I acknowledge the invitation to the Minister, Deputy Harris, to me and to the other Ministers of State to attend the meeting today. I also acknowledge the presence of Mr. Jim Breslin, the Secretary General. I also welcome Mr. John Connaghan, the acting director general of the HSE, and the accompanying HSE officials. We have been invited here to provide an update on issues affecting the Department of Health and the HSE, including expenditure to date on Vote 38. I am happy to do so and I will also outline priorities, significant developments and progress in the area of health.
I will begin with an update on the position of the Vote for 2018. As the committee is aware, the Government approved gross expenditure of just over €15.3 billion for the health services for 2018. The announcement by my colleague, the Minister for Finance, Deputy Donohoe, that he intends to allocate an additional €700 million to the health service in 2018 by way of a Supplementary Estimate is most welcome, as is the fact it has been possible to carry this additionality into the base for 2019. Consideration of the Supplementary Estimate will be before the committee very shortly so there will be an opportunity to go into further detail. The gross current budget for the health sector for 2019 is €16.36 billion. This is equivalent to an increase of €1.521 billion or 10.2% compared to the 2018 original allocation of €14.839 billion. I am also pleased to announce a capital budget of €667 million, which is an increase of €174 million on last year's capital budget. This brings the total gross health budget for 2019 to more than €17 billion.
For the immediate future, the next significant step is the agreement of the national service plan. The service plan for 2019 will set out the type and volume of services the HSE will provide in respect of the significant budget of more than €16 billion it has received for next year. The HSE must ensure the most beneficial, effective and efficient use of resources is made when planning the services to be provided in 2019. On budget day the Minister stated we are now firmly in the era of Sláintecare and, for the first time, 2019 will see the HSE's national service plan based and developed on the framework of the Sláintecare implementation strategy, which sets out the Government's plan for delivering a high quality, sustainable and equitable health and social care service over the next decade. The national service plan will set out the details on how the totality of health service resources will be made to advance Sláintecare objectives.
The HSE is now in discussion with the Department on developing the service plan for 2019 with the goal of delivering a plan that makes progress on meeting priority health and social care needs and clearly allows the executive to operate within its notified resources. The Minister expects to receive a draft service plan submitted for his approval from the HSE in the coming weeks. The focus on Sláintecare in this process is an important element of the strategic transformation of our health service but, of course, we must also focus on the here and now and the immediate challenges we face.
As we head into a period of pressure in our health service, I acknowledge the ongoing commitment, dedication and co-operation of people working in our health services. This is something of which the Minister and we in Ireland can be very proud. I know that on a daily basis our doctors, nurses and healthcare professionals make personal sacrifices in the interests of putting patients first. However, we have learned lessons from previous winter seasons. Consideration of staff management issues is just one element of a planning process to ensure that we prepare for the winter period in the best way we can. The Department is working closely with the HSE to ensure the most effective response to this winter within current capacity and resources. A total of €10 million in additional funding has been allocated in 2018, primarily for provision of supports to get patients home from hospital, where appropriate, before the end of the year, with a focus on supporting patients in the over-75 age group. The core objective of this measure is to ease congestion in hospitals as far as possible before the end of the year, to prepare for the expected peak in demand in the new year. In addition, the Minister has requested, in the context of the national service plan, that the HSE plans activity in 2019 to manage critical demand pressures, most particularly in respect of increased attendance at emergency departments. This planning will include activity in hospitals, primary care and community care to ensure the system is working at full capacity throughout busy periods. This request provides clarity to the HSE on the level of funding available in 2019 to meet winter pressures.
The challenges evident in hospital emergency departments are a symptom of broader challenges within the hospital itself and across the wider health service. Increasing capacity and efficiency throughout the hospital, improving services in the community to provide care for patients outside of the emergency departments and supporting the discharge of patients home or into other community services are all part of the solution. The national development plan provides for a major increase of 2,600 in bed capacity, as identified in the health service capacity review, and this will remain a priority in 2019. Over the past 12 months, an additional 240 beds have been opened and a further 79 additional beds are planned for the fourth quarter of 2018 and early 2019. Next year, a further €10 million will be invested to enable additional beds to be opened to alleviate pressure on emergency departments for this winter and the years ahead, on foot of the recommendations in the health service capacity review. The Department is in discussion with the HSE, in the context of the national service plan for 2019, to identify sites for investment and the associated number of beds, as part of an agreed capacity programme for 2019.
Increasing capacity and access go hand in hand with reducing waiting lists. A significant investment of €55 million was made in the National Treatment Purchase Fund, NTPF, this year and ambitious targets were set to reduce the number of patients waiting for a hospital procedure to below 70,000. I am pleased to report that as a result of the activity of the HSE and the NTPF we are on track to meet this target, with the number of patients at the end of October at 72,000, down from a peak of just over 86,000 in July 2017. The improvement has been delivered against a backdrop of increased demand for services and a very challenging start to the year that saw elective activity curtailed as a result of emergency department pressures and severe weather events. Building on this progress, in budget 2019 the Government further increased investment in this area, with funding to the NTPF rising to €75 million in 2019. The NTPF plans to reduce further the number of patients waiting to below 59,000 by year end. While significant progress has been made on inpatient and day case procedures, the number of patients waiting for their first outpatient appointment continues to be a challenge. The Minister has asked the HSE and the NTPF to bring a renewed focus to outpatient activity in 2019. Arising from the increased investment, the NTPF plans to arrange at least 40,000 first outpatient appointments in 2019.
