HSE Dublin North East Regional Service Plan 2011
Presentation to Regional Health Forum 28 February 2011
1
Contents
Page
Purpose of Regional Service Plan
3
Priorities for 2011
4
Key Issues & Risks for 2011
5
Resources – “More with less”
6-12
Regional Care Group Priorities 2011
13-15
Additional Funding / Strategic Priorities
16
Integrated Service Areas
17
Capital Infrastructure
18
Public Service Agreement (Croke Park)
19
Performance Management
20
Questions
21
2
Purpose of Regional Service Plan
National service plan 2011 details- type & volume of service provided Directly by HSE Through Voluntary Agencies Approved by Minister for Health & Children on 21 December 2010
Major drive in DNE 2011 to improve our regional and local service planning and implementation Clear link from national to local service plans via regional – i.e. each LHO / Hospital finalising service plans Integral Part of Regional Performance Mgmt Process – working tool to deliver Responsible persons clear in regional and local service plans KRAs / KPIs from NSP 2011 Additional Regional Priorities – clear responsibilities and timelines
Commenced Process September 2010 Briefing Material Circulated / RDO Newsletter Regional Management Team Special Meetings/Workshops Regional Acute Hospital Forum / Regional Mental Health Forum Workshops with Regional Specialist Management and Clinical input On-going Engagement with National System
Regional Communications Plan Regional Union Engagement session 23 Feb – follow up 1st April Regional Health Forum 28 Feb RDO Staff Message Feb 2011 LHOs and Hospitals to brief local unions (ISA basis) March
3
Priorities for 2011
Broadly maintain levels of service provided in 2010 Deliver cost reduction & re-structuring programmes without service reductions Deliver high quality & safe services Accelerate Reform Programme Reconfigure core services Appropriate balance – hospital / community Best care models – childcare, disability, mental health, older persons Implement National Clinical Programmes
4
Key Issues & Risks for 2011
Reduction of funding for 2011 on top of 2010 reductions Driving productivity while reducing cost and capacity Ensuring more efficiency through integration of services Employment ceiling - VER/VRS – moratorium Achieving PCRS savings NCHD availability Constant monitoring & assessment essential
5
Resources – “More with Less” 2009
Budget
2010
2011
Movement 2009 - 2011
€'000
€'000
€'000
2,334
2,251
2,032
Reduction €219 / 9.4%
23,315
22,789
22153*
1,162 / 5% reduction Dec. 2009 - Dec. 2011. of which 636 / 2.8% reduction Dec. 2010 - Dec. 2011 before 2011 reconfiguration - further approx. 0.7% i.e. 3.5% approx. Dec. 201 - Dec. 2011. * estimate
Medical Cards
290,979
335,451
373,712
Increase 28% *(2011 estimate)
↑
GP Visit Cards
16,715
21,992
26,375
Increase 57% (2011 estimate)
↑
Children in Care
1,392
1,440
1,433
Increase 3%
↑
Home Help Hours
2,361,666
2,423,689
2,410,000
Increase 2%
↑
Long Term Care Support
4,072
4,829
4,829
Increase 18 %
↑
Patients in receipt of methadone treatment
3046*
3106*
3050
*average
In- patient Discharges
112,073
110,263
105,398
Decrease 6%
↓
Day cases
128,392
137,831
143,100
Increase 11%
↑
In- patient Discharges + Day Cases
240,465
248,094
248,498
Increase 3%
↑
Outpatient Attendances
760,899
791,007
810,800
Increase 7%
↑
Emergency Presentations
274,444
264,645
240,200
Decrease 12%
↓
Ceiling at December ( HSE & Section 38 Vols.)
