Unprecedented National Service Plan budget

Having been expected in November 2020 but delayed until February 2021 amid the pandemic and other considerations, the publication of the HSE’s 2021 National Service Plan details an “unprecedented” increase of allocation by €3.5 billion.

The €3.5 billion increase for the 2021 National Service Plan brings the total amount of funding allocated to the HSE for 2021 to €20.6 billion and represents an increase of 21 per cent on the funding level of the 2020 National Service Plan.

€1.68 billion of the €3.5 billion increase is to be allocated to Covid-19 spending, with the remaining €1.8 billion representing an underlying increase of 10.6 per cent in health spending, itself an increase on the 7.3 per cent average annual increase recorded between 2016 and 2020. €1.1 billion of this €1.8 billion is dedicated to the delivery of “permanent enduring improvements in healthcare arising from the Sláintecare reform programme”; the remaining €700 million of the non-Covid related increase is “to cover the increased costs of providing existing levels of service which have increased due to demographics changes and various cost increases”.

Paul Reid, CEO of the HSE, said: “This significant investment represents the trust that the Government and the public have placed in us after a year in which our staff have gone above and beyond to do all they can to keep people safe and healthy. The last 12 months have brought very rapid changes in how we provide healthcare, and we intend to use the best of the changes coupled with the new investment to sustainably transform how we deliver healthcare in Ireland.”

The National Service Plan is the annual document that sets out the type and volume of health and personal social services to be provided by the HSE within a given year. Typically issued before the turn of the year into the year covered by the report (i.e., the 2020 version was published in December 2019), this year’s version suffered delays and was not published until late February.

The 2021 plan “provides for additional spending to improve many services including those in the areas of cancer, maternity and mental health”. It provides for the addition of 16,000 staff above December 2019 levels, which includes 1,100 medical and dental staff, over 3,500 nurses and midwives and 4,000 health and social care professionals.

With the Service Plan arriving in the midst of the Covid-19 pandemic, it is a given that healthcare measures to combat the pandemic would dominate the content of the Plan. Section 2 of the Plan comprises the HSE’s Covid-19 Action Plan, which includes plans for the procurement of PPE, a national operating model for testing and tracing and the Covid-19 vaccination programme.

On the procurement of PPE, the Plan pledges to: build and deliver a “dedicated, stable and responsive PPE supply and distribution service”; deploy a long-term procurement solution for the provision of PPE to healthcare services; conclude an independent audit of both the sourcing and management of PPE; and work with the Department of Health and Irish Government Economic and Evaluation Scheme to develop the PPE procurement demand forecast.

The national operating model for testing and tracing includes a pledge to deliver a daily capacity of 25,000 tests and to implement a national Virus Reference Laboratory Covid-19 offsite at Backweston, County Kildare in order to provide capacity and resilience. In terms of the vaccination programme, the plan says that it “expects vaccines to continue to be approved by the European Medicines Agency with increasing supplies being made available by manufacturers to Ireland”.

The vaccination rollout in the plan is broken into three phases: initial rollout; mass ramp-up; and open access. No timeline or figure specifications are given as to how to judge the need of one phase and the beginning of the next but given the opening of mass vaccination centres in February, the plan appears to have progressed to the second phase. The third phase, open access, will begin when there is “a large volume of vaccines available for the population and that vaccine storage and administration requirements will be simpler than early vaccines”. When such arrangements are in place, said vaccines will be delivered through mass vaccination centres, GPs and pharmacies.

In terms of the implementation of Sláintecare, the Service Plan is to be delivered within the strategic framework of the HSE Corporate Plan 2021–2024, which includes objectives such as early intervention and the enhancement of community services in order to reduce the need for people to attend hospital that are central to the Sláintecare model.

The plan pledges “whole-system reform”, stating that this is “critical if we are going to address the long-standing challenges of our health service”. Challenges specifically mentioned as being in need of transformation include: long waiting lists for scheduled care in hospitals; long waiting times in emergency departments, especially for older people and those with more complex needs; the functioning of hospitals with high occupancy levels; an overreliance on residential models of care and a lack of services “to enable our gaining population to maintain their independence and live well in the community”; waiting times for mental health services; and a lack of home-based support and person-centred and responsive support for people with disabilities.

The reform programme is said to centre around the enhancement of patient experience, the improvement of service access across primary, community and acute services, increasing the range and capacity of services delivered in community settings, increasing bed capacity and focusing on health promotion.

The HSE states that it expects the following impacts to come from these reform measures: health outcomes in Ireland will equal or better OECD averages; children will have access to an integrated high-quality child health service focused on prevention and early intervention; community services will provide preventative, management and support services for obesity; the health of those most disadvantaged will improve; prevalence of obesity will decrease annually, by 2 per cent for disadvantaged populations; and harmful alcohol consumption will be reduced.