The Government has  announced “a record” €25.8 billion health budget “to support the continued delivery and expansion of quality, affordable healthcare services in 2025”.

According to the Department of Health the funding represents an overall increase of €2.94 billion on the January 2024 allocation.

It will provide for more than 3,300 additional staff, deliver 335 additional hospital beds, “expand services, deliver increased productivity and continue the reductions in waiting lists and trolley numbers”.

The 2025 health budget includes €1.2 billion allocated for existing level of service, €1.5 billion additional funding for 2024 pressures and €335 million in additional new measures.

According to the Government the 2025 budget also includes  €33 million investment “to provide more and better cancer services”, publicly funded HRT products for women experiencing symptoms of menopause and extension of publicly funded IVF as part of €35 million measures for women’s healthcare.

On the budget announcement Minister for Health Stephen Donnelly said, “whether it’s an appointment with a GP, a home care package for a loved one, an X-ray or MRI, quick access to emergency care or a minor injury unit, an appointment with a hospital consultant or surgery, Budget 2025 is all about making this a reality for more and more patients and families”.

“We are living longer and living better, but our growing and ageing population place additional demands on our services. We continue to respond to these challenges, and we are placing a strong focus on more productivity alongside investment in increased capacity and in workforce planning to ensure we can meet the needs of our healthcare service into the future.”

In response to Budget 2025’s investment in cancer care, Irish Cancer Society CEO, Ms Averil Power said the charity weclomed “the priority given to people affected by cancer in Budget 2025. The investment provided for in this Budget will benefit people with cancer and their families all over the country”.

She added that “hopefully, this is the beginning of a new approach to funding cancer care that will see sustained increases in ringfenced funding for cancer services going forward”. 

“With cancer cases expected to double by 2045, continued increases in investment will be required to meet increased demand and ensure that Irish patients benefit from advances in cancer research and services.”

A new guideline has been launched by the HSE National Cancer Control Programme (NCCP) to support patients who have been diagnosed with melanoma skin cancer. Around 1,100 people are diagnosed with the disease annually in Ireland, and melanoma has become increasingly more prevalent in recent years.

Dr Eve O’Toole, Head of Evidence and Quality Hub in the NCCP, said: “The purpose of the guideline is to provide evidence-based recommendations on the staging and surveillance of patients with cutaneous melanoma through the integration of the best research evidence with clinical expertise, patient values, and experiences. Knowing what is happening now and what will be happening next can provide reassurance to patients that an optimum plan for them is in place. The guideline describes what tests patients should have and for how long surveillance should continue.”

The guideline will help provide information for treatment planning for people with melanoma and help to detect any recurrence or relapse early, leading to prompt treatments and interventions. It was developed in consultation with oncology patients, doctors, nurses, and researchers with an overall aim to improve the quality of clinical care for patients and optimise patient experience. The document will also provide reassurance for patients that they are being monitored based on the best current evidence.

Melanoma cancer patients and members of the Guideline Development Group Kay Curtin and Miriam Staunton said: “It was great to be involved in the process of creating the guidelines we felt the patient voice was heard. Melanoma cancer guidelines are essential as they give patients an ability to advocate for themselves and help ensure consistency across Ireland’s cancer centres.”

Dr Sinéad Field, Consultant Dermatologist and Chair of the Clinical Guideline Development Group, added: “Melanoma is on the increase in Ireland and while it is more common in people over 50, you can get it at any age. The new National Clinical Guideline for Radiological Staging and Surveillance of Patients with Cutaneous Melanoma will support people who are undergoing or have had treatment. Staging scans help to determine if a patient’s cancer has spread or is likely to spread to other parts of the body, or recur. This knowledge is useful as it provides an opportunity to optimise the patient’s treatment plan. Surveillance of patients after they have finished their treatment is to check for a recurrence or relapse of their cancer. This is useful as it provides an early opportunity for treatment.”

The full guideline can be accessed at: https://assets.hse.ie/media/documents/ncr/20240513_National_Clinical_Guideline_Cutaneous_Melanoma_V0.pdf.

The HSE is seeking additional funding to include chronic kidney disease (CKD) in the GP chronic disease management (CDM) programme in 2025, it has confirmed. The prevalence of CKD is significantly increasing in Ireland. Some 15.6 per cent of people aged 50 and over have CKD, but most are unaware, according to research published last year by TILDA and the National Renal Office (NRO).

