1. Presentation to Board Members Laverne McGuinness Assistant Chief Executive 22 nd January 2004 Service Progress Report 2003

2. 2 Financial Allocation 2003  Initial allocation €502.8m for 2003.  Final Determination €582.746  LETTER OF DETERMINATION:-  Strongly emphasised importance of controlling spending and managing within limits of financial and staffing resources.  Existing Level of Services (ELS) principle introduced.  No consideration to Supplementary Estimate in 2003 without exception.  Board’s Defecit 2002 - €8.3m  First charge on 2003 allocation.

3. 3 Provider Plan 2003  Provider Plan 2003 prepared within parameters of operational budget, statutory responsibility to breakeven.  Staff Ceiling Constraints.  Cost Containment Programme also prepared.  Main focus 2003 – consolidation of existing services and demonstrable value for money.

4. 4 Review - 2003  2003 challenging year for our Board.  Continuing Service Delivery within constraints in a number of service areas.  Increase demand and rising expectations.  Limited new development funding.  Long term effects of inadequate capital funding.  Increased costs of technological advances.

5. 5 Children and Family Services  Budget €75.173m  Youth Advocacy Project.  Services Homeless Youth.  Caretakers Residential Project.  Salvation Army.  Key service provision – ‘early years services’, family support services, child protection, alternative care and services for homeless youth.

6. 6 Targeted Efficiencies  Individual special arrangements kept to minimum.  Additional foster carers recruited. Activity  Number of Children in Care 2002 = 735 2003 = 680 Reduction of 7.5%  Number of Children Admitted to Care 2002 = 209 2003 = 182 Reduction of 12.9%

7. 7 Intellectual Disability and Rehabilitative Training  Budget €39.337m  New Development funding €2.982m  Additional Funding of New Residenital Places of €2.050m  Additional Funding of New Day Places of €.486m

8. 8 Targeted Efficiencies  St. Joseph’s Intellectual Disability Service - reduction in over time, staff redeployment, waste management, telecommunications. Health Strategy Objectives  Action 53 - more appropriate community residential type settings - acquisition 2 community houses. Long stay ward St. Joseph’s ID service closed.

9. 9 Activity Number of Clients in receipt of Day and Residential Services. Residential 2002 = 1,112 2003 = 1,142 3.2% Increase Day 2002 = 2,573 2003 = 2,737 6.4% Increase

10. 10 Monitoring and Evaluation  St. Joseph’s ID Service chosen as pilot site in National Disability Authority’s Pilot Project on development of National Standards within Disability Services.  Clonmethon Lodge received Fingal Chamber of Commerce Award for best public service, as recognition of the quality of service being provided.

11. 11 Physical and Sensory Disabilities  Budget €26.518m  Additional Funding€2.429m  Placement of identified clients in appropriate residential care settings.  Home Support Services.  Transfer of clients to community House Donabate.  Additional Funding €1.287m Delayed Discharge Initiative for Young Disabled transferred from Acute Hospitals

12. 12 National Health Strategy Objectives  Action Point 53 - Transfer of clients to community setting house in Donabate.  24 clients (Delayed Discharge Initiative) discharged from acute hospitals to more suitable setting. Activity Day Service20022003%Increase No. of Places11422750% No. of Clients receiving Care Attendant Service9611924%

13. 13 Mental Health Services  Budget €77.549m  €700k Capital funding - improved facilities for Area 7/Mater.  Refurbishment work on Lindsay House.  Enhancement of community services Area 7 – Bloomfield Hospital.  Development of new Rehab Team Area 7.

14. 14 Acute Units  Building of acute unit JCMH complete – transfer St. Brendan’s Hospital. Plans for new acute unit at Beaumont Hospital advanced. Community Services  Development of mental health resource centre in Fingals – incorporates a day hospital.  Plans advanced for sector headquarters in Blanchardstown.  Appointment of Consultant Psychatrist Area 8

15. 15 Psychiatry of Old Age  Considerable work undertaken on assessment of elderly long stay patients in St. Brendan’s, St. Ita’s and Verville Retreat – 130 patients transferred to community based nursing home care. Community Accommodation  Residence Blanchardstown opened – 5 clients.  Fingal County Council two houses Castlecurragh, Mulhuddart – 6 residents.  Lindsay House, Glasnevin commissioned – 6 residents.  Fingal County Council – house in Rush – commissioned as medium support hostel. Two houses Donabate currently being furnished – 8 residents low support.

16. 16 Targeted Efficiencies  Major programme carried out in St. Ita’s and St. Brendan’s to identify and access alternative care settings for patients in line with care needs.  Rationalisation of catering, transport and other support services and staff redeployment. Activity Number of Places in 20022003 Community Houses 357370

17. 17 Alcohol and Addiction Services  Budget - €18.814m Services 2003  Focus on quality in service delivery in 2003  Implementationof a comprehensive set of policies and procedures including a service users charter.

