National Service Plan Mr. Tony O Brien, Director General

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1 National Service Plan 2016 Mr. Tony O Brien, Director General

2 Population Changes ( ) Population has grown by 1.8% since 2010 and is projected to increase by 4% by 2021 Since 2010, 18% increase in those aged 65yrs and over; and 17.5% increase in those aged 85 years and over (with a 4% increase predicted in 2016)

3 1.5m Hospital Discharges 53% since % since m OPD attendances 861,057 (= 60% of activity) 0.308m Day cases 55% since % since 2010 Emergency Responses 13% (compared to 2012) 1.8m (39% of Pop) People with a medical card 208,833 since 2010 (13%) 0.409m GP Visit Cards (Oct 2015 figure) 10.3m 22,360 2,818 41,942 Home Help Hours delivered to 47,061 people Were supported for long term residential care = 4.1% of over 65 population vs. 4.5% OECD average People with disabilities living in congregated settings (decreased from 4,200 in 2012) Over 41,942 appointments to deliver counselling in Primary Care offered by Mental Health in 2014

4 Other Improvements 84% of patients with STEMI heart attacks received angioplasty (target was 70%) 12% of patients with acute stroke received thrombolysis (target 9%) 294 transplants carried out in 2014 compared to 275 in % decrease in waiting lists for CAMHS (from 2,634 in Oct 2014 to 2252 in October 2015, with a 3.6% growth in referrals) More screening occurred in ,141 invited to participate in Bowel Screen 115,907 invited to participate in Retina Screen 138,779 attended Breast check

5 Our Values Care We will provide care that is of the highest quality We will deliver evidence based best practice We will listen to the views and opinions of our patients and service users and consider them in how we plan and deliver our services Compassion We will show respect, kindness, consideration and empathy in our communication and interaction with people We Values will be courteous and open in our communication with people and recognise their fundamental worth We will provide services with dignity and demonstrate professionalism at all times Trust We will provide services in which people have trust and confidence We will be open and transparent in how we provide services We will show honesty, integrity, consistency and accountability in decisions and actions Learning We will foster learning, innovation and creativity We will support and encourage our workforce to achieve their full potential We will acknowledge when something is wrong, apologise for it, take corrective action and learn from it We will try to live our values every day and will continue to develop them over the course of this plan

6 National Service Plan 2016

7 Budget (Funding) 2016 HSE budget for 2016 is 12,928.5m Increase on budget 2015 of 758.5m (6.2%) Of this 720m for Existing Level of Service (ELS) and 38.5m for new service developments A further 58.5m is being held by the DOH for further specific initiatives Overall increase in funding of 817m (6.7%) 97m for new service developments ( 38.5m+ 58.5m) 720m to maintain existing level of service

8 Budget 2016 v Costs 2015 Total funding available in ,987m Funding for new service developments - 97m Funding to maintain existing services - 12,890m 2015 cost of providing existing services - 12,790m 2016 funding is 100m / 0.8% above 2015 cost of existing services 2016 cost pressures exceed 100m => substantial financial risk being managed within the 2016 plan

9 Existing Level of Service m for ELS consists of the following: Additional base funding 403.9m Pay funding including implementation of Lansdowne Rd Agreement 118m Non-pay (demographics/drugs/etc.) 210.6m Full year cost of 2015 commitments 112.5m Less: savings and efficiency targets ( 125m)

10 Approach to Financial Risk Governance budgetary control, enhanced Accountability Framework Pay integrated strategy on recruitment, agency conversion and workforce planning Non-pay targeted cost containment programmes Income sustain and improve income generation Activity ABF model within hospitals

11 2016 Priorities Sustaining maximum service access Improving quality and safety Reforming how we work Targeted investments

12 New Initiatives m (Full year costs 82.9m) Acute Division - 13m Cancer Services - 10m Disability Services m Health & Wellbeing - 2.5m National Ambulance Service - 2m Expansion of respite beds - 1m Palliative Care - 0.7m ABF/Finance Reform - 2m

13 Funding Held m Mental Health - 35m Primary Care m Therapeutic services for young people - 8m Implementation of recommendations of the nursing taskforce as a pilot - 2m Within this 58.5m, 21.5m will be used on a once-off basis in 2016 to support: 20m Home care and transitional care (Elderly) 1.5m Vaccine Advance Purchase Agreement

14 Quality and safety

15 National Quality Programme 3m The National Quality Programme drives quality improvement and quality assurance across all health and social care services 3m from 2016 allocation has been committed to support implementation of key priorities

16 Quality and Safety Developing quality, safety and risk management capacity of Hospital Groups, CHOs and National Ambulance Service Improving the reporting, monitoring and learning from safety incidents Listening to service users through the complaints system and service user experience surveys Further implementing the policy of Open Disclosure Implementing the National Clinical Effectiveness Committee (NCEC) Standards for Clinical Practice Guidance, 2015 Establish National Independent Review Panel for disability services Implementing patient safety programmes

