1. Tony O’Brien, Director General
National Service Plan
2017
Tony O’Brien, Director General

2. Welcome
2017
National Service Plan

3. Population Changes
2017
National Service Plan
Population is set to increase by 0.7% between 2016 and 2017
and is projected to increase by 4% by 2022
Between 2016 and 2017
3.7% increase in those aged 85 years and over

4. 2016 – What We Have Delivered
2017
National Service Plan
478,500
1.7m
Hospital Discharges
No. of patients seen for therapy in primary care
3.34m
OPD attendances
People with a medical card
GP Visit Cards
8,170
28,875
Home Help Hours delivered to 49,000 older people
Older people in residential settings
23,100
Ambulance Emergency Responses
People with disabilities provided with a residential place
Adults seen by the mental health services
309,500
17,790
Children seen by CAMHs services
1.5m
PA hours provided to adults with a physical and / or sensory disability
27,000
No. of CIT contacts
10.57m
Outturn ?
This means outcome, could we use that word instead as its plainer English and possibly more personable than the agricultural outturns.
No afraid not – these aren’t outcomes but estimated volumes of service provided – we could say ‘What we have delivered’ and not bother saying this is based on estimates to the end of the year.
Likely to change in final set presented in annual report – that is the risk of not pointing out they are estimates! 4

5. 2017 Priorities Improving the quality and safety of our services
National Service Plan
Improving the quality and safety of our services
Improving the health and wellbeing of the population
Providing care in a more integrated way
Programme for Health Service Improvement
Developing a performing and accountable health service
Developing our business supports and infrastructure
Implementing eHealth Ireland
Implementing the Health Services People Strategy , Leaders in People Services

6. Health Service Reform Integrated Care
Continue to implement integrated care programmes for chronic disease prevention and management, older people, children, and patient flow
Continue to work with service users, medical colleges and nursing and therapy leads to develop and implement processes that will improve the way in which care is provided
Health Service Improvement
Support the decisive shift of service to primary care
Support local service improvement programmes
Develop programme offices in each of the service delivery organisations
Continue the development of the new Children’s Hospital
Continue to develop the way in which our corporate ‘centre’ relates to Hospital Groups, CHOs and NAS
Why are we using reform here and improvement in other contexts. Suggest Slide be called Health Service Improvement and the order be rearranged with the improvement bullets coming first with no sub heading and the integrated care points as they are moved to the bottom of the slide.
Agree

7. Budget 2017 Total revenue budget available in 2017 is €13,948.5m
National Service Plan
Total revenue budget available in 2017 is €13,948.5m
Increase on revised budget 2016 of €458.6m (3.4%)
Full year effects of 2016 developments - €72.9m
Pay rate funding to support existing level of staff - €118.1m
Non-pay and demographics costs - €186.3m
Expanding existing & developing new services - €81.3m
Within the €13,948.5m, €36.5m is being held by the DoH to fund specific initiatives
Separately, a provision of €439m in capital funding will be made available to the HSE in 2017, comprising €384m for building, equipping and furnishing of health facilities and €55m for ICT.

8. Approach to Financial Risk
2017
National Service Plan
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 and the progression of a community costing framework

9. Expanding and Developing Services - €81.3m
2017
National Service Plan
Expanding and Developing Services - €81.3m
Acute Division - €9m
NAS and Emergency Management - €1m
Primary Care- €12m
Social Inclusion- €1.5m
Mental Health- €15m
Disability Services - €11.8m
Services for Older People- €10m
PCRS - €20m
National Services - €1m

10. Funding Held Department of Health 2017 - €36.5m
National Service Plan
Funding Held Department of Health €36.5m
Primary Care: €18.5m for service developments including reduced prescription charges for > 70s
Mental Health: €15m to initiate new developments in 2017 with a recurring full year value of up to €35m
Social Inclusion: €3m to invest in services relating to addiction
Can we express this more clearly. What is funding held? Is there a simpler way of saying it ?

