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Setting the healthcare agenda for 2021

Paul Mulholland reports on recent discussions of the HSE’s performance and delivery committee concerning the development of the Executive’s National Service Plan

One of the main items on the agenda of the HSE’s performance and delivery committee, when it met on 11 November 2020, was to discuss the development of the Executive’s National Service Plan (NSP) 2021.

Chief Strategy and Planning Officer (CSO) Mr Dean Sullivan provided an overview on the proposed structure of the draft plan and informed the committee that it will include several new components as required by the Letter of Determination from the Exchequer, including an access to care action plan, a recruitment plan, and a Covid-19 action plan.

He then set out the indicative timelines for delivery emphasising that the HSE was working to an “extremely tight schedule, especially considering competing priorities and demands of operating in a Covid-19 environment”, according to the minutes of the meeting, seen by the Medical Independent (MI) through Freedom of Information law.

Mr Sullivan advised that the level of services as delivered in 2020 will be used to inform baseline service levels in 2021 in the context of the impact of Covid-19 on service. The committee emphasised the need to ensure the plan is strategically aligned with the Corporate Plan. It was also necessary to facilitate and support the continued roll-out and implementation of the Winter Plan, in line with the agreed timescales, as well as providing funding to the levels set out in the pandemic plan in several key areas.

In relation to workforce management, the committee advised that the plan should include details on the additional whole-time equivalent posts provided for by Budget 2021.

“The committee stressed that in light of the significant increase in the funding allocation for 2021, it is incumbent on the HSE to ensure effective monitoring and reporting arrangements are in place,” according to the minutes.

Mr Sullivan revealed that a sum of €261.6 million was being held by the Department of Health for specific new initiatives and the incorporation of this funding within the HSE’s net revenue expenditure determination would be undertaken soon.

Voluntary sector

The committee also discussed the “relationship model” with the voluntary sector and the “importance of addressing public expectations which may arise from the publication of the NSP 2021”.

The issue of the voluntary sector was also discussed during the following meeting of the committee on 18 November, the minutes of which were also seen by MI.

“The committee raised the issue of the relationship structure with Section 38/39 organisations and suggested there is need to commit to a serious dialogue of reform with these organisations,” according to the minutes.
Mr Sullivan noted that there is a commitment to engage with the Section 38/39s in the Corporate Plan and a similar commitment would be reflected in the NSP.

Reporting methods

The committee discussed the measurement and reporting methods for existing levels of service in light of the impact of Covid-19.

“The committee stressed that substantial efforts in recruitment and resourcing will be required to increase capacity and permanent staffing levels to deliver the NSP,” according to the meeting minutes.

“It was recognised that the correct selection of metrics will be especially important in this area to ensure that staffing levels and expenditure on agency and overtime are fully aligned with available funding throughout 2021.”

The importance of the alignment of the plan with wording of the Sláintecare Report and its vision of universal healthcare was highlighted, particularly with regards to integrated care.

The committee then discussed the access to care action plan, noting that it deals with access to scheduled care and does not directly address unscheduled services. Mr Sullivan advised that enhanced access to scheduled care has been highlighted by the Department of Health as a priority for inclusion in the NSP 2021 “but that addressing unscheduled care access challenges is also a key priority”.

“It will be achieved via a significant uplift in acute bed capacity, the introduction of alternative pathways and processes for assessing care, and other measures, aligned to Sláintecare, the Corporate Plan, and Winter Plan,” according to the minutes.

“The patient engagement element of the NSP was considered and the CSO acknowledged that this is an area with potential for further development and he confirmed that this is currently being undertaken and discussed at EMT [executive management team] level.”

The NSP 2021 was published on Wednesday 24 February. The €20.623 billion allocation represents an increase of €3.5 billion on the 2020 figure.

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