HSE’s budget for 2019 is over €16 billion

The HSE has a budget of €16.050 billion to run the health services this year. This is an increase of €848m (5.6%) over the final budget for 2018, writes Maureen Browne.

However, the HSE has warned that this funding is required to meet the €198 million costs of new service developments set out by the Department of Health, the higher costs in 2019 of delivering 2018 levels of service activity as a result of centrally agreed pay rate and pension changes as well as other price increases, and the costs in 2019 of additional service activity to meet demographic changes and other service pressures.

Much of the service plan is devoted to plans for the integration and co-ordination of services and to working for the implementation of the Sláintecare Report.

Much of the service plan is devoted to plans for the integration and co-ordination of services and to working for the implementation of the Sláintecare Report. It says it will work with the Sláintecare Programme Office to develop a Citizen Care Masterplan.

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New Public Health Model
It also promises a new operating model for public health in Ireland, in conjunction with the DoH.

Electronic Health Record
The HSE says it will complete the procurement for an electronic health record (EHR) this year and re-prioritise existing resources to put a team in place to commence implementation, with an acute service solution in the first instance. It will also put in place a team to programme manage the Individual Health Identifier.

Changing Demographics
The service plan says changes in the demographics of the population will
see a projected increase of 3.3% in people over 65 years and 4.3% in people over 85 years in 2019, requiring both a change in how community services will be delivered and the need for improved integration with acute services.

It says The Health Service Capacity Review 2018 acknowledges this demand for services across primary and social care settings in the next 15 years as a result of demographic changes. It is estimated that there will be up to a 46% increase in demand for primary care, 39% in the need for long term residential care and a 70% increase in the demand for home care over this period.
“A significant challenge is maintaining the required workforce and skillset across all community services which has led to a reliance on agency staffing. Similarly we are experiencing issues in the area of recruitment of available staff in key areas.”

Primary Care Services

  • In 2019 the key quantum of services will be:
  • 581,661 patients to avail of physiotherapy.
  • 356,314 patients to avail of occupational therapy with a focus on addressing patients waiting over 52 weeks, through the appointment of 40 occupational therapists.
  • 279,803 patients to avail of speech and language therapy.
  • 743,605 patients to avail of the community nursing service.
  • 202 GP training places.
  • 1,147,496 GP out of hours contacts.
  • 457 children with complex medical conditions to avail of paediatric homecare packages following discharge from hospital.
  • 45,432 referrals to community intervention teams (CITs) to facilitate a high volume of complex hospital avoidance and early discharge.
  • An increase in general practice access to diagnostic imaging with 67,000 ultrasounds and 79,500 x-rays in 2019.
  • Implement, within existing resources and on a phased basis, the recommendations from the reviews of the primary care physiotherapy, occupational therapy and speech and language therapy services, psychology service, dietetic model of care, lymphoedema model of care, GP out of hours service, primary care eye care services and civil registration.
  • Improve access waiting times for oral health and orthodontic services for children within existing resources.
  • Refocus CIT and Outpatient Parenteral Antimicrobial Therapy (OPAT) services with a focus on increased referrals of complex hospital avoidance and early discharge cases, and develop and implement quality improvement initiatives.
  • Ensure treatment is offered to patients with hepatitis C in line with the National Hepatitis C Treatment Programme goal of eliminating hepatitis C by 2026.
  • Commission additional primary care centres.

Community Healthcare Networks (CHNs)
The NSP says Sláintecare positions Community Healthcare Networks (CHNs) as the ‘fundamental unit of organisation for the delivery of services’ in the community. CHNs are geographically-based units delivering services to an average population of 50,000. There will be 96 CHNs and each CHO will have between eight and 14 CHNs.
“The development of CHNs is a critical step in transforming our healthcare system and will enable real change that will be experienced by all who use our services and work in the HSE. Similarly, it is accepted that there is a need to ensure that general practice is sustainable both for current GPs in practice and those entering the profession. Building capacity in general practice will enable GPs to play a central role in achieving this shift in emphasis towards primary care.

