Opening Statement By Professor Brendan Drumm, Chief Executive Officer, Health Service Executive

To the Joint Committee on Health and Children

Chairperson and Members, thank you for the invitation to attend today's meeting and make an opening statement. A number of questions on specific issues have been put to us prior to the meeting and I understand that written replies have been issued.

Before taking your questions I would like to update you on our service plan for this year. Foremost in our mind in preparing the plan has been our Transformation Programme and how we can use the resources available to continue to make it easier for people to access the care they need.

Our challenge this year is to keep on enhancing the quality of the services we provide. We can only do this by improving our effectiveness and in so doing, reduce costs.

Thanks to the commitment and co-operation of staff we have achieved considerable success during the past three years. During 2008/2009 we delivered over €500m in efficiency savings and exceeded many service targets. In 2010 we aim to repeat this and introduce additional Value for Money efficiencies valued at over €100m.

From a service point of view we will continue to reorient services away from bringing people into hospital for the care they should get on a day case basis and in community facilities.

A high hospital admission rate is not a logical measure of the effectiveness of a modern health service. Given the worry and inconvenience hospitalisation can create for patients and their families, we need to continue to lower admission rates and only admit patients when there is no better clinical alternative. This is the standard of care we would all want for ourselves.

I am particularly pleased that during the year we will be completing the development of 1,200 very high quality residential beds for older people and new Primary Care Centres for 47 Primary Care Teams. These developments will greatly support our shift to the community. We plan to have almost 400 Primary Care Teams in place by year end. (See attached schedule).

More day case care

In line with international best practice we plan to carry out more procedures on a day case basis. Last year we exceeded our day case target by over 28,000. This year we will provide 14,000 more day case treatments than we did last year and reduce inpatient admissions.

Reducing ED Admissions

While the number of people who visit an Emergency Department (ED) this year is expected to remain constant, we plan to continue to reduce the numbers who are admitted through EDs just to get a consultant opinion or access to a diagnostic test. 17% of patients who were admitted through EDs in 2009 spent less than 24 hours in hospital and 30% were there for less than 48 hours; many of these admissions could clearly have been avoided. We owe it to patients to reduce these figures considerably by making it easier for them to see senior clinical decision makers in Medical Assessment Units, and improving access to diagnostics and other ambulatory care services. Several successful Medical Assessment Units, which provide a comprehensive day case medical review for urgent GP referrals within 24 hours, are now open but many more hospitals, especially in our cities, still need to be able to provide this very responsive type of care.

A significant number of people who visit EDs do so for treatment associated with their chronic illness which requires interventions such as intravenous antibiotics or simply monitoring and observation. With more active chronic illness management at primary care level, supported by fast track and direct access to a consultant opinion when it is needed, these ED visits, which often lead to admission, can be avoided.

During the year we will be implementing a number of projects, led by Dr. Barry White, National Director of Quality and Clinical Care, to develop these alternatives. The initial concentration will be on Diabetes, Heart Failure, Acute Coronary Syndrome, Stroke, Asthma and Chronic Obstructive Pulmonary Disease (COPD). The aim is to provide an effective bridge between community care and hospital care which will reduce the inconvenience for patients and take needless pressure off EDs. Chronic illnesses absorb substantial resources and while this new approach will not necessarily impact on budgets immediately, it will improve access and quality of care in the short term.

Lower average length of hospital stays

From audits carried out in 2007, and repeated in several hospitals during subsequent years, we know that up to 40% of patients in acute hospitals on a particular day do not need to be there - 43% of these were there simply because they were waiting to see a doctor or other clinician such as a physiotherapist. We also know that people can, for no explanation, spend much longer in some hospitals than in others for the same procedure.

During 2010, we will be seeking greater uniformity in the length of time people stay in hospital. This will involve better co-ordination of the hospital and community services patients need through more intensive discharge planning. The national discharge planning code of practice was piloted in five hospitals during 2009 with positive results and is now being applied nationally. This will be better for patients who can get home sooner and will free up beds for those who need them.

Shorter waiting times

Since 2007, the number of people waiting more than six months for a day case procedure has come down by almost 50% and the number of people waiting for inpatient care has dropped by 40%. While these reductions are welcome, there are still around 1,000 patients waiting over 12 months to receive their treatment at any one time. We look after 25,000 patients on an inpatient and day case basis each week. Our over 12 month waiting list therefore amounts to just over 20% of one day's work. This is something we should be dealing with in a relatively short space of time.

Outpatient clinics

During the year we will continue with our drive to increase the number of new patients seen in outpatients' clinics. During 2009, the number of patients who attended an outpatient clinic for their first appointment increased by almost 5%. Traditionally these clinics see large numbers of return patients who in other countries would have been referred back to their primary care doctor for follow up. This high return rate impacts very significantly on the number of new patients we can see, thereby increasing waiting lists. This year we also plan to reduce the percentage of patients who do not turn up for their outpatients' appointments.

Older People

In addition to maintaining 2009 community service levels, an additional €10m is being allocated to provide more homecare packages. Community services provided to older people in 2010 will include almost 12 million home help hours to over 54,000 people, 5,100 home care packages benefiting over 9,613 people and over 21,000 day care places. This will also be the first full year of A Fair Deal for which €117m has been provided.

Disability Services

2009 service levels will be maintained and we will be completing day care and residential facilities for people with disabilities. Additional funding of €19.5m will be available to develop 100 more residential places, 400 more day places and 140,000 additional Personal Assistant hours.

Mental Health Services

In addition to providing services to the same number of people as in 2009, €6m has been made available to staff two new 20 bedded child and adolescent acute units in Cork and Galway. The reconfiguration of mental health services in line with Vision for Change will create opportunities during the year for efficiency improvements.

Children and Families

We are committed to supporting parents to protect and safeguard their children. In 2010 key priorities are to deliver better outcomes for children, through structural changes and changes in children and families practices, supported by performance management and accountability. In addition €6m has been provided to deal with increased demand for foster care placements and the recruitment of additional social workers is being prioritised.

Demographic Funding

€14.5m has been provided to improve a range of specific acute hospital services including haemodialysis, transplant services, critical care, paediatric neurosurgery and paediatric immunology services.

National Cancer Control Programme

The proposed work programme for 2010 includes additional consultant medical oncology appointments to establish consultant teams, a reduction in the number of hospitals carrying out rectal cancer surgery and repatriation of ocular cancers from the UK. The National Plan for Radiation Oncology (NPRO) which forms part of the National Cancer Control Programme will continue with the development of radiation oncology facilities throughout the country. It is expected that the first of these new facilities at St James' and Beaumont Hospitals in Dublin will be opened before the end of the year.

While this is a demanding Service Plan, we believe achieving its targets is essential to meet the public need.

Thank you.