HSE DUBLIN MID-LEINSTER

REGIONAL SERVICE PLAN

2011

Easy Access z Public Confidence z Staff Pride

Regional Director of Operations HSE Dublin Mid-Leinster Oak House Millennium Park Naas Co. Kildare Tel: 045 882597 Email: [email protected]

Based on the HSE National Service Plan 2011 submitted to the Minister for Health and Children on 17th December 2010 and approved on 21st December 2010

Contents

Introduction from the Regional Director of Operations ...... 1

Resource Framework...... 10 Finance...... 10 Human Resources...... 12 Improving our Infrastructure ...... 13 Monitoring and Measuring NSP2011 ...... 13 Risks for Delivering on NSP2011 and DML Business Plan 2011 ...... 13

Quality and Safety ...... 15

Service Delivery...... 18 Delivering Integrated Services – Primary, Community and Hospital Care ...... 18 Primary Care Services in the Community...... 19 Acute Services and Pre-hospital Emergency Care ...... 24 National Cancer Control Programme...... 37 Children and Families...... 40 Mental Health ...... 44 Disability ...... 47 Older Persons...... 51 Palliative Care ...... 55 Social Inclusion ...... 57

National Performance Indicator and Activity Suite...... 61

Regional Balanced Scorecard (Non-Acute Services)...... 74

Key Result Areas & Deliverable Outputs – Responsible Appointment Holders……..…….. 88

Appendices Appendix 1 Financial Information...... 104 Appendix 2 a) Additional DoHC Funding Allocation for HSE National Priority Services ...... 105 b) HSE National Strategic Priorities Funded: Internal Resource Realignment ...... 105 c) HSE National Strategic Priorities: Internal Reconfiguration through Existing WTEs and Funding .....107 Appendix 3 DML HR Information...... 108 Appendix 4 DML Capital Projects 2011 by Programme...... 109 Appendix 5 Acute Hospitals in HSE Dublin Mid-Leinster (including Specialties)...... 112 Appendix 6 Public Service Agreement – DML Action Plan...... 113

Abbreviations ...... 124

Bibliography ...... 125

INTRODUCTION

Introduction from the Regional Director of Operations

The National Service Plan 2011 (NSP2011), which was published on 22 December 2010, sets out the type and volume of service the Health Service Executive (HSE) will provide directly, and through a range of agencies funded by us, during 2011, within the funding provided by Government and within the stipulated employment levels. In developing the NSP2011, the HSE’s national priorities for 2011 are to:

ƒ Maintain the levels of service provided in 2010 ƒ Deliver the cost reduction and restructuring programmes to enable the maintenance of these service levels on a total reduced budget basis of €962m (€683m net) ƒ Seek to ensure the delivery of high quality and safe services ƒ Accelerate our reform programme to reconfigure core services and in line with our strategy, deliver an appropriate balance between hospital and community services as well as best care models in childcare, disability, mental health and older person’s services, and ƒ Implement the national clinical change programmes and new service developments.

In this context, HSE Dublin Mid-Leinster (DML) has commenced the process of implementing the NSP2011, the detail of which is outlined in this document HSE Dublin Mid-Leinster – Regional Service Plan 2011. This service plan outlines the type and volume of services, key priorities and actions at regional and local level across hospitals and community services, arising out of the NSP2011, to be implemented in DML in 2011.

DML Demographic Profile DML is the largest of the four Regional Director of Operations (RDO) areas within the HSE with a total population of 1,216,848 as per the 2006 CSO Census. The area ranges from Dublin City south of the River Liffey, South County Dublin, Dun Laoghaire/Rathdown, and all of counties Kildare, Wicklow, Laois, Offaly, Longford and Westmeath. The region is currently divided into nine Local Health Office (LHO) areas as shown in the population table hereunder:

Local Health Office (LHO) Total Population Dublin South 126,382 Dublin South East 110,487 Dublin South City 134,344 Dublin South West 147,422 Dublin West 134,020 Kildare/West Wicklow 203,327 Laois/Offaly 137,927 Longford/Westmeath 113,737 Wicklow 109,202 Total 1,216,848 Source: CSO Census 2006

It is acknowledged that there are many areas of deprivation located within the Dublin Mid-Leinster Region. According to the National Deprivation Index for Health & Health Services Research (SAHRU Technical Report Dec 2007) some 45.5% of the 803,719 persons living in the most deprived Electoral Divisions (EDs) are in the Greater Dublin Region comprising Dublin City & County and Counties Wicklow and Kildare. In addition, of the 50 most deprived EDs nationally, 12 are located in the Dublin Mid-Leinster region. This presents additional challenges for DML in the provision of health and personal social services to the community.

DML Regional Service Plan 2011 1

INTRODUCTION DML Regional Structure In 2011, I will be supported in my role as DML RDO by a Regional Team which comprises Integrated Service Area Managers (ISAMs) x 5, Assistant National Director for Finance (DML), Assistant National Director for Human Resources (DML), Assistant National Director for Estates (DML), Business Manager and Communications Manager. In addition, 2 Local Health Managers – 1 each in the areas of Disabilities and Mental Health respectively – will lead out on the provision of these services in DML.

The Integrated Service Area (ISA) structure will be implemented in DML over the coming year. The 9 LHOs and the 2 Hospital Networks will be grouped into 4 ISAs and an ISA for the Paediatric Hospitals. The ISAMs will have full accountability and responsibility for all health and social care services (acute and non-acute) in each of these ISAs. They will also work closely with the National Care Group leads for Children and Families, Disability, Mental Health and Older Persons Services to ensure that the delivery of services to these groups is in line with policies agreed by Government and within the agreed targets and resources of the HSE, as set out in NSP2011 and this Service Plan.

It is the intention that the Integrated Service Areas will: • Be empowered to deliver an integrated service to patients. • Support and deliver services and resources consistent with best practice. • Ensure strong local accountability and adherence to robust national planning processes. • Support high quality clinical and business decisions. • Support consistent management of performance, quality and outcomes. • Have a public leadership and communications role to support staff morale and public confidence.

In 2011, DML will concentrate on a number of key areas in order to ensure that our services are delivered in a seamless, efficient and cost-effective way that facilitates easy access for our clients and addresses areas of greatest need.

The key DML service priorities for 2011 are:

1. To continue to deliver existing level of high quality and accessible health and personal social services to the DML population in the current climate of reduced financial allocation and recruitment moratorium. 2. To establish the four Integrated Service Areas and the Integrated Service Area for the Paediatric Hospitals and manage the associated human resource and structural reorganisation challenges, with a particular emphasis on ensuring that there is successful integration between hospital and community services. 3. To ensure that all of the reconfiguration projects within DML are planned and managed in a structured manner in order that this will ultimately translate into greater efficiencies in the delivery of health and personal social services across DML. This will include the development of stronger clinical networks between hospitals within the Region. 4. To monitor, support and improve the performance of our Acute Hospitals in the following areas in particular: Emergency Departments Admission Waits and Patient Experience Time, OPD Waiting Lists, Elective Surgery. 5. To progress the implementation of the National Clinical Programmes in DML Acute Hospitals. 6. To ensure that the service priorities in all Care Groups (e.g. Child Care, Disabilities, Mental Health, etc.) are monitored for progress against targets and that timely interventions are made to address any issues in this regard, if required. 7. To initiate the appropriate processes in accordance with the Public Service Agreement that will facilitate the redeployment of staff to frontline and other positions that are vacant as a result of the Voluntary Early Retirement Scheme/Voluntary Redundancy Scheme (VERS/VRS). 8. To continue the preparation of the three Paediatric Hospitals, Dublin, for migration to the new National Paediatric Hospital.

Reconfiguration and Integration

DML has commenced the reconfiguration and integration process in the context of the principles set out in the Corporate Plan and the features particular to the region. A Reconfiguration Project, chaired by me, and comprising appropriate representation from all stakeholders, has been set up to drive DML reconfiguration and integration. The goal of the Project is to identify, plan, develop and execute projects within the region which will reflect the corporate objectives taking into account issues of accessibility, patient safety, clinical standards and quality of services.

DML Regional Service Plan 2011 2

INTRODUCTION

Guiding all work in this area is the need to ensure that our service users’ experience of services is optimised to include improved access to and timeliness and appropriateness of service delivery; achieving reductions in waiting times for ED and admission, improving discharge planning, increasing day case activity and maximising cost reductions associated with these changes.

The continued roll out of the Clinical Care programmes, including the Acute Medicine Programme, the need to manage risk and safety issues in the light of current resources and definition of our integrated services areas will all inform this programme of re-configuration and integration.

The programme for reconfiguration will develop as specific projects are identified, planned and implemented. Initially there will be four sub-committees, each representing the outlined Integrated Service Areas, incorporating the major acute teaching hospitals, other hospitals and all primary care services. In addition, work will continue in relation to the ongoing paediatric hospitals re-organisation. Maternity services will also be reconfigured to ensure that all maternity services are co-located with acute hospitals providing the appropriate range of services to support the maternity unit.

Phase one of the project will be the continued development of the St. James’s Integrated Service Area, developing stronger clinical networks with the Midland Hospital Group, development of clinical networks between AMNCH (Tallaght Hospital) and Naas General Hospital, the current reconfiguration of paediatric services and current work being progressed in relation to the mental health services and St. Vincent’s Hospital/St. Columcille’s Hospital integration project.

Funding Position The gross current Estimate for the HSE is €13.456bn as set out in the published Estimates for the Public Services 2011. This reflects a net reduction of €683m (4.8%). The total reduction to the HSE is €962m (6.7%) which is being offset by the return of €279m for additional expenditure relating primarily to medical cards, new services, pensions costs and the Clinical Indemnity Scheme.

The table below sets out the budget reduction framework for 2011:

Budget Reduction Framework 2011 National Position €m 2010 Gross Current Estimate 14,139,64 Additional Medical Cards 90.0 Reductions Community (Demand led) Schemes -424.0

Total Reductions €962m Pay Total Increases €279m Recruitment Moratorium -90.0 Net adjustment €683m Exit Programme -152.0 Additional pension costs due to exit package 29.0 4% levy on pensioners -21.5 Non Pay Procurement -200.0 Other Adjustments National Cancer Screening Service- transfer 10.5 Superannuation 57.0 Clinical Indemnity Scheme (States Claims Agency) 36.0 Long-Stay Repayments Scheme -17.0 Pandemic -55.0 Dormant Accounts -2.3 Funding for priority areas 56.4 Total 13,456.7

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INTRODUCTION

DML Regional Position Arising from the total HSE budget, the Financial Allocation for DML ISD for 2011 is €2,716.9m.

This allocation is broken down as follows:

HSE Dublin Mid-Leinster Budget 2011 2011 Financial Allocation €m Acute Services Dublin South Hospitals Group Network 656.5 Dublin Midlands Hospitals Group Network 458.5 Paediatric Hospital Network 195.8 Total Acute: 1,310.8

Non-Acute/Community Services 1,406.1

HSE Dublin Mid-Leinster Total 2,716.9

The 2010 Budget Allocation for DML ISD was €2,858.5m. The reduction in 2011 is, therefore, €141.6m which equates to 4.95%.

A summary of the reductions is outlined in the table below.

Reduction €m Non-return of Once-off funding in 2010 19.221 Procurement Savings 45.237 Agency 1.906 Retraction of Income Target Allocation 9.915 Moratorium 24.458 On Call 1.647 Other Savings 12.604 Internal Top Slice 4.379 Casemix 4.465 Drugs/Medicines 3.300 Strategic Priorities 1.301 IBTS 3.064 Legal Budget Centralisation 10.103 Total Reductions 141.600

Directives

In line with Ministerial directive, DML has applied a 1.8% cap on the reductions to both the Disability and Mental Health Services. In doing so, €11.324m was allocated across acute and community services.

In line with HSE Management direction, DML afforded a level of protection to the two paediatric and two maternity hospitals. The level of protection afforded is €4.717m. This was allocated across all other acute services.

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INTRODUCTION

Non pay expenditure

The National Service Plan is based on savings in non-pay of €200m which are summarised in the table below. This is an aggressive savings target which will require strong focus across all service areas and which will also require significant engagement and negotiation with the supplier base to the HSE in seeking to reduce prices and control volumes of stock of supplies and services used by the HSE and the voluntary sector.

Expenditure Category €m Procurements and Contracts Management 78.7 Logistics and Inventory Management 20.0 Reduce Discretionary Spend 41.7 Agency Services 7.0 Medical and Nurse Training 2.6 Laboratory Services 5.0

Review of Rent / Lease Renewals 5.0

Further non-service impacting initiatives (to be 40.0

identified)

Total 200.0

Procurement Savings The HSE initiated a specific project in 2011 to reduce non-pay expenditure by €160m. Of this amount, €148m relates to price initiatives across contracts for services, €5m in respect of Laboratory costs and €7m in respect of Agency/Locum services. HSE Procurement Directorate commenced engagement with suppliers in 2010 to deliver this saving. The DML share of these savings amounts to approximately €64.7m for 2011.

A detailed breakdown of the target savings (nationally and DML) across the various categories of expenditure are shown in the “Resource Framework” section of this plan.

Community (Demand Led) Schemes A reduction in expenditure of €424m is required nationally. The 2011 national provision for Community Schemes is €2,478m, €424m (15%) less than in 2010. €90m is available for increased expenditure for additional medical cards bringing the net reduction on the 2010 provision to €334m. This programme of work will require extensive engagement with the pharmaceutical industry and other stakeholders and will require a targeted and unrelenting focus during 2011.

The Community Schemes are dealt with on a national basis and, therefore, the 2011 DML figures are accounted for under the PCRS.

DML Regional Service Plan 2011 5

INTRODUCTION Human Resources Position

Pay and pay related expenditure The HSE is targeting savings of €242m nationally in pay and pay related headings. This includes €90m (DML €24.458m) as a result of the moratorium on recruitment which will require a reduction in 1,530 WTEs during 2011, as well as €152m (DML €19.434m) for the exit schemes which is based on an estimated 2,250 staff leaving. The opening employment ceiling for the HSE for 2011 is 109,372 reducing to 104,810 by the end of 2011.

National Position WTE WTE WTE Reductions Increases Total End of 2010 / Start of 2011 Employment Ceiling 109,372 - Transfer of Community Welfare Services to Department of Social Protection -1,128 - Projected reductions under VER / VRS 2010 schemes* -2,250 - Reduction in employment under ECF and National Recovery Plan -1,530 Sub Total -4,908 104,464 - Adjustments in respect of staff in former health board companies not previously counted 341 - Transfer in of external functions, e.g. Office of Tobacco Control / Adoption Authority etc. 5 Sub Total 346 104,810 End of 2011 Employment Ceiling (National) 104,810*

• The end 2011 employment ceiling of 104,810 is based on a reduction of an estimated 2,250 WTEs for the exit schemes. This will require to be amended once the final figure is known

DML Regional Position The opening employment ceiling for DML for 2011 is 32,229 reducing to 31,604* by the end of 2011, broken down as follows:

WTE WTE WTE Reductions Increases Total End of 2010 / Start of 2011 Employment Ceiling (DML) 32,229 - Projected reductions under VER / VRS 2010 schemes -535 - Reduction in employment under ECF and National Recovery Plan - 431 Sub Total -966 31,263 - Adjustments in respect of staff in former health board companies not previously counted 341 Sub Total 341 31,604 End of 2011 Employment Ceiling (DML) 31,604* • NOTE: A figure for the DML WTE reduction due to the transfer of Community Welfare Services to the Department of Social Protection will not be known until Q2 2011, therefore, the “End of 2011 Employment Ceiling (DML)” figure above will be subject to adjustment at that time.

This service plan is based on having the above number of staff available to deliver the volume and type of services outlined. Deviations from this number may impact on the delivery of the plan and pose a financial risk for the HSE.

The Public Service Agreement (PSA) provides the framework for delivering significant change across the health sector during the course of 2011. It provides a unique opportunity to further transform and modernise the health services by facilitating a reduction in staff numbers, increasing efficiency and productivity, reducing cost and improving quality. These opportunities will be maximised in DML in 2011. See DML PSA Action Plan at Appendix 6.

A national shortage of Non Consultant Hospital Doctors (NCHDs) will challenge the delivery of acute hospital services in DML in 2011. Work is ongoing to minimise this but nonetheless, it could pose a serious challenge to service continuity in a number of hospitals.

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INTRODUCTION

In DML, the key challenge is the development of Integrated Service Areas (ISAs), the subsuming of the Local Health Offices into the new ISA structures, and the establishment of the single Finance and Human Resources functions to support these ISAs.

The biggest HR challenge in DML in 2011 is to establish the impact of the VER/VRS and make the appropriate redeployments to ensure continued service delivery, particularly front-line.

Further pressures will emerge throughout the year with staff availing of retirement at 2009 pension levels.

Service Delivery Challenging service level targets have been set for 2011, notwithstanding the impact of the recruitment moratorium on our ability to maintain services. In order to do this in a sustainable way, we need to change, reconfigure and develop many of our services to meet best practice both nationally and internationally.

Hospital activity levels will target a 2% reduction in inpatient activity to be off-set by a 3% increase in day cases leading to a modest increase in total hospital care. The implementation of a number of national programmes such as the acute medicine and surgical programmes will be needed to support the delivery of these targets in 2011. The quality agenda for cancer services will also continue, as will the outpatient service improvement programme.

In many of the acute hospitals in DML, a discernible pattern has emerged over the years whereby a substantial number of patients from outside the DML area are attending for in-patient, OPD and day case treatments, notwithstanding the fact that many of these treatments are readily available in their own areas. These practices will be monitored and managed closely throughout 2011 so that these patients can attend locally for these treatments.

There will be a modest increase nationally in homecare levels with 11.98m hours of home help in line with 2010 target levels and approximately an additional 580 people in receipt of homecare packages. This translates to 2.16m hours of home help in DML in 2011. Also, €2.1m additional funding is being provided to support an extra 52 homecare packages in DML in 2011. National quality guidelines for homecare services will be prioritised for implementation.

Funding reductions to mental health services and disability services will be capped at 1.8%. We will continue to seek efficiencies in excess of that in order to generate funds for investment in reform of these services such as the further implementation of a Vision for Change and the recommendations of the VFM and Policy Review of Disability Services. Respite services for people with disabilities will remain at 2010 levels.

Service Developments and Change Programmes A major theme of NSP2011 is the start of the implementation of the national clinical programmes. A highly ambitious plan of work has been outlined for 2011 in this regard. The focus will be on standardising care and implementing proven solutions to save lives, prevent complications, remove waiting lists and save money. While the full benefits of this work will take time to be fully realised, 2011 will be a very important year in embedding many of these solutions within our clinical services. The areas that will commence implementation include:

ƒ Acute Medicine Programme ƒ Emergency Medicine Programme ƒ Elective Surgery Programme ƒ Diabetes Programme ƒ Heart Failure Programme ƒ Stroke Programme

ƒ Epilepsy Programme ƒ Chronic Obstructive Pulmonary Disease (COPD) Programme, and ƒ A range of initiatives to address outpatient waiting lists including neurology, dermatology and rheumatology.

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INTRODUCTION

A striking example of the potential of these programmes is the plan for stroke care. The establishment of nine new stroke units and the availability to 24/7 thrombolysis therapy (clot busting treatment) across the country has the potential to improve patient outcomes and to prevent the development of severe disabilities.

Other areas for targeted internal investment are paediatric critical care, childcare, mental health, primary care and palliative care. Investment of €63m will take place to support the delivery of these initiatives which will be funded both through the use of some of the innovation fund and also by internally transferring some of the base budget. The full details of the resources required for these programmes are outlined in Appendix 2.

The implementation of these programmes will provide an opportunity to demonstrate the benefits to patients that have occurred as a result of the exceptional clinical leadership that is being demonstrated across all the professional groups. An allocation of €56m has been received to fund additional services in some strategically important areas (see Appendix 2). This includes home care packages (€8m), suicide prevention (€1m), services for people with disabilities (€10m), completion of developments which commenced in 2010 in both cancer (€10m) and childcare (€9m) services as well as some further service developments in these areas.

The appointment of a National Lead for Children and Families Services will ensure the acceleration of the change process in that sector. Sixty additional social workers will be recruited in 2011 to add to the 200 posts filled in 2010.

DML will facilitate and support the implementation of the above programmes throughout 2011.

Patient Safety and Quality Delivering high quality services and minimising risk will continue to be a high priority for the HSE in 2011 and will be strongly influenced by the National Standards for Safer Better Healthcare. Compliance will be enabled through the implementation of the Quality Safety and Risk Framework. The HSE will also seek to implement the recommendations of all HIQA and other relevant reports. The impact of the moratorium on recruitment on patient safety will be closely monitored and all efforts taken to minimise any emerging service quality issues.

The Regional Quality, Risk and Clinical Care programme recognises that quality, risk and audit management is a line management responsibility and seeks to support, enable and advise line management. In the coming year, the DML Quality Risk Audit (QRA) Governance Group will oversee and support Integrated Service Areas (ISAs) and their staff in advancing the QRA agenda.

Emphasis will be placed on ensuring that there is Regional compliance with relevant quality standards and in promoting incremental improvement and increasing safety for those who work in and access our services. This will be achieved through monitoring for trends that may indicate underperformance and the identification and exploitation of best practice models to improve performance, as necessary, in these areas.

Infrastructure The Capital Allocation of the HSE is €373m, a 16.2% reduction in comparison with a provision of €444m in 2010. A €15m additional spend on Mental Health is to be included in the Revised Estimates Volume to be funded from asset disposals. A separate Capital Plan has been developed. Details of the Capital Projects to be progressed in DML in 2011 are set out in Appendix 4. The total Capital Cost 2011 for DML for these projects is €29.88m. The 2011 WTE implication for these projects is 25.5WTEs. In addition, €9.003m has been allocated for minor capital projects in DML in the coming year.

Income The HSE will collect the increased inpatient and day case charges set out by the Minister in the Budget 2011. The target set for DML in 2011 is €9.915m in the Voluntary Hospitals and €3.304m in the Statutory Hospitals. Additionally the HSE is actively seeking to accelerate income collections and simplify the process of charging with the collaboration of the DoHC. Gains in this area could be of assistance in the management and the delivery of a balanced Vote in 2011. Several national initiatives will be implemented in 2011 and DML will assist these initiatives in order to reduce the overall debt reduction policy.

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INTRODUCTION

Monitoring Performance On foot of the 2011 Performance Management Framework, a Regional Performance Management Report will be produced by each of the 4 RDO areas every month. The DML report will demonstrate the region’s progress in implementing key national and regional targets and service priorities. This report will be the management reporting tool for the Performance Management Review process held at regional level between the National Director and myself. It will ensure accountability for the delivery of the Service Plan within the resource allocation and approved employment ceiling for DML, while meeting the agreed targets on service delivery and improvements; value for money and cost management; clinical quality, safety and efficiency.

The DML service priorities identified in this service plan were drawn up on the basis of the necessity to adhere to the HSE national targets and priorities as set out in NSP2011 and in cognisance of the wishes expressed by the then Minister for Health & Children and her Departmental teams, to the HSE Chairman and Board, with a view to building on progress already made in the past year. The key result areas will provide a definitive focus to assist us in achieving our various goals in 2011.

The National Performance Indicator and Activity Suite which sets out all the metrics that DML must report on throughout 2011 is appended to this document for ease of reference.

Conclusion Finally, I wish to acknowledge that there were many challenges for DML last year in terms of delivering NSP 2010 in a climate of reduced financial and human resources. I am greatly appreciative of the huge efforts made by individual staff members and teams within the region in overcoming same and in meeting our 2010 targets.

I am confident that the same focus and dedication will be displayed by our staff this year in surmounting new and ongoing challenges, not least the impact of the recent exit programme on management and administrative resources and the continued limitations on funding. Despite these difficult times, I have no doubt that DML staff will continue to be fully committed to the delivery of high quality, responsive, integrated and effective services in our hospitals and the wider communities within the region in 2011.

Gerry O’Dwyer Regional Director of Operations HSE Dublin Mid-Leinster

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RESOURCE FRAMEWORK Resource Framework

Under the legislative framework of the Health Act, 2004, Section 31, the primary purpose of the annual HSE National Service Plan (NSP) is to set out how the Estimate (budget) allocated to the HSE will be spent in the given year on the type and volume of health and personal social services delivered to the people of Ireland, within the approved employment levels set out by Government. It is guided by the vision, mission, values and objectives of the organisation as set out in the HSE Corporate Plan.

The data below includes a breakdown of the various resources (finance, HR, etc.) available within HSE Dublin Mid- Leinster in 2011.

Finance

The financial allocation for DML ISD for 2011 is €2,716.9m. This represents a reduction of €141.6m from 2010, which equates to a 4.95% reduction on last year’s funding.

The Acute/Non-Acute breakdown of the allocation is as follows:

• Acute Services: €1,310.8m - Dublin South Hospitals Group Network: €656.5m - Dublin Midlands Hospitals Group Network: €458.5m - Paediatric Hospitals Network: €195.8m

• Non-Acute / Community Services: €1,406.1m

The Care Group breakdown of the Financial Allocation, both Voluntary and Statutory services, is as follows:

Care Group 2011 Allocation – HSE Dublin Mid-Leinster Care Group by Programme 2010 Budget 2011 Budget €m €m Primary Care 48.012 46.197 Primary Care Reimbursement Service 9.352 9.052 Children & Families 157.898 130.693 Mental Health 167.128 164.219 Disability 483.359 474.578 Older People 300.648 296.345 Palliative Care 34.578 33.370 Social Inclusion 56.915 55.075 Multi Care Group 185.819 189.879 Acute Services 1,392.866 1,310.800 Other 21.925 6.692 Total : 2,858.500 2,716.900 The impact of the Exit Schemes has not been included in the above table. The DML portion is €19.434m. The HSE financial systems are a consolidation of multiple legacy systems from the former Health Board structure. In this context coding of budgets by care group is not standard nationally and can be subject to restatement.

