Joint Committee on Health & Children
23rd May 2013
Opening Statement
by
Mr. Tony O’ Brien
Deputy Chief Executive and Director General Designate
Health Service Executive
Good morning Chairman and members of the Committee.
Thank you for the invitation to attend the Committee meeting today.
I am joined by a number of my colleagues:
· Ms. Laverne McGuinness, Chief Operations Officer and Deputy Director General Designate
· Mr. Stephen Mulvany, National Director Finance
· Mr. Barry O’Brien, National Director of Human Resources
· Dr. Aine Carroll, National Director, Clinical Strategy & Programmes
The Committee requested information and replies on a number of specific issues prior to this meeting. You will have received a written response to these issues from the HSE and the Department of Health together with briefing material on the HSE March PMR, April Vote Return, Medical Cards and NCHDS. In my opening remarks I would like to update you on the following issues.
Service Plan Activity
· At the end of March, there were 100,740 emergency admissions in the acute system. This is 3,518 (3.6%) higher compared to the equivalent in the same period in 2012.
· 62.6% of all attendees at ED were discharged or admitted within 6 hours and 77.5% within 9 hours.
· Up to the end of March a total of 41,050 elective inpatient admissions and 202,425 day case procedures were provided in our acute hospitals (total 243,475; compared to 247,682 for the same period in 2012 which represents a 1.7% variance).
· 90.7% of all adults on the elective waiting list are waiting less than 8 months. It is intended that no adult will be waiting greater than 8 months for an elective procedure by year end.
· 85.1% of all children on the elective waiting list are waiting less than 20 weeks. It is intended that no child will be waiting greater than 20 weeks for an elective procedure.
· Medical Cards: The number of people covered by medical cards as at the end of March was 1,864,320 an increase of 6% on same time last year and the number with GP visit cards was 128,589 an increase of 1.7% on same time last year. 96% of properly completed medical card applications have been processed within the 15 day turnaround, which is ahead of our service plan target of 90%.
Financial update
The HSE is reporting year to date a gross deficit of €26.7m to the end of March 2013.
In vote terms (largely cash based government accounting); to the end of April there is a €5m surplus on net current vote expenditure. Based on the 1st Quarter data the HSE is not flagging any new concerns / risks beyond those which were clearly set out within the National Service Plan 2013 (NSP) as approved by the Minister on 9th January 2013 and within the Regional and Hospital Group Service Plans which were published in February. These risks remain and principally include:
§ PCRS - scale of savings required i.e. €353m. First quarter performance against cost savings plans has been very positive. However there will be a need for contingency measures to be implemented to address potential shortfalls which will otherwise occur. These contingencies are currently being scoped.
§ Croke Park Agreement - €150m - The need for validation of the €150m budget reduction assigned to the HSE within the NSP once there is an outcome to the Croke Park II process to which it relates.
It is also important to note that anything which jeopardises the current flexibility which is available under Croke Park I creates risks across most of the areas of cost savings set out in the NSP 2013.
§ Private Health Insurance Income - €104m accelerated income 2012 & €60m new legislation. NSP 2013 clearly referenced the need to work with the DOH to ensure the accelerated income achieved in 2012 does not reverse in 2013 coupled with ensuring the new private income legislation is enacted by July. The HSE plan to address €20m of accelerated income via improvements in our collection performance is being progressed. Engagement with the DOH at the most senior level is ongoing in relation to the proposed legislation and the balance of the accelerated income.
§ General scale of the overall challenge within the remainder of our community and in particular hospital services. The rebalancing of hospital budgets in 2013 has ensured that hospitals have been given budgets which are related more closely to their costs in 2012 however as indicated in the Service Plan it has not been possible to provide for the full amount of 2012 costs.
Hospitals are required to safely deliver cost savings of on average 3.5% in addition to further cost savings to offset any emerging / additional cost pressures in 2013. This is being closely monitored.
However it is clear that end of March deficit €27m, in the absence of significant delivery on our cost containment measures and the expected additional control actions could give rise to a very significant level of deficit to year end. This is particularly so given the extent to which savings have necessarily been profiled for later in the year. Initial control actions in relation to the key risks outlined above have been commenced. The scale of the risk and challenge in achieving financial breakeven by year end remains very significant as predicted in the NSP 2013 and will increase if there is an absence of continued and improved flexibility under the Croke Park Agreement.
Fair Deal Scheme
During the month of March/April the hospital system experienced increased wait times and congestion in our emergency department mainly due to a significant increase in respiratory illness amongst older patients and an extended outbreak of influenza.