The HSE has stated that recommendations from a review of the NRO are still being considered in the context of health service structural changes. The review was commissioned to examine the current and future work of the NRO, which was established in 2009 before the initiation of the HSE clinical programmes. Its original remit was end-stage kidney disease. The office now requires support for work in other areas, including preventative nephrology.

Commenting on the inclusion of CKD into the CDM programme, the Irish Kidney Association said: “We need to see the Government include provision for this positive development in the forthcoming Budget. We have seen the benefits for cardiac care as well as diabetes and hypertension management. Including CKD will be a significant move towards proactive health management in the general population. Remember, one-in-10 in the population has CKD, including one-in-seven of those over the age of 50.”

General practice completed 99,098 reviews of patients enrolled in the CDM programme in the first two months of 2024, according to figures provided to NiGP. The Department of Health also confirmed that it believes the programme is “the main contributing factor” in a reduction of chronic disease-related hospital admissions in recent years.

“The CDM programme forms part of the wider enhanced community care programme which has improved patient care and provided ongoing improvements to how health services are delivered,” said the Department’s spokesperson.

This reduction in hospital admissions was discussed at the Sláintecare programme board meeting in April. Board members were shown data that indicated a 16 per cent reduction in chronic disease-related hospital admissions as compared to a 3.5 per cent reduction in all other medical admissions per 100,000 population between 2019 and 2023. The meeting was also told that 91 per cent of patients on the programme “are now fully managed routinely in primary care” and are not attending hospital for ongoing management of their condition. The CDM programme commenced in 2020. It has been rolled out on a phased basis to adult patients with a medical or GP visit card. Approximately 94 per cent of eligible GPs have signed up to providing the CDM programme.

The Irish Nurses and Midwives Organisation (INMO) has served notice of industrial action on HSE West and North West. The notice follows voting by public health nurse management in Galway over the HSE’s failure to implement recommendations to help ease the “extreme pressure” on staff in the area. INMO Professional and Regulatory Officer David Miskell described the current pressures being experienced in the region as “intolerable”. He stated that patient care is “falling short”, and that the health and safety of INMO members practising in public health in Galway is now “significantly compromised” as a result of the ongoing challenges. “Public health nurse management in Galway are at a juncture now where they feel like they have no other option but to engage in industrial action,” he said.

Mr Miskell compared the Galway catchment of 285,000 people to the national average of 150,000, adding that the region is “unique” in view of its “large geographic area with an urban-rural mix, island populations, and a growing population”.

“Despite local engagement and two conciliation conferences that took place under the auspices of the Workplace Relations Commission, no meaningful resolution has been reached, with the additional resources required to maintain safe and effective care for the people of Galway not being put in place… HSE West and North West must now urgently and meaningfully engage with the INMO in relation to the matters at the centre of this dispute. The provision of putting all resources that are necessary to provide a safe public health nursing service for the people of Galway must be a priority. If the HSE fails to engage, regrettably this industrial action will escalate over the coming weeks.”

To align with National Breastfeeding Week 2024 (1-7 October), the HSE has published the Breastfeeding Action Plan Progress Report 2016-2023. Data demonstrates an 18.6 per cent increase in the number of infants breastfed at three months since 2015, and that 64 per cent of new mothers now initiate breastfeeding after birth. Other key highlights from the report include:

·        Almost a fourfold increase in the number of dedicated infant feeding specialists available to support mothers (increasing from 15-to-59 since 2017);

·        A new national infant feeding education programme underway for HSE staff;

·        Almost 22,000 queries were answered via the HSE online breastfeeding support service since 2016.

This year the theme for National Breastfeeding Week is ‘Supporting you from bump to baby and beyond’. Sheila Lucey, infant feeding specialist in West Cork, said “we are keen to encourage mums-to-be to consider preparing for feeding while pregnant” and encouraged women to contact breastfeeding specialists and attend local community groups.

“Our support groups are safe spaces for mothers at all stages, whether someone is pregnant and thinking about breastfeeding, new to breastfeeding and has questions, or having problems with breastfeeding. We are here to provide non-judgemental advice and support at each and every one of the 215 breastfeeding groups around the country. Support people are also welcome, whether that is dad, partner, granny, grandad, or a trusted friend. Take the opportunity to ask those questions or alleviate any concerns you may have.”

