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HSE Dublin North EastRegional Service Plan 2011

Presentation to Regional Health Forum 28 February 2011

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Contents Page

Purpose of Regional Service Plan 3Priorities for 2011 4Key Issues & Risks for 2011 5Resources – “More with less” 6-12Regional Care Group Priorities 2011 13-15Additional Funding / Strategic Priorities 16Integrated Service Areas 17Capital Infrastructure 18Public Service Agreement (Croke Park) 19Performance Management 20Questions 21

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Purpose of Regional Service Plan National service plan 2011 details- type & volume of service provided

Directly by HSE Through Voluntary Agencies Approved by Minister for Health & Children on 21 December 2010

Major drive in DNE 2011 to improve our regional and local service planning and implementation

Clear link from national to local service plans via regional – i.e. each LHO / Hospital finalising service plans Integral Part of Regional Performance Mgmt Process – working tool to deliver Responsible persons clear in regional and local service plans KRAs / KPIs from NSP 2011 Additional Regional Priorities – clear responsibilities and timelines

Commenced Process September 2010 Briefing Material Circulated / RDO Newsletter Regional Management Team Special Meetings/Workshops Regional Acute Hospital Forum / Regional Mental Health Forum Workshops with Regional Specialist Management and Clinical input On-going Engagement with National System

Regional Communications Plan Regional Union Engagement session 23 Feb – follow up 1st April Regional Health Forum 28 Feb RDO Staff Message Feb 2011 LHOs and Hospitals to brief local unions (ISA basis) March

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Priorities for 2011

Broadly maintain levels of service provided in 2010 Deliver cost reduction & re-structuring programmes without

service reductions Deliver high quality & safe services Accelerate Reform Programme

Reconfigure core services Appropriate balance – hospital / community Best care models – childcare, disability, mental health, older

persons Implement National Clinical Programmes

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Key Issues & Risks for 2011

Reduction of funding for 2011 on top of 2010 reductions Driving productivity while reducing cost and capacity Ensuring more efficiency through integration of services Employment ceiling - VER/VRS – moratorium Achieving PCRS savings NCHD availability Constant monitoring & assessment essential

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Resources – “More with Less”2009 2010 2011 Movement 2009 - 2011

€'000 €'000 €'000

2,334 2,251 2,032

Ceiling at December ( HSE & Section 38 Vols.) 23,315 22,789 22153*

1,162 / 5% reduction Dec. 2009 - Dec. 2011. of which 636 / 2.8% reduction Dec. 2010 - Dec. 2011 before 2011 reconfiguration - further approx. 0.7% i.e. 3.5% approx. Dec. 201 - Dec. 2011. * estimate

Demand - Led SchemesMedical Cards 290,979 335,451 373,712 Increase 28% *(2011 estimate) ↑GP Visit Cards 16,715 21,992 26,375 Increase 57% (2011 estimate) ↑Non - Acute Services

Children in Care 1,392 1,440 1,433 Increase 3% ↑Home Help Hours 2,361,666 2,423,689 2,410,000 Increase 2% ↑Long Term Care Support 4,072 4,829 4,829 Increase 18 % ↑Patients in receipt of methadone treatment 3046* 3106* 3050 *average

Acute ServicesIn- patient Discharges 112,073 110,263 105,398 Decrease 6% ↓Day cases 128,392 137,831 143,100 Increase 11% ↑In- patient Discharges + Day Cases 240,465 248,094 248,498 Increase 3% ↑Outpatient Attendances 760,899 791,007 810,800 Increase 7% ↑Emergency Presentations 274,444 264,645 240,200 Decrease 12% ↓

Budget Reduction €219 / 9.4%

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RESOURCES - Cost Management

Reducing Costs without Reducing Services

Nationally o 2010 €14.1bn → 2011 €13.5bn o €683m / 4.8% reduction o Plus €279m new / additional spend

accommodated (new developments, medical cards, priorities)

o →€962m / 6.7% total reduction o €200m → non frontline (see over) o €424m – PCRS – most drug price reductions,

probity and other efficiencies (see over) Regionally

o €127m total region → 6.1%

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Financial Resources 2011

•€127m funds reduction 2011•6.1% Reduction from 2010 for Total Region•4.8% Reduction for Service Under RDO Remit•DNE fully engaged and aligned with national procurement initiatives•Relative efficiency current spend

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Financial Resources 2011 contd.

