Minister for Health publishes Sláintecare Progress Report 2022 and Action Plan 2023

• 2022 highlights include: Sláintecare Consultant Contract; Public Hospital Inpatient Charges for Children Abolished; Elective Hospitals Approved in Principle; Waiting Lists Reduction of 11% for those exceeding Sláintecare Maximum Wait Times; Free Contraception Scheme; Increasing capacity (hospital and critical care beds); Additional frontline health and social care staff
• 2023 areas of focus include: Enhanced Community Care programme; Waiting List Action Plan; Workforce Planning; Regional Health Areas; Surgical Hubs; eHealth

The Minister for Health Stephen Donnelly today published the Sláintecare Progress Report 2022 and the Sláintecare Action Plan 2023.

Minister for Health Stephen Donnelly said:

The Sláintecare Progress Report 2022 sets out the very significant progress in improving access, affordability and quality in our health and social care services and in the measures taken that are making an immediate impact on the lives of patients, as well as working to deliver foundational longer-term change that will significantly enhance overall capacity and patient centred care.

This progress made last year was underpinned by the highest investment in health and social care in 2022 and 2023 in the history of the State. It enabled investment in innovation and the delivery of integrated services, by investing in people, new care pathways, new technologies, new facilities and new ways of working that will enable us to better respond to the growing health needs of our population.

The Sláintecare Action Plan 2023 looks to build on the very real progress made. In addition to the Sláintecare Implementation Strategy & Action Plan 2021-2023, it is aligned to the Programme for Government, the HSE’s National Service Plan and key policies, national strategies and initiatives. The focus in 2023 will continue to be on improving access, outcomes and affordability for patients by increasing the capacity and effectiveness of the workforce, infrastructure and delivery of patient care.

Sláintecare Progress Report 2022 - Key Highlights (Sláintecare and Programme for Government)

Regional Health Areas: Government approval was given, in April 2022, on next steps, the programme of work, and timelines for Regional Health Areas (RHAs) implementation.

Waiting Lists: Overall reductions were complemented by significant reductions in waiting times. In 2022, the overall number of patients exceeding the Sláintecare maximum wait time targets recommended in the 2017 Oireachtas Report (10 weeks OPD, 12 weeks IPDC / GI Scope) decreased by 11%.

The new Sláintecare Consultant Contract was approved by Government in December 2022.

Expansion in eligibility including:

• acute public in-patient charges for children under 16 years were abolished in all public hospitals from 21 September 2022
• funding allocated in Budget 2023 to provide for the abolition of all public inpatient hospital charges

Elective Hospitals received formal government approval-in-principle for the Preliminary Business Case for the Programme as well as the Project-level Business Cases for Cork and Galway.

2,400 healthcare workers have been recruited to the Enhanced Community Care (ECC) Programme, establishing 94 of the planned 96 Community Healthcare Networks (CHNs) and 21 Community Specialist Teams for Older Persons and 21 specialist teams for Chronic Disease Management.

The GP Direct Access to Diagnostics scheme provides a direct referral pathway for GPs to allow their patients access diagnostic scans. It delivered over 250,000 diagnostics in 2022.

Sláintecare Progress Report 2022 Key Highlights (additional Programme for Government)

A total of 970 additional acute beds have been delivered since January 2020. Latest figures from the HSE confirm that there are 14,508 beds in acute settings (including obstetrics and psychiatric beds) against a target of 13,600 beds identified in the Health Service Capacity Review.

Critical care capacity now has 323 beds, which represents an increase of approximately 25% over the 2020 baseline of 258 beds. This also means that Phase 1 of the Critical Care Strategy is now delivered and progress underway to deliver Phase 2.

There are 17,298 more WTE working in our health service than there were in January 2020 – this includes an additional 4,592 nurses and midwives, 2,654 health & social care professionals and 1,758 doctors and dentists.

Waiting Lists: Without the intervention of the 2022 Waiting List Action Plan, active hospital waiting lists would have increased by 42% to over 1 million people. Instead, there were c.1.56 million patients removed and c.1.53 million patients added to hospital waiting lists during 2022 – a net reduction of c.30,000 people (4.1%) to c.690,000.

Expansion in eligibility including:

• a free contraception scheme for women aged 17-25 was launched on 14 September 2022 and will be expanded to 26-year-olds on 1 January 2023
• the Drug Payment Scheme threshold was reduced twice in 2022. From €138 per month in 2018, the threshold has now reduced to €80 per month
• a free national STI home-testing scheme was introduced by the HSE in October 2022

21.02m of home support hours were delivered in 2022.

The National Stop Smoking Clinical Guideline was published in January 2022.

Sharing the Vision Implementation Plan 2022 – 2024 was published in March 2022.

Major Trauma Centre services commenced 2022 at the Mater Misericordiae University Hospital and on track to start at Cork University Hospital from early 2023.

The National Forensic Mental Hospital in Portrane opened in November 2022.

€11 million in 2022 secured 149 Advanced Nurse and Midwife Practitioner new additional posts for the health service.

The 1st National Nursing Home Experience Survey was launched in March 2022 and results were published in November 2022.

Health Performance Visualisation Platform (HPVP) phase 1 was deployed to 19 hospitals.

A Framework for the design and delivery of post-natal hubs was finalised and approval for the development of five hubs at Kerry, Kilkenny, Cork, Sligo and Portiuncula was agreed.

The Traveller Health Action Plan was launched on 28 November 2022.

Agreement for additional undergraduate places in medicine from September 2022 onwards was reached

with Irish Medical Schools.

Sláintecare Action Plan 2023 - Key areas of focus for 2023

Enhanced Community Care: The Enhanced Community Care (ECC) programme of reform represents a population-based approach to the expansion of primary and community care and, importantly, its integration with the acute hospital sector, providing health services closer to people’s homes and reducing pressure on acute hospitals.

