The HSE today (Thursday, December 20th 2018) published its National Service Plan 2019, following approval from Government. In the plan, the HSE confirms the level and type of health and social services to be delivered next year within the allocated budget of €16.05bn.
The €16,050m budget, featuring an overall increase of €848m (5.6%) on final 2018 funding, has been welcomed today by the HSE. A total of €198m of development funding has been provided by the Department of Health (€178m for new 2019 developments). Offsetting the 1st charge estimated as €114m, and setting aside €2.5m dormant accounts funding, this leaves a budget of €15,755m for all other 2019 costs.
The total cost, in 2019, of the existing level of service activity in place by the end of 2018, is estimated at €15,805m. This cost of €15,805m is €50m above the available €15,755m. It includes providing for centrally agreed pay rate, incremental credit and pension decisions (c.€375m), full year cost of approved 2018 developments (c.€102m) and the full year cost, in 2019, of additional service activity commenced in 2018 (c.€116m). It excludes the cost of additional service activity from 1st January 2019 to deal with demographic, technology, unmet need and other pressures on the system.
The HSE’s key service priorities for next year are to maintain activity levels at 2018 planned/outturn, focus on cost reductions and improved efficiency, minimise risk and promote patient safety, and reprioritise activities as necessary. Of paramount importance is ensuring that the most pressing patient and client needs are met within the resources available.
A number of new developments will be made in 2019 whilst maintaining services at the planned level. They include;
– New children’s hospital – €6.7m
– Mental health services – €55m
– Disability services – €14.5m
– CervicalCheck and HPV vaccination – €9m
– Termination of pregnancy – €12m
– Primary Care Scheme changes – €70.3m
– Care redesign and new entrant pay – €29m.
However, our growing and ageing population, along with increasing life expectancy, continue to place increasing pressure on services.
Speaking at today’s launch Dean Sullivan, HSE Deputy Director General – Strategy, stated: “While we will endeavour to ensure we provide value for the monies we spend, we are very cognisant that meeting both current and future challenges is not sustainable. We continue to experience high hospital occupancy levels, pressure regarding waiting lists and increasing demands on other social care and demand led schemes.
“We will however, continue to respond to the most pressing patient and client needs within the resources available. We will seek to maintain activity levels at 2018 planned outturn position and focus on cost reductions and improved efficiency.”
Priorities for 2019 in the area of Primary Care include the development of community healthcare networks, the agreement and implementation of GP contractual changes and an improvement in access to therapies services. The HSE will provide additional packages of care for children discharged from hospital with complex medical conditions. Featuring investment of €70.3m in Primary Care Scheme Changes and €4.5m in the delivery of safe abortion services, the service also aims to issue over 1.5m medical cards along with over 528,000 GP visit cards. They are also seeking to provide 457 home care packages and provide 45,432 community intervention team contacts.
Services for Older Persons
Despite the challenges the HSE is facing in delivering services and introducing new health programmes, Services for Older Persons will see the implementation of both the National Dementia Strategy and National Carer’s Strategy, and implement the integrated care programme for older persons in 2019.
The HSE will provide home support through a single funding model, and provide quality and safe residential and transitional care as follows:
– 18.2m home support hours to over 53,000 people, including 360,000 hours to 235 people through intensive home care packages
– 10,980 people to be supported for transitional care to leave hospital
– 23,042 people under NHSS in long term residential care in any month
– 4,900 long stay and 1,850 short stay public residential care beds.
The HSE will provide 90 new emergency residential places, 8,568 residential places, 32,662 day places, 3.08m home support hours to 8,094 people and 182,506 respite overnights whilst prioritising the continuing implementation of ‘Transforming Lives’ and the ‘Time to Move on from Congregated Settings’. These programmes underpin the collective effort nationally to fundamentally reform how we deliver services for people with a disability.
Further investments will be made in supporting disability needs assessment (€2.5m) and €12m is available for school leavers with a disability.
Mental Health Services
By improving community mental health team capacity, expanding out-of-hours responses for adults and continuing to implement Connecting for Life, the HSE will continue to support people with mental health needs. Mental Health sees a major investment of €55m to enhance and expand services in order to continue to safeguard vulnerable people. Targets for next year include:
– 28,716 adult referrals seen by mental health services
– 12,148 admissions to adult acute inpatient units
– 8,896 psychiatry of later life referrals seen
– 10,833 CAMHs referrals received and seen.
Acute Hospital Services
The Acute Hospitals will continue to deliver impatient and day cases to 1.707m people, see 3,339 new and return outpatient attendances and 1.228m ED visits, whilst enhancing capacity and improving access to both scheduled and unscheduled care. A continued focus in bringing down waiting lists and meeting 2019 targets set, and implementation of the National Cancer Strategy and the National Maternity Strategy will continue.
Projected activity includes;
– 1.706m in patient and day cases
– 3.339m new and return outpatient attendances
– 1.228m new ED attendances
– 80% of people waiting for OPD services seen <52 weeks
– 90% of children waiting 15 months for a day elective procedure +
– 85% for an inpatient procedure
– 95% of adults waiting <15 months for a day elective procedure +
– 85% waiting for an inpatient procedure.
National Ambulance Service
The National Ambulance Service (NAS) will implement ‘A Trauma System for Ireland’, deliver improved governance to support improved patient safety. They will support Sláintecare by developing alternative care pathways. NAS also projects taking 333,800 emergency calls and taking 34,000 inter-hospital transfers in 2019.
In the area of clinical quality and safety, the HSE plans in 2019 to strengthen clinical leadership and improve patient and service user communications and engagement. The recommendations of Scoping Inquiry into the CervicalCheck Screening Programme (Scally Report) will be implemented.
The HSE will further support Sláintecare and system transformation by establishing nine network learning sites in the Community Health areas.
Funding for infrastructure development is set at €567m allocation in 2019. The HSE Capital Plan will see investment in major projects including the urgent care sites at Connolly Hospital and Tallaght University Hospital as part of the New Children’s Hospital project, the National Rehabilitation Hospital, the Radiation Oncology Programme, the National Forensic Mental Health Service and the new National Maternity Hospital. Funding has also been allocated to new Primary Care Centres, the social care residential programme and provision of medical equipment and ambulance replacement.
Information technology has an allocation of €85m in the Service Plan to develop the Electronic Health Record programme, E-prescribing and a National Cancer Information System (NCIS).
To view or download a copy of the HSE National Service Plan 2018, please visit www.hse.ie/serviceplan2019