Details of the Voluntary/Statutory breakdown of the above Care Group figures are shown in the relevant Care Group sections of this plan.

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RESOURCE FRAMEWORK

Item €m Cost Management – Reducing cost without reducing services Laboratory Services 5.0 Agency Services 7.0 Medical and Nursing Training and Education 2.6 The range of reductions agreed for 2011, and outlined here, reflect the Procurement and Contracts Management 78.7 outcome of a process where the HSE has focused on maximising the Medical and Surgical Supplies, Contracts and 23.4 financial impact of nationally led programmes and processes to ensure Equipment the least impact on levels of service in meeting our financial breakeven Drugs and Medicines 18.0 Laboratory Consumables 8.9 requirements. These include the management and delivery of our Blood and Blood Products 2.0 procurement and logistics, estates and educations and training activities, X-Ray Consumables 1.6 as well as a national approach to managing discretionary expenditure Medical Gases 1.3 Cleaning and Washing Products and Contracts 3.1 under relevant headings. Energy 1.5 Catering Products and Contracts 2.6 The Procurement and Category Management includes savings of €30m Patient Transport Costs 0.8 Bedding and Clothing 1.0 within the relevant headings to reflect the significant focus being given to Vehicle Running Costs 0.2 maximising our market management and supplier engagement towards Office Stationery, Printing, Equipment, etc. 3.8 accelerating the planned multi-year procurement and contracts Telephony 2.5 management programme. Specific service-led initiatives are also Insurance 1.0 ICT Equipment 2.0 included where moving to a more appropriate model of care will also Legal 5.0 lead to reduced costs without impacting on the level of service. Review of Rent / Lease Renewals etc. 5.0 Logistics and Inventory Management 20.0 Stock Management (Non Pharmacy) 8.2 As in previous years of the cost reduction programme, financial reporting Point of Use Demand Management 0.8 of the maintenance and further delivery of VFM will happen within the Stock Management (Pharmacy) 6.0 2011 HSE Performance Reporting (PR) process. Aids and Appliances Recycling 5.0 Reduce Discretionary Spend 41.7 Furniture and Crockery 11.0 Vehicles Purchased 0.7 Maintenance 30.0 Further non-service impacting initiatives 40.0 The DML share of the target savings across the various categories of (to be identified) expenditure are outlined in the table below. Total 200.0

Non Service Impact Cost Reduction €m Month Applicable DML Share Programme 2011 On Call 5.0 02 to 12 1.647 Locum / Agency 7.0 02 to 12 1.906 Medical & Nursing Training & 2.6 01 to 12 - Education Procurement & Contract Management 78.7 32.482 Medical & Surgical Supplies, Contracts 23.4 04 to 12 9.053 & Equipment Drugs & Medicines 18.0 03 to 12 11.808 Laboratory Consumables 8.9 03 to 12 2.697 Blood & Blood Products 2.0 03 to 12 0.818 X-Ray Consumables 1.6 03 to 12 0.322 Medical Gases 1.3 03 to 12 0.422 Cleaning & Washing Products & 3.1 04 to 12 1.074 Contracts Catering Products & Contracts 2.6 04 to 12 0.833 Energy 1.5 02 to 12 0.495 Patient Transport Contracts 0.8 04 to 12 0.159 Bedding & Clothing 1.0 03 to 12 0.357 Vehicle Running Costs 0.2 04 to 12 0.026 Office Stationery, Printing & Equipment 3.8 01 to 12 2.622 Telephony 2.5 04 to 12 - Insurance 1.0 01 to 12 - ICT Equipment 2.0 06 to 12 0.539 Legal 5.0 04 to 12 1.257

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RESOURCE FRAMEWORK

contd. Non Service Impact Cost Reduction €m Month Applicable DML Share Programme 2011 Review of Rent/Leases etc 5.0 04 to 12 Logistics & Inventory Management 20.0 Stock Management - Non Pharmacy 8.2 Point of Use Demand Management 0.8 Stock Management - Pharmacy 6.0 Aids & Appliances Recycling 5.0 Manage Discretionary Spend 41.7 16.055 Furniture & Crockery 11.0 01 to 12 4.499 Vehicles Purchased 0.7 01 to 12 0.282 Maintenance 30.0 01 to 12 11.274 Total 160.0 52.090 Further Non Service Impacting 40.0 01 to 12 12.604 Savings Grand Total 200.0 64.694

Human Resources

Maximising the role of staff to deliver on the objectives of this plan will require a strong focus in 2011. Against the backdrop of reduced budgets and staffing resources in the health services, the challenge is not only to maintain access, quality and safety of services but to continue to improve them.

Public Service Agreement (2010 – 2014) The Public Service Agreement (PSA) provides the framework for delivering significant change across the public sector in the course of 2011. It provides a unique opportunity to further transform and modernise the health services by facilitating a reduction in staff numbers, increasing efficiency and productivity, reducing cost and improving quality. These opportunities must be maximised in 2011. See DML PSA Action Plan at Appendix 6.

Employment Control Framework and 2011 Approved Employment Ceiling The 2010 revised employment control framework for the health services devolved to the regions the day-to-day operation of the general moratorium on recruitment and promotion and delegated sanction to recruit specific grades and exceptions. The HSE operated within the approved reducing employment ceiling throughout 2010 and at the end of 2010 it is projected that the outturn for the HSE nationally will be of the order of 108,400, over 900 WTEs below ceiling. The outturn (Census) for DML in 2010 was 32,946 WTEs. This was 33 WTEs below ceiling.

Voluntary Early Retirement / Severance schemes for management / admin staff grades and support staff The HSE is finalising the impact of the voluntary early retirement / severance schemes for management and administrative grades and support staff. This will require significant redeployment / reassignment of remaining staff and reconfiguration of support functions and services in order to minimise the impact on front line services. The projected number of WTE reductions in 2011 related to the VER/VRS 2010 schemes in DML is 535.

2011 Employment Control Framework The opening 2011 DML WTE ceiling is 32,229 with an end of year target of 31,604. This is provisional and will be revised downwards when the number of WTEs related to the transfer of Community Welfare Services to the Department of Social Protection is known in Q2 2011. The employment control environment in 2011 will demand even more for less in terms of employment numbers and costs. The moratorium on recruitment and promotions will continue throughout 2011, with the continuing exception of some delegated sanction for a number of specific grades and services.

DML Regional Service Plan 2011 12

RESOURCE FRAMEWORK

Improving our Infrastructure Ensuring that our infrastructure supports us in delivering quality and safe services is essential to achieving all our objectives. The HSE Capital Programme and ICT Capital Plan define the priorities for 2011 and the period 2011 - 2015. The capital funding nationally for 2011 is €372m, down from €444m in 2010. A €15m additional spend on Mental Health is to be included in the Revised Estimates Volume to be funded from asset disposals.

In DML, capital projects totalling €29.88m will be progressed/completed in 2011.

Appendix 4 provides a table of DML capital projects by programme which includes those projects completed in 2010 but did not become operational in 2010, those projects that are due to be built and/or complete in 2011 and also those projects that are projected to become operational in 2011. Information is given on the facility, project details, additional and replacement beds, expected completion and operational dates, capital cost 2011 and total capital cost, revenue cost 2011 and WTE 2011, where appropriate. Wherever possible, capital projects will become operational as soon as the capital build has been complete.

In addition, €9.003m has been allocated for minor capital projects in DML in the coming year.

Monitoring and Measuring NSP2011 The HSE provides detailed monthly performance reports to the DoHC outlining progression of the type of volume of activity detailed in the NSP against agreed targets. Performance indicators (PIs) and measures used to support this process are outlined in each chapter and summarised in a table at the end of this plan. During 2010 a rigorous process was undertaken to review all measures and metrics that the HSE collects and reports in its NSP. This has resulted in some measures being discontinued, others amended and additional, improved measures being identified. Reporting against some of these measures is contingent on the development of processes and systems to support collection being in place. As these come on stream, reporting will commence through the monthly HSE Performance Reports. In addition measures that were developed arising from the NSP2010 development process but were not reported on in 2010, will now be reported in 2011.

DML will co-operate with the collection and reporting of all the required performance data in 2011.

Risks for Delivering on NSP2011 and DML Service Plan 2011 The HSE has a responsibility to identify, where possible, the impact pre-existing and future risks could have on delivering the planned service levels outlined in this plan while continuing to operate within its Estimate. NSP2011 is based upon an Estimate of €13.456bn. This is a net reduction of €683m from 2010. The gross reduction is €962m which is being offset by the return of €279m for specific purposes. This significant reduction in funds is on top of the reduction of €1bn in 2010 and is a major challenge to the delivery of health services. These reductions are set against the backdrop of the economic environment and the very significant issues facing the Exchequer. The reduction for ISD DML is €141.6m or 4.95%.

The HSE response to this budget reduction is to seek to maintain services at or close to current levels and target significant reductions in purchasing and stock costs while growing income. The plan is an aggressive attempt to preserve services while meeting the budgetary targets. We are relying upon the co-operation of the supplier base of the HSE to deliver significant savings to support healthcare delivery. The plan is targeted at driving productivity while reducing cost and capacity.

The HSE will also seek to ensure more efficient use of health resources through active pursuit of the actions set out in the integrated services delivery section of the plan. These will be key to supporting the maintenance of services in a resource constrained environment.

The key risk in this approach is the organisation’s capacity to realise the necessary savings from 1st January 2011. This is a major challenge for the whole organisation and will be the key focus in 2011.

DML Regional Service Plan 2011 13

RESOURCE FRAMEWORK

Other significant risks to the delivery of the plan are:

ƒ The opening employment ceiling for the HSE nationally for 2011 is 109,372 reducing to 104,810 by the end of 2011 (the DML equivalent figures are 32,229 reducing to a provisional figure of 31,604 by year end – a further downward adjustment will be required when figures relating to staff moving from Community Welfare services to the Department of Social Protection are known) and the NSP2011 is based on having this number of staff available to deliver the volume and type of services outlined. However because of the, as yet unknown, impact of the recruitment moratorium, the Voluntary Redundancy Scheme (VRS) and Voluntary Early Retirement Scheme (VER), there are possible risks to service delivery as the number, type and location of staff who will be available to provide services may vary from the plan. The actual savings in relation to these exit schemes will not be known until the process is completed at year end. Indications are that the savings will be less than the figure above. The HSE is assuming that it does not have to provide for any shortfall and the position will be reviewed as soon as final information is available. ƒ In addition to the voluntary schemes, the NSP2011 is based on a 1,530 reduction in employment levels through natural attrition/turnover during 2011. Achievement of this number may impact on the delivery of the NSP2011, posing both service and financial risks for the HSE. The likely unstructured impact of the moratorium on recruitment on the quality and levels of services will need to be monitored and managed in as far as is possible within the parameters of the Employment Control Framework. The full year impact of the 2010 moratorium is also an additional service risk. ƒ The risk of unanticipated costs associated with the Clinical Indemnity Scheme. ƒ The risk of savings associated with the Primary Care Reimbursement Scheme (PCRS) not materialising because of unanticipated additional demand as trends in medical cards and other schemes are difficult to predict. The HSE is dependent on actions of the DoHC in regard to early implementation of key decisions to achieve these savings. As in other years, the HSE will closely monitor delivery of the savings as the year progresses and will take alternative action if needed. ƒ The government proposal to accelerate payments to suppliers to 15 days would have financial and business effects. Unless separately funded it would impact on the delivery of a balanced Vote in 2011 as early estimates indicate that this could cost the HSE up to €100m in 2011 were it to proceed. ƒ Despite considerable ongoing focus on the supply of NCHDs, there remains a risk that the unavailability of NCHDs may impact on the continuity of services and the capacity to deliver services in some settings.

All of these, and other risks that emerge as 2011 proceeds, will be actively monitored and assessed nationally and, depending on their impact, there may be a need to adjust planned service levels during the year to ensure that the HSE can operate within its Estimate. The NSP2011 has made provision for costs relating to the financial risks within the monies provided by Vote 40 of the Oireachtas.

DML Regional Service Plan 2011 14

QUALITY SERVICES Quality and Safety

Introduction Delivering high quality services and minimising risk is a priority for the HSE. The quality of service provision is a key aspect of the clinical programmes now underway. Quality performance indicators (PIs) are being developed and introduced incrementally as part of this process. These PIs appear in the appropriate service delivery section of NSP2011 (see primary care and acute sections). A multi-agency approach is being taken under the auspices of the Patient Safety First initiative to ensure the provision of high-quality care to all service users. Learning from incidents which occur is applied and reflected in how we plan and deliver our services generally. Work will continue with our external stakeholders to develop a knowledge base of effective health care interventions which can support the implementation of the programmes and other specific quality and safety initiatives.

Regional Quality, Risk and Clinical Care Programme

Purpose The purpose of the programme relates to conformance and performance of the quality, risk and clinical care system in place in the region as follows;

1. Conformance – to provide assurance to the RDO in relation to the systems and processes that are required to manage issues relating to quality, risk and clinical care. This includes compliance with relevant standards (Mental Health Commission (MHC), Health Information Quality Authority (HIQA) etc.) standards, the HSE’s Integrated Risk Management Policy - the systems for the reporting and management of incidents (to include serious incidents), the HSE Medical Device and Equipment Management Policy, the HSE Procedure for the Development of Policies, Procedures, Protocols and Guidelines etc. 2. Performance - to place an emphasis on incremental improvement and increasing safety for those who work in and access services in the region. This will be achieved through monitoring for trends that may indicate underperformance and the identification and exploitation of best practice models to improve performance in these areas.

The programme recognises that quality, risk and audit management is a line management responsibility and seeks to support, enable and advise line management. The Dublin Mid Leinster Quality Risk Audit (QRA) Governance Group will oversee and support Integrated Service Areas (ISAs) and their staff in advancing the QRA agenda.

The HSE National priorities for 2011 are to: ƒ Further develop and implement the Quality, Safety and Risk Management Framework ƒ Strengthen accountability arrangements ƒ Increase service user input into planning and delivery of services ƒ Strengthen our healthcare audit, progress clinical audit, strengthen clinical effectiveness and develop health technology assessment capacity ƒ Comply with Health Information and Quality Authority (HIQA) report recommendations ƒ Enhance our management of serious incidents and complaints ƒ Improve preparedness for major emergencies ƒ Strengthen research and development, and ƒ Enforcement of statutory functions in relation to environmental health services.

In addition to the HSE National priorities, our DML Regional priorities for 2011 are to: ƒ Outline the accountability arrangements for quality and risk management within the Region and to have in place a structure for Quality, Risk and Clinical Care that ensures clear lines of accountability for quality and risk management leading up to the Regional Director of Operations (RDO).

ƒ Ensure that the core processes for quality, risk and audit management are defined, communicated and implemented in a consistent manner in all areas within the Region, e.g. risk registers, incident management (including the management of serious incidents), serious incident escalation, compliance with relevant standards, quality improvement programmes etc.

DML Regional Service Plan 2011 15

QUALITY SERVICES

ƒ Support the development of capacity and capability of staff in the region with respect to the requirements of the quality, risk and clinical care programme – this is considered particularly important given the low numbers of staff with the specific risk management and quality roles within DML. ƒ Provide mechanisms to support the professional development and networking of quality and risk staff within the region. ƒ Support the development of mechanisms to promote best practice and share learning to improve quality and safety. ƒ Collaborate with the National and other three Regional HSE Quality, Risk and Clinical Care functions to ensure alignment with National Quality, Risk and Clinical Care Programme. ƒ Monitor the outcomes of the Quality, Risk and Clinical Care Programme by way of measuring Healthcare Quality Indicators. ƒ Provide the RDO with assurance in relation to the progress and performance of the regional quality, risk and clinical care programme.

Scope Accepting that quality, risk and clinical care is a line management function, the scope of this programme is one of establishing and monitoring consistent frameworks and providing advice and support to enable their implementation with the Dublin Mid Leinster Quality Risk and Governance Group overseeing and monitoring workload.

Key Result Areas

Quality and Risk Management Framework: Building on existing work on quality and risk standards Deliverable Output 2011 Target completion • Review Current Quality Risk and Audit Management Activity within LHO and Q1 NHO Pillars as at end of Dec 2010. • Develop Service Plan and sign off by appropriate group for QRM Q1 Framework. • Establish clearly defined ISA and Regional Unit Governance Structures Q1 within DML.

Clear Accountability Arrangements Deliverable Output 2011 Target completion • Document a map re current staffing within Quality Risk and Audit and Q1 associated functions within DML HSE and associated Dublin Area Teaching Hospitals. • Each ISA Manager to define and present clear management governance Q1 arrangements within ISAs with effect 2011 as an interim basis initially.

Person Centred Care: Service User Involvement; Complaints [Your Service Your Say]; Advocacy Deliverable Output 2011 Target completion • Participate as appropriate and feasible in the nationally co-ordinated draft Q2 consultation on the supporting documents on service user involvements and methods of involvement. • Participate, as appropriate and feasible, in the nationally co-ordinated 16 Q3 regional training workshops for acute and non acute services regarding service user involvement, feedback mechanisms, communication skills for healthcare workers, shared decision making, health literacy and self-care. • Participate as appropriate and feasible in the nationally co-ordinated launch Q3 of the Patients Charter. • Participate, as appropriate and feasible, in the national consultation on the Q1 development of a code of practice for Post-Mortem Services.

DML Regional Service Plan 2011 16

QUALITY SERVICES

Effective Care: Assurance and Monitoring; Documentation; Clinical Effectiveness; Health Technology Assessment; Healthcare Records Management Programme Deliverable Output 2011 Target completion • Provide training tools to implement the national guidance document Ongoing regarding PPTs and provide training for staff within DML. • Participate as appropriate and feasible in the consultation and development Ongoing of a health care records management code of practice.

Safe Care: Serious Incident Management; Medication Safety; Preparedness for Major Emergencies Deliverable Output 2011 Target completion • Develop and define Major Emergency Plans in the context of the new ISA Ongoing structures and ongoing review. • Develop local ISA plans for HCAI section and monitor as appropriate. Ongoing

Performance Activity and Performance Indicators

See National Performance Indicator and Activity Suite appended to this document for full details re 2011 Quality and Safety metrics.

DML Regional Service Plan 2011 17

INTEGRATED C ARE Delivering Integrated Services Primary, Community and Hospital Care

Introduction The HSE aims to provide people with the type and quality of care they need, when they need it, in the most appropriate setting and from the most appropriate health professional or team of health professionals.

Delivery of services crosses between primary care, community services and hospitals. Services are being reconfigured to focus on the complete needs of the patient and / or client, while also prioritising effective working relationships across services, providing a more responsive and accountable service.

During 2011 the DML region will continue to strive for the maximum provision of integrated clinical services across acute hospitals, ambulatory and primary care settings.

This section sets out the key clinical services to be delivered for people in need of acute or chronic care. It initially focuses on services to be provided by primary care in the community, followed by the type and volume of services to be delivered in our acute hospitals in 2011, including the programmes of clinical care and chronic disease interventions commenced last year. This section concludes with a specific focus on what will be achieved by the National Cancer Control Programme in 2011.

HSE National Service Delivery Model

Level IV Tertiary Acute Services

Level III Integrated Service Areas (Including Secondary Care Hospitals)

Level II Community Health & Social Care Networks

Level I Primary Care Teams

Home

Patient N a t e io r n a a C l f P o 7,000-10,000 r o s g e r a m 30,000-50,000 m m m a r e g s o r o P f l C a 100,000-350,000 a n r o e

ti +

a 0

N 0

00,0 5

DML Regional Service Plan 2011 18

INTEGRATED C ARE Primary Care Services in the Community

Introduction Primary care services aim to support and promote the health and wellbeing of the population by making people’s first point of contact with our health services easily accessible, integrated and locally based. The availability of chronic diseases programmes and diagnostic services in primary care, where appropriate, will mean that patients do not need to attend hospitals for these services.

The HSE National priorities for 2011 are to: ƒ Continue developing Primary Care Teams (PCTs) and Health and Social Care Networks (HSCNs) ƒ Improve disease management in both primary and ambulatory care services ƒ Implement Audiology Report recommendations ƒ Improve prescribing patterns ƒ Implement recommendations from the General Practice (GP) Co-Op review ƒ Implement the Independent Strategic Review of the Delivery and Management of HSE Dental Services and DoHC’s Oral Health Policy, and ƒ Deliver the Human Papilloma Virus (HPV) vaccine to the specified cohort of young women.

In addition to the HSE National priorities, our DML Regional priorities for 2011 are to: ƒ Continue developing 150 Primary Care Teams (PCTs) and 36 Health and Social Care Networks (HSCNs). ƒ Improve disease management in both primary and ambulatory care services in line with prioritised QCCD programmes. ƒ Implement Phase 1 of National Audiology Review recommendations and prepare for roll out of newborn hearing screening. ƒ Further implement recommendations from the General Practice (GP) Co-Op review in MiDoc and KDoc. ƒ Implement the Independent Strategic Review of the Delivery and Management of HSE Dental Services and DoHC’s Oral Health Policy . ƒ Implement new Orthodontic Performance Indicators across DML. ƒ Deliver the Human Papilloma Virus (HPV) vaccine to the specified cohort of young women.

Resources FINANCE DML REGIONAL WTE DML REGIONAL 2010 Budget €m 2011 Budget €m DML WTE Dec 2010 DML WTE 2011 Statutory 41.291 39.994 (3.1%) DML 3,437 TBC Voluntary 6.721 6.203 (7.7%) Total 48.012 46.197 (3.8%)

DML Regional Service Plan 2011 19

INTEGRATED C ARE

Key Result Areas

Primary Care Teams (PCTs) and Health and Social Care Networks (HSCNs): Progress the establishment of PCTs and HSCNs Deliverable Output 2011 Target completion • Access to primary care services increased by having 150 Primary Care Q4 Teams in place in DML in 2011. Actions include: ¾ Continued negotiation with service managers to realign existing staff to fill staffing deficits in existing teams and to resource new teams, particularly nursing grades. ¾ Roll out of clinical leadership and service management for teams in operation. ¾ Ensuring that all teams in place are holding regular Clinical Team meetings with GPs present. ¾ Facilitated standardisation of approach to service delivery via roll out of business processes. • Service integration enhanced through the development of 36 Health and Q4 Social Care Networks in DML, achieved by: ¾ Implementing governance and management structures. ¾ Working with Care Group managers to align specialist and care group services to Teams and Networks. ¾ Rolling out, upon adoption, of general principles of referral and shared care arrangements with secondary care, care group and specialist services. • Co-operation with the National Primary Care Programme in relation to Q3 national research. • Referral systems from primary care to acute sector implemented, when Q4 developed.

Chronic Disease Management: Cross-directorate planning in delivering integrated chronic disease programmes Deliverable Output 2011 Target completion • Co-operation with the commencement of plans for the management of Ongoing chronic disease in primary care through the roll out of pilot sites in DML as identified nationally.

Enhancement of Primary Care Services: Promoting health; Delivering integrated cancer programmes Deliverable Output 2011 Target completion • Co-operation with planning for the delivery of IV therapy services in Q4 community settings. • Implementation of the Health Promotion Strategic Framework commenced. Q1

• Programmes, as directed nationally, for the following areas implemented Q3 through PCTs: ¾ falls prevention ¾ team based approaches to mental health, including the consultation liaison model as described in Vision for Change ¾ smoking cessation ¾ breast feeding

DML Regional Service Plan 2011 20

INTEGRATED C ARE

contd. Enhancement of Primary Care Services: Promoting health; Delivering integrated cancer programmes Deliverable Output 2011 Target completion • Specific measures from the Tobacco Control Framework implemented with a Q4 particular focus on DML acute settings, including: ¾ maintaining smoking cessation services at current level ¾ developing a plan to make health service campuses smoke free ¾ expanding the primary care tobacco control training programme developed by Health Promotion/NCCP following the publication of the evaluation. • Roll out of initiatives in DML primary care settings as developed by the Q3 cancer control programme including: ¾ Facilitate the release of Nursing to attend Community nurse education programmes if required. ¾ Roll out of follow-up care programmes in the community for patients who have had cancer in association with the NCCP. ¾ Facilitation of Information / training sessions for DML GPs delivered through ICGP and CME tutor groups.

Audiology Services Deliverable Output 2011 Target completion • Implementation of Phase 1 recommendations of Audiology review to Q4 enhance Audiology services in DML. • Preparation for roll out of Newborn Hearing Screening in DML in line with Q3 national model.

Prescribing Deliverable Output 2011 Target completion • Work with GPs in DML on cost effect prescribing as led by QCCD. Q3

Out Of Hours Deliverable Output 2011 Target completion • Further implementation of recommendations from the General Practice (GP) Ongoing Co-Op review in MiDoc and KDoc.

Oral Health Policy Deliverable Output 2011 Target completion • New orthodontic performance indicators will be implemented across DML in Ongoing 2011. • On-going discussions with the Irish Dental Association/IMPACT have commenced in relation to the implementation of the Independent Strategic Review of the Delivery and Management of HSE Dental Services. Alignment of dental services to ISA areas forms part of these discussions. • When the Oral Health Policy is received from the Department of Health and Children, an implementation plan for oral health services in DML will be developed.

Immunisation Deliverable Output 2011 Target completion To complete 3rd dose of HPV vaccine in the target group of 16,500 Q2 • secondary school girls for school year 2010/2011. • To offer 1st and 2nd dose of HPV vaccine to 8,200 Secondary school girls in Q4 school year 2011/2012.

