Mary Harney (Dublin Mid West, Independent)

I propose to take Questions Nos. 2 and 4 together.

The HSE National Service Plan 2010, which I approved on 5 February, commits the HSE to delivering activity levels for 2010 which are broadly in line with 2009 levels. The plan was laid before both Houses of the Oireachtas on 8 February and has been published on the HSE's website. During 2010, the HSE will provide me with monthly performance reports on all aspects of progression of the plan.

As part of the Estimates process, the Government made a series of decisions that will reduce HSE costs by approximately €1 billion in 2010, comprising savings of €630 million on pay and almost €400 million in non-pay. However, it also made available additional resources to assist the HSE in responding to priority demographic and other needs and to support ongoing reform of the public health services.

Planned activity levels for primary community and continuing care services in 2010 are in line with 2009, with some growth in activity proposed in areas such as fair deal, home care packages and medical cards schemes.

In respect of acute hospital services, the plan targets a reduction of 54,000 in-patient cases through a combination of reducing emergency admissions by more than 33,000 and providing access to diagnostics on a non-inpatient basis to at least 10,000 patients who would otherwise be admitted only for that purpose. It also targets a further increase in day case activity to 689,000 which is in line with the trend during the last decade whereby the number of day cases carried out in the public hospital system increased from 273,000 in 2000 to an estimated 679,000 in 2009.

The national service plan commits the HSE to specific and demanding targets for improvement in average length of stay, the proportion of a specified basket of procedures to be undertaken on a day surgery basis and day of surgery admission. These targets have been informed by international evidence and data indicating that within the Irish health service there is an appreciable variation in performance as between different hospitals for similar procedures. The Executive will therefore focus on reducing this variance in performance as well as on protecting in-patient beds for elective surgery in order to reduce waiting times.

I recognise that meeting these targets will require co-ordinated and sustained effort, involving clinicians, management and other professional and support staff. However, the changes required are driven not only by efficiency considerations but by evidence that they deliver other benefits in terms of patient safety, a more user-friendly service delivery and better patient outcomes. Achievement of the performance targets in relation to emergency admissions will require increased access to the specialist skills and senior clinical decision-making available in medical assessment units, to diagnostics and to other ambulatory care services. Accordingly, under the national service plan the acute sector will continue to manage emergency admissions while at the same time achieving elective activity targets.

By reforming the manner in which services are provided, I am confident the HSE will deliver the volumes of service provided for in the plan, while at the same time continuing to improve service quality and patient outcomes.

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