Presentation by Liam Woods Finance Director HSE

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Presentation by Liam WoodsFinance Director HSE

• 18 June 2009

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Content

• National financial outlook
• HSE finances for 2009
• Medium term planning focus
• Sample of change in Mental Health
• Sample of change in mid West hospitals
• Conclusion

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HSE financial trends in brief
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HSE financial challenges in 2009before the
recent budget
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HSE financial challenges in 2009after the recent
budget
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Focus of medium term planning
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International Experience

• Focus on key cost drivers
• Reconfigure care focusing on ambulatory care
• Develop clinical leadership
• Performance manage use data
• ICT enable
• Eliminate services that do not support strategy
• Shift to geographic management of services

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Cost Drivers

• In the USA, 75 of health costs are used to treat
  people with chronic illness. In Australia,
  chronic illness account for nearly 70 of
  allocated health expenditure while in Ontario,
  the economic burden of chronic disease is
  estimated at 55 of total direct and indirect
  health costs. Five illnesses are responsible for
  most of these costs Asthma, Congestive Heart
  Failure, Cardio Vascular Disease, Diabetes and
  mental illness. Reduction in and control of
  expenditure in these areas can have a large
  impact on the overall budgetary position.
• Health Care Reform Now, A Prescription for
  Change, George Halvorson, 2007
• National Health Priority Action Council (NHPAC),
  2006, National Disease Strategy, Australian
  Government Department of Health and Ageing,
  Canberra
• Preventing and Managing Chronic Illness
  Ontarios Framework, Ministry of Health and Long
  Term Care, May 2007

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Reconfiguration

• Reducing inpatient capacity in a planned, swift
  and sustained manner, substituting in-patient
  care with ambulatory care in either a hospital or
  primary care setting. This allows for the
  delivery of acute services in settings with a
  critical mass not only improving the cost of
  services but also the quality of the care
  provided.

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Example of change in mental health
servicesthrough resource reallocation
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Health Cake
1966 23
1984 12
2009 6.7
2013 8.4
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Number of Mentally Ill Persons Resident in
Institutions in Ireland per 100,000 Population
from 1850 - 2000
800 700 600 500 400 300 220 100
1850 1860 1870 1880 1890 1900
1910 1920 1930 1940 1950 1960
1970 1980 1990 2000
Source Inspectors Reports / Damien Brennan, 2007
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Vision for Change
Commitments
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Revenue Additional Investment of 21.6m annually
x 7 years Raising percentage of Health Spending
from 6.7 to 8.4
Capital Sale of Lands
Existing Assets Reinvestment of Proceeds to the
value of 796m
Human Resource Additional 1,800 WTEs MDT Working
New Skills Investment
Organisational Structure Larger
Catchments Service User in Management
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Facing to New Realities
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Dublin Mid Leinster for example
x 3.44
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Best Use of Resources?
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Retirement Window
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Example of change in Mid West region
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Services in Mid-WestNatural Hub and Spoke !

• Populatiion 360,000
• Regional hospital (Limerick)
• St Johns (Limerick)
• Ennis (lt 30 mins)
• Nenagh (lt 30 mins)
• 75 of population live within 25 miles of
  Limerick

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TEAMWORK Background Risk Issues

• Approx 1 inpatient elective case / day done in 2
  local hospitals
• 105 surgical emergencies in one month in
  Nenagh,
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  only 12 required anaesthetic
• Jan- July 08 -- 21 28 cases out of hours in
  St Johns and Ennis
• (Full theatre on call in 3 local hospitals)
• 1 in 3 rota (78 rest days) half of all weekends
  covered by locum!
• A/E clinical governance,

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TEAMWORK Report Mid West

• Surgery and Critical Care
• Unable to sustain safe reliable levels of care
  on a continuous basis in Trauma, Acute Surgery,
  and ICU/High Dependency
• These issues should be rectified
• Immediately.

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Stakeholder The Goal!Consultants Patients
GPs

• Ennis / Nenagh
• Local Hospital
• Advanced diagnostics
• Day Surgery
• MIU / MAU / CAAU
• Inpatient beds
• Therapies
• PCT / HSCN

• Mid West Regional hospital
• Tertiary Care Centre
• Major Trauma Unit
• Academic/University Teaching Centre
• Centre of Excellence

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Summary

• First phase of project now complete with out of
  hours services in Limerick