By the end of 2022, 94 of the 96 Community Healthcare Networks (CHNs) and 21 of 30 Community Specialist Teams for Older people and 21 of 30 CSTs for Chronic Disease Management had been established under the Programme. It is expected that all CHNs and CSTs will be established in 2023. It is projected that the impacts of these networks and teams over a full year will enable between 16,000 and 21,000 ED avoidances.

Waiting Lists: The 2023 Waiting List Action Plan developed by the Department of Health, HSE and NTPF will allocate €363 million in funding to deliver ambitious targets for sustained reductions in acute scheduled care waiting lists and waiting times, as well as progressing longer-term reforms. This is part of the total of €443 million allocated to addressing waiting lists in Budget 2023, with the other €80 million funding various community/primary care initiatives.

The 2023 Waiting List Action Plan is the continuation of a multi-annual approach to reducing and reforming waiting lists. It will build on the momentum delivered in 2021 and 2022 to reduce waiting list backlogs and waiting times, and sustainably close the capacity gaps in specialties and hospitals that create unacceptably long waiting lists.

Workforce Planning: The department is currently focused on the development of the Health and Social Care Workforce Strategy and Action Plan and Planning Projection Model. This will provide demand and supply projections of numbers required in medicine, nursing and HSCPs spanning short- (3-5 years), medium- (5-10 years) and long-term (18-20 year) time horizons.

Work is currently underway to advance model development. The main challenge concerns unanticipated delays on data access and constraints on data coverage. Initial workforce planning projections are due to be completed in Q3 of 2023. The key outcome of this work is that the department will have the tools, processes, and technical capacity to produce rolling health and social care workforce planning action plans and implement targeted policy measures for health and social care workforce reform.

Regional Health Areas (RHAs): The government is committed to the implementation of Regional Health Areas (RHAs), as outlined in the Programme for Government. A memorandum on next steps, programme of work, and timelines for RHA implementation was approved by Government in April 2022. A draft of the detailed Implementation Plan is currently being reviewed and refined. The Implementation Plan will contain a summary of the rationale for RHAs, descriptions of the relative roles of the forthcoming RHAs, the HSE Centre and the Department of Health and will set out the clear, practical steps that will be taken for implementation. It will pave the way towards implementation of the RHAs from 2024.

Sláintecare Consultant Contract: The new Sláintecare Consultant contract will be introduced. The contract will only permit holders to engage in public care within the public hospital system and is central to the delivery of the goal of universal, single-tier healthcare in Ireland.

Elective Hospitals: The National Elective Ambulatory Strategy agreed by Government in December 2021 will continue to be implemented through government approval of a Preliminary Business Case for Dublin and progressing the development of new elective hospitals in Cork, Dublin and Galway through the detailed design, planning and procurement phase of the elective hospitals programme in line with the Public Spending Code.

In parallel, the development of new surgical hubs in Cork, Limerick, Galway, Waterford and Dublin will be progressed.

Sláintecare Integration Innovation Fund (SIIF): Projects selected under Round 2 of the SIIF to test innovative care pathways/initiatives and eHealth transformation solutions are underway. These projects will be progressed during 2023 and a launch of Round 3 of the SIIF fund is planned for quarter 3.

eHealth: Sláintecare highlighted the need for investment in digital health solutions and electronic health records as key enablers for reform of the health service. Through successive budgets over recent years and again in 2023, funding has increased significantly for digital health to hire additional staff, expand systems and licensing and to build cyber resilience, and to progress the journey to facilitate integrated electronic health records as recommended under Sláintecare. The department and the HSE are working on the following initiatives:

• the development of a new Digital Healthcare framework 2023-2027 to succeed the eHealth Strategy published in 2013 is well underway. It will take on board experience from other countries, developments in the digital health industry, the expectations of patients and healthcare professionals, the fact that the population and patients are now better connected, government policy under the Harnessing Digital Strategy, EU and international obligations. It will align with Government’s Digital policy “Harnessing Digital” and set the roadmap for digital health in Ireland for the next decade
• the development of a Health Information Bill is well advanced. The Bill seeks to ensure Ireland has a fit for purpose national health information system to enhance patient care and treatment and support better planning and delivery of health services. Additionally, it will result in better research and innovation due to an increase in the availability of health information. The Bill will also provide for the appointment of a National Health Information Guardian and provisions to strengthen the rights of individuals in relation to their health information; a standards based approach to health information, and; support the establishment of a National Health Information Authority to play a strategic leadership role in the transformation of the health information systems and to enhance access and use of health information for primary and relevant purposes
• progress by HSE continues in 2023 to support a digital workplace. Following the criminally motivated major ransomware attack in May 2021 that saw widespread disruption, arrangements were established with 24/7 enhanced cyber security operations monitoring. The HSE continues to strengthen its cyber resilience and is rolling-out a prioritised cyber work programme
• 2022 also saw the HSE maintain eHealth and digital innovations including major national systems and patient digital engagement deployed in response to COVID-19 and it continues to roll-out a comprehensive programme of key clinical and enterprise technology solutions to support the delivery of health services
• the provision of Electronic Health Records (EHR) Systems for the New Children’s Hospital is underway with a contract signed with an international vendor following approval by Government in July 2022. This will be the most extensive EHR deployment in Ireland and builds on the success of EHR programmes at the largest maternity hospitals and at St James Hospital, Dublin. The new Digital Health Strategic framework will present options setting out a roadmap for the Shared Care record programme as an essential enabler to delivering Summary and Shared Care Records and also the approach to deploying plan to enable health professionals and patients access to electronic health records and interoperability with existing systems