The HSE National Service Plan (NSP) is an important accountability instrument in use by the Department in determining how the HSE is performing against its targets as it captures in a clear and quantified way the range of health and social care services to be provided by the HSE for the allocation it has received. It establishes links between funding, staffing and services and it incorporates activity measures, outcome-based performance indicators and deliverables in key service areas, which are matched with targets and timescales.
The Department provides oversight of the performance of the HSE in relation to the delivery of the services set out in the NSP. The mechanism for this oversight includes the ongoing monthly performance management process in place between the Management Board in the Department and the HSE Leadership (now the HSE Executive Management Team) where the HSE reports monthly to the Department on the performance of the health system against the agreed targets set out in the NSP.
As part of the monthly performance cycle, the HSE provides an update on the application of its Performance and Accountability Framework. This includes the submission of an Escalation report which provides detail on services which are in escalation for the month in question and the actions being carried out to mitigate these. Services in escalation are those which are experiencing significant performance issues.
The latest escalation report is for April 2019 and currently the HSE are reporting 7 areas (6 in acute hospitals and 1 in social care) which have been escalated to the National Performance Oversight Group. Improvement plans and support measures are in place to monitor the ongoing performance of the different areas in escalation.
The HSE’s latest income and expenditure position at 30 April 2019 shows a revenue deficit of €116.2m which represents 2.3% of the available budget. The main drivers of the deficit are acute hospitals, PCRS and demand led schemes, disability services, and the treatment abroad scheme. Current gross expenditure on the Health Vote, year to date, is 8.8% higher than the same period in 2018. This percentage varies on a monthly basis during the year depending on spending under various headings but is, nonetheless, a matter of concern.
Significant savings are profiled later in the year in line with the targets set out in the National Service Plan. However, on present trends, taking account of the pressure in certain areas, the HSE would have a deficit at the end of 2019. This is a matter of concern for the Government. My Department is working with the HSE to gain further clarity on the projected year end position and working to mitigate the deficit in so far as is possible, in co-operation with the Department of Public Expenditure and Reform.