Demand - Led Schemes
Non - Acute Services
Acute Services
6
RESOURCES - Cost Management
Reducing Costs without Reducing Services Nationally o 2010 €14.1bn → 2011 €13.5bn o €683m / 4.8% reduction o Plus €279m new / additional spend accommodated (new developments, medical cards, priorities) o →€962m / 6.7% total reduction o €200m → non frontline (see over) o €424m – PCRS – most drug price reductions, probity and other efficiencies (see over)
Regionally o €127m total region → 6.1%
7
Financial Resources 2011
•€127m funds reduction 2011 •6.1% Reduction from 2010 for Total Region •4.8% Reduction for Service Under RDO Remit •DNE fully engaged and aligned with national procurement initiatives •Relative efficiency current spend
8
Financial Resources 2011 contd. National €200m “Procurement”
PCRS Estimate 2010 Adjustments for 2011 Full year effect of 2010 schemes measures Efficiencies and control including probity and fees Funding for additional medical cards Full year 2010 savings – prescription charges Drug price reductions Efficiencies in hi-tech drug schemes Sub total Estimate 2011 per published Estimate
€m 2,812 -100 -114 90 -10 -165 -35 -334 2,478
Item Laboratory Services Agency Services Medical and Nursing Training and Education Procurement and Contracts Management Medical and Surgical Supplies, Contracts and Equipment Drugs and Medicines Laboratory Consumables Blood and Blood Products X-Ray Consumables Medical Gases Cleaning and Washing Products and Contracts Energy Catering Products and Contracts Patient Transport Costs Bedding and Clothing Vehicle Running Costs Office Stationery, Printing, Equipment, etc. Telephony Insurance ICT Equipment Legal Review of Rent / Lease Renewals etc. Logistics and Inventory Management Stock Management (Non Pharmacy) Point of Use Demand Management Stock Management (Pharmacy) Aids and Appliances Recycling Reduce Discretionary Spend Furniture and Crockery Vehicles Purchased Maintenance Further non-service impacting initiatives (to be identified) Total
9
€m 5.0 7.0 2.6 78.7 23.4 18.0 8.9 2.0 1.6 1.3 3.1 1.5 2.6 0.8 1.0 0.2 3.8 2.5 1.0 2.0 5.0 5.0 20.0 8.2 0.8 6.0 5.0 41.7 11.0 0.7 30.0 40.0 200.0
HSE DNE-Human Resources 2011 CEILINGS •Moratorium 2009: 228 Reduction •Moratorium 2010 : 298 Reduction •Exit schemes: 336 Reduction 12, 177 HSE plus 159 Vols •Moratorium 2011: 300?Est Reduction – plus effect internal reconfig top slice Appendix 2 • 5%+ overall ceiling reduction from 2009 to 2011 + internal reconfig impact
⇒Admin / Management down 434 WTE / 12% Mar 2009 to Dec 2010 (including VER / VRS) and falling - impacts / ICT? Actual WTE
Actual WTE
Actual
VER/
Mar-09
Dec 2010
Reduction
VRS 2010
( Start of current moratorium)
ACTUALS - Grade
Actual WTE reduction Mar 2009 to Dec 2010 including VER/VRS
Mar 09 to Dec 10
WTE
WTE
WTE
WTE
HSE DNE Medical / Dental
1,792.21
1,772.40
-19.81
0
-19.81
-1.11%
HSE DNE Nursing
8,110.82
7,600.06
-510.76
0
-510.76
-6.30%
HSE DNE Health and Social Care Professionals
3,617.96
3,661.57
43.61
0
43.61
1.21%
HSE DNE Management/Admin
3,707.19
3,504.48
-202.71
-230.93
-433.64
-11.70%
HSE DNE General support Staff
2,746.45
2,567.35
-179.10
-105.19
-284.29
-10.35%
HSE DNE Other Patient and Client Care
3491.98
3,490.50
-1.48
0
-1.48
-0.04%
23,466.61
22,596.42
-870.19
-336.12
-1,206.31
-5.14% *
HSE DNE - BY GRADE
Total All Grades - HSE DNE
WTE
* Some of this reduction is replaced by agency staff and limited recruitment which is in process.
