Minister for Health Stephen Donnelly Publishes the Sláintecare Progress Report 2021-2023

Minister for Health Stephen Donnelly has published the Sláintecare Implementation Strategy & Action Plan 2021 - 2023 Final Progress Report.

This report highlights the unprecedented progress being made in transforming our health and social care services to provide the Right Care, in the Right Place, at the Right Time.

Aligning with the Programme for Government commitment, record levels of investment has enabled the delivery of new care pathways, new facilities, new technologies and new ways of working that will enable health and social care professionals to respond to the growing health needs of our population. There has been an expansion of primary care capacity and community services to ensure that patients are treated in their locality or as close to their homes as possible.

Minister Donnelly stated:

"Significant progress has been achieved to ensure our health and social care services are treating more patients than ever before. The significant public investment, including in our community and primary services means that more people are being treated at home and in the community.

"We now have 96 Community Health Networks in place to support integrated care across primary, acute, and community care. For example, the Bray Integrated Care Hub is delivering a range of chronic disease and older persons specialist services in the community. GPs in the area can refer patients directly for pulmonary testing in the community, reducing waiting lists for respiratory consultants in hospitals and allowing patients to be tested faster and closer to home. A total of 904,857 GP directly referred community diagnostics were carried out over the last 3 years.

"We have Community Intervention Teams (CITs) across the country, which are providing enhanced services in the community in support of the overall primary care system, providing access to nursing and home care support. The CITs provide a range of services including the administration of home IV antibiotics, acute anticoagulation care, acute wound care and dressings, enhanced nurse monitoring following fractures and falls. The CITs are preventing unnecessary hospital admission or attendance, and facilitating early discharge of patients for whom CIT care is appropriate.

"We have been making positive progress in relation to our waiting list performance in recent years. The 2024 Waiting List Action Plan which we published in March 2024 will continue the positive progress. Facilities like the Ambulatory Gynaecology clinic in Sligo University Hospital are making a real difference to the women of Sligo and the Northwest.This clinic has already had a positive impact on the outpatient waiting list figures for Sligo University Hospital. Sligo is one of sixteen "see and treat" gynaecology clinics operational across the maternity network.

"More people are eligible for free access to our health and social care services than ever before which is moving us closer to universal health and social care. Eligibility for a GP visit card has been extended to over half a million people in 2023, including free GP care to people earning no more than the median household income. We are focused on building an equitable and world class health and social care service, where people access service on the basis of need, rather than ability to pay, and our talented health and social care workers are supported to provide the best service possible to the people of Ireland."

Minister Donnelly noted that:

"We have much more to do but I am very pleased to present this 3-year progress report setting out the detailed programmes that have been delivered or progressed and the tangible and significant improvements that are delivering better health services to patients and the public, on our road to delivering Universal Healthcare for all."

Notes to Editors:

Improving Access

• Waiting List Action Plan - A 32% reduction in patients waiting longer than 12 months was also achieved in 2023.
• The number of patients on trolleys in 2023 is down versus 2022- a 22% reduction for the second half of 2023 versus the same period in 2022.
• A total of 63.62 million home support hours provided between January 2021 and December 2023.
• There are now 174 Primary Care Centers in operation - up from 138 in 2020.

Expanding Eligibility & Affordability

• Expansion of GP Visit Card - Eligibility for a GP visit card has been extended to over half a million people in 2023, including free GP care to people earning no more than the median household income. Consequently, more than half the population are now eligible for either a medical or a GP visit card.
• Abolition of Public Hospital In-Patient Charges - public hospital in-patient charges for adults were abolished in April saving patients up to €800 per year. They were abolished for children under-sixteen in 2022.
• Free Contraception - the free contraception scheme was introduced in September 2022 and extended throughout 2023 and is available to all women aged 17 - 30. Access to free contraception further expanded to include women aged 31 from January 2024. Approximately 189,000 women availed of the scheme in 2023.

. *A state-funded IVF scheme launched in 2023.