“Within the overall resource package, opportunities to make improvements in areas such as CHN services will be developed through
recruitment of 130 posts on a half year basis, with an estimated 4,500 additional patients to be seen in 2019, with a full year impact in 2020 of 9,000 additional patients. The specific profile of community nursing and therapies will be determined in consultation with CHOs early in 2019.”

It plans to implement nine CHN learning sites, build the governance of CHNs with new structures at primary care level and deploy a pilot ICT solution to support the new CHN learning sites.

Chronic Diseases
The Service Plan says it will complete reviews of the existing approved models of care for the four chronic diseases (chronic obstructive pulmonary disease (COPD), asthma, diabetes, cardiovascular disease) and a service gap analysis will be conducted. It also plans to develop a plan to respond to the prevention and community healthcare needs of COPD patients.

Radiology Diagnostics
It will develop an improvement plan for access to radiology diagnostics in collaboration with the National Clinical Programme for Radiology, Hospital Groups, the National Integrated Medical Imaging System (NIMIS) and the NTPF.

Disability Services

  • The National Service Plan says it will reduce waiting times for assessment of need under the Disability Act 2005 through the provision of 100 additional posts.
    In 2019, the quantum of services will be:
  • 8,568 people with a disability are supported by a range of residential supports (65% of budget).
  • 27,067 people with disabilities access the 22,272 day places and supports in over 800 locations throughout the country (20% of budget).
  • 90 new emergency residential places.
    On a quarterly basis (15% of budget).
    – 6,559 people with disabilities will avail of respite.
    – 10,629 people with disabilities will avail of 4.7m hours of personal assistant / home support hours.

Older Persons

Within the budget allocation to the HSE for older persons’ services:

  • Over 53,000 people will receive home support services, to a total of 17.9m hours.
  • Over 230 people will receive intensive home care packages through a further 360,000 hours.
  • 28,000 places per week will be provided across 300 day care centres.
  • 4,900 long stay and 1,850 short stay public residential care beds will be available.
  • Over 10,900 people will be supported through transitional care funding in their discharge from acute hospitals.
  • Over 23,042 people on average at any one time in long stay care will be supported by the NHSS.

Mental Health Services

The HSE will:

  • Work to develop a seven day per week service for CAMHs to ensure supports for vulnerable young persons.
  • Implement agreed development of a 24/7 contact line, crisis text line and other eMental health digital responses.
  • Enhance Jigsaw and other early intervention services.
  • Expand out of hours responses for general adult mental health services by moving to the 7/7 model and continued appointment of agreed new staffing.

It also plans to develop a plan to respond to the prevention and community healthcare needs of COPD patients

Acute Services

Winter 2018 / 2019 – Increase acute bed capacity by 75 beds (part year) across ten locations with particular focus on maximising available capacity during the winter months.
Winter 2019/2020 – Plan and prepare for a further increase in acute bed capacity of 202 beds (including 16 critical care beds) across 14 locations, to be operational by quarter 1, 2020.

Continue to commission additional high dependency unit beds in the Mater Misericordiae University Hospital (MMUH) and Cork University Hospital (CUH), an additional 30-bed ward in Our Lady of Lourdes Hospital Drogheda, and a 40-bed modular ward block in South Tipperary General Hospital.

