HSE National Service Plan: Significant improvement wanted by Donnelly

Minister for Health Stephen Donnelly TD has written to HSE Chairman Ciarán Devane ahead of the publication of the HSE’s National Service Plan to demand significant improvement in Irish health services.

After the €3.5 billion increase in health spending that was announced in Budget 2021, taking the health budget to a record €21 billion, Donnelly addressed a letter to HSE Chair Devane to say that the “unprecedented level of investment” should be used to increase capacity and permanent staffing levels, to progress the implementation of various national strategies and to advance the implementation of Sláintecare.

Donnelly also emphasised the need for the HSE to continue its transition towards community care, emphasising that the HSE’s National Service Plan, which was due to be published but has not been forthcoming as yet, should “continue to prioritise the provision of care in the home and in the community to the greatest degree possible”. In his letter, the Minister for Health told Devane that he wants to see a “minimum” of 2,600 additional open and staffed EDs in acute and community settings in 2021 and that the extra funding should enable the health service to hire up to 16,000 additional staff. Donnelly also wrote that while the number of community beds must increase, the amount provided by the HSE was expected to be initiated at the least, if not raised in tandem.

In the upcoming National Service Plan, the HSE’s agreement with the Government over how its budget will be spent, Donnelly said that the HSE should outline “estimates of the number of employees, by grade, category and service area, consistent with the net non-capital expenditure limits together with a monthly profile of whole-time equivalent posts and costs, an overview of the full year cost of the proposed recruitment, and details of the executive’s strategy to deliver on this major expansion of the workforce”.

The Government is also pressing the HSE to publish an action plan concerning access to care along with its National Service Plan. Donnelly wrote in the letter that the Government wants to see the “implementation of integrated structural reforms to modernise and future-proof our health service”. He also said that he wanted the HSE to deliver “increased levels of healthcare to our citizens in community and primary care settings” and that the key priorities for the healthcare system would be to “protect vulnerable groups, service users, patients, healthcare workers, and the wider public in the face of Covid-19 in line with national and international public health guidance, with a specific focus on ensuring the health system is prepared to meet the emerging challenges”.

The Minister said that a total of 24.2 million home care hours should be provided in 2021 and that progress is expected towards the full rollout of community services, community health networks and specialist teams across Ireland. The letter stipulates that at least 5 per cent of the home care hours allocated under the plan should be reserved for patients suffering with dementia.

When breaking down the Government’s criteria for the allocation of the budget, Donnelly said that the Fair Deal nursing home scheme should receive €1.062 billion next year, with the State Claims Agency receiving €410 million. It also advises that €21.1 million has been provided to fund HSE Brexit preparation under the assumption of no deal or a “vey limited” EU-UK free trade agreement at the end of the transition period, said funding is “inclusive of €4.7 million allocation for the proposed direct reimbursement scheme for Northern Ireland medical expenses which is being held back by the Department pending the outcome of EU-UK negotiations and the ongoing review of the impact of Covid-19 travel restrictions on the proposed scheme”.

“There is significant scope for improved service delivery and reform within the totality of the net determination provided to the executive in 2021, alongside a continued focus on securing greater value-for-money and efficiency at a system level and the local procurement level.”

— Stephen Donnelly TD, Minister for Health

Within the letter, the Minister also outlines Government priorities for the increases in both net non-capital expenditure and net capital expenditure. Two of the most notable increases within the record healthcare budget were the extra €534 million and €181 million in net non-capital expenditure and net capital expenditure respectively. The letter starts the legal timeframe for the HSE to draw up the plan and submit it to Donnelly, which must be done by late November or early December 2020 but has not yet been published at the time of writing. The letter also notes that €261.6 million is being held for specific new initiatives.

“There is significant scope for improved service delivery and reform within the totality of the net determination provided to the executive in 2021, alongside a continued focus on securing greater value-for-money and efficiency at a system level and the local procurement level,” Donnelly wrote.

Relatedly, the measures contained within the National Service Plan and the HSE’s Winter Plan have been touted as the solution to the issue of Covid-19’s impact on cancer diagnosis service. The HSE has estimated that up to 2,000 diagnoses may not have been made in 2020 due to the impact of the pandemic on cancer service and patients presenting.

Despite significant drops in lung, breast and prostate cancer clinics in March and April, breast clinics have now outstripped 2019 attendance figures. Attendances at prostate clinics fell to 40 per cent of 2019 levels but have since recovered to 76 per cent. Risteárd Ó Laoide, the national director of the National Cancer Control Programme, said that the HSE had diagnosed 90 per cent of breast, lung and prostate cancers compared to 2019 levels, which equated to 371 “lost cancers” in these categories. Surgical oncology also dropped to 31 per cent of 2019 levels but has since returned to 71 per cent.

Ó Laoide said that, pre-Covid, clinics were “running at full speed… now they have two stones on their back and they’re continuing to run at full speed to provide the service”. “The most important thing that we’ve been trying to do is efficient and effective triage of patients who are referred. This is very important because this is seeking out the most urgent case which need to be seen quickly,” he said.

Ó Laoide added that there is “significant funding” in both the Winer Plan and the National Service Plan for cancer services that will help the HSE deal with the issue.

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