Unprecedented €3.5 bn increase in health service funding

The National Service Plan for the HSE, detailing how it will spend the €20.623 bn allocated to it for 2021, has been published today. The financial allocation represents an increase of €3.5 bn or 21% on the 2020 National Service Plan.

Within the extra €3.5bn for operating costs, some €1.68bn is for COVID-19 spending.

The remaining €1.8bn extra represents an underlying increase of 10.6% in health spending compared to last year, well ahead of the average annual increase of 7.3% received across the years 2016-2020.

€1.1bn of this additional investment is to deliver permanent and enduring improvements in healthcare arising from the Sláintecare reform programme. The remaining €0.7bn of this underlying (ie non-COVID) increase is to cover the increased costs of providing existing levels of service which have increased due to demographic changes and various cost increases.

Mr Paul Reid, CEO, 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.

According to the Chairman of the HSE Mr Ciarán Devane: “COVID-19 continues to pose a risk to ‘normal’ healthcare activities.  We have seen the most extraordinary of responses from both the public and from staff across the HSE during the pandemic. In 2021 we are investing in initiatives that we consider most likely to deliver demonstrable, sustainable improvements to health service performance and delivery. In this regard the NSP is characterised by a marked move towards the delivery of care in the community or at home whenever possible.”

The National Service Plan is the annual document setting out the type and volume of health and personal social services to be provided by the HSE in 2021, in line with priorities set out by the Minister for Health, and the longer-term transformation agenda for health and social care services in Ireland. In particular, this year, it sets out how a number of key Sláintecare reforms will be progressed.

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

It details programmes of work from improving patient safety and keeping the population healthy and well, to supporting people living at home with lifelong conditions.

The allocation for additional COVID-19 related spending includes Personal Protective Equipment, the vaccination programme, testing and tracing and improving access to care.

The plan addresses how to deliver services and functions in 2021 in the context of a global pandemic, and specifically what services are planned for 2021 to control the spread of COVID-19.

According to Mr Reid, CEO, HSE:

The need to adapt our services urgently to the requirements imposed by the pandemic has led to some rapid changes, such as a move to increasing the volume and variety of services provided in the community.  In 2021 we hope to use the additional funding to reinforce and support this move, which is in line with the Sláintecare reform agenda.

The Plan outlines reform measures and their expected impacts in 2021 which include:

• enhancing primary preventive services and partnerships
• reforming our services to better support our growing and ageing population
• delivering care as close to the patient as possible through enhancing primary and community care
• increasing capacity & reforming scheduled / planned care
• mainstreaming appropriate Sláintecare Integration Fund projects
• improving access to mental health services
• supporting the reform of disability services.

The plan also contains sections on improving the patient experience of the health service; improving population health and wellbeing.

Notes

Details of the NSP include:

• The total 2021 operating budget is €20,623m, an increase of €3,524m (21%) on the allocation in NSP 2020.
• Additional investment in new measures and service developments (€1,112m), including:

• €426m for increasing capacity
• €313m for enhanced community and social care services
• €87.5m for disability services and €23m for mental health services
• €89.5m for implementation of national strategies and expert reviews
• €12m for public health
• €78m improving access to care
• €50m introducing new drugs and €33m for eHealth.

• Additional investment in existing levels of service (€705m) including:

• €278m for Primary Care Reimbursement Service (PCRS)
• €12m mental health and €15m disability services
• €131 m for other ELS including demographics

• Additional investment in COVID-19 Programmes (€1,676m), including:

• €450m for personal protective equipment (PPE)
• €200m (initial provisional sum) for the COVID-19 vaccination programme
• €210m for Access to Care fund
• €445m for Testing & Tracing

Community Services: Primary Care:

Significant enhancement in primary and community care through the enhanced community care programme including:

• Establishment of 96 CHNs, providing the foundation and organisational structure through which integrated care is provided locally at the appropriate level of complexity
• Establishment of 32 community specialist teams for older people and people living with chronic disease
• Progress relevant eHealth initiatives
• Expand community diagnostics to improve access for general practice and community specialist teams including access to plain film x-rays, ultrasound, MPRI, CT, ECHO and spirometry with a target delivery of 136,000 additional diagnostic tests
• Continue implementation of the GP Agreement
• Implement a range of initiatives to progress the National Carers’ Strategy

Older People:

• Provide five million additional home support hours and an additional 1,250 rehabilitation and transitional care beds
• Support 22,500 people through NHSS, while maintaining the waiting period for funding at an average of four weeks for 2021
• Continue the implementation of key recommendations from the COVID-19 Nursing Homes Expert Panel Report
• Implement a range of initiatives to progress the National Positive Ageing Strategy and the National Dementia Strategy
• Fully roll out interRAI including the development of operational policies and procedures to inform the planned Statutory Home Support Scheme

Mental Health Services:

• Progress the roll-out of accessible integrated mental healthcare programmes including four crisis resolution teams, four crisis cafes and one respite house, as alternatives to acute inpatient care and ED presentations
• Establish three CAMHS telehealth hubs
• Increase community mental health team staffing in CAMHS by 10% from 2020 levels
• Increase capacity to deliver 6,250 additional counselling hours and a range of talk therapies
• Provide 28 additional beds to enable acute mental health services to respond to COVID-19 and increasing demand

Acute Hospital Care

Increase significantly the bed numbers within acute settings, including:

