I thank the Chairman for his remarks on Mr. Barry O'Brien, who will be sadly missed at the HSE. I will certainly pass on the Chairman's remarks, which I know Mr. O'Brien will appreciate. He is going to UCC so he will be near to where the Chairman has other interests.
I am joined by Ms Laverne McGuinness, Dr. Áine Carroll, Dr. Tony O’Connell, Mr. John Hennessy and Mr. Pat Healy.
The committee requested information and replies on a number of issues prior to the meeting and committee members have received responses, so I will confine my remarks to some of the key areas.
The latest performance assurance report for August is about to be published. It will show hospital emergency departments continued to be very busy during the month. The cumulative increase in the number of emergency or unscheduled admissions in 2014 compared with same period last year is just over 5,000, or 1.9%. As a result of increased emergency admissions, elective admissions for the same period have reduced by 3,700, or 5%, and this has had a knock-on effect on the number of people on waiting lists. The capacity of acute hospitals to respond to increased demand is reduced due to the number of patients who are medically fit for discharge and who are awaiting alternative arrangements. The Minister touched on this issue. At the end of August, 704 people awaited alternative care arrangements. Acute hospitals and the older persons service are working collaboratively to address this issue.
The number of home help hours provided to the end of August was 6.8 million, and home care packages are 20% above expected levels. At the end of August, 82% of adults, or 39,743 people, were waiting less than eight months for a scheduled procedure and 18%, or 8,692 people, were waiting more than eight months. Outpatient attendances are 25.1% ahead of the expected target with 2.14 million attendances recorded for the first eight months of the year. The National Ambulance Service recorded an increase in emergency calls of approximately 1,000 calls each month. Notwithstanding this, improvement in response times continue to be made, with ECHO calls reaching the target of 75.3% and DELTA response to calls improving from 64% to 67%. A total of 94% of specialist palliative care inpatient beds were provided within seven days of referral.
Despite the demographic and other service pressures which drive costs, the Comptroller and Auditor General's 2012 report shows that of the six Government Departments or agencies which generally required a Supplementary Estimate between 2008 and 2012, the health service had the lowest average annual supplementary at 1.3%, compared with a range of 1.7% to 7.1% for the other five, none of which operates in as complex an area as health. Similarly, despite much adverse media and other comment, over the period 2008 to 2013, the HSE received just 0.19%, or €137 million, in Supplementary Estimates related to its core services. In other words, it was 99.8% compliant with the available budget over the period. It received 0.63%, or €452 million in Supplementary Estimates related to medical cards, GMS drugs and demand-led schemes. This indicates it was 99.4% compliant with the available budget over the period despite these primary care reimbursement service areas not being within the sole control of the HSE, by virtue of being demand led. A total of 71% of the total Supplementary Estimates were related to Exchequer or technical items which do not reflect health service financial performance.
Within the overall 2014 projected deficit, the acute hospital section is expected to have a net deficit after application of held funding of €273 million by year end. To put this in context, hospitals had a deficit of approximately €180 million at the end of 2013. It was only possible for us to deal with approximately €100 million of this in setting the budgets for 2014, leaving an ongoing underlying problem of approximately €80 million. Hospital costs have grown by approximately €80 million, or just over 2%, against a €4 billion cost base in 2014. This is at or below the growth in the workload of the hospitals. Bed days used and day cases increased by between 1.8% to 3%. As I mentioned, total emergency admissions increased by 1.9%, with the number of very elderly patients, those aged over 85 years, up 4.5%. Medical agency and clinical non-pay costs, including drugs and medical supplies, have risen the most within this. Hospital pay and non-pay budgets were reduced by €115 million in 2014. Therefore the €80 million incoming problem, plus the €80 million cost growth linked to activity, plus the €115 million in budget cuts this year accounted for the current €275 million projected deficit for 2014. In light of the budget announcements last week, we are working to finalise the service plan for 2015, which we expect to submit to the Minister by mid-November.
Preparedness for Ebola was the subject of a specific meeting last week. As committee members are aware, the overall risk of a case of Ebola being imported into Ireland is low, and while there has been no case of Ebola in Ireland to date, we are preparing for the eventuality that we will have a case at some stage.
Our preparation includes Ireland's representation on the European Union health security committee, which was set up to co-ordinate health threats at EU level. Officials from the Department of Health attend and participate at the committee. The HSE emerging viral threats planning and co-ordination, EVT, group is focusing on the co-ordination of operational response plans for the HSE. An operational response subgroup of the main EVT group includes representation from emergency management, the Health Protection Surveillance Centre, public health, general practice and acute hospitals. The purpose of the subgroup is to ensure co-ordination of operational response plans, whether the patient presents in primary care or acute hospital settings. The HPSC produces up-to-date information on Ebola for the public and health professionals. This information includes extensive guidance for health professionals, hospitals, general practitioners and laboratories. There is also extensive information on travel advice for the public and a range of other information. Personal protective equipment in line with HPSC guidance is in place in hospitals and we have in place procedures for the urgent re-stocking of hospitals where required. We have also distributed PPE to GPs as an additional measure. Specific ambulance protocols are in place for the appropriate inter-hospital transfer of an Ebola patient throughout hospitals. We are linking in with international colleagues daily with respect to new or revised guidelines on PPE and all other matters. It is important to emphasise this is a dynamic process.
