The HSE national service plan, published on Tuesday, is essentially the agreement between the health service and the government on how its multibillion euro budget will be spent.
It sets out the nature and volume of health services to be provided, and the number of staff that will be available to deliver these. However, in reality key parts of the HSE plan are actually written by the Minister for Health who sets out policy priorities for funding in what is known technically as the letter of determination sent each year after the budget to the HSE chairman.
The Irish Times reported last week that Minister for Health Stephen Donnelly in his letter of determination directed that the focus of the HSE leadership this year “must be improved efficiency and increased productivity, as well as the ongoing focus on improving the quality of care”.
“This focus on increased productivity will reduce wait times and deliver better patient outcomes as patients will be seen and treated more quickly.”
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He also pressed for work practice reforms which would involve “a more decisive shift to an extended day and more weekend services”.
Both work practice reforms and productivity feature strongly in the HSE plan for the year.
Donnelly also told the HSE he wanted to see “new and better services” in areas such as cancer, cardiovascular and stroke as well as women’s health and mental health services.
Donnelly said he wanted the HSE to improve rapid access clinic performance for patients with breast, lung, and prostate cancer, to implement the hereditary cancer model of care to enhance and expand screening services such as BreastCheck and BowelScreen and to expand the acute oncology nursing service to aid patients in active treatment to avoid unnecessary attendance in emergency departments.
The Minister also said that funding in primary care was being provided “for the standardisation of the allowance payable to all women, irrespective of eligibility status, toward the cost of post-mastectomy products and hair loss products as a result of cancer-related treatment”. He directed that “this standardisation cannot be to the disadvantage of any existing recipient”.
Donnelly also wanted to see additional stroke consultants, health and social care professionals and psychologists so more patients could access specialised stroke unit care in hospitals and access rehabilitation in their own homes through expanding the early supported discharge team network.
The Minister said it was vital that funding allocated in 2025 ensured timely access to mental healthcare. He wanted to see the HSE’s Child and Adolescent Mental Health Services (CAMHS) enhanced by means of a waiting list reduction initiative, additional staff and a new CAMHS hub.
He also wanted to see the introduction of 18 new beds for national forensic mental health services at the new Central Mental Hospital in Portrane, Co Dublin.
The Minister also directed the HSE to deliver at least 24 million hours of home support for older people, provide for 24,000 Fair Deal residents by the end of 2025, maintain expanded transitional care and complex transitional care and open 615 new or reconfigured community beds.
He also said that funding for new drugs this year would be drawn from the first €30 million of new savings from within the medicines budget.
The government last summer provided the HSE with an additional €1.7 billion as part of a two-year funding agreement. This year it will receive exchequer funding of nearly €27 billion.
The HSE plan says that this additional funding as well as savings envisaged to be generated, brought the amount of money available “substantially in line” with expected costs for 2024.
However the plan also refers to the HSE at national level this year having to focus on “a projected challenge of circa €500 million in relation to a number of issues including working capital adjustment and once-off elements of the two-year (funding) agreement, increments and other savings”.
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