Item €m

Laboratory Services 5.0 Agency Services 7.0 Medical and Nursing Training and Education 2.6 Procurement and Contracts Management 78.7

Medical and Surgical Supplies, Contracts and Equipment

23.4

Drugs and Medicines 18.0 Laboratory Consumables 8.9

Blood and Blood Products 2.0 X-Ray Consumables 1.6

Medical Gases 1.3 Cleaning and Washing Products and Contracts 3.1

Energy 1.5 Catering Products and Contracts 2.6

Patient Transport Costs 0.8 Bedding and Clothing 1.0

Vehicle Running Costs 0.2 Office Stationery, Printing, Equipment, etc. 3.8

Telephony 2.5 Insurance 1.0

ICT Equipment 2.0 Legal 5.0

Review of Rent / Lease Renewals etc. 5.0 Logistics and Inventory Management 20.0

Stock Management (Non Pharmacy) 8.2 Point of Use Demand Management 0.8

Stock Management (Pharmacy) 6.0 Aids and Appliances Recycling 5.0

Reduce Discretionary Spend 41.7 Furniture and Crockery 11.0

Vehicles Purchased 0.7 Maintenance 30.0

Further non-service impacting initiatives (to be identified)

40.0

Total 200.0

€m Estimate 2010 2,812 Adjustments for 2011

Full year effect of 2010 schemes measures -100 Efficiencies and control including probity and fees -114 Funding for additional medical cards 90 Full year 2010 savings – prescription charges -10 Drug price reductions -165 Efficiencies in hi-tech drug schemes -35 Sub total -334

Estimate 2011 per published Estimate 2,478

PCRS

National €200m “Procurement”

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HSE DNE-Human Resources 2011CEILINGS •Moratorium 2009: 228 Reduction •Moratorium 2010 : 298 Reduction •Exit schemes: 336 Reduction 12, 177 HSE plus 159 Vols •Moratorium 2011: 300?Est Reduction – plus effect internal reconfig top slice Appendix 2• 5%+ overall ceiling reduction from 2009 to 2011 + internal reconfig impact Admin / Management down 434 WTE / 12% Mar 2009 to Dec 2010 (including VER / VRS) and falling - impacts / ICT?

ACTUALS - Grade

Actual WTE Actual WTE Actual VER/

Actual WTE reduction Mar 2009 to Dec 2010 including VER/VRS

Mar-09 Dec 2010 Reduction VRS 2010

( Start of current moratorium)   Mar 09 to Dec 10  

WTE WTE WTE WTE WTE %

HSE DNE - BY GRADE  

HSE DNE Medical / Dental 1,792.21 1,772.40 -19.81 0 -19.81 -1.11%

HSE DNE Nursing 8,110.82 7,600.06 -510.76 0 -510.76 -6.30%

HSE DNE Health and Social Care Professionals 3,617.96 3,661.57 43.61 0 43.61 1.21%

HSE DNE Management/Admin 3,707.19 3,504.48 -202.71 -230.93 -433.64 -11.70%

HSE DNE General support Staff 2,746.45 2,567.35 -179.10 -105.19 -284.29 -10.35%

HSE DNE Other Patient and Client Care 3491.98 3,490.50 -1.48 0 -1.48 -0.04%

Total All Grades - HSE DNE 23,466.61 22,596.42 -870.19 -336.12 -1,206.31 -5.14% * * Some of this reduction is replaced by agency staff and limited recruitment which is in process.

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Dublin North East Staffing - Dec 2010

Breakdown of DNE Employment Ceiling for end 2010 Provider WTE Voluntary Providers Hospitals Mater Misericordiae Hospital 2,492.58 Beaumont Hospital 2,919.30 The Rotunda Hospital 752.00 Cappagh National Orthopaedic 314.00 Hospital Total 6,477.88 Community Clontarf Orthopaedic 198.00

St Vincent's Hospital 224.00 Daughters of Charity 996.00

St Michael's House 1,288.00 Central Remedial Clinic 233.50 Community Total 2,939.50 Total Voluntary 9,417.38