DML Regional Service Plan 2011 21

INTEGRATED C ARE

Performance Activity and Performance Indicators - HSE Dublin Mid-Leinster

Indicator Expected DML Projected DML Expected DML Comment Activity/Target 2010 Outturn 2010 Activity/Target 2011 Primary Care Teams (PCTs) No. PCTs holding clinical team meetings 115 115 150 No. of PCTs in development 35 35 0 No. of patients / clients discussed at a clinical ------23,970 New PI. Team Meeting for the reported month No. and % of PHNs who are assigned to 100% 355 355 PCTs (as defined between DoHC and HSE) 100% 100% No. of PCTs that are implementing structured --- 27 31 For reporting in 2011. integrated diabetes care (as defined by the diabetes policy 2006 and the HSE’s EAG 2008) No. of PCTs implementing a structured ------26 New PI. education programme for diabetes patients separate from a structured integrated care programme. No. of patients / clients formally partaking in ------3,100 For reporting in 2011. structured integrated diabetes care (as defined by the diabetes policy 2006 and the HSE’s EAG 2008) No. of PCTs that are continuing to implement --- 6 6 For reporting in 2011. structured asthma prevention and care (as per 2010 pilot programme and as set out in the ICGP / Asthma Society of Ireland Clinical Guidelines, 2008) No. of patients / clients continuing to partake --- 185 185 For reporting in 2011. in formal structured asthma prevention and care (as per 2010 pilot programme and as set out in the ICGP / Asthma Society of Ireland Clinical Guidelines 2008) GP Out of Hours No. of contacts with GP out of hours 110,880 110,880 121,967 Increased target 2011 reflects inclusion of existing contracts not recorded rather than additional people being seen. Immunisations % of children 12 months of age who have ------95% For reporting in 2011. received three doses of vaccine against Diphtheria (D3), Pertussis (P3), Tetanus (T3), Haemophilus influenza type b (Hib3), Polio (Polio3),hepatitis B (HepB3) (6 in 1 vaccine). % of children at 12 months of age who have ------95% New PI for 2011. received two doses of the Pneumococcal Conjugate vaccine (PCV2) % of children at 12 months of age who have 95% 89% 95% New PI received two doses of the Meningococcal group C vaccine (MenC2) % of children 24 months of age who have ------95% For reporting in 2011 received three doses of vaccine against Diphtheria (D3), Pertussis (P3), Tetanus (T3), Haemophilus influenza type b (Hib3), Polio (Polio3) and hepatitis B (HepB3) (6 in 1 vaccine) % of children at 24 months of age who have 95% --- 95% New PI received one dose of the Meningococcal C vaccine (MenCb) between 12 months and 24 months of age. % of children 24 months of age who have 95% 88% 95% received the Measles, Mumps, Rubella (MMR) vaccine

DML Regional Service Plan 2011 22

INTEGRATED C ARE

contd. Indicator Expected DML Projected DML Expected DML Comment Activity/Target 2010 Outturn 2010 Activity/Target 2011 HPV – no and % of first and second year ------New PI for 2011. National girls to have received the third dose of HPV Target for 2011 = 46,400 vaccine in 2011 (80%) Child Health / Developmental Screening % newborn babies visited by a PHN within 100% 83% 95% 48 hours of hospital discharge % newborn babies visited by a PHN within ------100% New PI for 2011. 72 hours of hospital discharge % of children reaching 10 months within the 90% 24% 90% reporting period who have had their child development health screening on time before reaching 10 months of age Orthodontics Total no. of patients receiving treatment National = 22,130 National = 18,000 National = 18,000 during reporting period Total no. of patients in retention during Included in above. Included in above. To be disaggregated reporting period in 2011. Total no. of patients who have been National = 2,000 National = 5,000 National = 2,000 discharged with completed treatments during reporting period Waiting time for Orthodontic Assessment: (i) % assessed within 6 months --- New PI for 2011. National Target for 2011 = 75% (ii) % assessed within 9 months --- New PI for 2011. National Target for 2011 = 90% Waiting time for Orthodontic Treatment: (i) % of Grade 5 (surgically dependant --- New PI for 2011. National patients with impacted canines) treated Target for 2011 = 75% within 9 months (ii) % of Grade 5 (surgically dependant --- New PI for 2011. National patients with impacted canines) treated Target for 2011 = 90% within 12 months (iii) % of Grade 5a (functional case) treated --- New PI for 2011. National within 3 months Target for 2011 = 90%

(iv) % of Grade 4 treated within 2 years --- New PI for 2011. National (excluding Grade 4d, crowding) Target for 2011 = 75%

(v) % of grade 4d treated within 3 years --- New PI for 2011. National Target for 2011 = 75%

Improving our Infrastructure for Primary Care

A significant number of Primary Care Centres, the majority of which will be delivered by lease agreement, are planned to become operational in 2011. A full list of proposed capital projects for primary care for DML are shown below. Further details regarding these projects can be found in Appendix 4.

HSE Dublin Mid-Leinster

Facility Project Details Naas, Kildare To be provided by means of the Primary Care Strategy. By lease agreement. Longford Primary Care Centre. By lease agreement. Inchicore Primary Care Centre. Portarlington Primary Care Centre. By lease agreement. Mountmellick Primary Care Centre. By lease agreement.

Churchtown Primary Care Centre. By lease agreement. Wicklow Primary Care Centre. By lease agreement. Kilbeggan Primary Care Centre. By lease agreement. Kilcullen Primary Care Centre. By lease agreement. Greystones Primary Care Centre. By lease agreement.

DML Regional Service Plan 2011 23

INTEGRATED C ARE Acute Services and Pre-Hospital Emergency Care

Introduction HSE Dublin Mid-Leinster has fourteen acute hospitals, named below, which deliver a wide range of services to our population which include assessment, diagnosis, treatment and rehabilitation of both acute complex conditions as well as non-urgent conditions. Hospitals are providing more and more services each year as a result of the demands attributable to demographic changes and clinical advancements. A more diverse population base, increased births and elderly population is driving increased activity levels and higher patient acuity in hospitals. Hospital budgets have been cut for the past number of years and more efficiency has been delivered in both clinical and non clinical areas in order to maximise service levels.

Acute Hospitals – Dublin Mid-Leinster Region • St. James’s Hospital • St. Vincent’s University Hospital • St. Michael’s Hospital, Dun Laoghaire • St. Columcille’s Hospital, Loughlinstown • National Maternity Hospital, Holles Street • Royal Victoria Eye & Ear Hospital • AMNCH (Tallaght Hospital) • The Coombe Women & Infants University Hospital • Our Lady’s Children’s Hospital, Crumlin • The Children’s University Hospital, Temple Street • Naas General Hospital • Midland Regional Hospital Tullamore • Midland Regional Hospital Mullingar • Midland Regional Hospital Portlaoise • (St. Luke’s Hospital, Rathgar) under the control of the NCCP

See Appendix 5 for the details of individual hospital specialties, where applicable.

A significant focus across the hospital and primary care sector in 2011 will be the development of the delivery platforms (at hospital level) for each of the care programme elements. Introduction of the care programmes will require commitment to changes in service organisation and delivery and aim ultimately to ensure the best quality outcome for patients and the best value for money for the health service. The acute sector will need, during 2011, to maintain current service requirements in a difficult operating environment. The services will need to manage potential shortfalls in NCHDs and the impact of the recent retirement and redundancy arrangements at local hospital level.

A number of challenges for the hospital sector include: ƒ The current practice of delivering both acute and non acute healthcare in hospitals; ƒ The international evidence that acute complex healthcare, particularly for emergency medicine, complex surgical services and critical care services should be provided in hospitals with high volume activity by a critical mass of expert workforce; ƒ Evidence from the Acute Hospital Programme of the need and benefits of smaller hospitals in the provision of key growth areas in healthcare including day surgery, ambulatory care, outpatients, rehabilitation and palliative care; ƒ Access pressures in Outpatient Departments (OPDs), Emergency Departments (EDs), diagnostic and inpatient services despite providing more services year on year; ƒ Current significant budgetary constraints;

ƒ The shortage of NCHDs; ƒ Maximising the leadership of Clinical Directors; ƒ The impact of the current Moratorium on staffing levels.

DML Regional Service Plan 2011 24

INTEGRATED C ARE

The HSE National priorities for 2011 are to: ƒ Implement the Acute Medicine Programme (AMP): - Medical patients will be cared for based on their needs and acuity in an increasing number of Acute Medical Units (AMUs) in accordance with agreed pathways of care set out by the AMP. These will prevent admission in many cases and direct patients into more convenient avenues of care, such as rapid access clinics and day service units. Senior decision makers will be put in place at weekends ƒ Implement the Emergency Medicine Programme (EMP): - Emergency care will be improved by reducing waiting times for admission, better patient experience and ED avoidance ƒ Implement the Elective Surgery Programme (ESP): - The patient’s elective surgical journey will be improved through better access, the use of defined pathways, better processes and monitoring of clinical outcomes through the ESP. In 2011 actual performance for selected medical and surgical procedures will be monitored as part of the implementation of the acute medicine and surgical programmes. This will facilitate the development of appropriate performance indicators and targets in 2011, in particular on Average Length of Stay (ALOS) for elective and emergency surgical and medical procedures. Waiting times for elective surgery will also be measured. ƒ Implement the OPD Data Quality Programme ƒ Specifically target outpatient waiting times in outpatient services ƒ Commence chronic disease programmes in acute settings, and ƒ Continue taking into account issues of accessibility, clinical standards and quality of care in the reconfiguration and reform of our services.

In addition, we will address the shortage of NCHDs by expediting registration and recruitment processes, we will also address the shortfall in training places, introduce clinical governance and leadership and expand the role of nurses.

In addition to the HSE National priorities, our DML Regional priorities for 2011 are to: ƒ Deliver the levels of service outlined in the HSE National Service Plan 2011; ƒ Maintain activity and service delivery in 2011 within approved budget allocation; ƒ Deliver the cost reduction and restructuring programmes to enable the continued delivery of ELS; ƒ Seek to ensure the delivery of high quality and safe services within the budgets allowed; ƒ Continue reform and reconfiguration of services and progress work on integration of services to maximise clinical effectiveness and value for money; ƒ Enhance integration between all services; ƒ Co-operate with the National Cancer Control Programme, as required; ƒ Continue the preparation of the three Paediatric Hospitals, Dublin, for migration to the new National Paediatric Hospital; ƒ In line with the HSE’s National priorities for 2011, progress the implementation of the national clinical programmes and new service developments outlined below: ¾ Acute Medicine Programme (AMP): ¾ Emergency Medicine Programme (EMP): ¾ Elective Surgery Programme (ESP): ¾ OPD Data Quality Programme ¾ Specific targeting of outpatient waiting times in outpatient services ¾ Chronic disease programmes in acute settings, and ¾ Continue taking into account issues of accessibility, clinical standards and quality of care in the reconfiguration and reform of our services. ƒ Establish a DML Regional Implementation Team for Emergency Care to oversee the execution and monitoring of the national ED Improvement Project. This will include ensuring whole system escalation plans are in place to

address surge pressures, reviewing progress in meeting ED targets and use of business intelligence to support planning and service delivery to impact on ED performance. Local Joint Implementation Teams to be established also. These will work at hospital/network level to ensure day to day implementation is being progressed;

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ƒ Seek to protect in-patient elective beds for elective activity in order to reduce waiting times, whilst being cognisant of the priority need to delivery an excellent and timely Emergency Service; ƒ Continue engagement with the National Treatment Purchase Fund to ensure reduction in waiting time for procedures; ƒ Support hospitals in delivering HSE Quality & Risk Assurance Programme initiatives including engagements with HIQA; ƒ Work with hospitals to increase access to diagnostic services; ƒ Pilot a standardised GP referral system for AMNCH, under the aegis of the QCCD Clinical Programme for Primary Care. ƒ Be cognisant of Demographic changes, i.e. increase in births and the elderly population; ƒ Improve access times for Out-Patients / Ambulatory Care; ƒ Ensure no urgent referral for Colonoscopy is waiting over 4 weeks; ƒ Continue to work towards full compliance with the European Working Time Directive; ƒ Effectively manage blood supplies; ƒ Engage with Emergency Management, including re associated costs (Pandemic H1N1, Adverse Weather)

ƒ In addition, DML will continue to work with the National Group in relation to NCHD shortages and support the roll out of the Professional Development Posts.

Resources FINANCE DML REGIONAL WTE DML REGIONAL 2010 Budget €m 2011 Budget €m DML WTE Dec 2010 WTE DML 2011 Hospitals Hospitals Statutory 293.267 287.583 (2.00%) DML 16,751 TBC Voluntary 1,099.598 1,023.217 (6.95%) Total 1,392.866 1,310.800 (5.90%)

Ambulance Ambulance Statutory 60.054 47.612 (20.6%) DML 474 TBC Note: Funds t/f nationally in 2011 Total 1,452.920 1,358.472 (6.5%)

Key Result Areas

Medicine: Acute Medicine Programme (AMP) Deliverable Output 2011 Target completion • DML will co-operate with the implementation of the Acute Medicine Programme Q4 (AMP) with regards to the development of Acute Medical Units (AMUs) in accordance with agreed pathways of care set out by the AMP. These will prevent admission in many cases and direct patients into more appropriate avenues of care, such as rapid access clinics and day service units. Senior decision makers will be put in place at weekend.

Critical Care Programme Deliverable Output 2011 Target completion • DML will co-operate with the National Audit Progress for Critical Care. Q3

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Emergency Care: Emergency Medicine Programme Deliverable Output 2011 Target completion • DML will co-operate with the implementation of the National Emergency Q3 Medicine Programme. Emergency care will be improved by reducing waiting times for admission, better patient experience and ED avoidance. • DML hospitals will work to complete Patient Experience Time (PET) data set Q4 and work to address any constraints to full reporting. • DML Regional Implementation Group for Emergency Care established. Q1 • Local Joint Implementation Teams for Emergency Care established in DML Q1 acute hospitals.

Surgical Care: Elective Surgery Programme Deliverable Output 2011 Target completion • Continue the shift from in-patient to day case to increase rates of day surgery. Q4 • Support the EMP with regard to decreasing patient length of stay through the Q4 roll-out of selected common elective in-patient surgical procedures. • Support the development of National Standardisation guidelines. Q4 • Support the introduction of a National Audit Programme. Q4 • While emergency admissions will always have to be provided for, DML will Q4 strive to protect in-patient elective beds for elective activity in order to reduce waiting times.

Outpatient Programme: Outpatient data; OPD Service Improvement; Epilepsy; Dermatology; Neurology; Rheumatology and Orthopaedic Deliverable Output 2011 Target completion • Outpatient Data ¾ OPD Data Quality Programme – DML will co-operate with the roll out of Q4 the reformed data set. ¾ Reporting commenced. Q1 • OPD Service Improvement ¾ DML will continue to focus on improvement of OPD service delivery Q4 through the Continuous Waiting List validation, clear focus on reduction of DNA and improving the New to Return Ratio. • Epilepsy ¾ Epilepsy Regional Centres in DML to be defined Q1 • Increased new attendances in Dermatology, Neurology and Rheumatology. ¾ DML will appoint 10 Consultants, including 3 paediatric, on 4 sites Q4 (AMNCH, St. James’s Hospital, Our Lady’s Children’s Hospital Crumlin, Midlands Regional Hospital Tullamore) in the areas of Dermatology, Neurology, and Rheumatology.

Chronic Disease Interventions Deliverable Output 2011 Target completion • DML will co-operate and actively engage with programmes in the areas of Ongoing Stroke, Acute Coronary Syndrome, Heart Failure, Diabetes, COPD and Asthma.

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Ambulance Services : Reconfiguration of ambulance services to respond to changing models of service Deliverable Output 2011 Target completion • Improved response times for life threatening emergencies – collection of Q4 performance data to inform setting of performance targets for remaining 4 clinically appropriate response time standards to 112 (999) emergency calls in line with HIQA recommendations: ¾ Templates to allow reporting to DoHC developed and tested Q2 ¾ Data gathered, input onto templates and tested Q2 ¾ Training on systems completed Q1 ¾ Advanced Medical Priority Dispatch System (AMPDS) implemented Q1 ¾ AQUA Audit Tool for AMPDS to guarantee compliance implemented Q1 ¾ Engagement with hospitals re turnaround time of ambulances Ongoing

• Existing resources refocused from non-urgent patient transport services to Q4 improving response times to life threatening 999 emergency calls, in line with HIQA targets: ¾ PHECC dispatch standards implemented Q4 ¾ Dispatch models reviewed and enhanced, i.e. use of community first Q3 responder, rapid response vehicles ¾ Critical/Low acuity Patient Transport models reviewed, i.e. use of Q3 intermediate care vehicle

• Work streams in place to ensure focused targets re the National Command Q3 and Control Project are achieved and project delivered. This is on a national footing (enabled through ICT/Estates/HR) and involves the following: ¾ Digital radio system rolled out ¾ CAD in place ¾ National Integrated Command and Control (ICCS) ¾ Automatic Vehicle Location System ¾ National mapping solution ¾ Satellite navigation solution ¾ HR/Staffing engagement ¾ Procurement and fit out of building

• Local Medical Advisor appointed to assist with quality assurance and best Q1 practice guidelines.

• Ambulance management structures reconfigured to address new priorities Q2 and staffing gaps.

Other Service Development Areas Deliverable Output 2011 Target completion • Reconfiguration of DML Acute Services: ¾ Projects will be identified, planned and executed on a phased basis to Ongoing reflect corporate objectives of accessibility, patient safety, clinical standards and quality of services. The continued roll out of the Quality and Clinical Care Directorate programmes, particularly the Acute Medicine Programme, and the need to manage risk and safety issues will all inform this programme of re-configuration and integration. ¾ Continued development of St. James’s ISA project. ¾ Continued reconfiguration of paediatric services. Ongoing

¾ St. Vincent’s Hospital/St. Columcille’s Hospital integration project. Ongoing ¾ Development of stronger clinical networks for Midlands hospitals. Ongoing ¾ Scoping of maternity services reconfiguration to co-locate with acute Ongoing hospitals. Ongoing

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Other Service Development Areas / contd. Deliverable Output 2011 Target completion • Standardised GP referral system for AMNCH, under the aegis of the QCCD Q4 Clinical Programme for Primary Care, piloted. • Cystic Fibrosis: ¾ Newborn screening services - Implementation Phase commenced. Q1 • Enhanced Paediatric Cardiac Programme: ¾ Additional consultant sessions provided in Our Lady’s Children’s Q1 Hospital (initial increase from 3 days/week to 4.5 days/week). ¾ Additional support services provided to meet the needs of paediatric Q1 cardiac patients. • Consultant Work Practices ¾ Implementation of Consultant Contract progressed with further Q3 development of clinical directors and clinical led service development through accelerated and expanded work on clinical care programmes and their integration with regional hospital reconfigurations. ¾ Full benefits of extended working days realised with parallel Q2 implementation of Croke Park Agreement. ¾ Full compliance with public/private mix provisions. Q2 ¾ Complete contract audit rolled out from initial 2010 sites to all hospital Q3 sites. • Funding of selective elective orthopaedic procedures in public hospitals ¾ Continue to engage with NTPF in connection with additional orthopaedic Ongoing capacity, both adult and paediatric. • Renal services ¾ Continue development of renal services/capacity in DML. Ongoing • Treating Tobacco Addiction as a care issue ¾ All hospitals will have drafted plans to make their campuses smoke-free Q4 by 2015. ¾ Hospitals will treat tobacco addiction as a care issue by offering Q4 smoking cessation services monthly.

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Key Performance Measures The levels of services to be delivered by our acute hospital system in 2011 are set out in the following tables. Acute hospital activity has grown year on year and the challenge is to manage demand and ensure that care is offered in the most appropriate setting, at optimal quality and with the most efficient use of resource. The targets set out are based on the experience in 2010, the available resource and the anticipated impact of the AMP in 2011. The delivery of this planned activity in 2011 requires a renewed focus on ensuring costs are controlled and that resources are used in a flexible way. The overall treatment capacity will be managed throughout the year in line with the activity targets.

The relevant managers with responsibility for the specific hospitals will ensure that systems are in place so that the below activity levels are achieved in DML during 2011.

Inpatient / Day Case: The overall activity levels planned for 2010 reflect the continued shift from inpatient to day case activity. The plan is to increase day cases by an additional 3% above the very significant increase made in 2010 and to target a reduction in the level of inpatient care provided of 2% over the 2010 levels. The net impact of these targets is to continue the year on year additional acute service activity, to build on the shift from inpatient to day cases, yet to acknowledge the reliance our system still has on the use of inpatient care.

Inpatient Discharges Day Cases Expected Projected Expected Expected Projected Expected

Activity 2010 Outturn 2010 Activity 2011 Activity 2010 Outturn 2010 Activity 2011

Dublin Mid Leinster 160,527 179,954 176,400 246,936 268,606 276,700 Adelaide & Meath Hosp inc NCH (Adults) 14,577 18,220 17,813 27,385 29,273 30,154 Coombe Women and Infants University Hospital 18,606 18,959 18,583 6,803 17,529 18,058 Midland Regional Hospital, Mullingar 17,347 19,135 18,755 7,394 7,488 7,714 Midland Regional Hospital, Portlaoise 11,909 13,088 12,829 4,011 4,796 4,942 Midland Regional Hospital, Tullamore 7,864 9,298 9,115 15,611 16,655 17,158

Naas General Hospital 7,033 7,953 7,797 3,489 3,622 3,733 National Maternity Hospital, Holles Street 18,205 19,534 19,342 3,162 3,144 3,240 Royal Victoria Eye and Ear Hospital 2,285 2,384 2,292 4,235 5,576 5,745 St. Columcille’s Hospital, Loughlinstown 3,665 3,822 3,749 2,563 2,473 2,549 St. James’s Hospital 19,664 24,607 24,056 92,769 93,274 96,075

St. Luke’s Hospital (NCCP) 1,613 1,731 1,696 2,861 3,024 3,115 St. Michael’s Hospital, Dun Laoghaire 2,315 2,461 2,350 4,576 5,253 5,412 St. Vincent’s University Hospital, Elm Park 13,455 14,778 14,449 48,465 51,693 53,247 Adelaide & Meath Hosp inc NCH (Paediatrics) 6,066 6,016 5,869 3,659 3,691 3,804 Our Lady’s Children’s Hospital, Crumlin 9,813 10,412 10,258 15,221 16,197 16,685 Children’s University Hospital, Temple Street 6,110 7,558 7,447 4,733 4,919 5,069

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Emergency Presentations / Admissions: Emergency presentations in 2011 are planned to be in line with actual 2010 levels as are admissions from the ED. The AMP will involve the implementation of a range of clinical led initiatives aimed at emergency admission avoidance but nonetheless the numbers requiring admission will not significantly change in 2011. The AMP will also focus on a number of areas which will lead to improvements in EDs. There will be a continued focus on the development of acute medical and surgical assessment units and the use of MAUs for emergency admissions. Improvements within hospitals will be achieved through the focus on bed utilisation efficiency. In 2011 actual performance for selected medical and surgical procedures will be monitored as part of the implementation of the acute medicine and surgical programmes. This will facilitate the development of appropriate performance indicators and targets in 2011, in particular on ALOS for elective and emergency surgical and medical procedures. In addition, trends in elective surgical patient admission on the day of surgery will be further improved as well as proactive discharge planning, senior clinical decision-making particularly at weekends, and better access to assessment / diagnostics.

Emergency Presentations Emergency Admissions Expected Projected Expected Expected Projected Expected

Activity 2010 Outturn 2010 Activity 2011 Activity 2010 Outturn 2010 Activity 2011

Dublin Mid Leinster 331,446 331,741 331,700 84,348 95,498 94,500 Adelaide & Meath Hosp inc NCH (Adults) 74,164 74,264 74,261 18,480 20,828 20,616 Midland Regional Hospital, Mullingar 36,324 36,766 36,761 11,480 13,118 12,983 Midland Regional Hospital, Portlaoise 40,740 42,480 42,475 11,023 12,368 12,240 Midland Regional Hospital, Tullamore 29,031 29,410 29,405 5,645 7,154 7,078 Naas General Hospital 26,484 25,842 25,837 6,500 7,323 7,245 St. Columcille’s Hospital, Loughlinstown 21,174 21,328 21,323 3,570 3,599 3,556 St. James’s Hospital 45,894 44,679 44,674 16,430 18,981 18,789 St. Michael’s Hospital, Dun Laoghaire 15,174 14,567 14,562 1,225 1,288 1,268 St. Vincent’s University Hospital, Elm Park 42,461 42,407 42,402 9,995 10,837 10,725

Outpatient (OPD): The OPD Data Quality Programme in 2011 will deliver improved data in respect of both demand and access to OPD services to enable better management of OPD. Due to expanded and reformed metrics, a more full understanding of activity in Consultant delivered OPD clinics will begin to be available from Quarter 1. Safe recording, management and reporting of GP referrals is another key component of the programme. Attendance numbers are not expected to be directly comparable between 2010 and 2011 due to more refined definitions which will be in place. As a result, changes in month on month new attendance numbers will be of particular note during 2011. The focus will continue to be on proactively increasing the number of new attendees within the overall attendance numbers. Two targeted areas will be dermatology and neurology where the recruitment of additional consultants will lead to a 30% increase in new outpatient attendances over 12 months Jan-Dec 2011 based on reformed data set. Other clinical and administrative led quality improvement initiatives will also continue to improve access to OPD services.