• 1,146 additional acute beds by the end of 2021
• 135 additional sub-acute beds by the end of 2021
• 66 additional critical care beds, to bring the total number of adult critical care beds to 321 by the end of 2021
• Enhance the delivery of scheduled care services, mitigating as far as possible the impact of COVID-19, through the provision of 98,000 additional outpatient assessments and 36,500 additional inpatient / day-case procedures
• Build capacity and lay the foundations for transforming scheduled care in order to improve access in a targeted and integrated manner

Quality and Patient Safety

• Deliver high quality services through the continued implementation of the Patient Safety Strategy; promote an open and transparent safety culture; improve patient and service user experience across all care settings; and embed a culture of continuous learning
• Strengthen the culture of patient and service user partnership through involvement in the planning, design, delivery and evaluation of services, enabling collaborative working with people who use our health service
• Ensure progress with key service strategies (including Cancer, Maternity, Paediatrics and Trauma)
• Provide access to recommended, evidence-based medicines in a timely fashion within available resources, in line with the IPHA agreement

Population Health and Wellbeing

• Continue to support chronic disease prevention and self-management
• Augment community healthcare networks (CHNs) through the inclusion of health and wellbeing priorities to enhance services for smoking cessation, physical activity referrals, social prescribing supports and the implementation of Making Every Contact Count
• Implement childhood obesity prevention and treatment services and integrated alcohol services in two CHOs
• Deliver national population-based screening programmes

Minister for Health, Stephen Donnelly TD, and Ministers of State Mary Butler TD, Frank Feighan TD and Anne Rabbitte TD have today welcomed the publication of the HSE National Service Plan 2021.

The HSE National Service Plan 2021 sets out the type and volume of health and social services to be provided from the funding made available by Government in Budget 2021.

Welcoming the publication of the 2021 National Service Plan, Minister Donnelly said:

The National Service Plan being launched today reflects the significant additional investment that government has provided to the health service in 2021. The total health budget of €20.6 billion is an increase of 21% on the 2020 health allocation. A major focus of the Health Budget 2021 is to deliver the strategic reform in line with Sláintecare and to build on the positive and innovative changes made during the COVID 19 pandemic. A key focus of the National Service Plan is the transformation and reform of certain services and supporting the resilience and preparedness of the health service to continue to operate in the COVID 19 environment.

I would like to thank the HSE Board and officials for the considerable work undertaken in delivering the National Service Plan 2021 in this challenging COVID- 19 environment.

The budget for 2021 includes some very significant additional investments which will be applied to restart services in a COVID 19 environment, enhance or expand existing services, including enhancing service resilience and responding to demographic and other pressures, and to commence new approved service developments.

The Minister of State with responsibility for Disability, Anne Rabbitte TD, welcoming the publication of the Service Plan, said:

Budget 2021 was a record-breaking allocation to Disabilities and it has enabled major investment across services, which are detailed in this Plan, including the continued reform of disability services through the implementation of the Transforming Lives Programme. A priority for me was to provide additional multi-disciplinary posts within the children’s network teams, which will bolster both the assessments of need process, but more importantly the delivery of therapies. Subject to Government approval, staff will also be recruited to commence preparation for establishing the process of assessments of need for adults (19–21 year olds). One of the other key areas for this government is the delivery of respite, and funding has been provided to the HSE to develop and open an additional 9 dedicated centre-based respite services across all Community Healthcare Areas. This means real and tangible supports will be delivered for families across the country, offering them additional support when they need it most.

The Plan also outlines the continuation of moving people with disabilities from congregated settings to transition homes in the community. A model of service in one geographical area to support people with an intellectual disability and dementia to transition to community living will be piloted in 2021. The recommendations of the Report of the Review of the Irish Health Services for Individuals with Autism Spectrum Disorders will also be implemented, which will improve access to and responses by services to autistic children and adults in a timely manner.

The Minister of State with responsibility for Public Health, Wellbeing and the National Drugs Strategy, Frank Feighan TD, said:

The COVID-19 pandemic has highlighted significant challenges for socially excluded groups in society, particularly those with increased vulnerabilities including complex general health, addiction and mental health problems. The improvement of health outcomes for socially excluded groups in society is a key priority for 2021 and I will work with the HSE to improve access to health and to address health inequalities for socially disadvantaged groups including people who are homeless, Travellers, the Roma community, migrants and those experiencing addiction.

The Minister of State with responsibility for Mental Health and Older People, Mary Butler TD, said:

There is no doubt that COVID-19 has had an impact on people’s mental health, and it is crucial that we are able to respond to this, during and beyond the pandemic. A key priority outlined in the National Service Plan is the development of a sustainable costed plan for– Sharing the Vision –, the national mental health policy and the commencement of implementation of priority actions of Sharing the Vision in 2021. Also outlined in the Plan is the priority to continue implementation of the national suicide reduction strategy Connecting for Life, following its extension from 2020 to 2024. There is a clear commitment within the National Service Plan to recruit 123 new mental health staff in addition to 30 IPS employment specialists this year. Of the 123 staff, 29 new posts will be appointed in child and adolescent mental health services to enhance capacity across services. The transition to the new national forensic mental health service, increasing capacity on a phased basis, is also a priority action for 2021.

In relation to services for older people, the Plan being launched today sets out to support older people to live in their own communities for as long as possible, improve their access to care and to minimise the need for acute and residential care. In 2021, 5 million additional home support hours will be delivered in communities across Ireland. In line with the Department of Health’s policy and direction, the HSE will also work with us to roll out a reformed model of service delivery which will inform the development of a statutory home support scheme for the financing and regulation of home support services. Dedicated funding has also been allocated in 2021 to enhance community-based supports for people living with dementia, including the expansion of in-home day care, enhancing memory technology resource rooms and the appointment of additional dementia advisors.

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