18. 18 Alcohol Service  Stanhope Centre offered wide range of treatment services to problem drinkers and their families.  64 clients availed of residential treatment programme in Barrymore House.  1423 clients availed of the Substance Abuse Nurse led service at St. Vincent’s Hospital, Fairview.

19. 19 Addiction Services Treatment  Small increase in overall numbers receiving treatment  Increase in GPs and Pharmacists.  Hep C Liaison nurse appointed. Counselling  Review of services resulted in change in the deployment of counselling resources. Outreach  Review completed which recommended an enhanced management strucutre and development of ongoing training opportunities for outreach workers

20. 20 Activity  Needle Exchange Attendance 2002 = 2,883 2003 = 3,017 Increase of 4.6%  Number of Clients availing of services 2002 = 262 2003 = 297 Increase of 13.4%

21. 21 Asylum Seekers/Refugee Services  Decrease in uptake of persons availing of medical screening. Travellers Services In addition to mainstream services our Board provided the following specific initiatives for travellers:  Primary Health Care Project with Pavee Point.  Traveller Mobile Clinic.  Travellers Health Unit (managed by SWAHB). Adult Homeless  Development of new Action Plan on homelessness with key partners.  3049 homeless cases 2002  2988 homeless cases 2003 Decrease of 2%

22. 22 Acute Hospital Services  Budget - €68.680m Key Developments 2003 – JCMH  €96.37m Capital Project at Hospital completed on target and within budget.  JCMH awarded Pre-acrediatiation Early Status by the Irish Hospital Accrediation Board in 2003.

23. 23  High levels of performance achieved in the provision of outpatient and A & E services.  Individual appointment times offered to 96% of all outpatients.  100% seen by Consultant on first visit and within 60 minutes of appointment time.  99% of all A&E attendees were seen within standard waiting time for all five triage categories.

24. 24  Activity 2003  Admissions – Inpatient7,156  Bed Days110,308  Out Patient Attendances70,711  Theatre Procedures5,415  Accident & Emergency Attedances30,514  Day Surgery Procedures2,653  Medical Day Unit Procedures1,516

25. 25 Key Developments 2003 – St. Joseph’s, Raheny  Focus in 2003 on increasing public activity in partnership with Beaumont.  900 public patients in theatre – 1000 public patients from Beaumont waiting lists.  July 2003 development plans to facilitate transfer of operational responsibility for the hospital to Beaumont Hospital to enable the hospital to achieve maximum potential public activity.

26. 26 Targeted Efficiencies  32 beds JCMH closed in May 2003.  Redeployment of Staff  Efficiencies in Non Pay Areas  Significant reduction in staffing numbers.

27. 27 Services for Older Persons  Budget - €66.62m  New Development funding- €1.8m  Home First Project – Restricted due to staff ceiling. Funding diverted to critical areas eg. St. Mary’s Hospital – preventing closure of beds.  Additional Funding Initiative - €1.1m  Acute Hospital Delayed Discharges Initiative.  Enabled discharge of approximately 144 clients from Acutes.

28. 28 Targeted Efficiences  Bed Management System – greater bed days.  New Nursing Home Subvention Guidelines –Home Care Packages.  Full review of Nursing Home Inspection Service.  Rapid Access Clinic to reduce referrals to A & E.  Falls Research Clinic. Activity  Meals on Wheels = 430,797  Attendance of Day Care=209,293

29. 29 Primary Care Services  Budget - €44.774m  New Development Funding - € 2.43m  General Practice Unit  Expansion of team and practice model.  Courier service for the direct delivery of vaccines to general practices.  Participated in regional ‘macro’ need assessment which reviewed health need and service provision based on demography.

30. 30 Dental Services  2 additional dental hygienists employed. Orthodontic Service  785 patients assessed - 747 in treatment.  Waiting time for a Category 1 assessment appointement has been reduced from <12 months to < 3 months.  €0.605m from Treatment Purchase Fund for orthodontic services – 207 patients commenced treatment.

31. 31 Immunisation Service  Quarter 3 uptake rates  Men C73.8%  MMR 79.4%  Polio at 12 months 76.3%  Polio at 24 months82.9% Opthalmic Services  Community Opthalmic Physican appointed May 2003.

32. 32  Health Promotion - services delivered across all settings including prisons, schools, health servicews and workplaces.  Regional breastfeeding policy developed.  187 people trained in intervention in smoking cessation.  Target – Each GP to recruite 15 Heartwatch patients – 640 out of 705 recruited to date. Health Promotion

33. 33 Health Promotion  In addition to Cardiovascular Strategy developments:-  Developing framework document for strategy to address suicide.  Training on suicide prevention and mental health promotion to teachers, health services staff and young people.  Needs assessment completed in Darndale/Belcamp  Development of falls prevention programme in residential units for older persons.

34. 34 Summary  Throughout 2003 services were delivered in tandem with a strict control on finances and staff ceiling.  Management Team and Senior Managers and all staff worked in synergy to achieve the targets set. THANK YOU