Outpatient Attendances Ratio of New:Return Expected Projected *Expected Expected Projected Expected Activity 2010 Outturn 2010 Activity 2011 Activity 2010 Outturn 2010 Performance Level 2011

Dublin Mid Leinster 1,292,922 1,372,590 1,377,500 2.0 2.9 2.0 Adelaide & Meath Hosp inc NCH (Adults) 205,761 220,427 221,202 2.0 2.5 2.4 Coombe Women and Infants University Hospital 95,520 107,203 107,588 2.0 2.7 2.4 Midland Regional Hospital, Mullingar 76,139 76,441 76,715 2.0 3.6 2.6

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contd. Outpatient Attendances Ratio of New:Return Expected Projected *Expected Expected Projected Expected Activity 2010 Outturn 2010 Activity 2011 Activity 2010 Outturn 2010 Performance Level 2011 Dublin Mid Leinster 1,292,922 1,372,590 1,377,500 2.0 2.9 2.0 Midland Regional Hospital, Portlaoise 50,370 53,929 54,122 2.0 3.7 2.7 Midland Regional Hospital, Tullamore 77,380 89,719 90,041 2.0 2.5 2.4 Naas General Hospital 40,364 43,562 43,718 2.0 4.3 3.3 National Maternity Hospital, Holles Street 82,211 90,833 91,159 2.0 1.3 1.3 Royal Victoria Eye and Ear Hospital 40,083 40,776 40,922 2.0 5.3 3.3 St. Columcille’s Hospital, Loughlinstown 46,951 37,823 37,958 2.0 6.7 4.7 St. James’s Hospital 205,566 220,107 220,899 2.0 2.6 2.3 St. Luke’s Hospital (NCCP) 53,112 68,439 68,685 2.0 21.7 St. Michael’s Hospital, Dun Laoghaire 20,223 21,461 21,538 2.0 2.1 2.0 St. Vincent’s University Hospital, Elm Park 127,494 134,066 134,547 2.0 3.4 3.1 Adelaide & Meath Hosp inc NCH (Paediatrics) 34,881 27,900 28,000 2.0 Our Lady’s Children’s Hospital, Crumlin 81,959 79,217 79,501 2.0 2.2 2.1 Children’s University Hospital, Temple Street 54,908 60,688 60,905 2.0 2.1 2.0 *Due to clarified OPD data definitions, 2011 OPD activity may not be directly comparable with previous years. Close month on month monitoring will take place during 2011, beginning Quarter 1 when new metrics begin to be reported

A1. ED - Patient Experience Time - Admitted patients 2011 Target 2010 2011 Performance National Time in Hours Level Target Q1 Target Q2 Target Q3 Target Q4 Target Adelaide and Meath Hospital, incorporating the National Children’s Hospital, Tallaght (AMNCH) 7.8 6.0 6.0 6.0 6.0 6.0

Midland Regional Hospital, Mullingar - 6.0 6.0 6.0 6.0 6.0

Midland Regional Hospital, Portlaoise - 6.0 6.0 6.0 6.0 6.0

Midland Regional Hospital, Tullamore 7.4 6.0 6.0 6.0 6.0 6.0

Naas General Hospital 29.6 6.0 25.0 21.0 17.0 13.0

Our Lady’s Children's Hospital, Crumlin 6.0 - - - -

St. Columcille’s Hospital - 6.0 6.0 6.0 6.0 6.0

St. James Hospital 11 6.0 6.0 6.0 6.0 6.0

St. Michaels Hospital, Dun Laoghaire 4.6 6.0 5.2 5.2 5.2 5.2

St. Vincent’s University Hospital 7.1 6.0 6.0 6.0 6.0 6.0

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A2. ED admission waits > 12 hrs 2011 Target 2010 2011 Performance National Admission Wait Numbers Level Target Q1 Target Q2 Target Q3 Target Q4 Target Adelaide and Meath Hospital, incorporating the National Children’s Hospital, Tallaght (AMNCH) 311 0 350 200 200 300 Midland Regional Hospital, Mullingar 0 0 0 0 0 0 Midland Regional Hospital, Portlaoise 11 0 0 0 0 0 Midland Regional Hospital, Tullamore 20 0 0 0 0 0 Naas General Hospital 43 0 0 0 0 0 St. Columcille’s Hospital 47 0 0 0 0 0 St. James Hospital 0 0 0 0 0 0 St. Michaels Hospital, Dun Laoghaire 0 0 0 0 0 0 St. Vincent’s University Hospital 17 0 0 0 0 0

A3. Urgent Colonoscopy Waiting Numbers 2011 Target 2010 2011 Performance National Number of patients waiting > 28 days Level Target Q1 Target Q2 Target Q3 Target Q4 Target Adelaide and Meath Hospital, incorporating the National Children’s Hospital, Tallaght (AMNCH) 1 0 0 0 0 0 Midland Regional Hospital, Mullingar 0 0 0 0 0 0 Midland Regional Hospital, Portlaoise 2 0 0 0 0 0 Midland Regional Hospital, Tullamore 0 0 0 0 0 0 St. Columcille’s Hospital 0 0 0 0 0 0 St. James Hospital 0 0 0 0 0 0 St. Vincent’s University Hospital 0 0 0 0 0 0

A4. % Daycase Rate (basket of procedures) 2011 Target 2010 2011 Performance National % daycase rate (basket) Level Target Q1 Target Q2 Target Q3 Target Q4 Target Adelaide and Meath Hospital, incorporating the National Children’s Hospital, Tallaght (AMNCH) 83% (2615) 75% 75% 75% 75% 75% Coombe Women and Infants University Hospital 90% (714) 75% 75% 75% 75% 75% Midland Regional Hospital, Mullingar 85% (574) 75% 75% 75% 75% 75% Midland Regional Hospital, Portlaoise 49% (284) 75% 75% 75% 75% 75% Midland Regional Hospital, Tullamore 60% (1653) 75% 75% 75% 75% 75% Naas General Hospital 62% (251) 75% 75% 75% 75% 75% National Maternity Hospital, Holles St. 62% (434) Our Lady’s Children's Hospital Crumlin 80% (1348) 75% 75% 75% 75% 75% Children’s University Hospital,Temple Street 68% (1752) 75% 75% 75% 75% 75% Royal Victoria Eye & Ear Hospital 73% (2397) 75% 75% 75% 75% 75% St. Columcille’s Hospital 84% (257) 75% 75% 75% 75% 75% St. James's Hospital 73% (1156) 75% 75% 75% 75% 75% St. Michael’s Hospital, Dun Laoghaire 45% (632) 75% 75% 75% 75% 75% St. Vincent's University Hospital 72% (1068) 75% 75% 75% 75% 75%

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A5. % Day of Admission 2011 Target 2010 2011 Performance National % on day of admission Level Target Q1 Target Q2 Target Q3 Target Q4 Target Adelaide and Meath Hospital, incorporating the National Children’s Hospital, Tallaght (AMNCH) 30% (2931) 75% 75% 75% 75% 75% Coombe Women and Infants University Hospital 59% (720) 75% 75% 75% 75% 75% Midland Regional Hospital, Mullingar 53% (423) 75% 75% 75% 75% 75% Midland Regional Hospital, Portlaoise 59% (421) 75% 75% 75% 75% 75% Midland Regional Hospital, Tullamore 79% (1732) 75% 75% 75% 75% 75% Naas General Hospital 34% (390) 75% 75% 75% 75% 75% Our Lady’s Children's Hospital Crumlin 73% (3347) 75% 75% 75% 75% 75% Children’s University Hospital,Temple Street 46% (1983) 75% 75% 75% 75% 75% National Maternity Hospital, Holles St. 25% (698) 75% 75% 75% 75% 75% Royal Victoria Eye & Ear Hospital 59% (1843) 75% 75% 75% 75% 75% St. Columcille’s Hospital 26% (199) 75% 75% 75% 75% 75% St. James's Hospital 68% (4448) 75% 75% 75% 75% 75% St. Michael’s Hospital, Dun Laoghaire 62% (943) 75% 75% 75% 75% 75% St. Vincent's University Hospital 48% (3459) 75% 75% 75% 75% 75%

A6a. Number of Adults Waiting > 6 Months 2011 Target 2010 2011 Number of Adults In-pt and daycase Performance National waiting Level Target Q1 Target Q2 Target Q3 Target Q4 Target Adelaide and Meath Hospital, incorporating the National Children’s Hospital, Tallaght (AMNCH) 371 0 300 200 100 50 Midland Regional Hospital, Mullingar 96 0 80 70 50 0 Midland Regional Hospital, Portlaoise 27 0 0 0 0 0 Midland Regional Hospital, Tullamore 339 0 300 200 100 50 Naas General Hospital 5 0 0 0 0 0 Our Lady’s Children's Hospital Crumlin 0 0 - - - - Royal Victoria Eye and Ear Hospital 105 0 100 50 0 0 St. James’s Hospital 54 0 50 50 40 40 St. Vincent’s University Hospital 127 0 100 80 60 40

A6b. Number of Children Waiting > 3 Months 2011 Target 2010 2011 Number of Children In-pt and Performance National daycase waiting Level Target Q1 Target Q2 Target Q3 Target Q4 Target Adelaide and Meath Hospital, incorporating the National Children’s Hospital, Tallaght (AMNCH) 55 0 0 0 0 0 Midland Regional Hospital, Mullingar 17 0 0 0 0 0 Midland Regional Hospital, Portlaoise 1 0 0 0 0 0 Midland Regional Hospital, Tullamore 215 0 200 175 150 100 Naas General Hospital 0 0 - - - - Our Lady’s Children's Hospital Crumlin 1020 0 1000 750 500 250 Children’s University Hospital,Temple Street 431 0 300 250 200 150 Royal Victoria Eye and Ear Hospital 18 0 0 0 0 0 St. James’s Hospital 0 0 - - - - St. Vincent’s University Hospital 0 0 - - - -

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A7. OPD New : Return Ratio 2011 Target 2010 2011 Performance National New : Return Ratio Level Target Q1 Target Q2 Target Q3 Target Q4 Target Adelaide and Meath Hospital, incorporating the National Children’s Hospital, Tallaght (AMNCH) 2.5 2 2.5 2.4 2.4 2.4 Coombe Women and Infants University Hospital 2.7 2 2.5 2.4 2.4 2.4 Midland Regional Hospital, Mullingar 3.6 2 3.4 3.0 2.8 2.6 Midland Regional Hospital, Portlaoise 3.7 2 3.4 3.0 2.8 2.7 Midland Regional Hospital, Tullamore 2.5 2 2.5 2.4 2.4 2.4 Naas General Hospital 4.3 2 4.0 3.8 3.5 3.3 Our Lady’s Children's Hospital Crumlin 2.2 2 2.1 2.1 2.1 2.1 Children’s University Hospital,Temple Street 2.1 2 2.0 2.0 2.0 2.0 National Maternity Hospital, Holles St. 1.3 2 1.3 1.3 1.3 1.3 Royal Victoria Eye and Ear Hospital 5.3 2 5.0 4.4 3.8 3.3 St. Columcille’s Hospital 6.7 2 6.2 5.6 5.0 4.7 St. James’s Hospital 2.6 2 2.5 2.4 2.3 2.3 St. Michael’s Hospital, Dun Laoghaire 2.1 2 2.0 2.0 2.0 2.0 St. Vincent's University Hospital 3.4 2 3.3 3.2 3.1 3.1

A8. % of consultants compliant with contractual public : private mix ratio 2011 Target 2010 2011 Performance National % compliance rate Level Target Q1 Target Q2 Target Q3 Target Q4 Target Adelaide and Meath Hospital, incorporating the National Children’s Hospital, Tallaght (AMNCH) 71%, 74.23% 95% 95% 95% 95% 95% Coombe Women and Infants University Hospital 83.49%, 85.18% 95% 95% 95% 95% 95% Midland Regional Hospital, Mullingar 80%, 70% 95% 95% 95% 95% 95% Midland Regional Hospital, Portlaoise 84.62%, 53.85% 95% 95% 95% 95% 95% Midland Regional Hospital, Tullamore 34.62%, 35% 95% 95% 95% 95% 95% Naas General Hospital 100%, 100% 95% 95% 95% 95% 95% Children’s University Hospital,Temple Street 85.94%, 64.06% 95% 95% 95% 95% 95% Our Lady’s Children's Hospital Crumlin 58.75%, 58.5% 95% 95% 95% 95% 95% National Maternity Hospital, Holles St. 79%, 82% 95% 95% 95% 95% 95% Royal Victoria Eye & Ear 28.57%, 64.29% 95% 95% 95% 95% 95% St. Columcille’s Hospital 100%, 100% 95% 95% 95% 95% 95% St. James’s Hospital 81%, 90% 95% 95% 95% 95% 95% St. Michael’s Hospital, Dun Laoghaire 100%, 100% 95% 95% 95% 95% 95% St. Vincent's University Hospital 83.33%, 94.6% 95% 95% 95% 95% 95%

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Dialysis: This is a demand led service. In Ireland, about 450 people each year reach the end-stage of renal failure and need treatment or transplant to replace their non-functioning kidneys. The National Renal Office (NRO) predicts an additional 90-135 people nationally will require dialysis in 2011. Additional capacity is being sourced through reconfiguration of HSE facilities and use of haemodialysis facilities contracted from private providers. Access to home therapies will also be expanded. The renal transplantation programme will be supported to maximise the transplantation rate.

The NRO’s projected additional national growth in haemodialysis is between 20 – 30 per million of population (Pop 4.5m) per annum. Therefore, based on DML population of approximately 1.2m, the expected growth per annum in DML is an additional 24 – 36 people who will require dialysis in 2011.

National Dialysis Patients National Projected Activity National Projected National Projected Activity Modality 2010 Outturn 2010 Range 2011

Haemodialysis 1,560 1,580 1,650-1,740 Peritoneal Dialysis 220 225 245-270 Total 1,780 1,805 1,895-2,010

Dublin Mid-Leinster Dialysis Patients DML Projected Activity DML Projected Outturn DML Projected Activity Modality 2010 2010 Range 2011

Haemodialysis 381 385 400 - 423 Peritoneal Dialysis 58 60 65 - 72 Total 439 445 465 - 495 Note: The above DML figures are based on mid-year statistical returns 2010 and are subject to change when year end 2010 activity is known.

DML Funding 2011: €0.800m – the anticipated funding allocation for 2011 is for the provision of additional haemodialysis capacity and to support home therapies based on the population of the existing DML renal networks, i.e. South Dublin/Kildare/Wicklow and Laois/Offaly/Westmeath/S. Longford.

Performance Activity and Performance Indicators

See National Performance Indicator and Activity Suite appended to this document for full details re 2011 Acute Services and Pre-Hospital Emergency Care metrics.

Improving our Infrastructure for Hospital Services

See below capital projects that are to be completed and / or due to become operational in DML in 2011 (see also Appendix 4):

Dublin Mid Leinster

ƒ The Adelaide and Meath Hospital, incorporating the National Children’s Hospital, Tallaght – laboratory expansion ƒ St. James’ Hospital – upgrade of main electrical distribution ƒ Coombe Women and Infants University Hospital – emergency upgrade works ƒ Our Lady’s Children’s Hospital, Crumlin – provision of additional Paediatric Intensive Care Unit and High Dependency Unit beds ƒ Children’s University Hospital, Temple St. – theatre upgrade

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INTEGRATED C ARE National Cancer Control Programme

The National Cancer Control Programme, including its funding, is managed outside of the remit of the Regional Director of Operations, DML.

Introduction The National Cancer Control Programme (NCCP) is responsible for all components of cancer control with the exception of palliative care services. In 2010 the NCCP welcomed the planned integration of the National Cancer Screening Service (NCSS) and St. Luke’s Hospital, Rathgar into the HSE.

In line with its objectives, the programme is working to ensure that designated cancer centres for individual tumour types have adequate case volumes, expertise and a concentration of multi-disciplinary specialist skills. Symptomatic breast diagnosis and surgery which transferred into the 8 cancer centres in 2009 will continue to be monitored through the collection of monthly key performance indicators. St. Vincent’s University Hospital is the national centre for pancreatic surgery; it is planned to link a satellite unit in Cork University Hospital (CUH) into the national centre in 2011. Rapid access lung and prostate clinics are now opened in almost all of the centres. Lung surgery has been centralised into 4 regional centres (St. James, Mater, Galway and Cork University hospitals). In 2011 development of specialist cancer centres will continue with the centralisation of prostate cancer surgery, rectal surgery and upper gastrointestinal (GI) surgery. Essential support services will be delivered within the specialist centres. The quality agenda will continue to be pursued through further development of anatomical site specific expert groups and the implementation of clinical governance arrangements for treatments.

The HSE National priorities for 2011 are: ƒ Initiate measures to support optimal management of cancer drugs ƒ Enhance theatre and ICU services to support cancer surgical throughput in the designated cancer centres ƒ The new radiation oncology units (Phase 1) in Beaumont and St. James Hospitals, Dublin will be operational whilst planning for Phase 2 continues ƒ The National Cancer Screening work programme includes completion of round 1 breast screening in South and West, continued provision of cervical screening and preparation for the launch of the colorectal screening programme in 2012, and ƒ The 2011 community oncology work programme, including building on its existing partnership with Irish College of General Practitioners (ICGP), increasing the proportion of electronic referrals and delivering a community nurse training programme for medical oncology patients.

In addition to the HSE National priorities, the DML Regional priorities for 2011 are to: ƒ Provide Radiation Oncology through St. Luke’s Radiation Network in St. Luke’s and St. James’s Hospitals; ƒ Continue to monitor HIQA standards, including monthly and quarterly KPIs, for the Symptomatic Breast Services in St. James’s and St. Vincent’s Hospitals; ƒ Monitor delivery of additional 4 cancer WTEs approved in 2010 (2 each for St. Vincent’s and St. James’s Hospitals); ƒ Monitor the Ocular Bracytherapy service established in 2010 between the Royal Victoria Eye and Ear Hospital and St. Luke’s Hospital. Resources FINANCE NATIONAL WTE DML 2010 Budget €m 2011 Budget €m Projected WTE Dec 2010 WTE 2011 NCCP (inc. NPRO) 56.75 63.20* DML 63 Not available Eastern Radiation Network (St. --- 34.34 Luke’s) NCSS --- 62.82 Total 56.75 160.36* *NCCP budget is additionality only and reflects €4m transferred out for HPV and includes €10m additional allocation in 2011

NOTE: The NCCP finance does not form part of the DML RDO’s budget.

DML Regional Service Plan 2011 37

INTEGRATED C ARE

The number of new development cancer posts approved by NCCP since 2008, 2009 and 2010 = 33.

The breakdown of these posts by hospital is as follows:-

• St. James’s Hospital: 12.0 • St. Vincent’s Hospital 20.5 • Royal Victoria Eye and Ear Hospital 0.5

This excludes: 1. Existing cancer posts in place prior to 2008. 2. New radiotherapy posts. 3. WTEs transferred into St. James’s Hospital and St. Vincent’s University Hospital with the transfer of services from within the region and nationally as relates to pancreatic cancer. 4. WTEs agreed in 2011 – 3 nurses for St. Vincent’s University Hospital and 4 for St. James’s Hospital.

Key Result Areas

Lung Cancer Services Deliverable Output 2011 Target completion • Monitor throughput of Rapid Access Clinic in St. Vincent’s Hospital. Ongoing • Monitor throughput of Rapid Access Clinic and lung surgery in regional Ongoing surgical centre in St. James’s Hospital.

Urology Cancer Services Deliverable Output 2011 Target completion • Prostate cancer surgery consolidated into one regional cancer centre in Q4 DML. (Centre not identified/finalised as yet)

Pancreatic Surgery Deliverable Output 2011 Target completion • National cancer centre for pancreatic surgery established in St. Vincent’s Q1 University Hospital, with satellite unit in Cork University Hospital. Multi- disciplinary teams (MDTs) established in both centres and care pathways monitored. • Transfer of pancreatic surgery from AMNCH into St. Vincent’s University Q1 Hospital complete.

Rectal Cancer Services Deliverable Output 2011 Target completion • Transfer of all regional rectal cancer surgery into cancer centres in St. Q4 James’s Hospital and St. Vincent’s University Hospital complete.

Upper Gastrointestinal (GI) Cancers Deliverable Output 2011 Target completion • Upper gastrointestinal cancers consolidated in St. James’s Hospital. Q1

Theatre / ICU / Support Deliverable Output 2011 Target completion • Additional theatre ICU support provided to enable cancer surgical throughput Q1 in designated centres (funding to be agreed nationally).

DML Regional Service Plan 2011 38

INTEGRATED C ARE

Medical Oncology Deliverable Output 2011 Target completion • Continue to deliver medical oncology, as appropriate, in existing units as Ongoing close to patient’s home as possible in St. James’s Hospital, St. Vincent’s University Hospital, AMNCH, Naas General Hospital and Midlands Regional Hospital Tullamore, unless otherwise decided.

Radiation Oncology (Phase 1) Deliverable Output 2011 Target completion • New radiation oncology unit (Phase 1) in St. James’s Hospital fully Ongoing functional.

Radiation Oncology (Phase 2) Deliverable Output 2011 Target completion • Plan to develop Phase 2 radiation services on 6 sites, including St. James’s Q4 Hospital, continued. • Funding mechanism agreed and approved for Phase 2. Q4

Quality Assurance through establishment of formal national quality clinical governance arrangements for common cancers Deliverable Output 2011 Target completion • Lead clinicians to participate in national clinical networks established for Q2 common cancers for purposes of clinical audit, sharing of good practice and problem solving • Representation on national expert groups to advise on evidence based Q2 practice for common cancers. • Implementation of the appropriate parameters defined to devise and monitor Q2 quality domains across lung and prostate.

Gynaeoncology Deliverable Output 2011 Target completion • Planning commenced for consolidation of surgery for gynaecological cancers Q2 into cancer centres.

National Screening Service Deliverable Output 2011 Target completion • Preparation for participation in national colorectal screening programme. Q2

Community Oncology Programme Deliverable Output 2011 Target completion • Existing partnership with ICGP built upon. Q4 • Proportion of electronic referrals increased. Q4 • Community nurse training programmes delivered. Q4 • Brief interventions with smoking cessation with primary care teams Q4 developed.

Performance Activity and Performance Indicators

See National Performance Indicator and Activity Suite appended to this document for full details re 2011 National Cancer Control Programme metrics.

DML Regional Service Plan 2011 39

CHILDREN AND FAMILIES Children and Families

Introduction Our services aim to promote and protect the health and wellbeing of children and families, particularly those who are at risk of abuse and neglect. The key reforms needed in 2011 are to improve the quality and consistency of services, and establish clear governance arrangements that strengthen accountability.

A range of services, both universal and targeted, are provided to children and their families in the DML region. There are 1,557 children in the care of the HSE in the DML region, 166 in residential care, 908 in foster care, 445 in relative foster care and 38 in other care. The focus for DML Children and Families services in 2011 is to continue the work done by the National Task Force on Children and Families, to provide standardisation through the Standardised Business Processes and to enhance services for children and their families. DML will continue to implement the Report of the Commission to Inquire into Child Abuse (Ryan Report) and will work to improve quality in all areas of Child Care services, particularly in the areas of Care Planning, Child Protection and Alternative Care.

The HSE National priorities in 2011 are to meet all statutory requirements as per legislation, regulations and standards. This includes:

ƒ Delivering all statutory services for child protection, children in care, special care, after care, youth homelessness, and adoption ƒ Implementing the actions of the Commission to Inquire into Child Abuse (Ryan Report) ƒ Implementing recommendations of internal and external audits of services e.g. HIQA’s recommendations for children in care and child protection, and the HSE’s National Audit of Foster Care ƒ Implementing the Task Force Report and the Strategic Review of the Delivery and Management of Children and Family Services ƒ Implementing the Revised Children First guidelines ƒ Maintaining and developing family support services and ensuring the provision of aftercare services are strengthened ƒ Further development of the National Child Care Information System (NCCIS) to ensure the implementation of standardised business processes with regard to assessment and care planning, and ƒ Progressing the work of the Crisis Pregnancy Programme.

We will also continue working to improve quality and provision of effective community-based services for children with ‘additional needs’ and separated children seeking asylum, the rationalisation of special arrangements and maximising occupancy rates of residential units. The appointment of a National Lead for Children and Families Services will ensure the acceleration of the change process in this care group.

In addition to the HSE National priorities, our DML Regional priorities for 2011 are to: ƒ Review DML performance in respect of the targets in the 2011 National Service Plan and ensure that these are met by end Q2 2011. In compliance with statutory child care regulations, DML will ensure that all children in care have an allocated Social Worker and a current care plan which is reviewed in accordance with the Child Care Regulations 1995. ƒ Continue the review of Children in Care files (commenced in 2010) and ensure that these are of an appropriate standard and contain all relevant documentation to facilitate comprehensive care planning and meet regulatory requirements (as per recommendations of HIQA Audits). In 2011 this review will be expanded to include Child Protection files and Foster Carers files. An additional 52 Social Work Posts have been allocated throughout DML in accordance with the Ryan Report Recommendations and this has facilitated improved performance on NSP Targets which will carry forward into 2011. ƒ Continue to implement the standardised Business Process (commenced in 2010) as per national NCCIS Plan. ƒ Continue the ongoing work to address recommendations from the National Fostering Audit. ƒ Continue to work with the National Alternative Care Committee to address all outstanding recommendations from HIQA Inspections and the National Fostering Audit. ƒ Implement the revised Children First guidelines in line with national plans. ƒ Implement Family Support Service and Aftercare policy in line with national direction.