17 Primary Care

18 Primary Care 3.6B Resource capacity for 2016: 1.2B for Core Services (increase of 2.7%) 2.4B for PCRS (increase of 0.3%) 10,300 Directly employed staff 7,000 Contracted Healthcare Professionals Activity Profiles (Examples): 24,000 CIT Patient Referrals 1M GP out of hours Contacts 1M Therapy treatments in Primary Care 22,000 Orthodontic patients in treatment 9,500 Opoid substitution treatments 3,600 Patients in Palliative care Over 2M Medical card and GP visit card holders covered

19 Primary Care Expansion of Community Intervention Team activity Improved access to Diagnostics and Minor Surgery in Primary Care Extended Chronic Illness management in Primary Care Improved access to Therapy Services - especially Speech & Language and Psychology Targeted services for Homeless and the Traveller community Extended access to Free GP care, GP out of hours services and supports for Rural GPs Strengthened delivery of Hepatitis c treatment programme An Orthodontic waiting list Initiative Consultant and Clinical Nurse Specialist appointments in Palliative Care, and additional Specialist beds in Kerry and Galway Introduction of IHI and Children First compliance 17 new Primary Care Centres operational

20 Primary Care Focus on: Integrated Care Approach Reduce Reliance on Hospitals Transfer of Activity to Primary Care Strengthened Primary Care Infrastructure and address Access problems Focus on Safety and Quality Improved Productivity / Cost Reduction Targeted Approach to Vulnerable Groups Use of Technology as Enabler of Integration and Efficiency Staff Development and Manpower Planning

21 Social Care

22 Older People 1.643m NHSS: Additional 35m on 2015 out-turn ( 940m Budget) Average of 23,450 people per week supported in 2016 (increase of 649 people from 2015 target) Home Care: Maintain 2015 Outturn Using Time Related Savings from new initiatives ( 20m) -10.4m Home Help Hours (increase of 100,000 hours on 2015 target). 15,450 HCP clients (increase of 1,650 on 2015 target). Transitional care beds: Maintain 2015 Outturn 313 Transitional Care beds (109 Places per week) targeted at 17 Acute Hospitals Additional public beds : 214 including Mount Carmel (65) Public continuing care beds: 5255 available across 129 centres Achievements in 2015: 32% reduction in Delayed Discharge figure. Challenges for 2016: 3.1% increase in service demand for over 65 population. 4.2% increase in over 85 population in 2016.

23 Older People Reform Priorities Development of a model of integrated care across 4 pioneer sites which will promote effective integration between hospital and community sectors. 36 additional posts to be recruited across the four pioneer sites. We will implement a number of key reforms including: Key actions for the development of the Dementia Strategy - Co-investment programme of 27.5m Atlantic Philanthropies, Dept. of Health and HSE. Implementation of Single Assessment Tools (SAT) to enable standardised assessment of care needs across hospital and community sectors Implement Recommendations of the ED Taskforce to reduce delayed discharges. 23

24 Disability Services 1.558m New Directions ( 7.25m) Reconfiguring Day Services including School Leavers & Rehabilitative Training Places - New Funding School Leavers report - Learning Capacity Issues Progress Disability Services for Children & Young People ( 4m) Complete reconfiguration in 2016 with New Funding Integrated Development of Early Intervention Services & supporting access to Early Childhood Care & Education Programme (ECCE) Respite Service Development ( 1m) Targeted at alternative models such as host family programme

25 Disability Services 62m ELS : Consolidating Work Programme Commenced in 2015 Time to Move on from Congregated Settings - Accelerate implementation Capital programme - support move to community Service reform fund - support transition and innovation Commitment to stakeholder consultation and engagement Six Step Programme Full roll out of Safeguarding Policy Quality Improvement Team McCoy review out put to inform system wide change Volunteer / Advocacy & Family Fora Driving improved compliance with National Standards as regulated by HIQA

26 Mental Health

27 Mental Health 791.6m Budget 2016 The net opening budget allocation for 2016 of 791.6m inclusive of the PfG m, plus the additional PfG 2016 funding of 35m, represents an increase of 4.4% compared to equivalent figure for PfG 2016 priorities: Development of counselling services by Mental Health and Primary Care for children 2m assigned for new initiatives for mental health needs of the homeless in collaboration with Primary Care Development of two new Clinical Programmes 1. ADHD in adults and children 2. Dual Diagnosis of Mental Illness and Substance Misuse. Enhancement of community mental health services for psychiatry of old age; mental illness and intellectual disability; addressing the current service gap for low secure acute care and rehabilitation services for those with complex needs

