Billy Kelleher (Cork North Central, Fianna Fail)
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Question 295: To ask the Minister for Health the progress being made in developing the clinical care programmes within the Health Service Executive, particularly, with regard to reducing the level of inappropriate use of acute hospitals; the way the overall development process and that of the individual clinical care programmes is being reported on and evaluated; the way this work will be incorporated into recently announced directorates; when a detailed report can be available to the Health Committee; and if he will make a statement on the matter. [8826/12]

James Reilly (Dublin North, Fine Gael)
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Immediately following my appointment I set about establishing the Special Delivery Unit to unblock access to acute services by improving the flow of patients through the system. The SDU was established in June last year and quickly began work with the HSE to put in place a systematic approach to eliminate excessive waiting in emergency departments. The SDU is establishing an infrastructure based on information collection and analysis, hospital by hospital, so that we will know what is actually happening in real time. This will allow us to being to embed performance management in the system to sustain shorter waiting times.

I also want to ensure that as many services as possible can be provided safely in smaller, local hospitals. Joint HSE/Departmental group is currently developing a framework for the future development of smaller hospitals. Consultation with all the stakeholders, including patients and public representatives, will be an integral part of the process.

The organisation of hospital services nationally, regionally, and locally will be informed by the clinical programmes, which have been developed and implemented by the HSE, and by the work on the framework for the development of smaller hospitals. These inter-related programmes aim to improve service quality, effectiveness and patient access and to ensure that patient care is provided in the service setting most appropriate to individual's needs.

The clinical programmes, led by multidisciplinary teams, are developing and implementing solutions that will improve the quality, access to and cost of patient care. The benefits of the programmes are already been felt. The Acute Medicine programme, currently being implemented in 18 hospitals already contributed to a reduction in the average length of stay of medical patients and enabled bed day savings while at the same time improving the patient experience. The stroke programme is implementing nine new stroke units and standardising care in another 19. This will ensure that for the first time in Ireland there will be a thrombolysis service available 24/7 across the country. The Elective surgery programme is already generating savings through improving theatre management and will also generate reduction in the average length of stay for elective surgery.

Behind each of the programmes currently being implemented is a business case setting out the quality, access and cost benefits they are seeking to achieve. Each programme at a national level has a clinical programme lead, a programme manager and a multidiscipline working group including nursing, AHPs, GPs etc. At a regional level there are programme co-ordinators in place in each who co-ordinate the implementation of the programmes on behalf of the Regional Director of Operations. Implementation plans are developed are developed at a local hospital level by local project managers. Fortnightly meetings of the National Programme Managers and Regional Co-ordinators are held which focuses on tracking progress, issue resolution and monitoring of risks. There are also regular 1:1 meetings with the National Clinical Leads and the National Director of Clinical Care.

The 2012 service plan includes key performance indicator (KPI) for a number of the programmes. Progress on the delivery of these KPIs will be tracked in the usual service plan reporting progress process. The HSE itself acknowledges that there is a need to accelerate the process of health care reform and through the use of initiatives, such as the National Clinical Care Programmes, to move to models of care across all programmes that deliver services to patients and clients at the lowest level of complexity and the least possible unit cost. It is hoped to minimise the impact on services but the reality is that we are in very challenging times and there is going to be a consequence for every programme. A key way forward will be changing how services are delivered and this will involve full engagement from all concerned. The HSE will be working with all involved.

I have recently announced my intention to move the clinical programmes to my Department. The precise arrangements are now under consideration.