Annual Report 2018

1. Facts and Figureson Healthcare Activity Annual Report 2018

2. Our Staff and Organisation in Numbers Breakdown of Expenditure 2018 €6.3bn 117,857 gross expenditure on acute hospital services whole time equivalents (WTEs) employed 25% Health and Wellbeing 6% Primary Care Mental Health €4.0bn 346 39% Disability and Older Persons’ Services Acute Hospitals Services 20% Corporate Support Services gross expenditure on primary care increase in medical/dental staff since 2017 9% 1% €3.3bn 867 Staff Distribution December 2018 gross expenditure on disability and older persons’ services increase in nursing and midwifery staff since 2017 10,467 9% Medical and Dental €0.9bn 4.6% 37,644 32% Nursing and Midwifery gross expenditure on mental health annual absence rate 16,496 14% Health and Social Care Professionals 18,504 16% Management and Administrative 3,560 9,454 8% General Support 25,292 21% Patient and Client Care increase in overall staffing levels since 2017

3. Our Staff and Organisation in Numbers WTEs by staff grouping Data source: Health Service Personnel Census. Note: Difference in 2017 WTEs against that shown in Annual Report 2017 is due to the inclusion of home helps in the reporting.

4. Our Population 85% 13.3% of people perceive their health to be very good or good % Increase of population groups since 2009 of population are aged 65 years and over 64,500 increase in population since 2017 Over 4.8m people live in Ireland Data source: Health in Ireland – Key Trends 2018, DoH. Note: Data for 2017 and 2018 is preliminary. Life expectancy Over 1 million women men 83.6 79.9 ex-smokers in Ireland years years Approximately 25% of population are children aged between 0 and 17 years

5. Population Health and Wellbeing Health and Wellbeing services are provided by working with people across a variety of areas, including national services, Community Healthcare Organisations, Hospital Groups and a range of external partners and stakeholders. Population health and wellbeing is about supporting and enabling our whole population to stay healthy and well – with a consistent focus on prevention, early detection of disease and self-care support for people living with chronic diseases. Promotion of health and wellbeing is delivered through the National Policy Priority Programmes and national services including Health Promotion and Improvement, Public Health, the National Screening Service and Environmental Health Services.

6. Healthcare activity in 2018… Enabling better population health and wellbeing Responding to infectious diseases 94.5% 100,000 413 1,116 77 of children aged 24 months received 3 doses of the 6 in 1 vaccine people participated in Diabetic RetinaScreen healthcare professionals trained in Making Every Contact Count (MECC) brief intervention cases of verotoxigenicE. coli (VTEC) cases of measles 10,608 105,416 170,583 315 727 smokers received intensive cessation support people completed a BowelScreen FIT test women had a mammogram cases of tuberculosis infectious disease outbreaks managed 3,259 92.3% 339,161 89 people completed a structured patient education programme for diabetes of children aged 24 months received the MMR vaccine women had a smear test cases of meningococcal disease 6

7. Community Healthcare Services Primary Care Working to deliver accessible, comprehensive, continuous and co-ordinated primary care to service users close to home through community-based interventions, reducing the need for admission to hospital. People with Disabilities Supporting and enabling people with disabilities to live the life of their choosing in their own homes, in accommodation that is designed and/or adapted as necessary to meet their needs, enabling them to live ordinary lives in ordinary places as independently as possible. Mental Health Promoting positive mental health to enable people get the most out of spending time with their families and friends. Successfully treating those who experience mental health problems within a primary care setting, with less than 10% being referred to specialist community-based mental health services. Older People Empowering older people to live independently in their own homes and communities for as long as possible. Improving the quality of life for those with more complex health and social care needs by shifting the delivery of care towards community-based, planned and co-ordinated care. Community healthcare services are delivered across nine Community Healthcare Organisations (CHOs) and are provided through a mix of HSE direct provision as well as through voluntary section 38 and 39 service providers, GPs and private providers. The Chief Officer in each CHO has full responsibility for the delivery of all primary, community, social and continuing care services within their area, working to ensure appropriate integration with secondary care and all appropriate stakeholders.

8. Nine Community Healthcare Organisations, 2018 Areas we serve Donegal, SligoLeitrim, Cavan Monaghan Dublin North City and County Community Healthcare Midlands LouthMeath Community Healthcare Dublin South, Kildare and West Wicklow Community Healthcare Community Healthcare East South East Community Healthcare Cork Kerry Community Healthcare Mid West Community Healthcare Community Healthcare West

9. Healthcare activity in 2018… …supporting people in primary care in the community and at home …supporting those who are vulnerable 44,406 1.56m 96.5% €2.9bn 9,848 referrals to community intervention teams people with medical cards newborn babies visited by a public health nurse within 72 hours paid in reimbursement fees patients received opioid substitution treatment (outside of prisons) 23,471 77.5m 503,329 9,387 ultrasounds provided in primary care settings items submitted as claims for payment people with GP visit cards members of the Traveller community received health information on type 2 diabetes and cardiovascular health 1,615 377 1.06m 1,252 patients received treatment as part of the hepatitis C treatment programme paediatric home care packages provided contacts with GP Out-of-Hours of people admitted to homeless emergency accommodation hostels/facilities had their health needs assessed within two weeks 9