Provider WTE Statutory Providers Hospitals Our Lady of Lourdes 1,500.40 Louth County Hospital 297.00 Cavan General Hospital 784.00 Monaghan General Hospital 166.00 Our Lady's Hospital Navan 447.40 Connolly Memorial Hospital 1,099.59 Hospital Total 4,294.39 Community LHO Cavan Monaghan 1,240.34 LHO Louth 1,731.45 LHO Meath 960.11

LHO 6 Dublin North West 1,664.10 LHO 7 Dublin North Central 1,230.97 LHO 8 Dublin North 1,544.44 Total Community 8,371.41 Population Health 220.00 Ambulance 153.00 Corporate 332.82

Total Statutory 13,371.62

Total Ceiling 2010 22,789.00

Expect approx 2% reduction + VER/VRS 2011(ie in region of 3.5%) to include element of reconfiguration and service priorities

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Human Resources 2011- continued Must factor in “posts reconfigured” / prioritised

Agency and Labs – significant national achievement (HR, Procurement, ISD) – DNE zero tolerance of any non-compliance on implementation

Admin as a key resource – strategic approach and ICT enablement ?

Managing risks associated with staffing constraints

Management of change PSA VER/VRS Quality & Safety Reconfiguration Communication

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Regional Care Group Priorities for 2011 (1) Quality & Safety

Quality, Safety & Risk Management Framework Strengthened Accountability

Primary Care Sustainable PCTs

Acute Services Access / Waiting Clinical Care Programmes

NCCP Consolidation around Designated Centres

Children & Families Governance Standardisation

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Regional Care Group Priorities for 2011 (2)

Mental Health – Vision for Change Reconfiguration – Recovery Model CAMHs

Disability VFM / Increased Collaboration Respite & Emergency Places

Older Persons Home Support Infrastructure

Palliative Care Implement National Reports

Social Inclusion Social Inclusion Proofing

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Clinical Care Programmes Regional Implementation Approach

RDO Co-ordination Individual Programme Offices – Each site/group Approach

Business Case Gap Analysis Validate Implement

Robust Monthly Performance Reporting Appendix 2 NSP Pg 71

http://www.hse.ie/eng/services/Publications/corporate/nsp2011.pdf

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Additional Funding / Strategic Priorities

Set out in Appendix 2 - Nationally (a) Priority Services - Additional Funding

€56m / €108 wte (b) Priorities – Funded through Resource

Realignment - €46m / 307 wte (c) Priorities – Internal Reconfiguration of

Existing Resources - €4.8m / 78 wte

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Integrated Service Areas

New ISA Structures for 2011

4 ISA’s in DNE – 4 ISA Managers identified

Phased safe transition into full roles by end March

DNE ISP Steering Group linked via Lead ISM to National ISP process

Cavan/Monaghan – Leo Kinsella – existing LHO + Cavan Monaghan Hospital Group

Louth Meath ISA – Dermot Monaghan – 2 existing LHO’s plus Louth Meath Hospital Group

Dublin North ISA –Pat Dunne – initially existing Dublin North and Dublin North West LHO’s plus Connolly and Beaumont Hospitals (merger and AHC in progress)

Dublin North City – Anne O’Connor – initially existing Dublin North Central plus Mater, Rotunda and Cappagh hospitals

Immediate boundary adjustments to be tackled – includes move of Ashtown, Finglas, Granegorman, Cabra etc into Dublin North City

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Capital Infrastructure

Set out in Appendix 4 10 Primary Care Centres by PPP Acute Hospital Upgrading Children & Family Units Mental Health – Fairview & St Itas Older Persons – Raheny, Navan, Fairview, Clontarf

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Public Service Agreement (Croke Park)

Set out in Appendix 5 Re-organisation Flexibility / Mobility Working across sectoral, organisational and professional

boundaries Qualitative and Quantitative measurement

Savings / Efficiency Quality / Better Outcomes Access / Referral pathways

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Performance Management Communication / Alignment

Additional measures 2011 to ensure consistent translation of messages national to local

LHO & Hospital Service Plans Implementation Accountability KPIs

Improved Reporting Monthly PR – ISA Level Individual Meetings

Budgetary Control Cost Containment Procurement

Support Service KRAs 2011

Regional Care Group Governance Structures Regional Mental Health Forum Regional Acute Hospital Forum Adopt for other care groups

AEMG

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Questions?