DML Regional Service Plan 2011 40

CHILDREN AND FAMILIES

Resources FINANCE DML REGIONAL WTE DML REGIONAL 2010 Budget €m 2011 Budget €m DML WTE Dec 2010 DML WTE 2011 Statutory 157.898 130.693 (17.2%) DML 474 TBC Voluntary 0 0 Total 157.898 130.693 (17.2%) Once off not yet reinstated

Key Result Areas

DELIVERY OF STATUTORY SERVICES

Children in Care and Aftercare Deliverable Output 2011 Target completion • 100% compliance with NSP Targets will be achieved. Q2

Special Care Deliverable Output 2011 Target completion • DML will participate in the review of alternative care capacity, with particular Ongoing emphasis on requirements of Special Care, High Support and Residential services.

Youth Homelessness Deliverable Output 2011 Target completion • DML will ensure implementation of national recommendations. Ongoing

Child Protection and Implementing the Revised Children First Guidelines Deliverable Output 2011 Target completion • The revised Children First guidelines, in line with National policy, will be Q4 implemented.

Adoption Deliverable Output 2011 Target completion • Services will be reorganised in compliance with new legislation. Q4

IMPLEMENTING STRATEGIES TO SUPPORT SERVICE DELIVERY

Implementing the Task Force Report: Further development of the National Child Care Information System Deliverable Output 2011 Target completion • Referral and Assessment Standardised Business Processes will be Q4 implemented in line with National Plan.

Children’s Services Committees Deliverable Output 2011 Target completion • Children’s Services Committees will be established in line with national plan. Ongoing

Implementation of PA Consulting Report – Strategic Review of the Delivery and Management of Children and Family Services Deliverable Output 2011 Target completion • Recommendations will be implemented in line with national direction. Ongoing

DML Regional Service Plan 2011 41

CHILDREN AND FAMILIES

REPORT OF THE COMMISSION TO INQUIRE INTO CHILD ABUSE (RYAN REPORT) 2009

Implementing the actions of the Commission to Inquire into Child Abuse Deliverable Output 2011 Target completion • Actions will be implemented in line with national direction. Ongoing

Performance Activity and Performance Indicators - HSE Dublin Mid-Leinster

Indicator Expected DML Projected DML Expected DML Comment Activity/Target 2010 Outturn 2010 Activity/Target 2011 Child Abuse No. of referrals of child abuse (abuse includes ------For reporting in 2011. neglect as one of the 4 definitions) (i) % of referrals of child abuse and neglect where a ------New PI for 2011 preliminary enquiry took place within 24 hours 100% (ii) % of these initial assessments which took place ------New PI for 2011 within 20 days of the referral. 100% (iii) No. of first child protection conferences ------New PI for 2011. requested Family Support Services No. of families in receipt of a family support service ------New PI for 2011. (see metadata for list of relevant services) Residential and Foster Care No. and % of children in care by care type 1,598 1,553 1,580 (i) Children’s Residential Centre (Note: Include 154 173 < 7% Special Arrangements) 11% (ii) Foster care(not including day fostering) 984 900 60% 58% (iii) Foster care with relatives 428 446 30% 28.7% (iv) Other care placements 32 34 3% 2.2% No. of children in single care residential placements ------0 New PI for 2011. No. of children in residential care age 12 or under ------0 New PI for 2011. No. of children in care in third placement within 12 ------0 New PI for 2011. months Allocated Social Workers No. and % of children in care, by care type, who 92% 100% have an allocated social worker at the end of the reporting period: (i) No. and % of children in residential care 97% 100% (ii) No. and % of children in foster care 90% 100% (iii) No. and % of children in foster care with relatives 92% 100% (iv) No. and % of children in other care placement 92% 100% Care Planning % of children in care who currently have a written 85% 100% care plan as defined by Child Care Regulations 1995, by care type at the end of the reporting period. (i) % of children in residential care 92% 100% (ii) % of children in foster care 84% 100% (iii) % of children in foster care with relatives 85% 100% (iv) % of children in other care placement 87% 100% % of children (by care type) for whom a statutory ------100% New PI for 2011. care plan review was due during the reporting period and the review took place: (i) % of children in residential care ------100% New PI for 2011. (ii) % of children in foster care ------100% New PI for 2011. (iii) % of children in foster care with relatives ------100% New PI for 2011.

DML Regional Service Plan 2011 42

CHILDREN AND FAMILIES

contd. Indicator Expected DML Projected DML Expected DML Comment Activity/Target 2010 Outturn 2010 Activity/Target 2011 (iv) % of children in other care placement ------100% New PI for 2011. Foster Carer Total number of foster carers ------New PI for 2011. No. and % of foster carers approved and on the ------New PI for 2011. foster care panel, Part III of Regulations No. and % of relative foster carers where children ------0% New PI for 2011. have been placed for longer than 12 weeks who are not approved and on the foster care panel, Part III of Regulations No. and % of approved foster carers with an 72% 100% allocated social worker. Children in Care in Education (i) No. of children in care aged 6 to 16 inclusive. ------New PI for 2011. (ii) No. and & of children in care aged between 6 and ------100% New PI for 2011. 16 years in full time education After Care No. of young adults aged 18-21 in receipt of an ------100% New PI for 2011. aftercare service Children and Homelessness No. of children placed in youth homeless ------New PI for 2011. centres/units for more than 4 consecutive nights (or more than 10 separate nights over a year) No. and % of children in care placed in a specified ------New PI for 2011. youth homeless centre / unit No. of referrals made to the Emergency Out of Hours ------New PI for 2011. Place of Safety Service No. of children placed with the Emergency Out of ------New PI for 2011. Hours Placement Service Total number of nights accommodation supplied by ------New PI for 2011. the Emergency Out of Hours Placement Service Pre-School No. of notified pre-school services in LHO area. National = 5,000 National = 4,461 National = 4,461 % pre-school services which received an inspection National = 2,147 100% New PI for 2011. No. and % of pre-schools that are fully compliant. ------New PI for 2011. No. of notified full day pre-school services. ------New PI for 2011. % of full day services which received an annual ------100% New PI for 2011. inspection No. of pre-school services in the LHO that have ------New PI for 2011. closed during the quarter No. of pre-school complaints received ------New PI for 2011. % of complaints investigated ------100% New PI for 2011. No. of prosecutions taken on foot of inspections in ------New PI for 2011. the quarter

DML Regional Service Plan 2011 43

MENTAL HEALTH Mental Health

Introduction A Vision for Change sets the strategic direction for the provision of modern mental health care. There is a commitment to develop this model within the constrained resource base and to constantly aim to achieve compliance with statutory responsibilities arising from the Mental Health Act, 2001 in all mental health services offered.

The HSE National priorities in 2011 are to: ƒ Continue to implement elements of a Vision for Change, particularly reconfiguration of services from a model of care predicated on inpatient provision to a community based recovery model, reconfiguration of community mental health teams, development of clinical pathways and progressing the capital infrastructure ƒ Implement measures to reduce suicide rates ƒ Enhance the provision of Child and Adolescent Mental Health Services, and ƒ Progress provision of National Forensic Services.

In addition to the HSE National priorities, our DML Regional priorities for 2011 are to: ƒ Continue to reduce reliance on in-patient care through reconfiguration of resources towards community-based services. ƒ Implement national and regional initiatives designed to reduce suicide rates. ƒ Open new Adolescent Day Hospital on Cherry Orchard site in Ballyfermot. ƒ Respond to Amendment of Criminal Law Insanity Act. ƒ Develop Design brief for new National Forensic Mental Health Hospital.

Resources FINANCE DML REGIONAL WTE DML REGIONAL 2010 Budget €m 2011 Budget €m DML WTE Dec 2010 DML WTE 2011 Statutory 167.128 164.219 (1.75%) DML 1,048 TBC Voluntary 0 0 Total 167.128 164.219 (1.75%)

Despite significant global budget reductions, the reduction of funding for mental health services will be limited to 1.8% in 2011. This allocation will be spent in line with nationally agreed policy for mental health services whilst at the same time maximising value.

Key Result Areas

Enhancing Service Provision through Structural Changes; Changes in Procedures and Practices Deliverable Output 2011 Target completion • Continue development of Executive Clinical Directors (ECD) initiative Q4 through completion of Management Teams.

Service Reconfiguration: Reconfiguring services from a model of care predicated on inpatient provision to a community based recovery model; Reinvestment of Exchequer funding Deliverable Output 2011 Target completion • Reduce number of Acute Psychiatric beds further. Q4 • Pilot innovative Recovery and Early Intervention programmes through use of Innovation funding.

Suicide Prevention and Stigma Reduction

Deliverable Output 2011 Target completion • Implement nationally developed programmes for suicide prevention. Q4 • Continue involvement with SEE CHANGE programme aimed at stigma reduction.

DML Regional Service Plan 2011 44

MENTAL HEALTH

Continuous Service Development through Statutory and Regulatory Measures – Enhancing the Provision of Child and Adolescent Mental Health services Deliverable Output 2011 Target completion Implement measures to increase residential capacity: • Development of 11 bed interim Child and Adolescent Inpatient Unit for St. Ongoing Loman’s, Palmerstown, particularly targeting 16 and 17 year olds. • Progress plans to replace current In-Patient Unit in Warrenstown. Ongoing • Open new Child and Adolescent Day Hospital in Cherry Orchard. Ongoing

National Forensic Services Deliverable Output 2011 Target completion Compliance with the Criminal Law (Insanity) Act through: • Provision of 10-12 bed high support hostel for people granted conditional Q3 discharge by the courts under Criminal Law (Insanity) Act. • Provision of barricade / siege support to the Gardai in line with Barr Q3 recommendations. • Progress Design brief for new National Forensic Mental Health Hospital. Ongoing

Performance Activity and Performance Indicators - HSE Dublin Mid-Leinster

Indicator Expected DML Projected DML Expected DML Comment Activity/Target 2010 Outturn 2010 Activity/Target 2011 Adult Mental Health Services Total number of admissions to adult acute inpatient 3,860 3,532 3,532 units Median length of stay in adult inpatient facilities 11.0 11.5 11.0 Rate of admissions to adult acute inpatient units per National = 90.1 73.2 73.2 100,000 population in mental health catchment per quarter First admission rates to adult acute units (that is, first National = 26.38 22.4 22.4 ever admission), per 100,000 population in mental health catchment per quarter Readmissions as a % of total adult admissions 67% 70% 70% Inpatient readmission rates to adult acute units per National = 58.95 50.8 50.8 100,000 population in mental health catchment per quarter No. of adult acute inpatient beds per 100,000 National = 26.6 24.1 20.6 population in the mental health catchment area per quarter Total no. of adult involuntary admissions 348 320 320 Rate of adult involuntary admissions per 100,000 8.1 6.58 6.58 population in mental health catchment per quarter Child and Adolescent Mental Health Vision for Change recommended no. of Community 16 16 18 Child and Adolescent Mental Health Teams Vision for Change recommended no. of Child and 1 1 2 Adolescent Day Hospital Teams Vision for Change recommended no. of Paediatric 2 2 2 Liaison Teams No. of child/adolescent admissions to HSE Child and --- National = 150 New PI for 2011. Adolescent mental health inpatient units 220

DML Regional Service Plan 2011 45

MENTAL HEALTH

Indicator Expected DML Projected DML Expected DML Comment Activity/Target 2010 Outturn 2010 Activity/Target 2011 No. of children / adolescents admitted to adult HSE --- National = 140 New PI for 2011. mental health inpatient units (reported annually) <100 i). <16 years ii). <17 years Admission of children iii). <18 years to adult mental health inpatient units to cease except in exceptional circumstances by December 1st 2011 Total no. of involuntary admissions of children and ------New PI for 2011. adolescents (annually) 16 % of involuntary admissions of children and ------New PI for 2011. adolescents (annually) 5% No. of child / adolescent referrals (including re- --- 3,644 3,644 referred) received by Mental Health Services No. of child / adolescent referrals (including re- --- 2,639 2,639 referred) accepted by Mental Health Services Total no. of new (including re-referred) --- 2,272 2,272 child/adolescent cases offered first appointment and seen % of new (including re-referred) cases offered first 70% of new cases seen 70% of new cases appointment and seen within 3 months seen within 3 months i). <3 months --- 1,608 1,608 ii). >12 months --- 67 67 No. of cases closed/discharged by CAMHS service --- 1,962 New PI for 2011. % of cases closed/discharged by CAMHS service National = 75% New PI. 80% of accepted referrals. Total no. on waiting list for first appointment at end Reduce numbers waiting 660 628 Reduce numbers of each quarter by wait time: > 5% waiting by > 5% i). <3 months --- 269 260 ii). 3-6 months --- 228 217 iii). 6-12 months --- 159 151 iv). >12 months --- 4 0 % on waiting list for first appointment at end of each ------New PI for 2011. quarter by wait time i). <3 months ------ii). 3-6 months ------iii). 6-12 months ------iv). >12 months ------Self Harm No. of repeat deliberate self harm presentations in Reduce by 1% 337 373 ED Activity based on 2009 data No. of suicides ------New PI for 2011. In arrears per CSO Year of Occurrence

Improving our Infrastructure

See below capital projects that are to be completed and / or to become operational in DML in 2011 (see also Appendix 4):

Dublin Mid Leinster ƒ Ballyfermot and St. Lomas Road – provision of community facilities ƒ Lyons Villa, Chapelizod – replacement of 15 beds in St. Mary’s Phoenix Park ƒ Cherry Orchard – Child and Adolescent Mental Health day hospital ƒ St. Mary’s Mullingar – continuing care provision ƒ Grove House Celbridge and Grosvenor Road Dublin 6 – upgrade of High Support Hostel

DML Regional Service Plan 2011 46

DISABILIT Y Disability

Introduction Services to people with disabilities are provided in partnership with non-statutory sector service providers and in collaboration with service users and their families.

In Dublin Mid Leinster (DML), 8,300 individuals are registered on the National Physical and Sensory Disability Database (2009 NPSDD Annual Report) and 6,841 are registered on the National Intellectual Disability Database (2009 NIDD Annual Report). A significant cohort are not registered on either database as they do not meet the criteria for inclusion or choose not to have their needs registered.

The National Disability Strategy, 2004 provides the overarching framework for policy development and the key objective is to move away from institutionalised and isolated service settings to promote full and equal engagement with the community and society. The DoHC Value for Money and Policy Review will be finalised in 2011. It will require HSE disability services to be aligned to the policy direction. The report recommendations will guide allocation of resources in disability services and be critical to identifying HSE core business and opportunities for mainstreaming of non-core activity.

The HSE National priorities in 2011 are to: ƒ Contribute to the completion of the DoHC Value for Money (VFM) and Policy Review ƒ Comply with legislation and national quality standards, including the Disability Act, 2005 ƒ Re-configure services according to developed plans ƒ Implement the National Neuro-Rehabilitation Strategy ƒ Development of integrated information and data system, and ƒ Address demographic pressures in the provision of day, residential, respite, personal assistant and home support services utilising additional funding provided in 2011. This will be allocated based on emerging need during the year.

In addition to the HSE National priorities, our DML Regional priorities for 2011 are to:

ƒ Complete data returns to the DoHC Value for Money (VFM) and Policy Review; ƒ Update and deliver on the implementation plan for compliance with the Disability Act 2005; ƒ Develop implementation plan for Progressing Integration of Disability Services 0-18years; ƒ Re-establish Consultative Fora in line with National guidelines. ƒ Develop regional implementation for the implementation of the National Neuro-Rehabilitation Strategy; ƒ Develop action plan in relation to Statutory frameworks for residential and residential respite services for children with disabilities; ƒ Develop plan to progress the implementation of National Standards for individuals with Disabilities; ƒ Agree regional priorities to address service pressures from 2011 additional funding.

Resources FINANCE DML REGIONAL WTE DML REGIONAL 2010 Budget €m 2011 Budget €m DML WTE Dec 2010 DML WTE 2011 Statutory 220.648 217.804 (1.29%) DML 4,472 TBC Voluntary 262.711 256.774 (2.25%) Total 483.359 474.578 (1.82%)

Despite significant global budget reductions, the reduction of funding for disability services will be limited to 1.8% in 2011. This allocation will be spent in line with nationally agreed policy for disability services whilst at the same time maximising value.

DML Regional Service Plan 2011 47

DISABILIT Y

Key Result Areas VFM and Policy Review Provision Deliverable Output 2011 Target completion • Complete data returns. Q1 • Progress VFM Review recommendations. Q3 • Develop implementation plan for interagency collaboration. Q1

Compliance with Legislation and Quality Standards Deliverable Output 2011 Target completion • Pool resources within Integrated Service Area (ISA). Q1 • Provide Assessment of Need and Service Statements within statutory Ongoing timelines. • Be compliant with Disability Act 2005. Q4

Reconfiguration of Services Deliverable Output 2011 Target completion • Map Disability Services 0-18years. Q2 • Prepare Implementation Plan in collaboration with all stakeholders. Q2 • Develop Guidelines on referral care pathways. Q3 • Develop outline implementation plan in line with VFM and Policy Review. Q4

Neuro-Rehabilitation Strategy Deliverable Output 2011 Target completion • Develop Regional plan for implementation of Neuro-Rehabilitation Strategy. Q4

Development of Information and Data System Deliverable Output 2011 Target completion • Engage with National office in relation to scoping exercise re integrated ICT Q4 system.

Performance Activity and Performance Indicators - HSE Dublin Mid-Leinster

Indicator Expected DML Projected DML Expected DML Comment Activity/Target 2010 Outturn 2010 Activity/Target 2011 Day Services (0-18 and adults reported separately) No. of work/work-like activity WTE places provided National = 1,046 420 378 The implementation of for persons with intellectual disability and/or autism recommendations flowing from the review of Day Services is expected to result in a 10% decline in the number of people engaged in these services. As these people are largely also engaged in other Day Services, a consequent increase in those numbers is not expected. No. of persons with intellectual disability and/or National = 1,163 716 644 See above. autism benefiting from work/work-like activity also services Expected activity / targets 2010 have been modified following a validation exercise and so do not reflect what was included in NSP 2010.

DML Regional Service Plan 2011 48

DISABILIT Y

contd. Indicator Expected DML Projected DML Expected DML Comment Activity/Target 2010 Outturn 2010 Activity/Target 2011 No. of work/work-like activity WTE places provided --- 15 13 The implementation of for persons with physical and/or sensory disability recommendations flowing from the review of Day Services is expected to result in a 10% decline in the number of people engaged in these services. As these people are largely also engaged in other Day Services, a consequent increase in those numbers is not expected. No. of persons with physical and/or sensory disability --- 41 37 See above. benefiting from work/work-like activity services No. of Rehabilitative Training places provided (all --- 719 715 New PI disabilities) No. of persons (all disabilities) benefiting from 765 724 724 Rehabilitative Training (RT) No. of persons with intellectual disability and/or National = 9,951 National = 14,077 National = 14,077 Expected activity / autism benefiting from Other Day Services (excl. RT targets 2010 have and work/work-like activities) been modified following a validation exercise and so do not reflect what was included in NSP 2010. No. of persons with physical and/or sensory disability --- National = 3,924 National = 3,924 benefiting from Other Day Services (excl. RT and work/work-like activities) Residential Services (0-18 and adults reported separately) No. of persons with intellectual disability and/or 2,528 2,222 2,222 autism benefiting from residential services No. of persons with physical and/or sensory disability --- 290 290 benefiting from residential services Respite Services (0-18 and adults reported separately) No. of bed nights in residential centre based respite --- 40,491 40,491 services used by persons with intellectual disability and/or autism No. of persons with intellectual disability and/or --- 1,336 1,336 autism benefiting from residential centre based respite services No. of bed nights in residential centre based respite --- 345 345 services used by persons with physical and/or sensory disability No. of persons with physical and/or sensory disability --- 980 980 benefiting from residential centre-based respite services Personal Assistant / Home Support (0-18 and adults reported separately) No. of Personal Assistant/Home Support hours used National = 3.2m. 752,676 928,000 Projected outturn 2010 by persons with physical and/or sensory disability figures are based on extrapolations from incomplete data and are subject to validation. No. of persons with physical and/or sensory disability --- 2,696 3,305 benefiting from Personal Assistant/Home Support hours Implementation, Part 2 Disability Act No. of requests for assessments received 716 896 896 No. of assessments commenced as provided for in 612 841 841 the regulations

DML Regional Service Plan 2011 49

DISABILIT Y

contd. Indicator Expected DML Projected DML Expected DML Comment Activity/Target 2010 Outturn 2010 Activity/Target 2011 No. of assessments commenced within the timelines 612 588 841 as provided for in the regulations No. of assessments completed as provided for in the 328 489 489 regulations No. of assessments completed within the timelines 328 55 489 as provided for in the regulations No. of service statements completed 312 Not reported. 489 No. of service statements completed within the 312 Not reported. 489 timelines as provided for in the regulations

DML Regional Service Plan 2011 50

OLDER PERSONS Older Persons

Introduction The HSE’s strategic priority for 2011 and beyond is to maintain older people in their own home for as long as possible and where this is not possible, to provide high quality residential care, appropriate intermediate step up / step down and respite beds.

In Dublin Mid Leinster (DML) over 122,000 people (10% of total population) are over 65 years of age. A range of services are provided in partnership with older people themselves, their families, carers, statutory, non-statutory, voluntary and community groups. The principles of person-centredness and empowerment of service users underpin service delivery.

During 2011, we will strive to maintain our 2010 service delivery with 2.160 million home help hours provided to approximately 12,000 older people. We will also support approximately 2,355 older people with enhanced needs at home and we will deliver up to 1,460 Home Care Packages.

We will continue to support older people financially, within available resources, who require residential long stay care through the Nursing Home Support Scheme (NHSS) and existing clients through the Nursing Homes Subvention fund and contract beds.

To support the national policy of 4 Regional Offices to administer the NHSS, DML will subsume the applications currently administered in Laois/Offaly and Longford/Westmeath into the NHSS office in Naas.

The DML Governance and Standards team will continue supporting the residential care services to reach legislative requirements through education, on site visits, quality assurance and inspections to reach HIQA requirements, preparation of HIQA documentation for the registration of units and HIQA inspections and education for person in charge and providers.

To eliminate the risk of elder abuse, awareness training for staff of all grades will take place throughout the year. Staff will also participate in national awareness campaigns.

We will continue to further develop an integrated model of care for older people with all health service providers to ensure a continuum of services from home and community services through to acute intervention to residential long stay care with older person’s needs and preferences central to the decision making that is required throughout the process.

The HSE National priorities in 2011 are to: ƒ Provide equitable community based services and home supports ƒ Provide high quality residential care for older persons who cannot be maintained at home ƒ Implement the falls prevention guidelines, and ƒ Increase awareness of elder abuse.

In addition to the HSE National priorities, our DML Regional priorities for 2011 are to: ƒ Target those at risk of admission to long stay care, inappropriate admission to hospital or requiring discharge to home from hospital through the utilisation of the 2011 additional allocation of €2million for Home Care Packages. ƒ Implement the National Guidelines & Procedures for the Standardised Implementation of the Home Care Packages Scheme. ƒ Maintain 2010 home help service delivery. ƒ Implement a standardised approach for the allocation of home help hours. ƒ Ensure that all service users in receipt of home care services are regularly reviewed. ƒ Continue to develop and reconfigure residential care services. ƒ Continue, through the DML governance and standards team, to support residential care services to reach the requirements of legislation and the amended Health Act 2007. ƒ Have one office in DML administering the NHSS in line with national policy. ƒ Ensure that there is an elder abuse senior case worker in each Local Health Office.

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ƒ Continue to raise awareness of elder abuse through awareness training and awareness campaigns. ƒ Continue to develop integrated services with all health service providers. ƒ Support the provision of extended care, rehabilitation and respite care for older people through capital infrastructure developments.

Resources FINANCE DML REGIONAL WTE DML REGIONAL 2010 Budget €m 2011 Budget €m DML WTE Dec 2010 DML WTE 2011 Statutory 268.629 265.924 (1.0%) DML 3,140 TBC Voluntary 32.019 30.421 (5.0%) Total 300.648 296.345 (1.43%)

Key Result Areas

Community Services: Maintain a strong focus on the provision of equitable community based services and home supports. Deliverable Output 2011 Target completion • Procurement processes for Home Care Packages (HCPs) to be finalised and Q3 implemented in all LHO areas. • National Quality Guidelines for Home Care Services developed and agreed Q2 with DoHC. • Home Help guidelines implemented. Q2 • HCP review implemented. Q3 • National Single Assessment Tool (SAT) to determine access to range of Q4 services for older people, selected and rolled out nationally. • Geriatrician Led Community Outreach Teams targeted at vulnerable older Q4 people developed. • Work with the DoHC on legislative proposals for Community Care. Ongoing

Residential Care: Provide high quality public residential care for older persons who cannot be maintained at home. Deliverable Output 2011 Target completion • Continue implementation of the Nursing Home Support Scheme. Ongoing • Strive to optimise the provision of short and long term residential care in both Ongoing public and private settings by the development of local plans for residential care, to meet local need. • Maximise efficiencies in publicly funded residential care to ensure best value Ongoing for money by reviewing staffing types and levels.

Falls Prevention Guidelines. Deliverable Output 2011 Target completion • Implementation commenced on the recommendations of the Falls Q4 Prevention Strategy in all appropriate older persons services.