Earlier this year, the Minister approved the establishment of a central waiting list validation function within the National Treatment Purchase Fund. Validation has many benefits, including the identification of patients on waiting lists who are ready, willing and available to proceed with hospital care, a reduction in the rate of those who do not attend and an improvement in information for managing waiting lists. It is worth noting that each year more than 500,000 patients do not attend their appointments. Validation has been under way for a number of years at a local level and the NTPF estimates that next year more than 30,000 patients who no longer require an outpatient appointment will come off the outpatient waiting list as a result of this activity.
I will now update members on matters related to CervicalCheck. In September, as committee members know, Dr. Gabriel Scally provided the final report of his scoping inquiry into issues relating to CervicalCheck. His report provided welcome reassurance about the laboratories currently contracted by CervicalCheck.
He is satisfied with the quality management processes in these labs. It is very important to say that Dr. Scally confirmed that he found no reason the existing contracts for laboratory services should not continue until the new human papillomavirus, HPV, regime is introduced.
He also stated that continuation of screening in the coming months is of crucial importance.
The Government fully agrees with this as screening saves lives. CervicalCheck has been successful in reducing cervical cancer rates in Ireland. As stated in the Scally report, the lifetime risk of a woman getting cervical cancer was one in 135 in 2015, significantly lower than the lifetime risk in 2007 of one in 96. This represents a substantial improvement. The Government has accepted all 50 of Dr. Scally's recommendations. The Minister has committed to returning to Government within three months, as recommended by Dr. Scally, with a full plan for the implementation of these recommendations.
In June 2018, the Minister established a national cervical steering committee, that is co-chaired by the chief medical officer and the assistant secretary for acute hospitals in the Department and includes senior management of the Department, the HSE, clinicians and patient advocates.
It provides oversight and assurance on managing the response to the CervicalCheck issues, and ensuring the implementation of the key decisions taken by Government. The minutes and agenda for each meeting are published on the Department’s website, to allow for full transparency and for members of the public to be updated on the committee’s activities. The Minister is updated weekly, receiving updates on the progress of the steering committee and these are also published.
The committee has had 12 meetings to date since it was established on 21 June last. The most recent meeting was on 8 November. The committee will meet twice more before the end of the year.
Separate to the work carried out by Dr. Scally, the independent clinical expert panel review, which is being led by the Royal College of Obstetricians and Gynaecologists, RCOG, is under way. This review is examining the results of screening tests of all women who have developed cervical cancer who participated in the screening programme since it was established.
The review will provide independent clinical assurances to women about the timing of their diagnosis, and any issues relating to their treatment and outcome. The Minister would also like to take this opportunity to thank the committee for its time and engagement in recent days as they discussed the Health (Regulation of Termination of Pregnancy) Bill 2018. In addition, preparations are ongoing for the implementation of the service as soon as possible. The Department and the HSE are at an advanced stage of drafting contractual proposals for the provision of termination of pregnancy services in the community setting.
In parallel with service planning and expansion, clinical guidelines for medical practitioners are in preparation by the medical colleges and the Department has provided a grant to support their development.
The Minister is conscious that women are continuing to travel every day to access services abroad and in some cases to order medication over the Internet.
He wants to stress again that it is this Government’s priority to have a medically delivered, safe and regulated service for the termination of pregnancy for all those who require it, based on the huge mandate that the Irish people have given for this work.
There is also significant work being done to implement the national maternity strategy. Ireland’s national maternity strategy was published in 2016. The national women and infant’s health programme, NWIHP, has been established within the HSE and is driving the strategy’s implementation. A key aim of the strategy is to ensure that appropriate care pathways are in place so that mothers, babies and families get the right care, at the right time, by the right team and in the right place. The strategy’s three care pathways – supported, assisted and specialised – will deliver maternity care in a manner that is both appropriate and woman-centred.
A detailed implementation plan for the strategy was published in October 2017, providing a clear roadmap for the development of maternity services into the future and, in 2018, the Government provided additional development funding of €4.55 million to progress the strategy and to improve waiting times for gynaecology services.
The national women and infants health programme highlighted a number of priorities which this funding has continued to address over the course of 2018. These include the development of community midwifery teams, the development of quality and safety frameworks and the improvement of access to anomaly scanning services. This year, 2018, has seen the continued expansion of anomaly scanning services in maternity hospitals and units across the country and the development of critical quality and safety initiatives. The development of the supported care pathway and of community midwifery teams to deliver care in line with the recommendations of the strategy is also ongoing and a multidisciplinary steering group has been established by the NWIHP to oversee the implementation of the strategy’s model of care. This year has also seen the continued roll-out of the very successful maternal and newborn clinical management system, with phase 1 completed and implemented across 4 sites: Cork University Maternity Hospital, University Hospital Kerry, the Rotunda Hospital and the National Maternity Hospital.
Looking ahead, it is important to ensure that we build on developments to date and the Department will be engaging closely with the programme to ensure this progress continues into the coming year.
To conclude, planning for the weeks and months ahead now that we are in the winter period is of course the top priority. Yes, we face challenges. However, we now have a long-term plan for healthcare and as I have just outlined, we are making progress this year, and we will each and every year. I thank the committee again for the opportunity to brief it on developments. I am interested in hearing members' views and look forward to their questions.