We have a national isolation unit located at the Mater hospital in Dublin. It is the national referral centre for high-risk suspected and confirmed cases of viral haemorrhagic fever, such as Ebola, and other serious infectious diseases. The national virus laboratory is fully equipped to diagnose Ebola in the event of a case appearing here. The HSE is briefing staff representative organisations and a wider set of stakeholders on Ebola preparedness. The HPSC continues to monitor the situation closely and, together with our emergency management and response functions, will remain at a heightened level of activity until this crisis is over. The HSE is considering options for how to support the countries and the people most acutely affected by this outbreak.
It is important I should make clear that the HSE has no policy in respect of the manipulation of waiting lists. The HSE would never condone any such action. Had the HSE been aware that any manager urged employees to manipulate waiting lists, if indeed this ever happened, it would be the subject of appropriate disciplinary action. The HSE recently called on the Sunday newspaper in question to release the document or alternatively to furnish us with some of the necessary detail. To date, the HSE has not received any information from the newspaper to validate what it has alleged. We suggest it is neither just nor equitable that the Sunday newspaper failed to contact the HSE prior to publishing the article. Had it done so, it would have allowed us to bring a modicum of balance to an otherwise one-sided article. We consider it unreasonable that the Sunday newspaper chooses not to release some elementary detail of the alleged internal document when requested. If it were to do so, it would allow us to deal with many questions posed to us in an objective manner. Again, we call on the newspaper in question to release the document or, alternatively, to furnish us with some of the necessary detail. If no such document exists, we call on the newspaper to state as much and withdraw the allegations.
We announced recently the appointment of six new hospital group chief executives. These appointments are in addition to the appointment of Ms Eilísh Hardiman, chief executive of the children's hospital group, who has been in post since last November. The establishment of these groups is a fundamental modernisation of our health system in line with best international practice. The six new chief executives will report to Dr. Tony O'Connell, national director, acute hospitals. They are: Ms Mary Day, Ireland east; Mr. Bill Maher, RCSI hospitals group, also known as Dublin north-east; Dr. Susan O'Reilly, Dublin midlands group; Ms Colette Cowan, University of Limerick hospitals; Mr Gerry O'Dwyer, south and south-west hospitals group; and Mr. Maurice Power, on an acting basis, for the west and north-west hospitals group, which has recently re-styled itself as Saolta.
The hospital group chief executives will lead their respective groups through the next phase of implementation as they develop strategic plans to describe how they will provide safe, high-quality care in a cost-effective manner. The reorganisation of public hospitals into groups is designed to deliver improved outcomes for patients. I acknowledge in particular the willingness and commitment of each of the individuals for taking on these challenges. I thank Dr. Susan O’Reilly in particular for her significant and remarkable contribution to the development of our cancer services. I know she will bring the same determination and commitment to her new role as group chief executive. She will be succeeded by Dr. Jerome Coffey on an interim basis.
We published the Community Healthcare Organisations report recently which sets out how health services outside of acute hospitals will be organised and managed. Community health care services include primary care; social care, which includes services for older persons and persons with a disability; mental health; and health and well-being. More than half of our total spend on operational services in 2014 has been in this sector. The sector is significant and the reform of these structures will facilitate a move towards a more integrated health care system. This will improve services for the public by providing better and easier access to services, services that are close to where people live, more local decision-making and services in which people can have confidence.
The new governance and organisation structures being put in place to enable this type of integrated care will include the establishment of nine community health care organisations, CHOs, which are the best fit to deliver an integrated model of care. They will see the development of 90 primary care networks, averaging a 50,000 population, with each CHO having an average of ten such networks. The reform of social care, mental health and health and well-being services will better serve local communities through this process. Following the publication of the report, an intensive communication and engagement process has been under way, including feedback to all those who contributed to the process. Members will be aware we provided two briefing sessions in this precinct last week. A national steering group will oversee the implementation of the report's recommendations, the first step being the appointment of chief officers, with a view to their taking up responsibility by no later than the beginning of January.
The extensive process undertaken over the past 12 months by the HSE along with our section 38 agency colleagues to reach compliance with Government pay policy is in the final stages of nearing completion. All recommendations made in the HSE internal audit report have been rigorously addressed and are being concluded. A final report on the measures taken to address the issues and recommendations in the internal audit report is being finalised for consideration by me and the leadership team and, as previously advised, it will be made available to the committee, it is hoped by the end of October.
Positive Action is a section 39 agency. It is important to emphasise that section 39 agencies are distinctly different from section 38 agencies as they are not directly bound by the Department of Health consolidation salary scales. While employees of section 39 agencies are not members of a public sector pension scheme in the way section 38 agencies are, those agencies are expected to have due regard to overall Government pay policy in respect of their senior managers. A process to verify and validate the remuneration templates on section 39 agencies commenced this year with a priority focus on the large agencies. Details of the organisations in receipt of €3 million annually were provided to members at a previous meeting. We continue our work with these agencies as part of the service arrangement process to address the issues raised in the review. A new enhanced service arrangement is being finalised and its implementation will ensure a more enhanced process from 2015 onwards.
There has been reportage concerning a finalised internal audit report on Positive Action which has been provided to me and is awaiting consideration by our management team. I emphasise that Positive Action is a section 39 agency. It is not audited by the Comptroller and Auditor General. In this context I will be perfectly happy, once it has been cleared legally for release, for the HSE to provide it to this committee, as requested. Although Positive Action is no longer in existence, the community it served, those infected with hepatitis C, still have access to other agencies that we continue to fund.