Elder Abuse Deliverable Output 2011 Target completion • Elder Abuse Awareness campaigns / Elder Abuse Awareness Day Q2 undertaken. • Senior Case workers for Elder Abuse employed in each Local Health Office. Q2 • Monthly and annual statistical returns collected contributing to national Ongoing reports on Elder Abuse. • Elder Abuse awareness training provided for HSE and non HSE staff. Ongoing

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Performance Activity and Performance Indicators – HSE Dublin Mid-Leinster

Indicator Expected DML Projected DML Outturn Expected DML Comment Activity/Target 2010 Activity/Target 2010 2011 Home Help Hours and HCPs (as per 2010 guidelines) Total no of Home Help Hours provided for all care 2.16m 2.16m 2.16m groups (excluding provision of hours from HCPs) : Total number of people in receipt of home help hours 12,500 12,000 12,000 (excluding provision of hours from HCPs) : Total number of people in receipt of HCPs 2,148 2,200 2,355 i). No. and % direct provision ii). No. and % indirect provision iii). No. and % cash grant iv). No. and % respite v). No. and % multiple types Total no. of HCPs provided 1,408 1,408 1,460 Total no. of new HCP clients per month 840 900 1,000 (Total Target 2011 = 1,000) Day Care Total no. of day care places for older people National = 21,300 National = 21,300 Baseline to be set. Under review, to estimate baseline for 2011. No. of clients benefiting from day care places --- Under review, to estimate Baseline to be set. baseline for 2011 Subvention Total no. in receipt of subvention --- 550 Dependent on uptake of Nursing Home Support Scheme. Total no. in receipt of enhanced subvention 250 Dependent on uptake of Nursing Home Support Scheme. Nursing Home Support Scheme (NHSS, ‘A Fair Deal’) No. of people in long-term residential care availing of --- Not reported. Baseline to be set NHSS in 2011. No. and proportion of those who qualify for ancillary --- Not reported. Baseline to be set state support who chose to avail of it. in 2011. % of complete applications processed within four --- Not reported. 100% weeks Public Beds No. of beds in public residential care settings for 2,904 2,400 2,300 Older People Elder Abuse No. of new referrals by region --- National = 1,800 Demand led. No. and % of new referrals broken down by abuse --- type: (i) physical, (i) National = 298 (12%) Baseline to be set (ii) psychological, (ii) National = 668 (26%) in 2011. (iii) financial (iii) National = 456 (18%) (iv) neglect (iv) National = 455 (18%) Total number of active cases ------New PI for 2011. No. of referrals receiving first response from Senior --- National = 100% 100% Caseworkers within 4 weeks

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Improving our Infrastructure

See below capital projects that are to be completed and / or become operational in DML in 2011 (see also Appendix 4):

Dublin Mid-Leinster ƒ Inchicore – 50 bed Community Nursing Unit ƒ St. Mary’s, Mullingar – 100 bed community hospital ƒ Riada House, Tullamore – provision of an additional 20 bed unit ƒ Clonskeagh – provision of 94 replacement beds

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PALLIATIVE C ARE Palliative Care

Introduction Palliative care provides the best possible quality of life for patients and their families when their disease is no longer responsive to treatment. Services are provided directly by the HSE and in partnership with voluntary agencies.

The focus for 2011 will be to continue to develop services, supported by the palliative care programme within Quality and Clinical Care, and at the same time continue to drive efficiencies to ensure that services are maximised.

The HSE National priorities for 2011 are to: ƒ Progress the recommendations in the Report of the National Advisory Committee on Palliative Care, 2001 ƒ Implement Care at End of Life projects ƒ Progress the recommendations from the National Children’s Palliative Care Policy, and ƒ Implement the minimum data set for palliative care.

In addition to the HSE National priorities, our DML Regional priorities for 2011 are to: ƒ Reconfigure the Area Consultative Committees in line with new Integrated Service Areas (ISAs) ƒ Progress with the planned Specialist In-Patient Units at Wicklow and Laois/Offaly ƒ Review Palliative Care posts requirement

Resources FINANCE NATIONAL WTE NATIONAL AND REGIONAL 2010 Budget €m 2011 Budget €m DML WTE Dec 2010 DML WTE 2011 Statutory 5.146 5.438 +5.7% DML 529 TBC Voluntary 29.432 27.932 (5.0%) Total 34.578 33.370 (3.5%) * Includes Chronic Sick

Key Result Areas

Report of the National Advisory Committee on Palliative Care, 2001: Access to specialist services and treatment in location of choice where this can be achieved safely, effectively and efficiently. Deliverable Output 2011 Target completion Report of the National Advisory Committee: • Identified priorities progressed on a cost neutral basis Q4

Access to specialist services: • Agreed referral criteria and assessment of need for specialist services developed. Q4 • Service Level Agreements developed to reflect further efficiencies.

Treatment in location of choice where this can be achieved safely, effectively and efficiently: Q4 • Care pathways, governance arrangements and clinical guidelines developed to support treatment in location of choice.

Care at End of Life Deliverable Output 2011 Target completion • Care at end of life within both acute and long stay hospitals progressed Q4 through the implementation of projects through the Dignity and Design process.

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Children’s Palliative Care Deliverable Output 2011 Target completion Continued implementation of national policy on Children’s Palliative Care: • Consultant and key nursing positions in post. Q3 • Review of respite services for children with life limiting illnesses undertaken. Q3

Minimum Data Set Deliverable Output 2011 Target completion Minimum Data Set progressed through: • First phase of the pilot of MDS completed. Q2 • Day care services and acute hospitals data piloted and collected. Q4 • Review process concluded for intermediate/palliative care support beds. Q4

Performance Activity and Performance Indicators – HSE Dublin Mid-Leinster

Indicator Expected DML Projected DML Outturn Expected DML Comment Activity/Target 2010 Activity/Target 2010 2011 Specialist Palliative Care Wait times for specialist inpatient bed (patients seen within) i). 0 – 7 days ------National = 92% ii). 0 - < 1 month --- 95% 95% < Month = 28 days Wait times for home, non-acute hospital, long-term residential care delivered by community teams(patients seen within) i). 0 – 7 days --- National = 78% National = 78% ii). 0 - < 1 month --- 99% 99% Specialist Palliative Care (monthly averages) No. patients treated in specialist inpatient units 111 96 96 No. patients in receipt of community based specialist 696 618 618 palliative care No. patients in receipt of day care 85 74 74 No. patients in receipt of intermediate palliative care 44 53 53 in community hospitals No. of admissions to specialist inpatient units --- 727 727 New PI No. of discharges, transfers and deaths from New PI in 2011 specialist inpatient units i). Discharges --- 84 84 ii). Transfers --- 420 420 iii). Deaths --- 212 --- No. new patients to the service by age For reporting in 2011. i). Specialist inpatient bed --- 45 45 ii). Home care --- 154 154

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SOCIAL INCLUSION Social Inclusion

Introduction Poverty and social exclusion have a direct impact on the health and well being of the population. Vulnerable and/ or people at risk may be unable to access and utilise health services in a fair manner. In response to the needs of this diverse population services are provided either directly or through funding to the non-governmental organisation, community and voluntary sector.

The HSE Dublin Mid Leinster (DML) Social Inclusion Services improve access to mainstream services, target services to marginalised groups, address inequalities in access to health services and enhance the participation and involvement of socially excluded groups and local communities in the planning, design, delivery, monitoring and evaluation of health services.

DML will in 2011 maintain existing levels of service to the following areas of work which are provided under Social Inclusion services: • Drug and Alcohol Services • Services for Minority Ethnic Communities • Traveller Health Services • Services for Lesbian, Gay, Bisexual, Transsexual / Transgender communities • Community Development • HSE RAPID and CLAR Programmes • HIV / STI services

2011 Deliverables

Drug and Alcohol Services In 2010, DML provided 4,981 treatments for substance misuse. This is 140 clients in excess of the projected activity for 2011. Services are provided by mainstream acute and mental health services as well as community based detoxification through GPs. There are 53 addiction residential rehabilitation beds and 28 step down beds in the region. In 2010, DML also made use of a number of private and voluntary service providers not located within the DML region for residential treatments.

Substantial investment was provided in Drug and Alcohol Services in DML in 2010 and the full year impact of this will be seen in 2011.

Demographic Monies were allocated to Tullamore and Mullingar last year. An outreach service comprising three project workers who link in with service users was developed. The full extent of this outreach programme will be seen in 2011. This new service will assist in reducing waiting lists for Methadone treatment in this part of the region in 2011. In addition, harm reduction/ needle exchange clinics will open in Tullamore and Mullingar in 2011.

Traveller Services There are 8 Traveller Primary Healthcare Projects in DML. In 2011 the Traveller Primary Health Care Projects will work with the HSE to develop programmes in response to the findings of the All Ireland Traveller Health Study (A.I.T.H.S.). The 2011 scheme of work includes: cardiovascular training modules, men’s health screening, mental health / suicide awareness / access to counselling.

Plans to develop another primary health care project in Westmeath began in 2010. Capacity building for the development of conflict resolution skills in Westmeath and Ballyfermot were identified and will be implemented in 2011.

DML has two regional Traveller Health Units. The Eastern Regional Traveller Health Unit agreed last year to be co- chaired by DML and HSE Dublin North East (DNE). The Midland Traveller Health Unit provides services to the travelling community in Laois, Offaly, Longford and Westmeath. In 2011 the Traveller Health Units will work closely with

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the HSE in the development of Care Pathways for services required as a result of the screening programmes for men’s health, cardiovascular and diabetes, etc

Homeless Services There are 55 Homeless facilities in DML spread across the region, including 14 Women’s facilities, 1 Womens Only Refuge, 11 Emergency Men’s Hostels, 7 Emergency Mixed Singles Hostels, 13 Transitional/Supported Living facilities, 8 Long-term Residential facilities and 1 Homeless Detoxification Unit.

“A Key to the Door” targeted the ending of long term homelessness in Dublin by the end of 2010. A vital and overriding constituent of this target was the provision of 1,200 units of housing to allow clients move on from unsuitable accommodation, eliminate the provision of transitional housing and decommission unsuitable services. For various reasons this target of housing provision has not proved possible and the targets set out in “Key to the Door” will extend into 2011.

In addition, the funding sought by the voluntary sector to manage the reconfigured services is above the revenue stream available and further bi-lateral discussions with the voluntary sector under the umbrella of the DHCF are required early in 2011 to reach an agreed way forward.

Plans to decommission Ceder House – Salvation Army are at an advanced stage. This is targeted for the first quarter of 2011.

Other Social Inclusion Services In 2011 in accordance with the National Service Plan and the development of the LGBT Framework, DML will support national guidelines as they emerge and co-operate with the development of policy and guiding principles.

In 2011, DML will continue to support the RAPID and CLAR programmes.

DML provides designated health services such as health screening to the Ethnic Minority/Asylum seekers, as well as mainstream health services. In 2011, DML will continue to implement the National Intercultural Strategy which focuses on interpretative and other services.

DML will also support the implementation of the development of emergency multilingual aid toolkits for staff and the dissemination of the Intercultural Health Guide.

The transfer of Community Welfare Services (CWS) and associated resources to the Department of Social Protection (DSP) was outlined in 2010. This process will be further supported by DML in 2011. CWS staff are seconded to DSP from January until September 2011.

Cost Management The majority of Social Inclusion services are provided by non-statutory agencies funded by HSE. Some efficiencies will be required from non-statutory agencies in 2011, with particular emphasis on reduction in management and administration, travel and subsistence costs, etc.

The HSE National priorities in 2011 are to: ƒ Continue to address the health impacts of addiction and/or substance misuse ƒ Implement actions arising from the Strategy to Address Adult Homelessness in Ireland 2008-2013 ƒ Address the outputs from the All-Ireland Traveller Health Study, 2010 ƒ Support staff in helping ethnic minorities access services, and ƒ Support Lesbian, Gay, Bisexual and Transgender (LGBT) communities in equitable access and use of health services.

In addition to the HSE National priorities, our DML Regional priorities for 2011 are to: ƒ Implement the DML elements of the National Service Plan; ƒ Support national service developments as required. These include: ¾ Assisting in tackling the impact of addiction and /or substance misuse; ¾ Developing harm reduction / needles exchange programmes in Tullamore and Mullingar;

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¾ Participating in an Alcohol Public Awareness Campaign; ¾ Assisting in the recruitment of the Clinical Director of Addiction Services; ¾ Assisting in the implementation of the National Drugs Strategy actions, 32, 33, and 34; ¾ Working with other HSE regions to assist in the development of a metric rule to calculate the level of demand per Integrated Service Area for Tier 3 and Tier 4 addiction rehabilitation services. ƒ Work with service providers to improve clinical governance. ƒ Effect significant operational efficiencies and cost reduction in 2011 in the context of the Public Service Agreement (P.S.A.). (A significant effort was made by the Addiction Services in drawing up plans to increase operational efficiencies and reduce costs using the framework of the PSA. Initial meetings were held with staff representative bodies in December 2010 in this regard.) ƒ Work in partnership with Traveller Projects to further develop the HSE National Traveller Health Action Plan, in accordance with the priorities of the A.I.T.H.S. ƒ Integrate the recommendations in the National Drugs and Homeless Strategies into the provision of mainstream health services. ƒ Target Homeless Services at supporting clients to develop the skills and supports to be able to move into independent and supported social housing. ƒ Work to ensure that medical card services to vulnerable clients are managed in a swift and efficient manner. ƒ Continue to support the remaining RAPID and CLÁR programmes. ƒ Support the implementation of the National Intercultural Strategy Action Plan in 2011 ƒ Assist in the dissemination of the multilingual Aid toolkits for staff.

Resources

FINANCE DML REGIONAL WTE DML REGIONAL 2010 Budget €m 2011 Budget €m DML WTE Dec 2010 DML WTE 2011 Statutory 56.915 55.075 (3.23%) DML 291 TBC Voluntary 0 0 Total 56.915 55.075 (3.23%)

Key Result Areas

National Drugs Strategy and National Substance Misuse Strategy Deliverable Output 2011 Target completion • Open harm reduction/needle exchange services in Tullamore and Mullingar. Q2 • Assist in the Alcohol Public Awareness Campaign. Q2 • Assist in the recruitment of the Clinical Director of Addiction Services post. Q3

National Homelessness Strategy Deliverable Output 2011 Target completion • Progress the implementation of the Dublin Joint Homelessness Consultative Q4 Forum Action Plan to eliminate homelessness. • Assist in the development of referral pathways between addiction/mental Q4 health and homeless services.

All-Ireland Traveller Health Study Deliverable Output 2011 Target completion • Develop and implement the regional plan to address five priorities agreed Q4 Nationally.

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National Intercultural Health Strategy Deliverable Output 2011 Target completion • Support the implementation of the development of emergency multilingual Q3 aid tool-kits for staff • Assist in the completion of the Intercultural Health Guide. Q3 • Assist in the national plan to implement the ethnic identifier field in core data. Q2

LGBT Framework Deliverable Output 2011 Target completion • Support national guidelines as they emerge and co-operate with the Q4 development of policy and guiding principles.

Performance Activity and Performance Indicators – HSE Dublin Mid-Leinster

Indicator Expected DML Projected DML Outturn Expected DML Comment Activity/Target 2010 Activity/Target 2010 2011 Methadone Treatment (monthly in arrears) Total no. of clients in methadone treatment (outside 4,481 4,900 4,900 prisons) Total no. of clients in methadone treatment (prisons) National = 497 National = 500 National = 500 Substance Misuse (quarterly in arrears) Total no. of substance misusers (over 18 years) for 520 272 300 whom treatment has commenced following assessment No. and % of substance misusers (over 18 years) for 100% 70.6% 100% whom treatment has commenced within one calendar month following assessment Total no. of substance misusers (under 18 years) for 20 19 25 whom treatment has commenced following assessment No. and % of substance misusers (under 18 years) 100% 100% 100% for whom treatment has commenced within two weeks following assessment Homeless Services (quarterly in arrears) No. of individual service users admitted to statutory ------New PI for 2011 and voluntary managed residential homeless services who have medical cards 75%

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NATIONAL PERFORMANCE INDICATOR AND ACTIVITY SUITE

National Performance Indicator and Activity Suite

Quality and Safety Performance Activity / Key Performance Indicator Reported Expected Activity Projected Expected / Target 2010 Outturn 2010 Activity / Target 2011 Health Care Assurance % of national audits, as specified in audit plan, commenced Quarterly ------New PI for 2011 100% % of national audits completed within the timelines in audit plan Quarterly ------New PI for 2011 75% Service Level Agreements Agencies with whom the HSE has a Service Arrangement / Grant Aid Quarterly Agreement in place: i). % of agencies --- 100% 100% ii). % of funding 100% 100% Service User Involvement and advocacy % of primary care Local Implementation Groups with at least 2 Quarterly ------New PI for 2011 community representatives in each LHO 75% ------New PI for 2011 No. of volunteer advocates trained Bi-annually 200 Parliamentary Questions ------New PI for 2011 % of Parliamentary Questions dealt with within 15 working days Quarterly 75% Complaints % of complaints investigated within legislative timeframe Quarterly ------New PI for 2011 75% % of reviews conducted and concluded within 20 working days of the Monthly ------New PI for 2011 request being received (Health Act 2004 (Complaints) Regulations) 75% Environmental Health Tobacco Control ------For reporting in No. of sales to minors test purchases carried out Quarterly 2011 80 Food Safety Quarterly ------New PI for 2011 % of the total number of high risk food premises which receive one full 100% programmed inspection Import control Quarterly ------New PI for 2011 % of total number of food consignments imported which are subject to 100% additional controls that receive the additional official controls required by legislation International Health Regulations ------New PI for 2011 All designated ports and airports to receive an inspection to audit Bi-annually 8 compliance with the International Health Regulations 2005 Cosmetics and Food Product Safety ------New PI for 2011 Quarterly % achievement with the cosmetic plan 100% % achievement with the food sampling plan Quarterly ------New PI for 2011 100% Blood Policy No. of units of platelets ordered in the reporting period Monthly --- 22,750 22,000 ------New PI for 2011 % of units of platelets outdated in the reporting period Monthly < 10% ------New PI for 2011 % usage of O Rhesus negative red blood cells per hospital Monthly <11% ------New PI for 2011 % of red blood cell units rerouted to hub hospital Monthly < 5% % of red blood cell units returned out of total red blood cell units 3% 1.73% <2% Monthly ordered

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NATIONAL PERFORMANCE INDICATOR AND ACTIVITY SUITE

Primary Care Performance Activity / Key Performance Indicator Reported Expected Projected Expected Activity / Activity / Outturn 2010 Target 2011 Target 2010 Primary Care Teams (PCTs) No. of PCTs holding clinical team meetings Monthly 394 394 527 No. of PCTs in development Monthly 133 133 0 No. of patients/clients discussed at a clinical team meeting for the Monthly ------New PI for 2011 reported month 83,205 No. and % of PHNs who are assigned to PCTs (as defined between Quarterly 100% 1,283 1,283 DoHC and HSE) 100% 100% No. of PCTs that are implementing structured integrated diabetes care Quarterly --- 34 For reporting in 2011 (as defined by the diabetes policy 2006 and the HSE’s EAG 2008) 57 No. of PCTs implementing a structured education programme for Quarterly ------New PI for 2011 diabetes patients separate from a structured integrated care programme. 87 No of patients / clients formally partaking in structured integrated Quarterly ------For reporting in 2011 diabetes care (as defined by the diabetes policy 2006 and the HSE’s 3,880 EAG 2008) No. of PCTs continuing to implement structured asthma prevention and Quarterly ------For reporting in 2011 care (as per 2010 pilot programme and as set out in the ICGP / Asthma 16 Society of Ireland Clinical Guidelines, 2008) No. of patients / clients continuing to partake in formal structured asthma Quarterly ------For reporting in 2011 prevention and care (as per 2010 pilot programme and as set out in the 457 ICGP / Asthma Society of Ireland Clinical Guidelines 2008) GP Out of Hours No. of contacts with GP out of hours Monthly 880,000 880,000 *968,000 Immunisations % of children 12 months of age who have received three doses of Quarterly ------For reporting in 2011 vaccine against Diphtheria (D3), Pertussis (P3), Tetanus (T3), 95%

Haemophilus influenza type b (Hib3), Polio (Polio3),hepatitis B (HepB3B ) (6 in 1 vaccine). % of children at 12 months of age who have received two doses of the Quarterly ------New PI for 2011 Pneumococcal Conjugate vaccine (PCV2) 95% % of children at 12 months of age who have received two doses of the Quarterly 95% 89% New PI for 2011 Meningococcal group C vaccine (MenC2) Q2 data 95% % of children 24 months of age who have received three doses of Quarterly ------For reporting in 2011 vaccine against Diphtheria (D3), Pertussis (P3), Tetanus (T3), 95% Haemophilus influenza type b (Hib3), Polio (Polio3) and hepatitis B (HepB3) (6 in 1 vaccine) % of children at 24 months of age who have received one dose of the Quarterly 95% 91.5% New PI for 2011 Meningococcal C vaccine (MenCb) between 12 months and 24 months Q2 data 95% of age. % of children 24 months of age who have received the Measles, Mumps, Quarterly 95% 90% 95% Rubella (MMR) vaccine Q2 data HPV – no and % of first and second year girls to have received the third Annually ------New PI for 2011 dose of HPV vaccine in 2011 46,400 80% Child Health / Developmental Screening % newborn babies visited by a PHN within 48 hours of hospital discharge Quarterly 100% 85% 95% Q3 data % newborn babies visited by a PHN within 72 hours of hospital discharge Quarterly ------New PI for 2011 100% % of children reaching 10 months within the reporting period who have Monthly 90% 64% 90% had their child development health screening on time before reaching 10 Q3 data months of age Orthodontics Total no. of patients receiving active treatment during reporting period Quarterly 22,130 18,000 18,000 commence Q3

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NATIONAL PERFORMANCE INDICATOR AND ACTIVITY SUITE

Primary Care Performance Activity / Key Performance Indicator Reported Expected Projected Expected Activity / Activity / Outturn 2010 Target 2011 Target 2010 Total no. of patients in retention during reporting period Quarterly Included in above Included in above To be disaggregated in commence 2011 Q3 Total no. of patients who have been discharged with completed Quarterly 2,000 5,000 2,000 treatments during reporting period commence Q3 Waiting time for Orthodontic Assessment : Quarterly ------New PI for 2011 i). % assessed within 6 months commence 75% Q3 ii). % assessed within 9 months Quarterly ------New PI for 2011 commence 90% Q3 Waiting time for Orthodontic Treatment : Quarterly ------New PI for 2011 i). % of Grade 5 (surgically dependant patients with impacted canines) commence 75% treated within 9 mths Q3 ii). % of Grade 5 (surgically dependant patients with impacted canines) Quarterly ------New PI for 2011 treated within 12 mths commence 90% Q3 iii). % of Grade 5a (functional case) treated within 3 months Quarterly ------New PI for 2011 commence 90% Q3 iv). % of Grade 4 treated within 2 years (excluding Grade 4d, crowding) Quarterly ------New PI for 2011 commence 75% Q3 v). % of grade 4d treated within 3 years Quarterly ------New PI for 2011 commence 75% Q3 *Increased target 2011 reflects inclusion of existing contracts not currently recorded rather than additional people being seen

Acute Services Key Performance Activity Reported Expected Projected Expected Activity Activity 2010 Outturn 2010 2011 Discharges Activity No. of patients discharged: i). Inpatient Monthly 540,993 586,102 574,400 ii). Day Case Monthly 689,310 733,131 755,100 iii). Elective Monthly ------iv). Non Elective/Emergency Monthly ------% of discharges which are public: i). Inpatient Monthly 80% 77.2% 80% ii). Day Case Monthly 80% 82.6% 80% iii). Elective Monthly ------iv). Non Elective/Emergency Monthly ------Emergency Activity i). No. of emergency presentations Monthly 1,190,435 1,199,863 1,199,900 ii). No. of ED attendances Monthly ------iii). No. of emergency admissions Monthly 330,298 365,061 361,400 Outpatients (OPD) Activity i). No. of outpatient attendances Monthly 3,394,882 3,577,560 *3,591,700 ii). No. of outpatient attendances (new) Monthly ------

iii). No. of outpatient attendances (return) Monthly ------iv). % of total appointments that are DNA Monthly 10% 14% 10% v). % DNA (new appointments) Monthly 10% 14% 10% vi). % DNA (return appointments) Monthly 10% 14% 10%

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NATIONAL PERFORMANCE INDICATOR AND ACTIVITY SUITE

Acute Services Key Performance Activity Reported Expected Projected Expected Activity Activity 2010 Outturn 2010 2011 vii). No. of Referrals to Consultant OPD Clinics Monthly ------New PI for 2011 viii). No. of Clinics held Monthly ------New PI for 2011 ix). No. of Clinics postponed/cancelled Monthly ------New PI for 2011 Births Activity Total no. of births Monthly 74,996 74,279 74,200

Acute Services Key Performance Indicator Reported Target 2010 Projected Target 2011 Outturn 2010 Average Length of Stay (ALOS): Overall ALOS for all inpatient discharges and deaths Monthly 5.6 6.16 5.6 Overall ALOS for all inpatient discharges and deaths excluding LOS over Monthly ------New PI for 2011 30 days 5 Median LOS for patients admitted with STEMI Quarterly ------New PI for 2011 7.5 Median LOS for patients admitted with heart failure Quarterly ------New PI for 2011 Baseline to be established Readmission Rate of readmission for heart failure following discharge from hospital Quarterly ------New PI for 2011 < 20% Day Cases % of day case surgeries as a % of day case plus inpatients for a specified Quarterly 75% 69% 75% basket of procedures (General surgery, ENT, Ophthalmology) Day of Procedure Overall % of elective inpatients who had principal procedure conducted on Monthly 75% 49% 75% day of admission Emergency Department Average time from registration to discharge from ED for: Monthly 6 hours Under review; < 6 Hours i). All patients Baseline to be ii). Patients who require admission established iii). Patients who are not admitted and are discharged % of patients admitted to hospital within 6 hours of ED registration Monthly 100% Under review; 100% Baseline to be established % of patients discharged within 6 hours of ED registration Monthly 100% Under review; 100% Baseline to be established % of patients admitted to hospital or discharged from ED within 6 hours of Monthly 100% 60% 100% ED registration Oct data Outpatients (OPD) New: Return ratio Monthly 1 : 2 1:2.6 1:2 Public Inpatient, Day Case and OPD Waiting Lists Adults % of adults waiting < 6 months (inpatient) Monthly 100% 75.3% 100% % of adults waiting < 6 months (day case) Monthly 100% 86.9% 100% % of adults waiting < 6 months (OPD) Monthly 100% --- 100% Children

