Stephen Donnelly (Wicklow, Fianna Fail)
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In 2017, the Oireachtas Committee on the Future of Healthcare in Ireland published the Sláintecare Report which set out a new vision for the future of healthcare in Ireland. Sláintecare is the most significant reform programme in Ireland’s Health Sector. The shared vision of Sláintecare is to introduce a universal health and social care system where everyone has equitable access to services based on need, and not ability to pay.

The first three-year Sláintecare Implementation Strategy was approved by Government and published in 2018. It set out an ambitious programme of reform commencing with implementing an initial set of key actions in the Sláintecare Initiation Phase. Key progress in this period included the establishment of an independent HSE Board, of The National Safety Office, Community Healthcare Networks and of the Integrated Care Hubs for Older People with Chronic Diseases. The establishment of the six new HSE Health Regions was approved and increased eligibility for GP access was achieved. Significant investment in workforce and in various Healthy Ireland projects increased health system capacity and improved health awareness and disease prevention.

The 2018 Implementation Strategy was succeeded by the Sláintecare Implementation Strategy & Action Plan 2021–2023. It built on the reform progress made in the first three years, as well as on COVID-19 learnings and commitments made under the Programme for Government. This Sláintecare foundational phase has continued to deliver significant progress during the implementation of concurrent key reform projects in multiple areas, such as Enhanced Community Care (ECC), HSE Health Regions, Elective Care, Eligibility Expansion, Digital Health and Healthy Ireland. During this period the Public-Only Consultant Contract was also introduced, and 3 major Trauma Centres were established. A Final Progress Report on the implementation of the 2021-23 Strategy and Action Plan is in preparation.

Work on the next phase of implementation of Sláintecare from 2024 onwards is also at an advanced stage of development. The Government remains fully committed to the continued delivery of Sláintecare reform. The 2024 Health Budget provided €22.5 billion to build on the significant reform progress made to date, to continue the delivery and expansion of quality, affordable healthcare services.

Key Sláintecare progress to date has included:

• Health Regions (formerly Regional Health Areas). The Government approved the creation of 6 new strategic Health Regions on 31 July 2023. They will become operational this year. Each region will align community and hospital services based on defined populations and their local needs. This will increase efficiency and will maximise the use of resources. The recruitment of Regional Executive Officers (REOs) is now complete.
• The new Sláintecare Public Only Consultant Contract was implemented in March 2023 and is the only contract available to new consultants. This will increase the number of senior decision-makers in our hospitals, including out of hours and at weekends. The new contract will benefit public patients by allowing for the incremental removal of private care from public hospitals. As of end of January 2024, there are more than 1,821 consultants on the new POCC. More than 40% of the total number of consultants working across our health service are now on the new contract.
• Eligibility Expansion. In 2023, additional measures which also facilitate better access to affordable, high-quality healthcare have been introduced. These include:

-Public inpatient hospital charges were abolished in April 2023.

-All children under 8 years of age are eligible for a Free GP Card since August 2023.

-Expansion of free GP care to people earning no more than the median household income,

-Free contraception is now available for women aged 17 to 30 (extending to 31 in 2024 following Budget 2024).

• Enhanced Community Care. A patient-centred population-based approach is integrating community care with the acute hospital sector, providing health services closer to people’s homes, and reducing pressure on acute hospitals. A total of 96 Community Health Networks (CHNs), 24 Community Specialist Teams (CSTs) for Older Persons, 24 CSTs for Chronic Disease, and 21 Community Intervention Teams (CITs) are now operational.
• Workforce Planning. Since 2020 we have 22,655 more staff (a 19% increase). This includes 6,683 nurses and midwives, 3,132 health and social care professionals (HSCPPs) and 2,501 doctors and dentists. With €4.6m in 2023 funding, we now have 59 new postgraduate places, and a total of 879 intern posts of which are 24 new. GP training increased by over 80% since 2015. In 2023, 287 GPs entered training and 350 places are planned for this year. The HSCPP Projection Model will provide demand and supply projections of numbers required in medicine, nursing and HSCPs spanning short- (3-5 years), medium- (5-10 years) and long-term (18-20 year) time horizons.
• Digital Health. There are 43 programmes funded under the eHealth Capital Plan, such as:

-The Digital Healthcare Framework (2024-2027) will set out our roadmap towards digital health.

-The Health Information Bill will ensure a fit for purpose health information system.

-The New Children’s Hospital Electronic Health Records (EHR) Systems is underway.

• Waiting Lists. €443 million of funding was allocated in 2023 to reduce hospital waiting lists by 10% and to move towards the Sláintecare waiting targets of 10 weeks for outpatient appointments and 12 weeks for procedures. There has been an 11% reduction in the numbers waiting longer than the Sláintecare targets of 10/12 weeks and a one-third reduction in those waiting over 12 months. The average waiting time for outpatients reduced from 9.7 months to 7.5 months in 2023. Last year was the second consecutive year that national hospital waiting lists fell.
• The Sláintecare Integration Innovation Fund Programme identifies and promotes innovative and integrated models of care and new ways of working, leveraging technology where possible, by funding projects that serve as a ‘proof of concept’, from ring fenced funding in the health budget, with a view to mainstreaming/scaling successful projects. To date over 100 projects have been successfully tested and are receiving recurring funding annually.

The above-mentioned reports can all be found at the following link: www.gov.ie/en/publication/0d2d60-slaintecare-publications/#slaintecare-report.