capital plan supports the Government's priorities, including the new children’s hospital and the national maternity hospital, as well as programmes for critical care, surgical hubs, urgent emergency care, elective hospitals, disability services, community and primary care, older persons, mental health and so on. That is an important area for us on which we have been engaging very heavily with the Department recently.

Digital health goes back to the key enabler of supporting people to live well in the community. The digital health and social care framework, which came out recently, and the introduction of the new health app, which will go public very soon, are another milestones.

Those areas, which are all consistent and embedded in the corporate plan and come out of the combination of ministerial priorities and the Sláintecare report, are our priorities going forward. A challenge for us is to ensure that the positive trends for people’s health persist while we manage these capacity deficits, with the increased number of people accessing emergency services in particular. There is still a great deal to do on access. We have been given the tools we have wanted for a long time, such as increased numbers and the new consultant contract. We now have to show that we can use those effectively. We can celebrate unquestioned progress but we also have to apologise for those failures when they happen and act decisively to make sure they cannot be repeated. There is a much to be done on that agenda. I look forward, on behalf of the board, to working with the full range of partners and stakeholders to build that better health and community care service.

That concludes my statement. I am of course happy to answer questions.