% of children waiting < 3 months (inpatient) Monthly 100% 43.4% 100% % of children waiting < 3 months (day case) Monthly 100% 46.3% 100% % of children waiting < 3 months (OPD) Monthly 100% --- 100%

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NATIONAL PERFORMANCE INDICATOR AND ACTIVITY SUITE

Acute Services Key Performance Indicator Reported Target 2010 Projected Target 2011 Outturn 2010 Births PI % delivered by Caesarean Section Monthly 20% 26% 20%

Colonoscopy Service % of urgent referrals waiting less than 4 weeks for colonoscopy Monthly 100% 99.2% 100% Health Care Associated Infection (HCAI) MRSA bacteraemia notification rate per 1,000 beds days used Quarterly 5% reduction 0.088 Reduce to 0.085 per Q3 data 1,000 bed days Total antibiotic consumption rate (defined daily dose per 100 bed days) per Quarterly 4% reduction 75.18 76 DDD per 100 bed hospital Q3 data days Alcohol Hand Rub consumption per 1,000 bed days used Quarterly ------23 litres per 1,000 bed days used Consultant Public: Private mix Casemix adjusted public private mix by hospital for inpatients Quarterly 80:20 --- 80:20 Casemix adjusted public private mix by hospital for daycase Quarterly 80:20 --- 80:20 Consultant Contract Compliance % of consultants compliant with contract levels (Type B / B*) Quarterly 95% --- 100%

*Due to clarified OPD data definitions, 2011 OPD activity may not be directly comparable with previous years. Close month on month monitoring will take place during 2011, beginning Quarter 1 when new metrics begin to be reported

Ambulance Key Performance Indicator Reported Expected Projected Target 2011 Activity / Outturn 2010 Target 2010 Pre-Hospital / Ambulance Response Times First Responder response times to potential or actual 112 (999) life Monthly ------New PI for 2011 threatening emergency calls Baseline to be i). % of Clinical Status 1 ECHO incidents responded to by a first responder established in 7 minutes and 59 seconds or less. ii). % of Clinical Status 1 DELTA incidents responded to by a first Monthly ------New PI for 2011 responder in 7 minutes and 59 seconds or less. Baseline to be established

National Cancer Control Programme Performance Activity / Key Performance Indicator Reported Expected Projected Expected Activity / Activity / Outturn 2010 Target 2011 Target 2010 Symptomatic Breast Cancer Services Total no. of urgent attendances Monthly 10,000 12,700 13,000 Total no. of non urgent attendances Monthly 22,000 25,600 26,000 No. and % of attendances whose referrals were triaged as urgent by the Monthly 9,500 12,000 12,350 cancer centre and adhered to the HIQA standard of 2 weeks for urgent 95% 95% 95% referrals (No. and % offered an appointment that falls within 2weeks) No. and % of attendances whose referrals were triaged as non-urgent by Monthly 20,900 25,000 25,000 the cancer centre and adhered to the HIQA standard of 12 weeks for 95% 95% 95% urgent referrals (No and % offered an appointment that falls within 12weeks) No. and % of newly diagnosed breast cancers discussed at MDT Monthly 2,500 2,100 2,100 100% 100% 100%

Lung Cancers Attendances at rapid access lung clinic Quarterly ------New PI for 2011 % of patients attending the rapid access clinic who attended or were Quarterly ------New PI for 2011 offered an appointment within 10 working days of receipt of referral in the 95% cancer centre

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National Cancer Control Programme Performance Activity / Key Performance Indicator Reported Expected Projected Expected Activity / Activity / Outturn 2010 Target 2011 Target 2010 No. of Rapid Access Diagnostic centres providing services for lung Quarterly 8 6 8 cancers Prostate Cancers No. of centres providing services for prostate cancers i). Rapid Access Diagnostics Quarterly 8 5 8 ii). Surgery Quarterly 5 7 5 Rectal Cancers No. of centres providing services for rectal cancers Quarterly 8 13 8

Community (Demand-Led) Schemes Performance Activity Reported Expected Projected Expected Activity Activity Outturn 2010 2011 2010 Medical and GP Visit Cards No. persons covered by GP Visit Cards Monthly 114,436 116,824 138,816 No. of persons covered by discretionary GP Visit Card Monthly --- 17,423 New PI for 2011 17,423 No. persons covered by Medical Cards Monthly 1,622,560 1,628,536 1,779,585 No. of persons covered by discretionary Medical Card Monthly --- 80,502 New PI for 2011 80,502 Long Term Illness No. of claims Monthly 1,084,656 908,031 978,111 No. of items Monthly 3,449,205 2,951,206 3,178,861 Drug Payment Scheme No. of claims Monthly 5,030,180 3,867,176 3,836,264 No. of items Monthly 13,631,788 11,446,841 11,355,342 GMS No. prescriptions Monthly 18,445,234 18,631,988 20,364,442 No. of items Monthly 57,364,678 54,661,446 63,076,913 No. of claims – special items of service Monthly 714,293 736,361 740,274 No. of claims – special type consultations Monthly 1,084,945 1,056,679 1,098,668 HiTech No. of claims Monthly 383,324 390,900 435,345 DTSS No. of treatments (above the line) Monthly 1,084,517 1,352,702 968,784 No. of treatments (below the line) Monthly 111,428 112,499 53,916 No. of patients who have received treatment (above the line) Monthly ------New PI for 2011 No. of patients who have received treatment (below the line) Monthly ------New PI for 2011 Community Ophthalmic Scheme No. of treatments Monthly 679,310 671,978 715,455 i). Adult Monthly 617,170 612,554 652,186 ii). Children Monthly 62,140 59,424 63,269

Community (Demand-Led) Schemes Key Performance Indicator Reported Target 2010 Projected Target 2011 Outturn 2010 % of Medical Cards processed centrally Quarterly ------Baseline to be set in 2011 % of Medical Cards processed centrally which are issued within 15 working Quarterly ------Baseline to be set in days of complete application 2011

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NATIONAL PERFORMANCE INDICATOR AND ACTIVITY SUITE

Community (Demand-Led) Schemes Key Performance Indicator Reported Target 2010 Projected Target 2011 Outturn 2010 Median time between date of complete application and issuing of Medical Quarterly ------15 days Card % of GP Visit Cards processed centrally Quarterly ------Baseline to be set in 2011 % of GP Visit Cards processed centrally which are issued within 15 working Quarterly ------Baseline to be set in days of complete application 2011 Median time between date of complete application and issuing of GP Visit Quarterly ------15 days Card

Children and Families Performance Activity / Key Performance Indicator Reported Expected Projected Expected Activity / Activity / Outturn 2010 Target 2011 Target 2010 Child Abuse

No. of referrals of child abuse ( abuse includes neglect as one of the 4 Quarterly ------For reporting in 2011 definitions) i). % of referrals of child abuse and neglect where a preliminary enquiry Quarterly ------New PI for 2011 took place within 24 hours 100% ii). % of these initial assessments which took place within 20 days of the Quarterly ------New PI for 2011 referral. 100% iii). No. of first child protection conferences requested Quarterly ------New PI for 2011 Family Support Services No. of families in receipt of a family support service (see metadata for list of Quarterly ------New PI for 2011 relevant services) Residential and Foster Care No. and % of children in care by care type Monthly 5,790 5,892 5,985 Oct data i). Children’s Residential Centre (Note: Include Special Arrangements). Monthly 399 421 < 7% 7% 7% Oct data ii). Foster care(not including day fostering) Monthly 3,567 3,479 60% 61% 59% Oct data iii). Foster care with relatives Monthly 1,596 1,829 30% 28% 31% Oct data iv). Other care placements Monthly 228 163 3% 4% 2.8% Oct data No. of children in single care residential placements Bi-annually ------New PI for 2011 0 No. of children in residential care age 12 or under Quarterly ------New PI for 2011 0 No. of children in care in third placement within 12 months Quarterly ------New PI for 2011 0 Allocated Social Workers No. and % of children in care, by care type, who have an allocated social Monthly 100% 92% 100% worker at the end of the reporting period: i). No. and % of children in residential care Monthly 100% 96% 100% Q3 data ii). No. and % of children in foster care Monthly 100% 93% 100% Q3 data iii). No. and % of children in foster care with relatives Monthly 100% 90% 100% Q3 data iv). No. and % of children in other care placement Monthly 100% 92% 100% Q3 data

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NATIONAL PERFORMANCE INDICATOR AND ACTIVITY SUITE

Children and Families Performance Activity / Key Performance Indicator Reported Expected Projected Expected Activity / Activity / Outturn 2010 Target 2011 Target 2010 Care Planning % of children in care who currently have a written care plan as defined by 100% 88% 100% Child Care Regulations 1995, by care type at the end of reporting period. Q3 data i). % of children in residential care Monthly 100% 92% 100% Q3 data ii). % of children in foster care Monthly 100% 89% 100% Q3 data iii). % of children in foster care with relatives Monthly 100% 86% 100% Q3 data iv). % of children in other care placement Monthly 100% 89% 100% Q3 data % of children (by care type) for whom a statutory care plan review was due ------100% during the reporting period and the review took place: i). % of children in residential care Quarterly ------New PI for 2011 100% ii). % of children in foster care Quarterly ------New PI for 2011 100% iii). % of children in foster care with relatives Quarterly ------New PI for 2011 100% iv). % of children in other care placement Quarterly ------New PI for 2011 100% Foster carers Total no. of foster carers Quarterly ------New PI for 2011 No. and % of foster carers approved and on the foster care panel, Part III of Quarterly ------New PI for 2011 Regulations No. and % of relative foster carers where children have been placed for Quarterly ------New PI for 2011 longer than 12 weeks who are not approved and on the foster care panel, 0% Part III of Regulations No. and % of approved foster carers with an allocated social worker. Quarterly 100% 83% 100% Oct data Children in Care in Education ------i). No. of children in care aged 6 to 16 inclusive. Quarterly New PI for 2011

------ii). No. and % of children in care aged between 6 and 16 years in full time Bi-annually New PI for 2011 100% education After Care No. of young adults aged 18-21 in receipt of an aftercare service Quarterly ------New PI for 2011 Q3 100% Children and Homelessness No. of children placed in youth homeless centres/units for more than 4 Annually ------New PI for 2011 consecutive nights (or more than 10 separate nights over a year) Q4 No. and % of children in care placed in a specified youth homeless centre / Annually ------New PI for 2011 unit Q4 No. of referrals made to the Emergency Out of Hours Place of Safety Quarterly ------New PI for 2011 Service No. of children placed with the Emergency Out of Hours Placement Service Quarterly ------New PI for 2011 Total no. of nights accommodation supplied by the Emergency Out of Hours Quarterly ------New PI for 2011 Placement Service Pre-School No. of notified pre-school services in LHO area. Monthly 5,000 4,461 4,461 % pre-school services which received an inspection Monthly 2,147 --- New PI for 2011 100% No. and % of pre-schools that are fully compliant. Quarterly ------New PI for 2011 No. of notified full day pre-school services. Quarterly ------New PI for 2011

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Children and Families Performance Activity / Key Performance Indicator Reported Expected Projected Expected Activity / Activity / Outturn 2010 Target 2011 Target 2010 % of full day services which received an annual inspection Quarterly ------New PI for 2011 100% No. of pre-school services in the LHO that have closed during the quarter Quarterly ------New PI for 2011 No. of pre-school complaints received Quarterly ------New PI for 2011 % of complaints investigated Quarterly ------New PI for 2011 100% No. of prosecutions taken on foot of inspections in the quarter Quarterly ------New PI for 2011

Mental Health Performance Activity / Key Performance Indicator Reported Expected Projected Expected Activity / Activity / Outturn 2010 Target 2011 Target 2010 Adult Total no. of admissions to acute inpatient units (adult) Quarterly 15,702 14,908 14,908 Median length of stay in adult inpatient facilities Quarterly 10.5 12.0 10.5 Rate of admissions to adult acute inpatient units per 100,000 population in Quarterly 90.1 88.1 New PI for 2011 mental health catchment per quarter 88.1 First admission rates to adult acute units (that is, first ever admission), per Quarterly 26.38 26.7 26.7 100,000 population in mental health catchment area per quarter Readmissions as a % of total adult admissions Quarterly 68% 69% 69% Inpatient readmission rates to adult acute units per 100,000 population in Quarterly 58.95 61.4 61.4 mental health catchment area per quarter No. of adult acute inpatient beds per 100,000 population in the mental Quarterly 26.6 28.2 24.2 health catchment area per quarter Total no. of adult involuntary admissions Quarterly 1,372 1,332 1,332 Rate of adult involuntary admissions per 100,000 population in mental Quarterly 9.3 7.86 7.86 health catchment per quarter Child and Adolescent Mental Health Vision for Change recommended no. of Community Child and Adolescent Quarterly 50 50 54 Mental Health Teams Vision for Change recommended no. of Child and Adolescent Day Hospital Quarterly 2 2 3 Teams Vision for Change recommended no. of Paediatric Liaison Teams Quarterly 3 3 3 No. of child/adolescent admissions to HSE Child and Adolescent mental Monthly --- 150 New PI for 2011 health in-patient units 220 No. of children/adolescents admitted to adult HSE mental health inpatient Quarterly --- 140 New PI for 2011 units <100 i). <16 years Admission of children to adult mental health ii). <17 years inpatient units to cease iii). <18 years except in exceptional circumstances by December 1st 2011 Total no. of involuntary admissions of children and adolescents Annually ------New PI for 2011 16 % of involuntary admissions of children and adolescents Annually ------New PI for 2011 5% No. of child/adolescent referrals (including re-referred) received by mental Monthly --- 11,319 11,319 health services No. of child/adolescent referrals (including re-referred) accepted by mental Monthly --- 7,925 7,925 health services Total no. of new (including re-referred) child/adolescent cases offered first Monthly --- 7,503 7,503 appointment and seen % of new (including re-referred) cases offered first appointment and seen Monthly --- <3 months: 70% seen within three

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NATIONAL PERFORMANCE INDICATOR AND ACTIVITY SUITE

Mental Health Performance Activity / Key Performance Indicator Reported Expected Projected Expected Activity / Activity / Outturn 2010 Target 2011 Target 2010 i). <3 months 5088 / 68% months ii). >12 months >12 months: 720 / 9% No. of cases closed/discharged by CAMHS service Monthly --- 5,757 New PI for 2011 % of cases closed/discharged by CAMHS service Monthly --- 75% 80% of accepted referrals % on waiting list for first appointment at end of each quarter by wait time: Quarterly Reduce 2,338 Reduce numbers i). <3 months numbers waiting waiting by ii). 3-6 months by >5% <3 months 746 >5% iii). 6-12 months 3-6 months 600 6-12 months 602 iv). >12 months >12 months 390 Total no. on waiting list for first appointment at end of each quarter by wait Quarterly ------New PI for 2011 time: i). <3 months ii). 3-6 months iii). 6-12 months iv). >12 months Self Harm No. of repeat deliberate self harm presentations in ED Annually <1% 1,356 1,342 Activity based on 2009 data No. of suicides Annually in ------New PI for 2011 In arrears per CSO Year of Occurrence arrears

Disability Services Performance Activity Reported Expected Projected Expected Activity Activity 2010 outturn 2010 2011 Day Services (0 – 18s and adults reported separately) No. of work/like-work activity WTE places for persons with intellectual Bi-annually 1,046 1,547 **1,393 disability and/or autism No. of persons with intellectual disability and/or autism benefiting from Bi-annually *1,163 3,035 **2,731 work/like-work activity services No. of work/like-work activity WTE places for persons with physical and/or Bi-annually --- 65 **58 sensory disability No. of persons with physical and/or sensory disability benefiting from Bi-annually --- 124 **112 work/like-work activity services No. of Rehabilitative Training places provided (all disabilities) Monthly --- 2,628 New PI for 2011 2,624 No. of persons (all disabilities) benefiting from Rehabilitative Training (RT) Monthly 2,800 2,915 2,915 No. of persons with intellectual disability and/or autism benefiting from Bi-annually *9,651 14,077 14,077 Other Day Services (excl. RT and work/like-work activities) No. of persons with physical and/or sensory disability benefiting from Other Bi-annually --- 3,924 3,924 Day Services (excl. RT and work/like-work activities) Residential Services (0 – 18s and adults reported separately) No. of persons with intellectual disability and/or autism benefiting from Quarterly 8,004 8,350 8,350 residential services No. of persons with physical and/or sensory disability benefiting from Quarterly --- 894 894 residential services Respite Services (0 – 18s and adults reported separately) No. of bed nights in residential centre-based respite services used by Quarterly --- 139,456 139,456 persons with intellectual disability and/or autism No. of persons with intellectual disability and/or autism benefiting from Quarterly --- 4,681 4,681 residential centre-based respite services No. of bed nights in residential centre-based respite services used by Quarterly --- 6,461 6,461 persons with physical and/or sensory disability

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NATIONAL PERFORMANCE INDICATOR AND ACTIVITY SUITE

Disability Services Performance Activity Reported Expected Projected Expected Activity Activity 2010 outturn 2010 2011 No. of persons with physical and/or sensory disability benefiting from Quarterly --- 2,979 2,979 residential centre-based respite services Personal Assistant / Home Support (0-18 and adults reported separately) No. of Personal Assistant/Home Support hours used by persons with Quarterly 3.2m ***2,710,156 3.34m physical and/or sensory disability No. of persons with physical and/or sensory disability benefiting from Quarterly --- 12,628 15,387 Personal Assistant/Home Support hours * Expected activity / targets 2010 have been modified following a validation exercise and so do not reflect what was included in NSP2010 **The implementation of recommendations flowing from the review of Day Services is expected to result in a 10% decline in the number of people engaged in these services. As these people are largely also engaged in other Day Services, a consequent increase in those numbers is not expected. ***These figures are based on extrapolations from incomplete data and are subject to validation.

Disability Services Key Performance Indicator Reported Target 2010 Projected Target 2011 Outturn 2010 Implementation, Part 2 Disability Act (all quarterly in arrears)

No. of requests for assessments received Quarterly 2,712 3,006 3,006 No. of assessments commenced as provided for in the regulations Quarterly 2,340 2,645 2,645 No. of assessments commenced within the timelines as provided for in the Quarterly 2,340 2,200 2,645 regulations No. of assessments completed as provided for in the regulations Quarterly 1,692 2,346 2,346 No. of assessment completed within the timelines as provided for in the Quarterly 1,692 500 2,346 regulations No. of service statements completed Quarterly 1,608 Not Reported 2,346 2010 No. of service statements completed within the timelines as provided for in Quarterly 1,608 Not Reported 2,346 the regulations 2010

Older People Performance Activity Reported Expected Projected Expected Activity Activity 2010 Outturn 2010 2011 Home Help Hours and HCPs (as per 2010 guidelines) Total no of Home Help Hours provided for all care groups (excluding Monthly 11.98m 11.98m 11.98m provision of hours from HCPs) Total no. of people in receipt of home help hours (excluding provision of Monthly 54,500 54,000 54,000 hours from HCPs) Total no. of people in receipt of HCPs Monthly 9,613 9,650 10,230 i). No. and % direct provision . ii). No. and % indirect provision iii). No. and % cash grant iv). No. and % respite v). No. and % multiple types Total no. of HCPs provided Monthly 5,100 5,100 5,300 Total no. of new HCP clients per month (No. of new HCPs dependent on Monthly 4,315 4,000 4,400 persons in receipt of HCP finishing their package)

Older People Key Performance Indicator Reported Target 2010 Projected Target 2011 Outturn 2010 Day Care Total no. of day service places for older people Bi-annually 21,300 21,300 Baseline to be set in Under review: 2011 Establish baseline for 2011

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NATIONAL PERFORMANCE INDICATOR AND ACTIVITY SUITE

Older People Key Performance Indicator Reported Target 2010 Projected Target 2011 Outturn 2010 No. of clients benefiting from day care places Bi-annually --- Under review: Baseline to be set in Establish baseline 2011 for 2011 Subvention Total no. in receipt of subvention Monthly --- 2.860 Dependant on uptake of Nursing Home Support Monthly --- 1,440 Total no. in receipt of enhanced subvention Scheme Nursing Home Support Scheme (NHSS - ‘A Fair Deal’) No. of people in long-term residential care availing of NHSS Monthly --- Not reported Baseline to be set in 2011 No. and proportion of those who qualify for ancillary state support who Monthly --- Not reported Baseline to be set in chose to avail of it. 2011 % of complete applications processed within four weeks Monthly --- Not reported 100% Public Beds No. of beds in public residential care settings for Older People Monthly 10,536 8,600 8,200 Elder Abuse No. of new referrals by region Quarterly --- 1,800 Demand led No. and % of new referrals broken down by abuse type: Quarterly --- Baseline to be set in i). physical, 298 (12%) 2011 ii). psychological, 668 (26%) iii). financial 456 (18%) iv). neglect 455 (18%) Total no. of active cases Quarterly ------New PI for 2011 % of referrals receiving first response from Senior Caseworkers within 4 Quarterly --- 100% 100% weeks. .

Palliative Care Performance Activity / Key Performance Indicator Reported Expected Projected Expected Activity / Activity / Outturn 2010 Target 2011 Target 2010 Specialist Palliative Care Wait times for: Monthly i). Specialist inpatient bed within 1 month --- 98% 98% ii). Specialist inpatient bed within 7 days ------92% Wait times for: Monthly --- 98% 98% i). Home, non-acute hospital, long term residential care delivered by community teams within 1 month ii). Home, non-acute hospital, long term residential care delivered by Monthly --- 78% 78% community teams within 7 days Specialist Palliative Care (monthly averages) No. patients in treatment in specialist inpatient units Monthly 325 326 326 No. patients in receipt of community based specialist palliative care Monthly 2,865 2,851 2,851 No. patients in receipt of day care Monthly 297 277 277 No. patients in receipt of intermediate palliative care in community Monthly 127 125 125 hospitals No. of admissions to specialist in-patient units Monthly --- 2,617 New PI for 2011 2,617 No of discharges, transfers and deaths from specialist in-patient units. Monthly --- New PI for 2011 i). Discharges Discharges 277 Discharges 277 ii). Transfers Transfers 1,486 Transfers 1,486 iii). Deaths Deaths 811 No. new patients to the service by age Monthly --- For reporting in 2011 i). Specialist inpatient units, and 120 120 ii). Home care 605 605

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NATIONAL PERFORMANCE INDICATOR AND ACTIVITY SUITE

Social Inclusion Performance Activity / Key Performance Indicator Reported Expected Projected Expected Activity / Activity / Outturn 2010 Target 2011 Target 2010 (Sept TYD) Methadone Treatment Activity (monthly in arrears) Total no. of clients in methadone treatment (outside prisons) Monthly 8,278 8,500 8,500 Total no. of clients in methadone treatment (prisons) Monthly 497 500 500 Substance Misuse (quarterly in arrears) Total no. of substance misusers (over 18 years) for whom treatment has Quarterly 1,380 1,372 1,350 commenced following assessment % of substance misusers (over 18 years) for whom treatment has Quarterly 100% 97.7% 100% commenced within one calendar month following assessment Total no. of substance misusers (under 18 years) for whom treatment has Quarterly 115 136 130 commenced following assessment % of substance misusers (under 18 years) for whom treatment has Quarterly 100% 94.8% 100% commenced within two weeks following assessment Homeless Services (quarterly in arrears) No. of individual service users admitted to statutory and voluntary Quarterly ------New PI for 2011 managed residential homeless services who have medical cards 75%

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REGIONAL BALANCED SCORECARD (NON ACUTE SERVICES ) - DML

Regional Balanced Scorecard DML (Non-Acute Services)

2011 Target v 2010 Performance Level Regionally and by LHO / Business Unit

Primary Care Services

Number of Primary Care Teams holding Clinical Team Meetings

2010 Performance Monthly Level Q1 Target Q2 Target Q3 Target Q4 Target Target 2011 DML 94 118 127 140 150 150 Dun Laoghaire 12 13 14 15 16 16 Dublin South East 8 10 10 10 10 10 Wicklow 10 14 14 14 14 14 Dublin South City 11 12 13 14 15 15 Dublin South West 6 11 13 16 18 18 Dublin West 7 10 12 14 15 15 Kildare/W Wicklow 19 19 21 24 25 25 Laois/Offaly 9 15 16 18 20 20 Longford/Westmeath 12 14 14 15 17 17

Number of Primary Care Teams that are implementing structured integrated diabetes care - New metric in 2011

2010 Performance Quarterly Level Q1 Target Q2 Target Q3 Target Q4 Target Target 2011 DML 27 30 30 30 31 31 Dun Laoghaire 2 2 2 2 2 2 Dublin South East 0 0 0 0 0 0 Wicklow 4 5 5 5 5 5 Dublin South City 6 6 6 6 6 6 Dublin South West 1 1 1 1 1 1 Dublin West 0 0 0 0 0 0 Kildare/W Wicklow 0 0 0 0 0 0 Laois/Offaly 5 5 5 5 5 5 Longford/Westmeath 9 11 11 11 12 12

Number of patients/ clients formally partaking in structured integrated diabetes care - New metric in 2011

2010 Performance Quarterly Level Q1 Target Q2 Target Q3 Target Q4 Target Target 2011 DML 2,276 2,611 2,638 2,711 3,100 3,100 Dun Laoghaire 18 18 25 30 40 40 Dublin South East 0 0 0 0 0 0 Wicklow 349 367 367 367 370 370 Dublin South City 194 284 284 284 290 290 Dublin South West 90 90 90 90 100 100 Dublin West 0 0 0 0 0 0 Kildare/W Wicklow 0 0 0 0 0 0 Laois/Offaly 692 692 692 720 800 800 Longford/Westmeath 933 1,160 1,180 1,220 1,500 1,500

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REGIONAL BALANCED SCORECARD (NON ACUTE SERVICES ) - DML

contd.