11. 2017
National Service Plan
Quality and Safety

12. €13.1m
Quality and Safety
We will establish a 3 year patient safety programme to:
Develop the capacity of Hospital Groups, CHOs and NAS to manage safety and risk and improve quality
Plan, oversee and ensure clinical leadership for targeted safety initiatives including Healthcare Associated Infections
Implement the new National Standards for the Conduct of Reviews and Patient Safety Incidents
Implement the revised Integrated Risk Management Policy
Strengthen accountability for safety, risk and quality by building capacity for gathering and analysing safety information and audit, including clinical audit

13. 2017
National Service Plan
Health and Wellbeing

14. Health and Wellbeing Budget 2017:
€233m
Health and Wellbeing
Budget 2017:
€233.3m for Health and Wellbeing (increase of 4.2%)
Expected activity includes:
155,000 women having a complete Breastcheck mammogram
242,000 women having one or more smear tests
106,875 satisfactory BowelScreen FIT tests
87,000 screenings for Diabetic RetinaScreen clients
13,000 smokers receiving intensive cessation support
2,440 people having completed a structured patient education programme for diabetes
33,000 official food control planned, and planned surveillance, inspections

15. Health and Wellbeing
Improve research capability and continue to assess the health needs of the population as part of designing services to promote good physical and mental health
Integrate illness prevention, early detection and self-management into our services through initiatives such as Making Every Contact Count and Self Management Support
Implement programmes to reduce the burden of chronic disease across the policy priority areas of Tobacco, Alcohol, Healthy Eating Active Living, Healthy Childhood, Sexual Health, Positive Ageing and Mental Health
Deliver Healthy Ireland actions through the development and implementation of Hospital Group and CHO Healthy Ireland plans
Population health protection and capacity building for prevention, surveillance and management of HCAIs
Cross-sectoral partnerships to improve health outcomes and address health inequalities

16. 2017
National Service Plan
Primary Care

17. €3.6bn
Primary Care
Budget 2017:
€808m for Primary Care Services (increase of 4%)
€2.6bn for PCRS (increase of 0.2%)
€133m for Social Inclusion (increase of 2.6%)
€76.5m for Palliative Care (increase of 1.2%)
€21.5m DoH held funding for service developments including reduced prescription charges for >70s and addiction services
Expected activity includes:
32,861 CIT Patient Referrals
1.5m therapy treatments in Primary Care
9,700 opioid substitution treatments (outside prisons)
3,620 patients receiving specialist palliative care treatment in their normal place of residence
1.7m medical card holders covered

18. Primary Care
Improve quality, safety, access and responsiveness of primary care services to support the decisive shift of services to primary care
Improve health outcomes for the most vulnerable in society including those with addiction issues, the homeless, refugees, asylum seekers, Traveller and Roma communities
Improve access, quality and efficiency of palliative care services
Reimburse contractors in line with health policy, regulations and within service level arrangements governing administration of health schemes
Process applications for eligibility (under PCRS) within agreed timelines
Strengthen accountability and compliance across all services and review contractor arrangements

19. 2017
National Service Plan
Mental Health

20. €853m
Mental Health
Budget 2017:
€853m for Mental Health (increase of 3% on 2016 closing budget)
Above includes :-
€15m DoH held funding for additional spending in 2017 for enhanced services up to €35m on a full year basis;
€9.4m to stabilise growing pay cost to provide existing level of service.
National Forensic Service :
Significant Capital Investment in 2017 with Contact to be signed in Q1
Expected Activity (Examples):
18,496 children attending CAMHs
74 CAMHs inpatient beds
335 admissions to CAMHs acute inpatient beds
39,321 adult referrals seen by mental health services
13,104 admissions to adult acute inpatient units
10,013 psychiatry of old age referrals seen by mental health services

21. Mental Health
Promote the mental health of the population in collaboration with other services and agencies including reducing the loss of life by suicide
Design integrated, evidence-based and recovery focused mental health services
Deliver timely, clinically effective and standardised safe mental health services in adherence to statutory requirements
Ensure that the views of service users, family members and carers are central to the design and delivery of mental health services
Enable the provision of mental health services by highly trained and engaged staff and fit for purpose infrastructure