10. Healthcare activity in 2018… …supporting people with disabilities …supporting the achievement of optimal mental health 155 93.1% 10,796 12,106 people transitioned from congregated settings new school leavers provided with day care placement children/adolescents seen by child and adolescent mental health services (CAMHs) admitted to adult acute inpatient units 1.6m 3.1m 27,124 8,553 personal assistant hours provided home support hours provided adults seen by mental health services psychiatry of later life patients seen by mental health services 17,092 156,725 203 1.3m people attended other day services respite overnights provided admitted to CAMHs acute inpatient units page views for www.yourmentalhealth.ie 10

11. Healthcare activity in 2018… …supporting older people …supporting people with palliative care needs 17.13m 991 home support hours (excluding hours from intensive home care packages) delivered to over 53,000 people people supported through transitional care 303 people on average each month supported by specialist palliative day care services 250 23,305 3,772 people in receipt of intensive home care packages people supported under the Nursing Homes Support Scheme people accessing specialist inpatient beds within seven days 406,047 home support hours provided from intensive home care packages 11

12. Pre-hospital and Acute Hospital Services Pre-Hospital Emergency Care Services Providing professional and compassionate clinical care and transport for patients, in partnership with the wider health service. Acute Hospital Services Providing safe and effective patient-centred care to the population through seven Hospital Groups and forty-eight acute hospitals. Cancer Services Leading the development and provision of cancer care from prevention, early diagnosis and treatment, to appropriate follow-up and support in both the acute hospital and community settings. Women and Infants’ Health Leading the management, organisation and delivery of maternity, benign gynaecologyand neonatal services. Acute hospital services are provided to patients in 48 acute hospitals and through seven Hospital Groups, each led by a Chief Executive Officer and management team. This governance structure facilitates improved access to quality services supported by robust management and accountability arrangements at all levels of the service.

13. Seven Hospital Groups, 2018 Areas we serve Children’s Hospital Group Dublin Midlands Hospital Group Ireland East Hospital Group RCSI Hospital Group Saolta University Health Care Group South/South West Hospital Group UL Hospitals Group

14. Healthcare activity in 2018… Pre-Hospital Emergency Care Services 480 923 vehicles including 269 emergency ambulances available specialised unit transfers undertaken by children’s ambulance, neonatal unit, National Paediatric Transport Programme and mobile intensive care service 32,983 over 90% inter-hospital transfers undertaken patient transfer calls managed by the intermediate care service 337,754 451 emergency ambulance calls answered Aeromedical calls completed 14

15. On a typical weekday… Services provided within acute hospital settings 1,761 2,887 10 15 2,347 Inpatients discharged from hospital people admitted or discharged from ED within 9 hours elective laparoscopic cholecystectomies performed patients presented to lung rapid access clinics people admitted or discharged from ED within 6 hours 9 83 3,635 1,205 167 cases of verotoxig emergency hip fracture surgeries performedenicE. coli (VTEC) patients, triaged as urgent, presented to symptomatic breast clinics people attended an emergency department (ED) emergency inpatients discharged babies born 13,505 254 258 4,349 14 people attended hospital outpatients departments elective inpatients discharged patients attended an injury unit peoplereceivedday case treatment patients presented to prostate rapid access clinics

16. Enabling Healthcare Delivery National Human Resources Providing strategic support, direction, advice and interventions to all areas of the health service, through the Health Services People Strategy 2015-2018, recognising that our staff are key to the delivery of safe, efficient and effective services. National Finance Supporting the organisation to secure and account for the maximum appropriate investment in our health services, to ensure the delivery of high quality services and demonstrate value for money. Office of the Chief Information Officer Implementing the eHealth Ireland Strategy which is focused on improving population wellbeing, health service efficiency and economic opportunity through the use of technology. Health Business Services Providing a range of business services, including procurement, finance, human resources, estates, HR/payroll systems and analytics, and business excellence and innovation, on a shared basis to our corporate partners and customers, supporting health structures as they continue to evolve and mature. National Communications Supporting people to manage their health and use the best health services for them, and making information about health services more widely accessible to the population. Emergency Management Working with services across the organisationto provide advice and support in the preparation of emergency plans, and working on an interagency, interdepartmental and cross border basis in the planning and response phase of emergency planning. Internal Audit Identifying risks and control issues, and providing assurance on the adequacy and degree of adherence to our procedures and processes. In conjunction with frontline services, the provision of a compassionate and efficient healthcare system is dependent on having these key enabling support services in place.

17. Some activity undertaken within enabling healthcare delivery in 2018… 87,639 354,728 122,379 calls 2.3m and 375,000 37,534 staff and electronic referrals processed invoices processed emails to service desk supported pensioners paid 116 450 Approximately 2,540 eHealth systems and upgrades went live ICT projects supported media queries answered Approximately Approximately 500 100 media interviews arranged press releases sent 17