Presentation on the Service Plan 2016

Item type Presentation

Authors O'Brien, Tony

Publisher Health Service Executive (HSE)

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Link to item http://hdl.handle.net/10147/604064

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National Service Plan 2016

Mr. Tony O’Brien, Director General

Population Changes (2010 – 2015) • 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)

1.5m Hospital Discharges 53% since 2004 13% since 2010

861,057 (= 60% of activity)

Day cases 55% since 2004 17% since 2010

3.2m OPD attendances

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

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 22,360

Emergency Responses 13% (compared to 2012)

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

0.308m

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 2011

16% 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 2014

212,141 invited to participate in Bowel Screen 115,907 invited to participate in Retina Screen 138,779 attended Breast check

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 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

Our Values

National Service Plan 2016

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

Budget 2016 v Costs 2015

• Total funding available in 2016 - €12,987m • 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

Existing Level of Service 2016

€720m 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)

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

2016 Priorities Sustaining maximum service access

Improving quality and safety

Reforming how we work

Targeted investments

New Initiatives 2016 - €38.5m (Full year costs €82.9m)

Acute Division - €13m Cancer Services - €10m Disability Services - €7.25m Health & Wellbeing - €2.5m National Ambulance Service - €2m Expansion of respite beds - €1m Palliative Care - €0.7m ABF/Finance Reform - €2m

Funding Held 2016 - €58.5m

Mental Health - €35m Primary Care - €13.5m 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

Quality and safety

National Quality Programme

• 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

€3m

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

Primary Care

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

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

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

Social Care

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.

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

Older People € 1.643m

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

Older People

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

Disability Services € 1.558m

€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

Disability Services

Mental Health

Mental Health

Budget 2016 • The net opening budget allocation for 2016 of €791.6m inclusive of

the PfG2015 €35m, plus the additional PfG 2016 funding of €35m, represents an increase of 4.4% compared to equivalent figure for 2015.

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

€791.6m

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

Health and Wellbeing

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 65–69 years. (New Funding €1.5m)

• Augment the current Primary Childhood Immunisation schedule to address agreed public health priorities. (New funding €2.5m)

€221.7m

• 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

Health and Wellbeing

Acute Service

€13.1m

Acute Service – Service Developments 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 2015 €2.87m – 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

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)

Acute Service – Challenges

National Ambulance Service

National Ambulance Service • 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

€5.2m

Health Service Reform

• 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

€9m+€10m

Health Service Reform

Knowledge & Information Plan

Cross Setting

Information Integration

Electronic Health

Records

National Support Systems

Care Delivery

Enablement

Integrated, Patient Centric, Efficient Care Delivery

Health Service Insights

Knowledge & Information Delivery Transformation

Clinical & Information Governance

Knowledge & Information Plan

E-Health Ireland 2016

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

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)

Phase 2

€100m

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

Human Resources

Thank You.