1. 1 Agenda Introduction Purpose of Service Plan Underlying Assumptions Care Group Profiles Questions

2. 2 Purpose of Service Plan Details Type & Volume of service provided  Directly by HSE  Through Voluntary Agencies Service Plan has a backdrop of  New Challenges for 2010  Establishing Integrated Service Areas Overarches Lower Level Plans  Regional Performance Contract  Dublin North East Level 1 Business Plan  Local Service Plans

3. 3 Issues & Risks for 2010 Plan Deliver on Vote Increasing Economic Constraint / Reduced Income Impact of Recruitment Moratorium Introduction of Integrated Services Programme Continuation of Transformation Programme Increasing Population Trends in Community Demand Led Schemes Changing Health Technology Capital & ICT Plans

4. 4 Finance Dublin North East Budget Allocation Service Area2009 Re-stated 2010 €m North Dublin Hospitals791748691 North East Hospitals282266242 Community Services1,071964924 Major Voluntary Agencies184172166 Population Health2120 Corporate Functions817461 Total€2,431€2,244€2,104

5. 5 Service Plan 2010 Presentation Regional Health Forum – Dublin North East 22 February 2010

6. 6 Key National Service Developments 2010 Pandemic Vaccination - €55 million Ryan Report Implementation - €14 m / 200 WTEs Demand Led Schemes - €230 million Disability – Additional Day Services – 400 places NHSS – ‘Fair Deal’ - €117 million Home Care Packages - €10 million Cancer Services - €20 million / 79 WTEs* Innovation Funding €17m / 80 WTE’s * Demographic Funding - €70m / 410 WTE* * To be confirmed

7. 7 Value for Money Considerable success over last 3 years  €500m efficiencies in 2008/2009 Target for 2010  €106m Nationally  €22m Dublin North East €12m Hospitals €9m Community €1m Corporate Delivered from Non-pay Costs Not Intended to Impact on Service Provision

8. 8 Dublin North East Staffing – Dec 2009 Service AreaStaff Number Hospitals (Inc. Acute Voluntaries)12,008 Ambulance170 Major Voluntaries (Non-acute)3,576 Community Services7,785 Population Health217 Corporate324 Total24,080

9. 9 Staff CategoryHospitalsAmbulanceMajor Vols (PCCC)PCCCPop HealthCorporate Medical /Dental1,50502635873 Nursing4,75009902,438215 Health & Social Care1,47308081,3521201 Mgt/Admin (Includes, medical Sec., welfare staff, receptionists and telephonists, primary care teams support etc) 1,96953311,19072248 Gen Support1,632415175051156 Other Patient /Client Care 6791249041,94251 Totals12,0081703,5767,785217324 Dublin North East Staff Breakdown - Dec 2009

10. 10 Quality & Clinical Care Quality & Clinical Care Directorate  Established late 2009 Role  Further Strengthen Clinical Leadership  Improve Clinical Performance  Programmatic Approach to Improving Care Reducing Costs Key Result Areas 2009  Respiratory Diseases  Cardiovascular Diseases  Diabetes  ED Functionality

11. 11 Primary Care Support & Promote Health & Wellbeing  Locally Based Services In 2010 Continue to Support Standardisation  Across All PCTs  Chronic Disease Management  Direct Linkages with Mental Health  Hospital Integration & Avoidance  Health Promotion / Immunisation

12. 12 Primary Care Key Issues, Activity & Challenges - Dublin North East  Primary Care Teams 59 New Teams will be put in place in Dublin North East Projected Teams at 31 Dec 2010 – 84 Teams  Immunisations – 95% Target of Children in DNE  Out of Hours GP Service 145,200 Contacts in Dublin North East  Delivering Primary Care Infrastructure 6 Centres in Dublin North East

13. 13 Community (Demand Led) Schemes Government Funded GP, Pharmacy, Dental, Ophthalmic, Addiction & Special Payments  GMS – Medical / GP Visit Cards  Community Drugs – LTI, High Tech etc.  Primary Care Schemes – Maternity & Infant Recent Trends  Unprecedented Increase in Uptake Medical Cards – 200,000 Increase Nationally since 2005

14. 14 Community (Demand Led) Schemes Key Issues, Activity & Challenges - Dublin North East  Centralisation of Medical Cards PCRS  National Activity Levels 2010 Budget – Community DLS - €2.8 billion GP Visit Cards Issued – 114,436 Persons Covered by Medical Card – 1,622,560 GMS Prescriptions – 18.4 million Drug Payment Claims – 5 million Long Term Illness Claims – 1 million

15. 15 Mental Health Span all Life Stages & Covers Primary/Community & Specialist Services Strategic Objectives  Vision for Change, 2006  Executive Clinical Directorates  Re-configuration of Long-stay Units  Continued Shift to Community Based Services

16. 16 Mental Health Key Issues, Activity & Challenges - Dublin North East  Infrastructure Implementing Mental Health Capital Plan Community Focus  Key Activity in Dublin North East Acute In-patient Admissions – 2,990 Re-admissions as % of Total –66% Target Child & Adolescent Teams - 11

17. 17 Disability Services Services to Adults & Children to Enable the to Reach their Full Potential  Interdisciplinary Supports  Rehabilitative Training  Day Services, Home Support, PAs  Residential National Disability Strategy, 2004 Disability Databases/Demographic Pressures 2010

18. 18 Disability Services Key Issues, Activity & Challenges - Dublin North East  60 Bed Streetscape – Knockamann, Portrane  Legislative / Quality Requirements  Reconfiguration of Service Delivery  Key Activity in Dublin North East Persons in Rehabilitative Training – 505 Residential / Respite Places – 1,464 Emergency Residential Services – 31 Assessments Completed within timelines – 100%