Increasing Capacity

• Beds - Since 2020, this government has opened 1,182 new acute inpatient beds. A further 91 acute beds are planned to open in 2024. In addition, circa 250 Acute beds are either under construction or have funding commitments to progress to construction over the next number of years. 330 critical care beds are now available, 72 more beds than in March 2020.
• Workforce - As of end of December 2023, the total workforce stood at 145,985 staff working in our health service. The report details a 26,000 increase in healthcare workers to the end of December. Numbers have increased again since then. Employment levels at the end of March 2024, show there were 148,293 WTE (equating to 166,997 personnel) directly employed in the provision of Health & Social Care Services by the HSE and Section 38 hospitals & agencies.
• New Elective Hospitals are planned in Cork, Galway, and Dublin - currently in design phase.
• In addition to Elective Hospitals, the government also approved the development of Surgical Hubs in Cork, Galway, Limerick, Waterford and Dublin. Locations have been identified and planning applications made for surgical hubs in Cork, Dublin, Galway, Waterford and Limerick.
• The National Forensic Mental Hospital in Portrane opened in November 2022.
• Enabling works for the National Maternity Hospital have commenced and the tender process for the full build is underway.
• Major Trauma Centre services commenced at the Mater Misericordiae University Hospital and Cork University Hospital in 2023.
• GP training places - The number of doctors entering GP training has been increased significantly in recent years, with 286 new entrants in 2023 and 350 places for new entrants for this year. Annual intake to the GP training scheme has been increased by over 80% from 2015 to 2023, and the number of new entrant places to be available this year is a 22% increase on last year's intake. In addition, GP recruitment is ongoing under the joint non-EU GP Training Programme between the HSE and Irish College of General Practitioners (ICGP). 112 non-EU GPs were recruited last year under the training programme and it is planned to recruit up to 250 more non-EU GPs to Ireland this year. The placement of GPs under the programme is targeted to rural and underserviced areas. Internal DoH statistical analysis indicates that between 1.5 and 3.1 GPs will exit training for each retiring GP over the coming years.

Reform

• We are restructuring our health and social care service through the establishment of the HSE Health Regions to enable the provision of better and more integrated care along regional lines. HSE Health Regions Implementation Plan was published in July 2023 - Six Regional Executive Officers have now been recruited and are in place.
• Enhanced Community Care (ECC - We are expanding our primary care capacity and community services to ensure that patients are treated in their locality or as close to their homes as possible. Community Specialist Teams for Older Persons (ICPOP) are seeing complex and more frail patients urgently and that most such cases are discharged home as opposed to going to acute hospital. The Chronic Disease Management (CDM) Community Support Team (CST) programme shows that more people with chronic disease are being managed at GP practice and in the community by these teams, who would otherwise be seen in the acute setting.
• Since January 2021, GPs can directly refer their patients for scans and diagnostic tests- a total of 904,857 GP directly referred community diagnostics were carried out over the 3 years.
• Removing Private Care from Public Hospitals - Public-only Consultant Contract - Introduced on the 8 March 2023. The new Contract means that there will be more senior decision-makers in our hospitals out of hours and at weekends. This is delivering on the Government's commitment to phase out private practice from public hospitals. By the end of 2023 1472 consultants representing 35% of all consultants had signed up to the new contract. As of 24 April, 2195 consultants had signed, including 462 new entrants.

Quality & Safety

• Sláintecare Integration Innovation Fund (SIIF) - €46.6 million was committed to 143 projects through three rounds of funding from the SIIF, a ring-fenced fund designed to test and evaluate "proof of concept" and new ways of working to deliver better services. 106 of these projects were successful and are now receiving permanent funding while 20 are still in testing phase.
• Healthy Ireland Strategic Action Plan 2021 - 2025 launched providing a clear roadmap of how we can continue to work together to bring about good health and wellbeing, healthy environments and the promotion of resilience to ensure that everyone can enjoy physical and mental health and wellbeing to their full potential.
• Stakeholder Engagement - significant engagement with service user, patients, and workforce groups has been carried out.

Background

The 2017 Oireachtas Committee on the Future of Healthcare in Ireland set out the policy direction for the reform of our health services. The Sláintecare vision is for a universal health and social care system where everyone has equitable access to services based on need and not the ability to pay - the Right Care, in the Right Place, at the Right Time, with the Right Team. Sláintecare is the most significant reform programme of Ireland's health and social care sector in the history of the State.

The foundation for this reform was progressed based on the Sláintecare Implementation Strategy 2018, which set out key reforms to be implemented, based on the Oireachtas report over a three-year period. The Programme for Government (PfG) provided significant funding to support and direct the second phase of implementation as set out in the Sláintecare Implementation Strategy & Action Plan 2021-2023. €1.235 billion was allocated by government in 2021 to support Sláintecare reforms. This report sets out the progress made with these government supported reforms over the period 2021-2023.

Building on the first three years of progress and the learnings and response to COVID-19, the Sláintecare Implementation Strategy & Action Plan 2021-2023 called out two high level priority areas, namely:

1. Improving Safe, Timely Access to Care, and Promoting Health & Wellbeing; and

2. Addressing Health Inequalities-towards Universal Healthcare.

These priority programmes had eleven associated projects to deliver on tangible outcomes for patients over the three-year period. The reforms in this plan were delivered against the challenges of COVID-19 and the cyber-attack in May 2021. The record level of investment provided by government for reforms in the 2021 and subsequent budgets supported key initiatives associated with the two priority programmes including innovation, the delivery of integrated services, investment in people, new care pathways, new technologies, new facilities, and new ways of working aligned with the PfG priorities.