I thank the committee for the opportunity to speak to it. So far this year we are meeting and, in many instances, exceeding the service plan targets for 2009. Between inpatient and day cases we are ahead of target by over 24,000 patients. Importantly, we have seen 30,000 more new patients in our outpatient clinics so far this year compared with the same period last year. This is critical because I believe outpatient access has for a long time been probably one of the biggest problems in our health service. Overall, we have seen 80,000 more outpatients than we had planned to see.
Year on year, the number of people waiting over six months for inpatient care is down by over 15% and 38% for day case care.
Last week there was media comment on cancellations during the first six weeks of this year and it is important to put these figures in perspective. The figures show that there were almost 9,000 inpatient and day case cancellations. This, in isolation, sounds high but it amounts to approximately 1.4% of total inpatient and day case activity during the period. I appreciate cancellations whenever they occur are distressing for patients but in a health service, one must adapt swiftly and put emergencies first. Against this backdrop, it is a tribute to staff across the country that the cancellation rates are relatively low, albeit we must focus on reducing these even further.
In regard to the primary care teams, at the end of August, 127 teams were holding clinical team meetings. This is 60% of the target for 2009 which is to have 210 teams holding clinical meetings by the end of the year.
In regard to staffing, we are operating slightly below the allocated ceiling and absenteeism rates are coming down. Again, this has been a major focus for this organisation. At the start of the year, absenteeism was at 5.95%, almost 6%, and at the end of July, it came down to 4.96%. Our absenteeism target is 3.5%. This is closely tracked through our HealthStat process on a monthly basis.
As indicated to the joint committee last March, a number of issues are emerging that are putting pressure on our budget. For example, an increasing number of people are now eligible for medical cards. At the end of August, 14,288 more medical cards than planned had been issued. This upward trend is likely to continue.
Last week the annual euro health consumer index report was published. The index compares health care systems across Europe. The report shows that since the HSE's transformation programme started in 2006, we have moved up 15 places to 13th out of 33. The report points out that the Irish health service has been steadily climbing up the ranks and stated that "the creation of the Health Service Executive was obviously a much-needed reform".
In addition to improving services, more transparent performance data have contributed to our improved ranking. We believe one of the big successes of this organisation has been bringing transparency to the performance of the services throughout the country and no longer simply throwing money where services have failed to perform. It demonstrates that our transformation programme is delivering results thanks to the commitment and support of staff throughout the country.
I refer to the corporate plan. We recently completed an analysis of our performance in regard to the three year plan's objectives. The analysis shows that in 23 of the 35 representative areas measured, we are performing at 70% or greater against our 2011 target. With two years to go in the life cycle of the corporate plan, these are positive results.
We are performing well in terms of the speed of reduction in MRSA levels, although in this part of the world and not only in this country, this remains a significant challenge. Other areas of significant success include childhood vaccination which is now reaching 95% and the establishment of child and adolescent mental health teams.
Areas that need focused attention continue to be identified. These include a very low breast-feeding rate by any international comparisons and high Caesarean section rates. Disability assessment rates against regulations and emergency department experiences in selected hospitals are also challenges.
I acknowledge that in the vast majority of hospitals which were experiencing major accident and emergency problems three to four years ago, these have been resolved. However, we must accept that approximately four hospitals consistently continue to have significant challenges in this area. This is the first time we have carried out such a detailed analysis and in line with our total focus on performance measurement, it will be repeated every six months.
I refer to the influenza pandemic, and Dr. Holohan who is an expert in this area is here. The rate of influenza-like illnesses has risen from approximately 45 per 100,000 to 76 per 100,000 following the reopening of schools. It is important to note that the vast majority of cases are relatively mild and, in most situations, people can look after themselves at home.
Plans are advanced for a mass vaccination programme to begin later this year, although this could extend into early 2010 in terms of start up depending on the availability of vaccine which has been challenging for the supplier companies. Prior to this, high risk groups will be vaccinated followed by health care workers.
General practitioners have played a very important role in dealing with the pandemic to date and they have the best record of who in the community is considered at higher risk. Therefore, they have been invited to play a central role in vaccinating this high risk group.
