Joint Committee on Health & Children

3rd April 2014

Opening Statement

by

Mr. Tony O’Brien

Director General

Health Service

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GoodMorning Chairmanandmembersofthe Committee.

ThankyoufortheinvitationtoattendtheCommittee meeting. Iamjoinedbya numberof mycolleagues:

  • Ms Laverne McGuinness, Chief Operations Officer and Deputy Director General
  • Mr Pat Healy, National Director Social Care Division
  • Mr John Hennessey, National Director, Primary Care Division
  • Dr Aine Carroll, National Director, Clinical Strategy and Programmes
  • Mr Ian Carter, National Director, Acute Hospital Division
  • Mr Stephen Mulvany, National Director, Mental Health Division

The Committee requested information and replies on a number of specific issues prior to this meeting and you will have received a written response to these issues from the HSE and the Department of Health.

I will therefore confine my opening statement to updating the committee on the following matters.

National Ambulance Service (NAS)

Members will be aware of last weeks television programme on the National Ambulance Service (NAS) and I would like to clarify a number of points in relation to the programme.

The programme placed considerable focus on Officer Response Vehicles (ORVs).

These vehicles and the Officers (all paramedics or advanced paramedics) are available to respond to emergency calls as and when required. During the period January to March 2014 these vehicles carried out 629 emergency call outs, of which 252 occurred outside working hours.

The NAS has recently commissioned a "National Capacity Review". The review will utilise a modelling provider with extensive international experience of modelling ambulance operations. The review will analyse current ambulance vehicle numbers, call cycles, and response time performances. Additionally, the review will examine current and projected resourcing levels for emergency ambulance cover and intermediate care and ORV’s. Overall the review will determine the level of resource required across the country.

Despite statements in the programme referring to "cutbacks" in the NAS, it is important to understand that despite cutbacks in other areas of the health services,

  • The budget available for the National Ambulance Service has increased by 4.3% between 2012 and 2013. There is a further increase of 2.6% in the 2014 allocation to the service.
  • €9.3m was spent on NAS vehicle equipment and vehicle replacement in 2013 with a further €7.5m set aside for 2014.
  • This has resulted in the purchase of replacement vehicles which forms part of the fleet modernisation programme including 27 Emergency Ambulances, 25 Intermediate Care Ambulances and 27 Rapid Response Vehicles. It is planned to purchase a further 35 Emergency Ambulances for 2014.
  • €26.2m is being invested for the development of a single National Control centre which will operate over two sites,Tallaght and Ballyshannon.
  • It is also planned to spend €4.6m on a national defibrillator and mechanical CPR purchase programme in 2014.

Since 2008 the number of staff in the NAS has increased by 16%. This is despite a significant reduction in staff within the wider health services.

At the end of 2014 it is anticipated that the complement of advanced paramedics will be 300, an increase of 400% since 2008. The NAS has also trained approximately 300 paramedics since 2008 as well as recruiting and training approximately 70 Emergency Medical Technicians (EMTs) during 2013 and proceeding to recruit a further 20 paramedics during 2014.

In addition, the Emergency Aeromedical Servicehas completed 556 missions since its inception in June 2012 to February 2014. In 2013, the Irish Coast Guard also performed over 300 helicopter missions in support of the National Ambulance Service and will continue to do so in 2014.

The HSE and the NAS is fully committed to and will continue to investin services to ensure the best outcome for its patients in addition to the investments towards improvement which are already underway across the service.

PortlaoiseHospital Maternity Services

In relation to the eight overall recommendations specific to HSE in the recent report on Portlaosie Hospital Maternity Services, I want to update the committee on the following key actions that have been undertaken to date:

  • The staff at PHMS has apologised unreservedly to any families who experienced care below the expected standard.
  • A new Management Team was appointed on the 28th February on an interim basis in order to run the PHMS service.
  • Dialogue has already commenced with CoombeWomen & InfantUniversityHospital in order to provide support to Portlaoise Maternity Unit in a collaborative working arrangement into the future.
  • The HSE is implementing its policy on Open Disclosure.
  • Currently a Diagnostics Review is underway in PortlaoiseHospital.
  • The HSE has issued a directive to all healthcare providers requiring them to notify the director of quality and patient safety and HIQA of all key risk events.

Other cases that have become known to the HSE since the airing of the televison programme where families were not treated in a sufficiently or compassionate manner by the PMHS are being dealt with by the new management team and the Regional Director Performance and Integration.

Service Plan 2014 – Finance and Activity Overview

The Service Plan highlighted that the health service faced a severe financial challenge in 2014. At the end of January the HSE is not flagging any new concerns or risks beyond those which were clearly set out within the National Service Plan.

Financial Overview

At the 31st January 2014 the HSE is showing expenditure of €999.5m against a budget of €975m leading to a variance of €24.5m.