28 Mental Health Implementation of Connecting for Life:- Suicide Prevention Resource Officers in place nationally Enhanced services in place nationally to prevent and respond to the incidence of suicide Early Intervention Services for adults and children:- Ten JIGSAW services nationally fully operational Development of new JIGSAW services in Dublin and Cork Enhanced counselling services for adults (CIPC) Enhanced psychological and therapeutic supports for adults and children with mental illness CAMHS Enhanced CAMHs community teams and Liaison Services in General Hospitals CAMHs Forensic Service developed CAMHs Eating Disorder service developed. Service User and Family Member Engagement Head of Service User and Family Member Engagement appointed to NMHT Peer Support Worker role in place

29 Health and Wellbeing

30 Health and Wellbeing Support the development and implementation of CHO and hospital Group Healthy Ireland plans. Further integrate prevention, early detection and self-management supports into existing and new national clinical care programmes (diabetes, COPD, asthma and heart failure). Reduce chronic disease by delivering actions arising from the national policy priority programmes in areas such as: Tobacco, Healthy Eating and Active Living, Healthy Childhood, Alcohol, Wellbeing, Positive Ageing and Sexual Health. Deliver and expand our screening programmes and continue the implementation of age-extension for the BreastCheck Programme to eligible women aged years. (New Funding 1.5m) Augment the current Primary Childhood Immunisation schedule to address agreed public health priorities. (New funding 2.5m) 221.7m

31 Health and Wellbeing Provide statutory surveillance, management, investigation and control of infectious diseases. Enforce HSE environmental health statutory responsibilities Produce data to support national and local population needs assessment to support services with planning, resource allocation and evaluation. Develop and implement a Healthy Workplace Policy and supporting initiatives to support and encourage staff to look after their own health and wellbeing building on work this year such as calorie posting. Identify mechanisms to incentivise the delivery of preventative activities as part of the activity based funding framework. Increase proportion of patients utilising self management supports

32 Acute Service

33 Acute Service Service Developments 13.1m Maternity services 3m Coombe Portlaoise maternity network Women and Infant s Programme Maternity Strategy implementation Children s Hospital developments 3.8m North South cardiology developments Ongoing reform programme Integration of services in advance of satellite centres opening 2017 Organ transplantation 0.62m Transition of pancreatic transplant from Beaumont to SVH Haemophilia services in CUH and OLCHC Organ donation and transplant coordinator Hospital service developments from m Paediatric Scoliosis, Stroke telemedicine, Cochlear implant Opening of commissioned new units 2.8m St Luke s Kilkenny acute floor (ED, AMU, Oncology) phased basis Wexford General Hospital Delivery Suite and Theatre phased basis Roscommon Endoscopy Unit

34 Acute Service Challenges Deliver equivalent activity as 2015 with a funding challenge of 100m Planned activity will give priority to urgent and complex cases Optimise existing capacity through reducing LOS Shift care to appropriate settings including primary care Inpatient activity target is to deliver 2015 levels OPD activity funded at 2015 levels Target for % adults waiting <15mths for elective procedure 95% in 2016 Target for % adults waiting <8mths for elective procedure 70% in 2016 (66% 2015) Target for % children waiting <15mths for elective procedure 95% Target for % children waiting <20wks for elective procedure 60% (55% 2015)

35 National Ambulance Service

36 National Ambulance Service 5.2m Funding to sustain existing level of service and address equipping pressures Training 100 paramedics in 2016 to ensure more staff on the front line Rollout of Mobile Data Terminals in ambulances including satellite navigation Establishment of a Clinical Hub in the National Emergency Operations Centre to support lower acuity patients Expansion of Community First Responder Schemes to improve response times Implementation of an electronic patient care record to support improved clinical audit Further upgrade of our emergency ambulance fleet

37 Health Service Reform

38 Health Service Reform 9m+ 10m The Health Service Reform Programme aims to drive the delivery of person-centred, integrated models of care Objective is to ensure better health outcomes and improved patient and service user experiences To support this goal we have prioritised 9m in 2016 to progress the implementation of the Integrated Care Programmes strategy 10m has also been committed from existing resources to support Hospital Groups, CHOs, the Centre Reform Programme and the National Ambulance Service to expand and grow in capacity

39 Knowledge & Information Plan

40 Knowledge & Information Plan E-Health Ireland 2016 Integrated, Patient Centric, Efficient Care Delivery Clinical & Information Governance Care Delivery Enablement Electronic Health Records Cross Setting Information Integration Health Service Insights National Support Systems Knowledge & Information Delivery Transformation

41 Single health analytics capability Three EHR Lighthouse Projects Electronic Health Record Business Case to Procurement Implementation of MN-CMS & MedLIS & ipms Completion of ereferral and PoC of IHI Phase 1 100m Phase 2 Data Dictionary / Data Governance Process Service management function for technology support Enhanced team capacity across reformed HSE functions Continued growth of the CCIO Council Innovation capacity & infrastructure (Future Health)

42 Human Resources

43 Human Resources Goal 4 Engage, develop and value our workforce to deliver the best possible care and services to the people who depend on them

44 Thank You.

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