22. 2017
National Service Plan
Social Care

23. €1.7bn
Older People
Budget 2017:
€765m for Services for Older People (increase of 3.6%)
€940m for Nursing Homes Support Scheme (NHSS)
Expected activity includes:
Provide additional 496 places under NHSS(Fair Deal) to over 23,603 people
Maintain 2016 outturn of 10.57m home help hours
Provide an additional 300 Home Care Packages increasing the number of recipients to 16,750 people through the Winter Initiative
Maintain 190 Intensive HCPs included 60 funded by Atlantic Philanthropies
Provide 152 approvals per week for transitional care and 167 in January and February 2017

24. Older People
Continue to implement a reform and improvement programme in home care and short stay residential care
Provide each CHO with an audit and quality team to support home care reform
Continue to rollout SAT and share learning's of the Integrated Care Teams as part of the ICP OP
Continue to implement the National Dementia Strategy and the overall investment programme of €27.5m

25. Disability Services Budget 2017:
€1.7bn
Disability Services
Budget 2017:
€1.69bn for Disability Services (increase of €96.3m or 6%)
Expected activity includes:
Emergency Cases – (€16.2m supporting 395 people)
New Residential Emergency places – 185
New Home support/in home respite for emergency cases – 210
Home Support – PA Hours (€5.5m to maintain ELS in mainstream services)
€5.5m additional budget to maintain ELS ,000 hours over 2016 target.
Emergency Cases funding stream will support remaining 250,000 hours over target as part of new person centred initiative.

26. Disability Services
New Directions including School Leavers (€10m Supporting 1,500 People)
Provide day service support for approximately 1,500 people leaving school/rehab training
“Time to Move on from Congregated Settings” (€100m Capital Programme)
223 People will move to Community Living additional homes purchased
Service reform fund (€45m over 3 years) - supporting transition and innovation
Commitment to stakeholder consultation and engagement
Neuro Rehabilitation Strategy
Framework for Neuro rehabilitation Strategy completed & an innovative pilot day service aimed at supporting people with severe acquired brain injury
National Policy on Safeguarding Vulnerable Persons at Risk of Abuse

27. Pre-Hospital Emergency Care
2017
National Service Plan
Pre-Hospital Emergency Care

28. National Ambulance Service
Budget 2017:
€155m for NAS
Expected activity includes:
315,000 emergency ambulance calls
5,589 clinical status 1 ECHO calls activated
125,985 clinical status 1 DELTA calls activated
30,503 inter-hospital transfer calls
26,846 intermediate care vehicle transfer calls

29. National Ambulance Service
Improve operational performance and outcomes for patients
Provide a flexible, safe, responsive and effective service to meet planned alternative models of patient care
Enhance clinical competencies and governance arrangements to improve quality of care and patient safety
Play an active role in improving the health needs of the population
Deploy the most appropriate resources safely, quickly and efficiently

30. 2017
National Service Plan
Acute Services

31. Acute Hospital Care Budget 2017:
€4.4bn
Acute Hospital Care
Budget 2017:
€4.367bn for Acute Services (increase of 2.8%)
€78.4m for National Cancer Control Programme (increase of 9.7%)
Expected activity includes:
1.7m inpatient and day cases
1.2m new Emergency Department attendances
3.4m new and return outpatient attendances
18,000 patients triaged as urgent presenting to symptomatic breast clinics
3,300 patients attending rapid access lung clinics
2,600 patients attending rapid access prostate clinics

32. Acute Hospital Care
Ensure Hospital Groups have clear structures to govern and deliver quality care
Monitor and control healthcare associated infections (HCAIs)
Increase critical care capacity
Improve inpatient flow with continued focus on delayed discharges in partnership with social care services
Continue to improve patient experience times in EDs
Improve access to urgent and planned care by increasing efficiencies, streamlining processes and maximising capacity in hospitals
Implement the National Maternity Strategy 2016–2026
Implement the new cancer strategy

33. 2017
National Service Plan
Thank you