HSE flags golden opportunity to change how healthcare delivered

Unprecedented funding allocated this year by Government will provide a once-in-a-generation opportunity to change how healthcare is delivered in Ireland, according to the Health Service Executive.

An additional €3.5 billion is to be set aside for the health service for 2021, a 21 per cent increase on the amount provided originally to the HSE for last year prior to the Covid-19 pandemic. Overall, the organisation is to receive €20.6 billion this year.

It said on Wednesday that the new service plan for 2021 will mean 1,146 additional acute hospital beds provided by the end of the year as well as 66 more critical care beds, bringing the total for adults to 321.

The HSE said the new plan provided for additional spending to improve many services including those in the areas of cancer, maternity and mental health.

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It said it would allow for an addition of 16,000 staff above the number employed at the end of 2019 including more than 1,100 medical and dental staff, in excess of 3,500 nurses and midwives and 4,000 health and social care professionals.

HSE chairman Ciarán Devane said the organisation now, for the first time, had “the financial means to bring the [Sláintecare health reform] plans to life”.

Within the additional allocation of €3.5 billion, some €1.68 billion is being earmarked for spending on Covid-19 requirements while €1.8 billion will go on non-Covid areas.

“ [A total of] €1.1 billion of this additional investment is to deliver permanent and enduring improvements in healthcare arising from the Sláintecare reform programme. The remaining €0.7 billion of this underlying [ie non-Covid] increase is to cover the increased costs of providing existing levels of service which have increased due to demographic changes and various cost increases.”

The plan states that this year the HSE will “commence, at scale, the implementation of service reform that have been planned for many years. This will involve a demonstrable shift in the provision of care from hospital to community settings . . . to improve access across the board and expanding services that support people to remain at home.”

The plan says services in the community will be strengthened. It says five million additional home-support hours and an additional 1,250 rehabilitation and transitional care beds will be provided. It says 22,500 people will be supported through the Fair Deal nursing home scheme.

The plan also sets out that there will be 28 additional beds provided to enable acute mental health services to respond to Covid-19 and increasing demand.

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The plan also emphasises that whole-system reform will be critical.

It says challenges facing the system include waiting lists for scheduled care in hospital and long waits in emergency departments, particularly for older people and those who have more complex needs.

“There are also difficulties for hospitals that are running with very high occupancy levels . . . waiting times for mental health services for children and adults and long waits for community-based services such as therapies also pose challenges. There is not enough home-based support and a lack of person-centred and responsive support for people with disabilities and their families.”

The service plan reveals that the cost of the current deal to access capacity in private hospitals during the current surge in Covid-19 cases is costing €47 million per month.

It also says that the HSE will have “limited capacity” within its plan to respond in 2021 to further pay or other pressures, beyond those which have already been provided for.

"In the event that additional unfunded pressures emerge, for example, via the industrial relations machinery of the State, regulatory processes, Government decisions or the courts etc, the HSE will engage with the Department of Health as to how to proceed."

It says the HSE’s capacity to respond to new drugs and new indications for existing drugs is “finite” in that it has a budget in this area of €50 million for the year. The organisation says that needs “to be looked at in the context of the circa €2.4 billion the HSE is already paying each year to drug companies”.