discusses the transition to a zero carbon future National Service Plan published

Dr Steevens' Hospital, HSE headquarters.

Unprecedented National Service Plan budget

Having been expected in November 2020 but delayed until February 2021 amid the pandemic and other considerations, the publication of the HSE’s 2021 National Service Plan details an “unprecedented” increase of allocation by €3.5 billion.

The €3.5 billion increase for the 2021 National Service Plan brings the total amount of funding allocated to the HSE for 2021 to €20.6 billion and represents an increase of 21 per cent on the funding level of the 2020 National Service Plan.

€1.68 billion of the €3.5 billion increase is to be allocated to Covid-19 spending, with the remaining €1.8 billion representing an underlying increase of 10.6 per cent in health spending, itself an increase on the 7.3 per cent average annual increase recorded between 2016 and 2020. €1.1 billion of this €1.8 billion is dedicated to the delivery of “permanent enduring improvements in healthcare arising from the Sláintecare reform programme”; the remaining €700 million of the non-Covid related increase is “to cover the increased costs of providing existing levels of service which have increased due to demographics changes and various cost increases”.

Paul Reid, CEO of the HSE, said: “This significant investment represents the trust that the Government and the public have placed in us after a year in which our staff have gone above and beyond to do all they can to keep people safe and healthy. The last 12 months have brought very rapid changes in how we provide healthcare, and we intend to use the best of the changes coupled with the new investment to sustainably transform how we deliver healthcare in Ireland.”

The National Service Plan is the annual document that sets out the type and volume of health and personal social services to be provided by the HSE

within a given year. Typically issued before the turn of the year into the year covered by the report (i.e., the 2020 version was published in December 2019), this year’s version suffered delays and was not published until late February.

The 2021 plan “provides for additional spending to improve many services including those in the areas of cancer, maternity and mental health”. It provides for the addition of 16,000 staff above December 2019 levels, which includes 1,100 medical and dental staff, over 3,500 nurses and midwives and 4,000 health and social care professionals.

With the Service Plan arriving in the midst of the Covid-19 pandemic, it is a given that healthcare measures to combat the pandemic would dominate the content of the Plan. Section 2 of the Plan comprises the HSE’s Covid-19 Action Plan, which includes plans for the procurement of PPE, a national operating model for testing and tracing and the Covid-19 vaccination programme.

On the procurement of PPE, the Plan pledges to: build and deliver a “dedicated, stable and responsive PPE supply and distribution service”; deploy a long-term procurement solution for the provision of PPE to healthcare services; conclude an independent audit of both the sourcing and management of PPE; and work with the Department of Health and Irish Government Economic and Evaluation Scheme to develop the PPE procurement demand forecast.

The national operating model for testing and tracing includes a pledge to deliver a daily capacity of 25,000 tests and to implement a national Virus Reference Laboratory Covid-19 offsite at Backweston, County Kildare in order to provide capacity and resilience. In terms of the vaccination programme, the plan says that it “expects vaccines to continue to be approved by the European Medicines Agency with increasing supplies being made available by manufacturers to Ireland”.

The vaccination rollout in the plan is broken into three phases: initial rollout; mass ramp-up; and open access. No timeline or figure specifications are given as to how to judge the need of one phase and the beginning of the next but given the opening of mass vaccination centres in February, the plan appears to have progressed to the second phase. The third phase, open access, will begin when there is “a large volume of vaccines available for the population and that vaccine storage and administration requirements will be simpler than early vaccines”. When such arrangements are in place, said vaccines will be delivered through mass vaccination centres, GPs and pharmacies.

In terms of the implementation of Sláintecare, the Service Plan is to be delivered within the strategic framework of the HSE Corporate Plan 2021–2024, which includes objectives such as early intervention and the enhancement of community services in order to reduce the need for people to attend hospital that are central to the Sláintecare model.

The plan pledges “whole-system reform”, stating that this is “critical if we are going to address the long-standing challenges of our health service”. Challenges specifically mentioned as being in need of transformation include: long waiting lists for scheduled care in hospitals; long waiting times in emergency departments, especially for older people and those with more complex needs; the functioning of hospitals with high occupancy levels; an overreliance on residential models of care and a lack of services “to enable our gaining population to maintain their independence and live well in the community”; waiting times for mental health services; and a lack of homebased support and person-centred and responsive support for people with disabilities.

The reform programme is said to centre around the enhancement of patient experience, the improvement of service access across primary, community and acute services, increasing the range and capacity of services delivered in community settings, increasing bed capacity and focusing on health promotion.

The HSE states that it expects the following impacts to come from these reform measures: health outcomes in Ireland will equal or better OECD averages; children will have access to an integrated high-quality child health service focused on prevention and early intervention; community services will provide preventative, management and support services for obesity; the health of those most disadvantaged will improve; prevalence of obesity will decrease annually, by 2 per cent for disadvantaged populations; and harmful alcohol consumption will be reduced.