  • A material proportion of this variance or €20.2m is within the acute hospital sector with €5.9m or 29% of the acute deficit relating to hospital income generation and €10.1m or 50% relating to agency staffing levels.
  • €4.2m or 41% of the acute variance relating to agency is within the medical category which relates to the growth in NCHD agency costs.

However it should be noted that there remains a significant issue nationally relating to the recruitment of NCHD’s which is driving agency expenditure in certain hospitals.

  • As well as the wider performance management of the acute system in 2014 a more targeted approach with individual poorer performing hospitals is now being undertaken.
  • The Acute system is facing a challenging year in 2014 with legacy deficit issues to be addressed in year with hospitals expected to meet the full value of cost containment plans unachieved in 2013 of €56.5m.This is in addition to the full value of savings measures that are to be delivered in 2014.
  • There is an emerging issue in relation to private health insurance income and the HSE has identified an increase in claims being pended for payment by insurers. This issue has been highlighted to insurers andthe HSE is currently actively engaging with them in order to reduce the lead time from submission to payment of claims.

Activity Overview

Overall in January, the data shows activity against the service plan was as follows;

  • The Health Service has seen an increase in new ED attendances (+3% or 2,261 people) and a 3% increase in emergency admissions in January of 2014.
  • A 34% reduction has been achieved in the number of ED patients waiting on trolleys for ward bed accommodation betweenJanuary 2011/2014.
  • Emergency admissions in January 2014 were 3% higher than January 2013 admission values.
  • Day Care attendances were 2% lower (1,100) than January 2013.
  • The health service has seen an overall improvement in Adult waiting lists in January 2014. At the end of the month 96% (41,251) of adults were waiting less than eight months for a planned procedure (94% in the same period in 2013). There were 1,764 adults waiting over 8 months at the end of the month compared to 3,073 in the same period in 2013.
  • During the 12 Months of 2013 the ambulance service responded to over 281,000 emergency calls (AS1and AS2) an increase of 14,000 over 2012.
  • The number of people covered by medical cards as of January 2014 was 1,840,760 (40.1% of the population). Included in these cards were 50,505 medical cards granted on discretionary grounds.
  • The total number of GP visit cards as of January 2014 was 125,930. Included in these cards were 27,204 GP visit cards granted on discretionary grounds.
  • 46,513 Clients were in receipt of a home help service and 11,969 clients are in receipt of a home care packages.
  • 22,959 clients are supported by the nursing home support scheme (NHSS) with 4.1% of the population or 21,880 people aged over 65 years were supported in NHSS/Saver beds.

Up date on Section 38 and 39 Funded Agencies

Section 38 Funded Agencies

The process which has been ongoing with the Section 38 Agencies to reach compliance with Government Pay Policy is nearing completion.

Since the beginning of the year the Regional Directors of Performance and Integration (RDPI’s), with support from Regional HR, have been working with each Agency through a further process of verification and clarification where deviance from the pay policy was previously recorded to ensure the full implementation of the provisions of the pay policy in assisting the Agencies to reach compliance.

In line with the pay policy, and as part of the ongoing process to reach compliance, organisations seeking to make a business case for the continuation of an unapproved allowance were invited to submit their business cases for consideration by the HSE. Business cases were also required for the continued payment of allowances which are not encompassed by or in line with the Department of Health Consolidated Salary Scales but may have been sanctioned in the past. A total of 202 business cases have now been received.

An Internal Review Panel, comprising of nominated members of the HSE Leadership Team, have reviewed each business case in detail and are currently in the process of making a decision in relation to each case and a report will be published shortly.

143 business cases were received in respect of Senior Managers i.e. those at salary level of Grade VIII and above for consideration by the Internal Review Panel.

In addition, 59 business cases in respect of salary level below Grade VIII have been reviewed at operational level by the Regional Directors of Performance and Integration with support from Regional HR.

As indicated above the process is nearing completion following which we will be in a position to provide a full report on the outcome of the compliance process.It is important to note that as a result of the co-operation received in reaching compliance with the pay policy no Agency received a reduction in cash funding.

Section 39 Agencies

In relation to section 39 agencies, since the introduction of the National Standard Governance Framework with the Non -Statutory Sector the HSE has been continuously reviewing and strengthening these arrangements in accordance with the requirements of sound governance and accountability and in order to ensure that it is aligned with the ever changing exigencies of our health and personal social services. One such enhancement was the introduction in 2013 of a requirement on all agencies covered by a service arrangement, both Section 38 and 39, to complete a template setting out details of the remunerative arrangements for Senior Managers (Grade VIII and above).

The HSE is close to completing a verification and validation of Service Managers’ remuneration template in the larger Section 39 Agencies who receive in excess of €5million in funding annually from the HSE.

A report will be finalised by week commencing 14th April, which will be available to the Committee.

Thisconcludes myopeningstatementand,togetherwith mycolleagues,wewill endeavourtoansweranyquestionsthat youmayhave.

Thankyou.

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