10
%
Dublin North East Staffing - Dec 2010 Provider
Breakdown of DNE Employment Ceiling for end 2010 Provider
WTE
WTE Statutory Providers
Voluntary Providers
Hospitals
Hospitals
Our Lady of Lourdes
1,500.40
Mater Misericordiae Hospital
2,492.58
Louth County Hospital
297.00
Beaumont Hospital
2,919.30
Cavan General Hospital
784.00
The Rotunda Hospital Cappagh National Orthopaedic Hospital Total
752.00
Monaghan General Hospital
166.00
314.00
Our Lady's Hospital Navan
447.40
6,477.88
Connolly Memorial Hospital
1,099.59
Hospital Total
4,294.39
Community Clontarf Orthopaedic
198.00
St Vincent's Hospital
224.00
Daughters of Charity
996.00
St Michael's House Central Remedial Clinic
1,288.00 233.50
Community Total
2,939.50
Total Voluntary
9,417.38
Expect approx 2% reduction + VER/VRS 2011(ie in region of 3.5%) to include element of reconfiguration and service priorities
Community LHO Cavan Monaghan
1,240.34
LHO Louth
1,731.45
LHO Meath
960.11
LHO 6 Dublin North West
1,664.10
LHO 7 Dublin North Central
1,230.97
LHO 8 Dublin North
1,544.44
Total Community
8,371.41
Population Health
220.00
Ambulance
153.00
Corporate
332.82
Total Statutory
13,371.62
Total Ceiling 2010
22,789.00
11
Human Resources 2011- continued
Must factor in “posts reconfigured” / prioritised
Agency and Labs – significant national achievement (HR, Procurement, ISD) – DNE zero tolerance of any non-compliance on implementation
Admin as a key resource – strategic approach and ICT enablement ?
Managing risks associated with staffing constraints
Management of change
PSA VER/VRS Quality & Safety Reconfiguration Communication
12
Regional Care Group Priorities for 2011 (1)
Quality & Safety
Primary Care
Access / Waiting Clinical Care Programmes
NCCP
Sustainable PCTs
Acute Services
Quality, Safety & Risk Management Framework Strengthened Accountability
Consolidation around Designated Centres
Children & Families
Governance Standardisation 13
Regional Care Group Priorities for 2011 (2)
Mental Health – Vision for Change
Disability
Home Support Infrastructure
Palliative Care
VFM / Increased Collaboration Respite & Emergency Places
Older Persons
Reconfiguration – Recovery Model CAMHs
Implement National Reports
Social Inclusion
Social Inclusion Proofing 14
Clinical Care Programmes
Regional Implementation Approach
RDO Co-ordination Individual Programme Offices – Each site/group Approach
Business Case Gap Analysis Validate Implement
Robust Monthly Performance Reporting Appendix 2 NSP Pg 71
http://www.hse.ie/eng/services/Publications/corporate/nsp2011.pdf
15
Additional Funding / Strategic Priorities
Set out in Appendix 2 - Nationally
(a)
(b)
(c)
Priority Services - Additional Funding €56m / €108 wte Priorities – Funded through Resource Realignment - €46m / 307 wte Priorities – Internal Reconfiguration of Existing Resources - €4.8m / 78 wte
16
Integrated Service Areas
New ISA Structures for 2011
4 ISA’s in DNE – 4 ISA Managers identified
Phased safe transition into full roles by end March
DNE ISP Steering Group linked via Lead ISM to National ISP process
Cavan/Monaghan – Leo Kinsella – existing LHO + Cavan Monaghan Hospital Group
Louth Meath ISA – Dermot Monaghan – 2 existing LHO’s plus Louth Meath Hospital Group
Dublin North ISA –Pat Dunne – initially existing Dublin North and Dublin North West LHO’s plus Connolly and Beaumont Hospitals (merger and AHC in progress)
Dublin North City – Anne O’Connor – initially existing Dublin North Central plus Mater, Rotunda and Cappagh hospitals
Immediate boundary adjustments to be tackled – includes move of Ashtown, Finglas, Granegorman, Cabra etc into Dublin North City
17
Capital Infrastructure
Set out in Appendix 4
10 Primary Care Centres by PPP Acute Hospital Upgrading Children & Family Units Mental Health – Fairview & St Itas Older Persons – Raheny, Navan, Fairview, Clontarf
18
Public Service Agreement (Croke Park)
Set out in Appendix 5
Re-organisation Flexibility / Mobility Working across sectoral, organisational and professional boundaries Qualitative and Quantitative measurement
Savings / Efficiency Quality / Better Outcomes Access / Referral pathways
19
Performance Management
Communication / Alignment
LHO & Hospital Service Plans
KRAs 2011
Regional Care Group Governance Structures
Cost Containment Procurement
Support Service
Monthly PR – ISA Level Individual Meetings
Budgetary Control
Implementation Accountability KPIs
Improved Reporting
Additional measures 2011 to ensure consistent translation of messages national to local
Regional Mental Health Forum Regional Acute Hospital Forum Adopt for other care groups
AEMG
20
Questions?
21