19. 19 Social Inclusion Targeted towards Marginalised & at Risk to ensure equitable access to services 2010 Key Focus  Integrate Recommendations into Mainstream Health Services of National Drugs Strategy National Homeless Strategy National Intercultural Strategy  Conclusion of Traveller Health Study

20. 20 Social Inclusion Key Issues, Activity & Challenges - Dublin North East  Homeless Strategy - Implementation  Ethnic Minorities – Physical & Mental Health  Key Activity in Dublin North East Clients in Methadone Treatment – 3,020 Commencing Substance Abuse Treatment – 250 Homeless Service – Providers Operating HSE Code of Practice – 100%

21. 21 Older People Services to Support Older People to Remain at Home in Independence where possible & then in Appropriate Residential Setting Focus for 2010 – Implementing Nursing Homes Support Scheme  Development Funding - €117 million Nationally Enhancement of Home Care packages  Development Funding - €10 million Nationally

22. 22 Older People Key Issues & Challenges - Dublin North East  NHSS ‘Fair Deal’ Processing Applications  Hospital Avoidance Measures Home Help/Home Care Packages  Community Based Services Geriatrician-led Teams  Infrastructure – CNUs 4 New Units in Dublin North East

23. 23 Older People  Key Activity in Dublin North East Home Help Hours provided – 2.41 million (2.34m – 2009) Total in Receipt of Home Help – 12,900 (12,731 – 2009) Increased Home Care Package Funding Total in Receipt of Home Care Packages – 3,373 (3,099 – 2009) Number of Home Care Packages – 1,205 (1,088 – 2009) Total new HCP Clients per Month – 1,053 (809 – 2009) Total Beds in Public Residential Facilities – 1,627 (1,513 – 2009)

24. 24 Children & Families Promote & Protect Health & Well Being  Particularly those at Risk of Abuse or Neglect Focus for 2010  Build on work of Task Force on Children  Implement Ryan Report, 2009  Implement Agenda for Children’s Services, 2007

25. 25 Palliative Care Active Holistic Care of Patients with Advanced, Progressive Illness Direct HSE Provision & Voluntary Providers  St Francis Hospice, Raheny 2010 Focus  Implement Agreed National Priorities for Specialist Care  Continue to roll-out Minimum Data Set

26. 26 Palliative Care Key Issues, Activity & Challenges - Dublin North East  Implementing Minimum Data Set  Key Activity in Dublin North East Patients Treated in Specialist Unit – 34 Patients – Specialist Domiciliary Care – 561 Patients receiving Day Care - 55

27. 27 Acute Services & Pre-Hospital Emergency Care Services include Assessment, Diagnosis, Treatment & Acute Rehabilitation 2010 Focus – Continue to provide for emergency admissions & priority services while controlling overall level of acute work  Managing Elective Workloads  Continue Shift to Day Case Activity  Improve Performance – Day of Surgery Admissions/ALOS Continue on-going Hospital re-configuration

28. 28 Acute Services & Pre-Hospital Emergency Care Challenges  Historic Overdependence on Acute System  On-going Demographic Change Diversity Increased Births  Increased Emergency Presentations  Higher Patient Acuity  Delayed Discharges  Increased Demand  European Working Time Directive

29. 29 Acute Services & Pre-Hospital Emergency Care Dublin North East Infrastructure 2010  Connolly Hospital Refurbishment of Surgical Block  Beaumont Hospital Neurosurgical Upgrade Cystic Fibrosis Outpatient Acute Medical Assessment Unit  Mater Hospital Neurophysiology Outpatients Second CT Scanner Cath Lab & Intervention Radiology Metabolic Services

30. 30 Acute Services & Pre-Hospital Emergency Care Dublin North East Infrastructure 2010  Temple Street Theatre Upgrade  Our Lady of Lourdes Emergency Department Wards over ED

31. 31 Acute Services & Pre-Hospital Emergency Care Key Issues, Activity & Challenges - Dublin North East  In-patient / Day Case Continued Shift from In-patient to Day Case Activity Increase Day Cases by 6.5% Reduce In-patient Care by 5.6%  Out-patients Increasing number of New Attendances  Emergency Presentations/Admissions 9% Reduction in Emergency Admissions  Quality & Risk Focus – Improvements  Tackling ED Waits  North East Re-configuration  High Birth Rate

32. 32 Activity Levels – Dublin North East Service Type2009 Target 2010 Target In-patient Discharges116,100109,800 Day Cases125,380139,518 Total In-patient & Day Case241,480249,318 Emergency Presentations242,970246,086 Emergency Admissions73,74066,366 OPD Attendance784,410813,326 Births15,75015,100

33. 33 National Cancer Control Programme NCCP Established under Strategy for Cancer Control in Ireland 2006 Provide Necessary Governance, integration, Leadership, Operational Framework & Core Support Services for Cancer Control 2010 Programme Includes  Additional Oncology Appointments  Reduction in Number of Hospitals Carrying Out Rectal Surgery  Centralisation of Upper GI & Gynae. Cancers  Continued Implementation - National Plan for Radiation Oncology

34. 34 National Cancer Control Programme Key Issues, Activity & Challenges - Dublin North East  Colonoscopy 28 Day Urgent (Priority 1) Appointment  Centralisation of Cancer Services Pancreatic Cancer Surgery Rectal Cancer Surgery

35. 35 Questions?