Skilled breastfeeding supports are available in all maternity units and hospitals, in local health services, and online at mychild.ie. Common questions include:

·        Is baby getting enough?

·        How to settle baby?

·        How to treat sore nipples?

·        How best to express and store milk?

·        Can I take certain medication while breastfeeding?

Minister for Public Health, Wellbeing, and the National Drugs Strategy Colm Burke said:“It is very positive to see that, with investment in resources in breastfeeding supports, there is an increase in the numbers of new mothers choosing to breastfeed throughout the country. The health benefits for both mothers and their infants in the short term are significant and continued breastfeeding can reduce the risk of long-term health outcomes such as obesity, diabetes, and some cancers.

“Helping more mothers to breastfeed is crucial to improve long term population health and we must continue our efforts to support parents who want to breastfeed their children. We all have a role to play to promote breastfeeding; within our communities, in public services, in the workplace, along with the invaluable support of volunteer breastfeeding groups and dedicated staff in the health service.”

The full progress report is available at: www.hse.ie/eng/about/who/healthwellbeing/our-priority-programmes/child-health-and-wellbeing/breastfeeding-healthy-childhood-programme/research-and-reports-breastfeeding/.

A new digital initiative is being launched for cardiology and respiratory patients at St Vincent’s University Hospital, Dublin, and University Hospital Limerick. Virtual wards are expected to offer a safe and efficient alternative to hospital stays and support patients who prefer to receive expert hospital care through monitoring and treatment in their own homes. The virtual ward service may be offered to appropriate hospital inpatients with a respiratory or cardiac condition that are medically stable, but require ongoing monitoring and care prior to formal discharge.

HSE Chief Clinical Information Officer Prof Richard Greene noted that virtual wards are “a new health innovation that has emerged internationally”. He also said: “Central to the National Virtual Wards Programme is the empowerment of patients to be active partners in managing their health and wellbeing. Patients remain under the care of the consultant-led team that provided their care in the hospital and will have a dedicated team monitoring their care 24/7, while they are in the comfort of their own home.”

Healthcare teams will work with patients, and their families or carers if appropriate, to assess whether individuals might be suitable to be treated through the virtual ward service. A member of the clinical team will explain how the service works and why they think it might be a suitable option, and will also ensure patients/carers receive adequate education and training regarding any equipment they will be given. Once a patient is transferred to the virtual ward service, they remain under the care of the consultant team that provided their care in the hospital.

A personalised care plan will be agreed between the patient, their family/carer, and consultant-led care team, and they will establish the best ways to make contact, as well as what to do if the patient feels unwell. Care will continue to be reviewed 24 hours per day, seven days a week by their consultant-led care team. The virtual ward team will be automatically alerted by the monitoring technology if the patient’s readings worsen, or if they are not responding to treatment as expected. Following completion of the patients’ treatment and care, they will be discharged by the consultant-led care team from the virtual ward.

Maureen Gilbert, patient representative on the Virtual Ward Steering Group, described the virtual wards initiative as “a really positive development”, and said it will “offer great potential for patients and their empowerment”. She added: “Virtual wards can support enhanced recovery, and there’s more quality one-to-one communication between patients and their care team. Research shows that patients who recover at home experience less of the stress and anxiety that can sometimes be associated with a hospital stay. There are lots of other benefits too – lower risk of hospital-acquired infection and loss of muscle strength. People who join virtual wards can be more active partners in their own healthcare and they are less likely to need another inpatient hospital stay in the near future.” The national Virtual Wards programme is a collaborative initiative bringing together stakeholders from across the health service including eHealth Ireland, the National Clinical Programme Respiratory, the National Heart Programme, St Vincent’s University Hospital, and University Hospital Limerick.

A new online tool called My Mental Health Plan has been launched by the HSE to improve access to mental health supports for adults and young people over the age of 18. The interactive platform is a development of the mental health literacy campaign, and is designed to help people reflect on their own mental health needs. It offers personalised advice, information, and self-help tips to help people address issues and improve mental health and self-care.

Speaking at the launch, Minister of State for Mental Health Mary Butler said she was “delighted to launch” the new resource, and described it as “a great way to check in with your mental health and get advice and self-care tips”.