Specialist Services

  • Recruit a national clinical lead and establish the National Office for Trauma Services.
  • Designate the major trauma centre and trauma unit(s) for the central trauma network.
  • Prepare the implementation plan for the further recommendations of A Trauma System for Ireland
  • Progress the opening of transplant service beds for pre, peri and post-transplant related activity in MMUH.
  • Further develop the national organ retrieval service in compliance with the European Working Time Directive (EWTD).
  • Implement the recommendations of the National Genetic and Genomic Medicine Network
  • Strategy Group Report with the recruitment of a national clinical lead associated with an academic centre, a lead for genetics diagnostics and a programme manager.
  • Support the roll-out of a Laboratory Information System in acute hospitals.
  • Support the implementation of recommendations of the policy review on sexual assault treatment units, once completed, including the provision of enhanced resources in 2019 to support the phased implementation, and support the continuing professional development of forensic examiners.
  • Continue to support bariatric surgery and weight management services within existing resources.
  • Implement the HSE’s response to Valproate Plan to ensure the safe prescribing of Epilim (Valproate) for women of childbearing age.
  • Continue service enhancements in GI physiology, the national neonatal transport programme, deep brain stimulation, narcolepsy, spina bifida, intestinal failure, and paediatric otolaryngology (ENT) complex airways management, which commenced in 2018 in association with the national clinical programmes.

Cancer Services
Each year approximately 38,000 people in Ireland develop cancer (National Cancer Registry Ireland, 2016). Cancer is the second most common cause of death after diseases of the circulatory system such as heart attack or stroke.
The HSE Service Plan says it will:

  • Progress the development of an adolescent and young adult service within Children’s Health Ireland and the adult services.
  • Continue focus on the NCCP rapid access clinic KPI improvement recommendations for breast, lung and prostate cancers.
  • Continue focus on the implementation of the surgical oncology centralisation project.
  • Support the expansion of the NPRO including NPRO phase 2 developments and the cross-border radiotherapy initiative.
  • Monitor and evaluate the provision of private radiotherapy providers in University Hospital Limerick (UHL) and University Hospital Waterford.
  • Progress the development of an oncology service for older persons.
  • Progress development of a national cancer genetics programme.

Implement the recommendations of the National Genetic and Genomic Medicine Network Strategy Group Report with the recruitment of a national clinical lead

Women and Children’s Services
The HSE will open the new Paediatric Outpatient and Urgent Care Centre at Connolly Hospital in 2019, including the recruitment of the relevant staff to support the expansion of a consultant-delivered workforce and increased capacity through additional outpatient clinics.

It will support and enable the implementation of a safe, high quality termination of pregnancy service.

It will open the new Paediatric Outpatient and Urgent Care Centre at Connolly Hospital in 2019, including the recruitment of the relevant staff to support the expansion of a consultant-delivered workforce and increased capacity through additional outpatient clinics.

Social Inclusion services
In 2019, the key quantum of services will be:

  • 10,063 clients will be in receipt of opioid substitution treatment (outside prisons).
  • 1,126 service users admitted to homeless emergency accommodation hostels / facilities whose health needs will have been assessed within two weeks of admission.
  • 1,650 individuals will attend pharmacy needle exchange

Vaccination Programme
The HSE will implement a national pertussis (whooping cough) vaccination programme for pregnant women in the health service.

Sun bed inspection programme
Undertake a sun bed inspection programme, including planned inspection, test purchase and mystery shopper, under the Public Health (Sunbeds) Act 2014.

Screening Services
The Scally Report
The HSE has established a Steering Group chaired by the Chief Operations Officer and Chief Clinical Officer to oversee the implementation of the HSE recommendations. A senior manager has been appointed to lead on the development of a HSE implementation plan as part of an overall implementation plan, developed under the auspices of the CervicalCheck Steering Committee established by the Minister earlier this year.
The NSS will support the implementation of all recommendations contained in the Scally Report as a key priority for 2019. Many of the recommendations apply to all screening programmes.

BreastCheck
Continue to implement the age-extension of the BreastCheck Programme by rolling out the Programme to remaining 67 year olds (50%) and 68 year olds (50%) in line with the agreed programme of implementation.
Maintain uptake >70%.

BowelScreen
Increase uptake through targeted communications and promotion amongst eligible men and women aged 60-69 years.

Diabetic RetinaScreen
Roll out a digital surveillance screening programme and model of care that will improve timeframes for treatment of diabetic retinopathy to a further 2,500 patients in 2019.
Increase uptake amongst eligible population aged 12 years and over.