In the interest of patient safety and quality of care we took a decision in March to release an additional 400 Fair Deal beds to assist with the hospital pressures. Usually 120 Long Term Care beds are released on a weekly basis for the whole country. Sunday counts provide a strong indication of the pressures in emergency care in the week following and therefore are used as a point in time to make intervention decisions.
On Sunday 14th April the number of patients awaiting admission in our Emergency Departments at the 8pm count was so high (at 243) that there was significant concern for the safety and quality of care of our patients in Emergency Departments.
Given this situation it was deemed necessary to immediately move to temporarily pause the normal chronological Fair Deal placement process and to direct the prioritisation of Long Term Care beds for qualifying patients in the 6 Dublin Academic Teaching Hospitals and Cork University Hospital, the hospitals which had the highest number of patients waiting for long term care.
With effect from the 9th of May we have reverted to the normal chronological placement in respect of 100 of the 120 fair deal beds released on a weekly basis. Full chronological placement will resume on the 30th of May.
Ambulance Service Cork
Members you will be aware of the recent tragic death of VakarisMartinaitis in Middleton Co Cork. I would like on behalf of the HSE to extend our deepest sympathies to the family of VakarisMartinaitis on their very sad loss.
On Friday 10th May 2013 following a preliminary examination of the facts surrounding this tragic accident, the Medical Director of the National Ambulance Service (NAS), in line with the HSE’s Incident Management policy, commissioned a formal Incident Review into the manner in which the 999 call received from Middleton, Co. Cork at 2.00pm on Monday 6th May 2013 was managed.
The make up of the Review Team includes experts in pre-hospital emergency care and primary care from both Ireland and the UK namely:
§ Dr. David McManus, Medical Director, Northern Ireland Ambulance Service (Chairperson)
§ Ms. Tracey Barron, Clinical Studies Officer, International Academy of Emergency Dispatch, UK
§ Mr. Pat Mooney, Control Manager, National Ambulance Service, North Leinster
§ Dr. Mel Bates, Medical Director, GP Out of Hours, North Dublin
§ Ms Deirdre O’Keeffe from the Quality and Safety Directorate will support the investigation process
The Review Team and terms of reference have been agreed. A NAS representative will liaise with the family on behalf of the Review Team to keep them informed of progress and ensure the family are provided with ongoing support.
This formal review, which will be concluded as expeditiously as possible, will fully establish all the facts surrounding the management of this emergency call, including why an available emergency ambulance was initially assigned to the call and then stood down, as well as the level of information available to Ambulance Control about the patient’s injuries.
Medicines Management Programme
The HSE has recently established a Medicines Management Programme which, as a first step towards increasing quality, access and value in medicines management, has identified ‘preferred drugs’ for prescribers when prescribing Proton Pump Inhibitors (PPIs) (indigestion medication) or Statin (cholesterol lowering) medication for patients. This is the first time that the State has introduced a preferred drug initiative. The preferred PPI is Lansoprazole and the preferred Satin is Simvastatin.
The HSE is asking doctors to prescribe these preferred drugs in order to save money both for patients who pay for their medication and to deliver savings of an estimated €15million for the taxpayer. PPIs and Statins account for up to 20% of the HSE’s drugs budget. By switching existing patients to the preferred drug, and by prescribing these drugs for new patients, significant savings can be achieved.
Although the initiative was only launched in mid-April, there is very positive feedback from prescribers.
HSE Directorate and Leadership Team
The Public Appointments Service (PAS), on behalf of the HSE, has recently concluded a recruitment process to complete the new HSE Directorate and Leadership Team.
This process leads to a revised HSE Management Structure planned in conjunction with the new governance arrangements provided for in the Health Service Executive (Governance) Bill, 2012.
Five new posts are being established, following a confined PAS competition which commenced earlier this year. The following senior health managers have been appointed to the five posts:
- Ian Carter (Acute Hospitals),
- John Hennessy (Primary Care),
- Stephen Mulvany (Mental Health),
- Pat Healy (Social Care), and
- Stephanie O’Keeffe (Health & Well Being)
They will take up their new posts when the governance legislation is enacted. The five Directors are now Directors Designate and will be participating in the process of designing the new structures prior to taking up post.
In addition Thomas Byrne joins the Senior Management Team as Chief Finance Officer following an open competition conducted by PAS. He takes up his post on Monday next, 27th May. The current Director of Integrated Services, Laverne McGuinness, takes up the post of Chief Operating Officer and will assist in safely managing our system through this period of transition. Mr Liam Woods has taken up the role as National Director Shared Services.
These changes are an important step in the reshaping of the health service and an important part of the journey towards the post HSE era.
The make up of the new team is indicative of the importance of clinical pathways, patient and client care and outcomes to the whole process of reform in the health service.
This concludes my opening statement and together with my colleagues we will take your questions.
Thank you.
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