I am committed to tackling the key challenges our health service faces in relation to long waiting times and hospital overcrowding. Improving timely access for patients to scheduled and unscheduled care is at the heart of Sláintecare. The Sláintecare Action Plan 2019 which was published by my Department, includes a specific workstream on Access and Waiting Lists. Sláintecare emphasises the need to invest in increased capacity while also shifting the balance of care from hospitals to community services for better health outcomes and a more sustainable health service. In addition, many of the other service reforms and enhancements included in Slaintecare will support timely access to care for patients in the coming years.
Last year saw considerable improvement in the number of patients waiting for procedures. As a result of increased activity and the ongoing collaboration between the HSE and the NTPF, the number of patients waiting for an Inpatient or Day case procedure fell to 70,204 in December 2018, from a peak of 86,100 in July 2017. This represents a reduction of over 18% in the overall number of patients waiting for a procedure. The number of patients waiting more than 3 months fell by more than 17,700, or 31% in the same period from July 2017 to the end of December 2018.
Budget 2019 announced that the Government had further increased investment in tackling waiting lists, with funding to the NTPF increasing from €55 million in 2018 to €75 million in 2019.
The joint Department of Health, HSE, and NTPF Scheduled Care Access Plan 2019 was published in March. Under the Plan, the HSE in accordance with the National Service Plan, will aim to deliver 1.155 million elective inpatient and day case discharges at a value of €1.4 billion in 2019. The Scheduled Care Access Plan also includes:
- detailed plans from the NTPF to fund 25,000 IPDC treatments; 5,000 Gastro Intestinal Scopes and 40,000 first outpatient appointments.
- Projections by year end to reduce the overall number of patients on the Inpatient/Day Case waiting list (excluding GI scopes) from just over 70,200 in Dec 2018 to under 60,000;
- Within this overall reduction the number of patients waiting longer than 3 months will reduce from 40,200 at the end of 2018 to 31,000;
-It is also projected that for ten identified high volume procedures, all clinically suitable patients waiting more than 6 months will be offered treatment in 2019. These 10 procedures account for over a third of the active inpatient day case waiting list and represent 60% of NTPF planned activity in 2019.
A key element of the Scheduled Access Plan is the stabilisation of the Outpatient Waiting List. Under the Plan the HSE will aim to deliver 3.3 million outpatient appointments, of which approximately 1 million will be first appointments.
While the meeting of short-term targets is always welcome, more can be achieved and, in this regard, the HSE, Department of Health and NTPF, under the Access Plan, will work together with the objective of developing medium-long term improvement initiatives for patient access to hospital procedures. This will include moving care to more appropriate settings and providing care at the lowest level of complexity such as providing ophthalmology in the community; maximising the use of Advanced Nurse Practitioner led clinics; and physiotherapists to manage orthopaedic clinics.
With regard to unscheduled care, Ireland is seeing a growing demand, which is evident from the increased pressures on hospital Emergency Departments (EDs), particularly during peak periods such as winter. This is a very busy period for our health services, with many hospitals reporting significant numbers of patient attendances. For the first five months of 2019, the number of patients attending hospital EDs increased by 4.9%, and the number of ED admissions increased by 3.3% compared to the same period last year.
Despite the significant increase in demand, our health services have managed better for the first five months of 2019 than in the previous year, and the numbers of patients waiting on trolleys nationally were 6.8% lower than the same period last year.
The HSE are undertaking a review of performance across all Hospital Groups and Community Health Organisations over the winter period, which has now been extended to include a review by an independent expert group.
The group will carry out a comparative analysis of unscheduled care performance across the nine hospital sites and the relevant Community Healthcare Organisations that were the subject of specific focused support through Winter 2018/2019. The terms of reference and membership of the group have been agreed and are now published on the HSE website.
The Health Service Capacity Review published last year was crystal clear on the need for a major investment in additional capacity in both hospital and community – combined with a widescale reform of the manner and the location of where health services are provided.
Increasing capacity is a priority for Government. Since 2017, an additional 241 acute hospital beds opened, and the National Service Plan for 2019 provides for a comprehensive capacity programme. The number of available inpatient beds is expected to increase to above 11,000 following the investment planned in the National Service Plan 2019.