“It provides people with a tailored mental health plan with advice ranging from information and self-help resources to clear signposting to appropriate mental health supports. This is just one example, as a result of Sharing the Vision recommendations, of how we are making progress in addressing people’s mental health needs, from population-based mental health promotion all the way through to specialist mental health services.”

My Mental Health Plan consists of four questions on the most commonly reported mental health issues, particularly stress, anxiety, low mood, and sleep. Once complete, users have a tailored mental health plan with advice ranging from information and self-help resources, to clear signposting towards appropriate mental health supports. There is also an option for users to email their plan to themselves for future reference. The resource is available at: www2.hse.ie/mental-health/my-mental-health-plan/

The HSE has published the 2024 National Service Plan following approval by the Minister for Health Stephen Donnelly and the Minister for Children, Equality, Disability, Integration, and Youth Roderic O’Gorman. The Government has allocated a budget of €23.5 billion for health and social care services, which is 4.6 per cent above last year’s budget. Of this €23.5 billion, €2.8 billion has been provided by the Department of Children, Equality, Disability, Integration, and Youth in respect of specialist disability services, with a balance of €20.7 billion provided by the Department of Health, which will allow for 683 new whole time equivalent (WTE) staff for disability services and 2,268 WTEs for other health and social care services.

The plan includes:

• €162.8 million investment in new service developments, including enhancing mental health and disability services;
• €918.7 million once-off funding;
• €834.7 million to fund increased costs of providing the existing level of service
• Funding to support the implementation of the six new health regions.

The HSE’s focus for 2024 is to improve access to urgent and emergency care; prioritise waiting lists; continue to enhance mental health and disability services; and build on existing partnerships to develop and improve services.

Mr Ciarán Devane, HSE Chairman, said: “The National Service Plan for 2024 is a continuation of the work of the preceding year and represents another year of growth. Together, the two years will see staff increase in the region of over 9,000 WTE and funding by €3 billion. During 2024, we will consolidate the developments of recent years, particularly around access, and ensure we deliver the increased capacity this investment is intended to provide. We want to allow the increased number of clinical staff to care for an increasing number of patients and users of our services.”

The Irish Hospital Consultants Association (IHCA) has criticised the lack of commitment in the plan to open a specified number of additional general acute hospital beds this year. The Association has pointed out that the Minister for Health previously announced plans to open 147 additional acute beds in 2024; however, this is not reflected in the plan. The figure is also significantly below what is required to start addressing the severe overcrowding in public hospitals and tackle the persistently high waiting times for treatment, according to an IHCA statement.

“It is deeply disappointing that the service plan for 2024 has failed to commit to opening a specified number of additional general public hospital beds this year. Even if all of the 147 additional beds promised by the Minister for 2024 are opened on time, this would mean a net increase of just 45 hospital beds over and above where we should have been at more than a year ago…. It is also regrettable that the HSE and Government continues to renege on its pledge to commit the €1 billion in funding required to open 1,500 additional rapid build hospital beds across 15 acute public hospital sites this year.

“Despite a slight overall increase in spending, just €3.1 million is allocated for new measures in mental health. This is the second year in a row when the level of funding for new measures has actually decreased compared with the previous year, from €24 million in 2022 to €14 million in 2023, and to just €3.1 million in 2024 – a reduction of almost €21 million, or 87 per cent, in two years.”

January-February 2024 | Issue 2 | Vol 17

An updated guide called Having your Prostate Checked is now available at the HSE’s health promotion website. The HSE National Cancer Control Programme (NCCP) guide provides information on prostate issues and highlights the importance of shared decision-making when having a prostate check. Over 3,300 men are diagnosed with prostate cancer each year, and it is the second most common cause of cancer death in men in Ireland. Almost one-in-three of all invasive cancers in men in Ireland are due to prostate cancer.

Mr Paul Sweeney, HSE National Urological Cancer Clinical Lead, explained: “The guide aims to help patients and their families understand why you might have a prostate check and also understand the impact that a family history of prostate cancer might have. People are encouraged to discuss prostate checks with their GP.”

Dr Una Kennedy, GP Advisor, HSE NCCP, added: “There are many reasons why someone might wish to have their prostate checked, such as concerning symptoms or a family history of prostate issues. This guide was developed to provide clear and easy to understand information about prostate checks, to help people make that decision.”

Printed copies of the guide can be ordered free of charge by patients and healthcare providers or downloaded from www.healthpromotion.ie.