€20.6 billion total funding for HSE in 2021 €3.5 billion increase on 2020 funding €1.8 billion on underlying health spend €1.68 billion for Covid-19 costs €1.1 billion for Sláintecare reforms €700 million for increasing costs

Three Ireland: Securing value for money for small public bodies

In the last year, Three Ireland re-engineered its network in response to changing work patterns due to Covid-19.

A new direct drawdown arrangement from Three Ireland offers smaller public bodies such as smaller charities, local authorities and education institutions simple access to mobile voice and data contracts. Public bodies who spend €25,000 or less on mobile voice and data can now enter a contract simply by visiting the Three Ireland website or emailing a dedicated account team.

This service is offered under an Office of Government Procurement framework and provides a compliant, value for money solution with a seamless switch from other providers. For smaller public sector bodies (PSBs), procuring relatively small quantities of goods and services in a compliant way can take a great deal of time and effort. For a PSB that might typically have between 10 and 70 employees, the standard process of defining requirements, publishing a tender, and evaluating submissions, could take up to a year and consume a lot of resources across IT, finance and procurement roles.

But under a “direct drawdown” arrangement which is provided under the national framework for mobile voice and data services, any PSB that spends €25,000 or less per year for their mobile voice and data services can enter into a contract with Three Ireland without needing to take on the overhead of a costly and resource-intensive competitive tendering process. Three Ireland won the right to offer services under the direct drawdown facility offered as part of the Office of Government Procurement Mobile Voice and Data Framework. Direct drawdown is a simple process that’s designed to remove much of the red tape involved in tendering for small PSBs. In effect, this direct drawdown provision gives these organisations the buying power of a much larger group, bringing significant benefits in terms of scale, service and cost.

It’s the best solution for the PSB buying the service and, ultimately, for the taxpayer.

Value for money

While public procurement frameworks are typically renewed every four or five years, this direct drawdown contract is renewed annually. This means the buyers are guaranteed to get the best available value for money.

Three scored highest in the competition to establish the direct drawdown contract when measured against several criteria including network performance, billing and invoice management, mobile device management, transition and porting and value for money.

Let’s look at the criteria in turn. If we take network performance, over the past year, we re-engineered our network in response to the changed working patterns and increased working from home due to the Covid-19 restrictions.

Ireland’s fastest mobile network

This network performance has been independently verified by Ookla®, the global leader in fixed broadband and mobile network testing applications, data and analysis which, based on Speedtest Intelligence® data for Q3–Q4 2020, found that Three is Ireland’s fastest mobile network. (You can find out more about Ookla’s testing process at speedtest.net/awards/three). So, at a time when Covid-19 restrictions are still in place and a return to the office is unlikely for many people in the short- to medium-term, people working from a home office may have access to our enhanced mobile broadband services.

And with 5G now launched, and currently rolling out across Ireland, agencies will be able to take advantage of even faster speeds.

A seamless porting process

When a PSB switches to the Three network as part of the framework agreement, we manage and facilitate the onboarding process. This transition and porting process from another provider’s network can involve replacing mobile handsets, SIMs or both, while keeping their existing numbers. We have a dedicated account management team, supported by a service team operating from Limerick, which means that agencies can avail of multiple layers of support to make the switch seamlessly and swiftly.

We can also remove logistical challenges for PSBs by facilitating delivery of devices and SIMs to staff members in a seamless way. This saves the PSB’s IT department from having to get new devices delivered to the agency’s main office and then manage the process of supplying them onwards, while ensuring an optimal subscriber experience. This is a procurement challenge at the best of times, but especially now while we still face Covid19 restrictions.

While Three was awarded the contract on the basis of the “most economically advantageous tender”, there are benefits beyond price alone in the additional service Three can provide and our extensive experience of the public sector. We can apply this knowledge to help PSBs, because we are likely to have encountered similar challenges before.

For example, we can act as a trusted advisor on issues like mobile security, which has become much more pressing due to the risks involved in remote working. We can suggest security applications that can address the agency’s risks around protecting data and securing their staff.

Three Ireland manages and facilitates the onboarding process, making it easy for a PSB to switch.

Predictable costs for PSB finance teams

Three also provides a higher data allowance than other operators, so PSBs can be sure they get more for their money. This gives predictability of cost. Now that working from home is much more common, employees are more likely to be using mobile data to connect to conference calls or go online if fixed broadband isn’t available. Because our data plans have a large allowance, PSBs can be confident there’s no ‘bill shock’ caused by high data use.

For finance teams, we can import internal cost centres and reporting codes into our billing system. This way, PSBs get high levels of transparency and reporting on their mobile charges, with a full breakdown per user on their bills.

All told, this is a prime opportunity for PSBs to take advantage of the fastest network in the country, which is also the largest carrier of mobile data in Ireland; more than all other mobile networks combined.

Any PSB that spends €25,000 or less each year on their mobile voice and data can take advantage of everything this framework has to offer by simply contacting the dedicated account team at framework@three.ie or visiting the Three website at Three.ie.