I thank the committee very much for the invitation to meet again to discuss implementation of Sláintecare. I am joined, as the Chair mentioned, by Ms Louise McGirr, Ms Siobhán McArdle and Ms Rachel Kenna, chief nursing officer.
As the committee will have seen from our recently published Sláintecare progress report, Ireland’s health services are undergoing the most significant programme of reform and expansion in the history of the State. Our driving objective, as set out in the report, is to increase the volume of public activity and treat more people in non-acute settings through improved integrated care. In addition, healthcare productivity is key to achieving this objective. The more productive we are, the more patients we treat, the less time they must wait and the better outcomes we can achieve for them.
Through the enhanced community care programme’s community specialist teams for older persons, 76% of the 31,000 older people treated in the first three months of 2024 were discharged home as opposed to going to acute hospitals. Only 6% were admitted to hospital, with a further 6% going into long-term care. Some 91% of patients with chronic disease are now fully managed in primary care through the chronic disease management programme. As a result, we have seen a 16% reduction in chronic disease admissions to acute hospitals versus a 3.5% reduction in all medical patients between 2019 and last year. Similarly, there has been a 24% reduction in chronic disease 30-day readmission rates versus 5% for all medical patients. These programmes are a very significant part of Sláintecare and are now making a significant contribution to our success in tackling bottlenecks and waiting lists in unscheduled emergency care, as well as addressing the ongoing issues with regard to waiting lists.
On waiting lists, I will briefly give some summary information. More detail is set out in the report. Waiting lists were down last year for the second year in a row, with 177,000 more patients removed from waiting lists last year than in 2022. We have seen a 32% reduction in patients waiting longer than 12 months, and the average waiting time was reduced from over 9.2 months to 7.2 months, a 21% reduction last year compared with the previous year. The 2024 waiting list plan was published in March of this year. Despite the anticipated increased rate of additions - we are again seeing very significant additions to waiting lists across all specialties - the plan aims to deliver an even greater number of removals this year compared with 2023. There are ongoing improvements in productivity and increases in activity across the public health system.
On unscheduled care, our emergency departments are seeing increased levels of demand, with nearly 48,000 extra attendances up to the middle of April this year. Despite this, there has been a 10% decline in patients waiting on trolleys in the same period. The Department will shortly bring the urgent and emergency care plan for 2024-25 to Government. We will focus, in particular, on delivering timely and appropriate care to our elderly and vulnerable patients. The Department, with colleagues in the HSE, is concentrating on ensuring that our challenged sites receive assistance and support to achieve meaningful improvements in their performance.
The new public-only consultant contract, which is a significant part of the Sláintecare reforms, commenced in March last year. It gives us the ability to improve access to care for public patients and to have senior decision-makers on site in our public hospitals for extended periods in the evening and weekend. This is delivering on the Government’s commitment to phase out private practice from public hospitals. We are delighted that 2,229 consultants - representing just over half of all consultants - had signed up to the new contract by 2 May. It is a significant increase in the numbers who have signed up.
Despite the progress we are making, every day we see the immense challenges we face as our population increases and gets older. We see these trends in increased presentations to our emergency departments in particular and we know the centrality of moving to integrated care models, as set out, in meeting these challenges. Notwithstanding our progress in this regard, it is worth noting that we currently have a population over the age of 65 of 800,000. By 2031, it is estimated that this number will reach 1 million; by 2041, it will reach 1.3 million; and in the subsequent decade, it will be nearly 1.6 million - double that of today. This puts into context the enormous challenges we face now and into the future in dealing with the consequences in ageing, which is a positive but transforms fundamentally the nature of the services we have to provide for a different cohort and more people within those older groups. To meet this challenge, we simply must do better with the resources at our disposal.
Through the work of the productivity and savings task force, jointly chaired by myself and the CEO of the HSE, we will be further driving reforms to ensure that we are delivering the highest standard of care, to the greatest number of people, for the investment provided by the Government. This is an important issue that is critical to the success of Sláintecare reform. We need to be able to identify areas where investment in community and primary care services, and our reformed governance, will deliver value to the patient and the taxpayer and make health services more sustainable.
The work of the productivity task force allows us to focus in on where productivity in the services we currently deliver can be improved. This includes mobilising and analysing the data and information we have available in order that we can monitor where real improvements are being delivered on an ongoing basis. Second, we can and must consider how this evidence, alongside developments in technology, operational improvements and targeted investment, can be leveraged to deliver the highest standard of care to the greatest number of patients.
Over the past decade, health funding has increased by €9.1 billion, from €13.7 billion in 2014 to €22.8 billion this year. As a consequence, we have been able to add 43,000 healthcare staff to the public service, improve our healthcare infrastructure, expand eligibility and reduce waiting lists. The same is true in our acute sector. Looking at the data for the acute sector, we have seen that a 68% increase in the budget - more than €3 billion - was provided from 2016 to 2022. This amounts to a real increase in expenditure of 45%, allowing 16,000 additional acute staff and 1,000 new inpatient beds to open during this period.
We must, however, be honest with ourselves if we are to meet the needs of our people in the future. In contrast to the 45% increase in real expenditure, activity has only marginally increased across most treatment areas. While there has been a 21% growth in the number of emergency patients treated over this period, we have seen a lower level overall activity commensurate with the resources that have been allocated to the service. The next step is to align our investment in these areas more directly with the potential impact these interventions could have on activity. We will identify areas where increased care can be delivered through appropriate and targeted investment and reform. We will focus on the divergence in activity and costs across hospitals and take measures to improve relative underperformance.
I believe that we are starting to see evidence that this approach is working. In figures released a fortnight ago, we saw that our hospitals treated a record number of patients in 2023, with a 9.1% increase in inpatient and day case treatments relative to the previous year. While this represents progress, a gap remains, and this is the gap we are targeting in the context of the productivity task force.
To conclude, significant progress is being made in moving towards universal healthcare. Solid foundations and governance are now in place across the Department and the HSE to continue successful implementation towards this vision. Under the programme for Government, we have invested significantly in the health and social care services and to achieving these reforms. Some €1.235 billion was allocated to Sláintecare reforms in budget 2021 and over 2021 to 2023, a total of approximately €2 billion has been invested to support delivery of the goals outlined in the Sláintecare report. This has been further supported by the highest levels of investment overall in our health and social services in 2022 and 2023.
We continue to invest in our workforce and are delivering new care pathways, new facilities, new technologies and new ways of working that will enable our talented health and social care professionals to respond to the growing needs of our population.