I refer to integrated services. This week we introduced two important initiatives that will, over time, deliver many tangible benefits to patients and clients and, indeed, health care staff. First, we have devolved a significant amount of decision-making from national level to our four regions. This is a major change for us. The immediate impact of this new arrangement is that operational responsibility is being transferred from the national hospitals office and the primary, community and continuing care directorate, PCCC, at national level to the four local management teams headed by regional directors of operations.
This means regional directors will be responsible for all service delivery and reconfiguration in their areas. This will simplify our management processes and enable strong local responsibility coupled with national consistency. I stress that it is different from any older system in that there will be national consistency.
The second initiative involves bringing together the national hospitals office and the PCCC directorate into a single unit — the integrated services directorate. This unit will hold the regional teams to account by monitoring and measuring their performance against agreed targets.
These are not changes for the sake of structural changes. This integration process will make it easier for staff to form effective teams unencumbered by whether somebody works in a hospital or in the community. It will enable us to forge stronger connections between our services, such as acute hospital, long stay care, general practitioner, mental health, child care, emergency, rehabilitation, social work services and so on. Most important, it will make it easier for patients and clients to get access to all the health and social care they need without delay or inconvenience.
I hope we will see an end to the day when a patient cannot go home on a Friday afternoon simply because extra budget would have to be applied in the community over the weekend which is not available because it is tied up in the hospital. There will be a common purpose focus on the patient rather than on where budgets reside in the organisation.
I wish to comment on paediatric services because there have been some major changes even in the past week. In regard to acute paediatric service, I advise the joint committee that we are establishing a team to be headed by Mr. John O'Brien, chief executive officer of St. James's Hospital, who is on secondment to the HSE, to manage the relationships between the HSE and the acute paediatrics community.
The team's focus will centre, in particular, on the three paediatric hospitals in Dublin in the context of ensuring the total resource deployed is used to maximum effect and assuring their preparedness for the move to the new children's hospital in 2014. We have spoken before about the need for co-ordination of the spend of this money across the entire system.
The team will also manage the HSE's relationships with the National Paediatric Hospital Development Board and, ultimately, acute paediatric services in hospitals outside Dublin and in primary and community care. This team will begin its work over the coming months. It will lead to a much more co-ordinated approach to the spend of money on child care in hospitals and, ultimately, in the community.
In a related development and perhaps most important, Our Lady's Hospital for Sick Children is to begin engaging fully with the development of the new paediatric hospital and will have representation on the hospital's development board. I cannot overemphasise the importance of this development. It is a major step forward for paediatric care in Ireland.
I am conscious that for a number of years, there has been a degree of uncertainty among staff at the hospital. They have had genuine apprehensions about the model of care to be provided in the new paediatric hospital. While there will never be a perfect plan for such a development, the full participation by Our Lady's Hospital for Sick Children will ensure that the best possible decisions are made as we go forward. It will add hugely to the overall project which will deliver a paediatric service that will be admired across the world.
The urgency of moving forward with this project cannot be overstated. Nobody who has experienced the infrastructure in place at the Children's University Hospital in Temple Street or in Our Lady's Hospital for Sick Children in Crumlin would propose it is an acceptable level of infrastructure. The fact we have run specialist teams across numerous sites has undermined the capacity of those teams to perform at the level they can for the children of Ireland.
Now that we have arrived at this important point, where all three hospitals share a common purpose, it is an opportune time for these hospitals — Temple Street, Our Lady's Hospital for Sick Children and the National Children's Hospital in Tallaght — to move towards a single governance structure. The benefits of such an arrangement would not only deliver many better services to children and their families and, indeed, for staff but would also pave the way for a smooth and more effective transition to the new paediatric hospital.
When we talk about hospitals coming together, I am always conscious that they have their own history and have pride in their delivery for their local communities. However, it is extremely important the boards move forward in a conjoined way to develop a common governance structure. I encourage the boards of these hospitals to move in this direction. I am very happy to pledge the HSE's full support to this development which has become all the more possible in the light of the recent decisions.