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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


HSE Dublin North East Regional Service Plan 2011