Number of Primary Care Teams that are continuing to implement structured asthma prevention and care - New metric in 2011 2010 Performance Quarterly Level Q1 Target Q2 Target Q3 Target Q4 Target Target 2011 DML 6 6 6 6 6 6 Dun Laoghaire 0 0 0 0 0 0 Dublin South East 0 0 0 0 0 0 Wicklow 0 0 0 0 0 0 Dublin South City 0 0 0 0 0 0 Dublin South West 1 1 1 1 1 1 Dublin West 0 0 0 0 0 0 Kildare/W Wicklow 0 0 0 0 0 0 Laois/Offaly 1 1 1 1 1 1 Longford/Westmeath 4 4 4 4 4 4

Number of patients/ clients continuing to partake in structured integrated asthma prevention and care (as per 2010 pilot programme and as set out in the ICGP / Asthma Society of Ireland Clinical Guidelines 2008) New metric in 2011 2010 Performance Quarterly Level Q1 Target Q2 Target Q3 Target Q4 Target Target 2011 DML 185 185 185 185 185 185 Dun Laoghaire 0 0 0 0 0 0 Dublin South East 0 0 0 0 0 0 Wicklow 0 0 0 0 0 0 Dublin South City 0 0 0 0 0 0 Dublin South West 39 39 39 39 39 39 Dublin West 0 0 0 0 0 0 Kildare/W Wicklow 0 0 0 0 0 0 Laois/Offaly 17 17 17 17 17 17 Longford/Westmeath 129 129 129 129 129 129

Child Health

% of children 24 months of age who have received three doses of vaccine against Diphtheria (D3), Pertussis (P3), Tetanus (T3), Haemophilus influenza type b (Hib3), Polio (polio3), hepatitis B (hepB3) (6 in 1 vaccine) - New metric for 2011

2010 Performance Quarterly Level Q1 Target Q2 Target Q3 Target Q4 Target Target 2011 DML new PI for 2011 95% 95% 95% 95% 95% Dun Laoghaire new PI for 2011 95% 95% 95% 95% 95% Dublin South East new PI for 2011 95% 95% 95% 95% 95% Wicklow new PI for 2011 95% 95% 95% 95% 95% Dublin South City new PI for 2011 95% 95% 95% 95% 95% Dublin South West new PI for 2011 95% 95% 95% 95% 95% Dublin West new PI for 2011 95% 95% 95% 95% 95% Kildare/W Wicklow new PI for 2011 95% 95% 95% 95% 95% Laois/Offaly new PI for 2011 95% 95% 95% 95% 95% Longford/Westmeath new PI for 2011 95% 95% 95% 95% 95%

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REGIONAL BALANCED SCORECARD (NON ACUTE SERVICES ) - DML

contd.

Child Health Developmental Screening

2010 Performance Monthly Level Q1 Target Q2 Target Q3 Target Q4 Target Target 2011 DML 61% 90% 90% 90% 90% 90% Dun Laoghaire 64% 90% 90% 90% 90% 90% Dublin South East 20% 90% 90% 90% 90% 90% Wicklow 2% 90% 90% 90% 90% 90% Dublin South City 100% 90% 90% 90% 90% 90% Dublin South West 6% 90% 90% 90% 90% 90% Dublin West 91% 90% 90% 90% 90% 90% Kildare/W Wicklow 69% 90% 90% 90% 90% 90% Laois/Offaly 88% 90% 90% 90% 90% 90% Longford/Westmeath 93% 90% 90% 90% 90% 90%

Primary Health Visit by Public Health Nurse within 48 hours of hospital discharge

2010 Performance Quarterly Level Q1 Target Q2 Target Q3 Target Q4 Target Target 2011 DML 84% 95% 95% 95% 95% 95% Dun Laoghaire no data 95% 95% 95% 95% 95% Dublin South East 91% 95% 95% 95% 95% 95% Wicklow 84% 95% 95% 95% 95% 95% Dublin South City 85% 95% 95% 95% 95% 95% Dublin South West 77% 95% 95% 95% 95% 95% Dublin West 91% 95% 95% 95% 95% 95% Kildare/W Wicklow 78% 95% 95% 95% 95% 95% Laois/Offaly 89% 95% 95% 95% 95% 95% Longford/Westmeath 89% 95% 95% 95% 95% 95%

Children and Families

All Care Types - Percentage of children in care who currently have a written care plan as defined by the Child Care Regulations 1995

2010 Performance Monthly Level Q1 Target Q2 Target Q3 Target Q4 Target Target 2011 DML 92.7% 96% 98% 100% 100% 100% Dun Laoghaire 93% 93% not completed 100% 100% 100% Dublin South East 94% 94% not completed 100% 100% 100% Wicklow 91% 91% not completed 100% 100% 100% Dublin South City 64% 74% not completed 100% 100% 100% Dublin South West 90% 90% not completed 100% 100% 100% Dublin West 64.6% 75% not completed 100% 100% 100% Kildare/W Wicklow 85.2% 90% not completed 100% 100% 100% Laois/Offaly 78.5% 84% not completed 100% 100% 100% Longford/Westmeath 100% 100% not completed 100% 100% 100%

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REGIONAL BALANCED SCORECARD (NON ACUTE SERVICES ) - DML

contd.

Residential Care - Percentage of children in care with a Written Care Plan

2010 Performance Monthly Level Q1 Target Q2 Target Q3 Target Q4 Target Target 2011 DML 93.4% 95.6% 97.8% 100% 100% 100% Dun Laoghaire 72.7% 81.7% 90.7% 100% 100% 100% Dublin South East 100% 100% 100% 100% 100% 100% Wicklow 100% 100% 100% 100% 100% 100% Dublin South City 100% 100% 100% 100% 100% 100% Dublin South West 88.5% 92.5% 96.5% 100% 100% 100% Dublin West 92.3% 94.9% 97.4% 100% 100% 100% Kildare/W Wicklow 100% 100% 100% 100% 100% 100% Laois/Offaly 83.3% 88.9% 94.4% 100% 100% 100% Longford/Westmeath 100% 100% 100% 100% 100% 100%

Foster Care - Percentage of children in care with a Written Care Plan

2010 Performance Monthly Level Q1 Target Q2 Target Q3 Target Q4 Target Target 2011 DML 91.5% 94.3% 97.2% 100% 100% 100% Dun Laoghaire 95.7% 97.1% 98.6% 100% 100% 100% Dublin South East 100% 100% 100% 100% 100% 100% Wicklow 100% 100% 100% 100% 100% 100% Dublin South City 100% 100% 100% 100% 100% 100% Dublin South West 84.5% 89.7% 94.8% 100% 100% 100% Dublin West 90.3% 93.5% 96.9% 100% 100% 100% Kildare/W Wicklow 86.4% 90.9% 95.4% 100% 100% 100% Laois/Offaly 82.8% 88.5% 94.3% 100% 100% 100% Longford/Westmeath 100% 100% 100% 100% 100% 100%

Foster Care With Relatives - Percentage of children in care with a Written Care Plan

2010 Performance Monthly Level Q1 Target Q2 Target Q3 Target Q4 Target Target 2011 DML 94.8% 96.5% 98.3% 100% 100% 100% Dun Laoghaire 92.5% 95.0% 97.5% 100% 100% 100% Dublin South East 100% 100% 100% 100% 100% 100% Wicklow 100% 100% 100% 100% 100% 100% Dublin South City 100% 100% 100% 100% 100% 100% Dublin South West 86% 90.7% 95.3% 100% 100% 100% Dublin West 91.7% 94.5% 97.2% 100% 100% 100% Kildare/W Wicklow 92.1% 94.7% 97.4% 100% 100% 100% Laois/Offaly 100% 100% 100% 100% 100% 100% Longford/Westmeath 100% 100% 100% 100% 100% 100%

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REGIONAL BALANCED SCORECARD (NON ACUTE SERVICES ) - DML

contd.

Other Care - Percentage of children in care with a Written Care Plan

2010 Performance Monthly Level Q1 Target Q2 Target Q3 Target Q4 Target Target 2011 DML 100% 100% 100% 100% 100% 100% Dun Laoghaire 100% 100% 100% 100% 100% 100% Dublin South East 100% 100% 100% 100% 100% 100% Wicklow 100% 100% 100% 100% 100% 100% Dublin South City 100% 100% 100% 100% 100% 100% Dublin South West 100% 100% 100% 100% 100% 100% Dublin West No children in other care 100% 100% 100% 100% 100% Kildare/W Wicklow No children in other care 100% 100% 100% 100% 100% Laois/Offaly No children in other care 100% 100% 100% 100% 100% Longford/Westmeath 100% 100% 100% 100% 100% 100%

All care settings - Percentage of children for whom a statutory care plan review was due during the reporting period and the review took place - New metric for 2011

2010 Performance Quarterly Level Q1 Target Q2 Target Q3 Target Q4 Target Target 2011 DML new for 2011 75% 81% 87% 100% 100% Dun Laoghaire new for 2011 100% 100% Dublin South East new for 2011 100% 100% Wicklow new for 2011 100% 100% Dublin South City new for 2011 100% 100% Dublin South West new for 2011 100% 100% Dublin West new for 2011 100% 100% Kildare/W Wicklow new for 2011 100% 100% Laois/Offaly new for 2011 100% 100% Longford/Westmeath new for 2011 100% 100%

Residential Care - Percentage of children for whom a statutory care plan review was due during the reporting period and the review took place - New metric for 2011

2010 Performance Quarterly Level Q1 Target Q2 Target Q3 Target Q4 Target Target 2011 DML new for 2011 100% 100% Dun Laoghaire new for 2011 100% 100% Dublin South East new for 2011 100% 100% Wicklow new for 2011 100% 100% Dublin South City new for 2011 100% 100% Dublin South West new for 2011 100% 100% Dublin West new for 2011 100% 100% Kildare/W Wicklow new for 2011 100% 100% Laois/Offaly new for 2011 100% 100% Longford/Westmeath new for 2011 100% 100%

DML Regional Service Plan 2011 78

REGIONAL BALANCED SCORECARD (NON ACUTE SERVICES ) - DML

contd.

Foster Care - Percentage of children for whom a statutory care plan review was due during the reporting period and the review took place - New metric for 2011

2010 Performance Quarterly Level Q1 Target Q2 Target Q3 Target Q4 Target Target 2011 DML new for 2011 100% 100% Dun Laoghaire new for 2011 100% 100% Dublin South East new for 2011 100% 100% Wicklow new for 2011 100% 100% Dublin South City new for 2011 100% 100% Dublin South West new for 2011 100% 100% Dublin West new for 2011 100% 100% Kildare/W Wicklow new for 2011 100% 100% Laois/Offaly new for 2011 100% 100% Longford/Westmeath new for 2011 100% 100%

Foster Care with Relatives - Percentage of children for whom a statutory care plan review was due during the reporting period and the review took place - New metric for 2011

2010 Performance Quarterly Level Q1 Target Q2 Target Q3 Target Q4 Target Target 2011 DML new for 2011 100% 100% Dun Laoghaire new for 2011 100% 100% Dublin South East new for 2011 100% 100% Wicklow new for 2011 100% 100% Dublin South City new for 2011 100% 100% Dublin South West new for 2011 100% 100% Dublin West new for 2011 100% 100% Kildare/W Wicklow new for 2011 100% 100% Laois/Offaly new for 2011 100% 100% Longford/Westmeath new for 2011 100% 100%

Other Care Settings - Percentage of children for whom a statutory care plan review was due during the reporting period and the review took place - New metric for 2011

2010 Performance Quarterly Level Q1 Target Q2 Target Q3 Target Q4 Target Target 2011 DML new for 2011 100% 100% Dun Laoghaire new for 2011 100% 100% Dublin South East new for 2011 100% 100% Wicklow new for 2011 100% 100% Dublin South City new for 2011 100% 100% Dublin South West new for 2011 100% 100% Dublin West new for 2011 100% 100% Kildare/W Wicklow new for 2011 100% 100% Laois/Offaly new for 2011 100% 100% Longford/Westmeath new for 2011 100% 100%

DML Regional Service Plan 2011 79

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contd.

All care settings - Percentage of children in care who have an allocated Social Worker at the end of the reporting period 2010 Performance Monthly Level Q1 Target Q2 Target Q3 Target Q4 Target Target 2011 DML 91% 91% 100% 100% 100% 100% Dun Laoghaire 96% 100% 100% 100% 100% 100% Dublin South East 95% 95% 100% 100% 100% 100% Wicklow 100% 100% 100% 100% 100% 100% Dublin South City 100% 100% 100% 100% 100% 100% Dublin South West 90% 90% 100% 100% 100% 100% Dublin West 95% 95% 100% 100% 100% 100% Kildare/W Wicklow 68% 68% 100% 100% 100% 100% Laois/Offaly 88% 88% 100% 100% 100% 100% Longford/Westmeath 100% 100% 100% 100% 100% 100%

Residential Care - Percentage of children in care who have an allocated Social Worker at the end of the reporting period 2010 Performance Monthly Level Q1 Target Q2 Target Q3 Target Q4 Target Target 2011 DML 96% 98% 100% 100% 100% 100% Dun Laoghaire 96.4% 98.2% 100% 100% 100% 100% Dublin South East 100% 100% 100% 100% 100% 100% Wicklow 100% 100% 100% 100% 100% 100% Dublin South City 100% 100% 100% 100% 100% 100% Dublin South West 100% 100% 100% 100% 100% 100% Dublin West 96.2% 98.1% 100% 101% 100% 100% Kildare/W Wicklow 92.3% 96.2% 100% 103% 100% 100% Laois/Offaly 83.3% 91.7% 100% 102% 100% 100% Longford/Westmeath 100% 100% 100% 100% 100% 100%

Foster Care - Percentage of children in care who have an allocated Social Worker at the end of the reporting period

2010 Performance Monthly Level Q1 Target Q2 Target Q3 Target Q4 Target Target 2011 DML 89.3% 94.7% 100% 100% 100% 100% Dun Laoghaire 100% 100% 100% 100% 100% 100% Dublin South East 94.1% 97.1% 100% 100% 100% 100% Wicklow 100% 100% 100% 100% 100% 100% Dublin South City 100% 100% 100% 100% 100% 100% Dublin South West 87.3% 93.7% 100% 100% 100% 100% Dublin West 93.1% 96.6% 100% 100% 100% 100% Kildare/W Wicklow 68% 84% 100% 100% 100% 100% Laois/Offaly 82.8% 91.4% 100% 100% 100% 100% Longford/Westmeath 100% 100% 100% 100% 100% 100%

DML Regional Service Plan 2011 80

REGIONAL BALANCED SCORECARD (NON ACUTE SERVICES ) - DML

contd.

Foster Care with Relatives - Percentage of children in care who have an allocated Social Worker at the end of the reporting period 2010 Performance Monthly Level Q1 Target Q2 Target Q3 Target Q4 Target Target 2011 DML 92.1% 96% 100% 100% 100% 100% Dun Laoghaire 100% 100% 100% 100% 100% 100% Dublin South East 92.9% 96.4% 100% 100% 100% 100% Wicklow 100% 100% 100% 100% 100% 100% Dublin South City 100% 100% 100% 100% 100% 100% Dublin South West 87.1% 93.6% 100% 100% 100% 100% Dublin West 97.7% 98.9% 100% 100% 100% 100% Kildare/W Wicklow 47.4% 73.7% 100% 100% 100% 100% Laois/Offaly 100% 100% 100% 100% 100% 100% Longford/Westmeath 100% 100% 100% 100% 100% 100%

Other care settings - Percentage of children in care who have an allocated Social Worker at the end of the reporting period 2010 Performance Monthly Level Q1 Target Q2 Target Q3 Target Q4 Target Target 2011 DML 94% 97% 100% 100% 100% 100% Dun Laoghaire 97.6% 98.8% 100% 100% 100% 100% Dublin South East 100% 100% 100% 100% 100% 100% Wicklow 100% 100% 100% 100% 100% 100% Dublin South City 100% 100% 100% 100% 100% 100% Dublin South West 100% 100% 100% 100% 100% 100% Dublin West 100% 100% 100% 100% 100% 100% Kildare/W Wicklow 83.3% 91.7% 100% 100% 100% 100% Laois/Offaly 100% 100% 100% 100% 100% 100% Longford/Westmeath 100% 100% 100% 100% 100% 100%

Percentage of Approved Foster Carers with an Allocated Social Worker

2010 Performance Monthly Level Q1 Target Q2 Target Q3 Target Q4 Target Target 2011 DML 82.4% 86.8% 91.2% 95.6% 100% 100% Dun Laoghaire 100% 100% 100% 100% 100% 100% Dublin South East 100% 100% 100% 100% 100% 100% Wicklow 100% 100% 100% 100% 100% 100% Dublin South City 100% 100% 100% 100% 100% 100% Dublin South West 100% 100% 100% 100% 100% 100% Dublin West 85.5% 89.1% 92.7% 96.3% 100% 100% Kildare/W Wicklow 46.6% 60.0% 73.3% 86.7% 100% 100% Laois/Offaly 59.1% 69.3% 79.5% 89.8% 100% 100% Longford/Westmeath 83.1% 87.4% 91.6% 95.9% 100% 100%

DML Regional Service Plan 2011 81

REGIONAL BALANCED SCORECARD (NON ACUTE SERVICES ) - DML

contd.

Standard Business Processes implemented in all LHOs for referral, initial assessment and further assessment processes - New for 2011 (KRA) 2010 Performance Quarterly Level Q1 Target Q2 Target Q3 Target Q4 Target Target 2011 DML new for 2011 2 7 7 9 9 Dun Laoghaire new for 2011 1 1 Dublin South East new for 2011 1 1 Wicklow new for 2011 1 1 Dublin South City new for 2011 1 1 Dublin South West new for 2011 1 1 Dublin West new for 2011 1 1 Kildare/W Wicklow new for 2011 1 1 Laois/Offaly new for 2011 1 1 Longford/Westmeath new for 2011 1 1

Additional Children's services committees in place - New for 2011 (KRA) 2010 Performance Quarterly Level Q1 Target Q2 Target Q3 Target Q4 Target Target 2011 DML (cumulative) new for 2011 0 1 1 2 2

% of referrals of child abuse and neglect where a preliminary enquiry took place within 24 hours - New PI for 2011 2010 Performance Quarterly Level Q1 Target Q2 Target Q3 Target Q4 Target Target 2011

2 LHOs to be quarterly in reported on for 9 LHOs to be DML new for 2011 arrears Q1 reported on for Q2 100% 100% quarterly in Dun Laoghaire new for 2011 arrears 100% 100% 100% quarterly in Dublin South East new for 2011 arrears 100% 100% 100% quarterly in Wicklow new for 2011 arrears 100% 100% 100% quarterly in Dublin South City new for 2011 arrears 100% 100% 100% quarterly in Dublin South West new for 2011 arrears 100% 100% 100% quarterly in Dublin West new for 2011 arrears 100% 100% 100% quarterly in Kildare/W Wicklow new for 2011 arrears 100% 100% 100% quarterly in Laois/Offaly new for 2011 arrears 100% 100% 100% quarterly in Longford/Westmeath new for 2011 arrears 100% 100% 100%

DML Regional Service Plan 2011 82

REGIONAL BALANCED SCORECARD (NON ACUTE SERVICES ) - DML

contd.

Mental Health

Provision of 10-12 bed high support hostel for people granted conditional discharge by the courts under the Criminal Law Insanity Act (New for 2011 - KRA)

2010 Performance Quarterly Level Q1 Target Q2 Target Q3 Target Q4 Target Target 2011 Funding identified and Service premises Arrangement Fully Fully DML new for 2011 secured in place Fully operational Operational Operational

Development of an 11-bed interim C&A Inpatient Unit at St. Loman's Palmerstownt (New for 2011 - KRA)

2010 Performance Quarterly Level Q1 Target Q2 Target Q3 Target Q4 Target Target 2011

Funding & Refurbishment WTEs identified complete and and recruitment Approved Centre refurbishment process status achieved Unit Unit DML new for 2011 planned commenced from MHC operational operational

CAMHs: Percentage of new (including re-referred) child/ adolescent cases offered first appointment and seen within 3 months

2010 Performance Monthly Level Q1 Target Q2 Target Q3 Target Q4 Target Target 2011 DML 71% 70% 70% 70% 70% 70% Linn Dara Mid Kildare 70% 70% 70% 70% 70% Linn Dara Ballyfermot 70% 70% 70% 70% 70% Linn Dara South Kildare 70% 70% 70% 70% 70% Laois/Offaly 70% 70% 70% 70% 70% Lucena (7 teams) 70% 70% 70% 70% 70% Linn Dara St. James & Clondalkin 70% 70% 70% 70% 70% Longford/ Westmeath 70% 70% 70% 70% 70% Linn Dara North Kildare 70% 70% 70% 70% 70% Linn Dara Lucan 70% 70% 70% 70% 70%

CAMHs: Total number of new (including re-referred) child/ adolescent cases offered first appointment and seen 2010 Performance Monthly Level Q1 Target Q2 Target Q3 Target Q4 Target Target 2011 DML new for 2011 568 1,136 1,704 2,272 2,272 Linn Dara Mid Kildare new for 2011 Linn Dara Ballyfermot new for 2011 Linn Dara South Kildare new for 2011 Laois/ Offaly new for 2011 Lucena (7 teams) new for 2011 Linn Dara St. James & Clondalkin new for 2011 Longford/ Westmeath new for 2011

Linn Dara North Kildare new for 2011 Linn Dara Lucan new for 2011

DML Regional Service Plan 2011 83

REGIONAL BALANCED SCORECARD (NON ACUTE SERVICES ) - DML

contd.

Disability Services

Compliance with Disability Act: Percentage of Assessments Completed within the timeframes provided for in the Regulations

2010 Performance Quarterly Level (Q3 data) Q1 Target Q2 Target Q3 Target Q4 Target Target 2011 DML 6% 30% 53% 77% 100% 100% Dun Laoghaire 0% 25% 50% 75% 100% 100% Dublin South East 11% 33% 56% 78% 100% 100% Wicklow 9% 32% 55% 77% 100% 100% Dublin South City 0% 25% 50% 75% 100% 100% Dublin South West 4% 28% 52% 76% 100% 100% Dublin West 0% 25% 50% 75% 100% 100% Kildare/W Wicklow 3% 27% 52% 76% 100% 100% Laois/Offaly 3% 27% 52% 76% 100% 100% Longford/Westmeath 17% 38% 59% 79% 100% 100%

Compliance with the Disability Act: No. of applications overdue for completion on the last day of each month.

2010 Performance Monthly Level (Dec data) Q1 Target Q2 Target Q3 Target Q4 Target Target 2011 DML 602 542 361 211 0 0 Dun Laoghaire 37 33 22 13 0 0 Dublin South East 6 5 4 2 0 0 Wicklow 25 23 15 9 0 0 Dublin South City 33 30 20 12 0 0 Dublin South West 110 99 66 39 0 0 Dublin West 236 212 142 83 0 0 Kildare/W Wicklow 87 78 52 30 0 0 Laois/Offaly 31 28 19 11 0 0 Longford/Westmeath 37 33 22 13 0 0

Compliance with the Disability Act: No. of Service Statements overdue for completion on the last day of each month - New PI for 2011

2010 Performance Monthly Level Q1 Target Q2 Target Q3 Target Q4 Target Target 2011 DML new PI for 2011 0 Dun Laoghaire new PI for 2011 0 Dublin South East new PI for 2011 0 Wicklow new PI for 2011 0 Dublin South City new PI for 2011 0 Dublin South West new PI for 2011 0 Dublin West new PI for 2011 0 Kildare/W Wicklow new PI for 2011 0 Laois/Offaly new PI for 2011 0 Longford/Westmeath new PI for 2011 0

DML Regional Service Plan 2011 84

REGIONAL BALANCED SCORECARD (NON ACUTE SERVICES ) - DML

contd.

Reconfiguration of therapy services for children and young people (0-18 years) - New KRA for 2011 2010 Performance Quarterly Level Q1 Target Q2 Target Q3 Target Q4 Target Target 2011 Regional Co- Regional & ordinating Group local plans for DML Regional & submitted to including local Mapping of local plans National Co- Leads convened current submitted to ordinating and met at least resources National Co- Group for once completed + ordinating each ISA for Group for required each ISA for services and Key principles for required teams at Local Co- reorganisation and services and primary ordinating development of teams at care, Groups including services agreed primary care, network and stakeholders convened and and signed off at network and sub- met at least Regional and local sub-specialist specialist DML new KRA for 2011 once levels levels levels

Services for Older Persons

Total number of home help hours provided for all care groups (excluding provision of hours from HCPs) 2010 Performance Level Q1 Target Q2 Target Q3 Target Q4 Target Target 2011 DML 2,063,682 522,171 1,053,794 1,598,463 2,160,000 2,160,000 Dun Laoghaire 112,726 28,224 55,877 83,939 113,000 113,000 Dublin South East 110,358 25,112 52,066 80,773 106,500 106,500 Wicklow 269,860 69,806 142,840 221,766 296,000 296,000 Dublin South City 154,109 42,157 85,982 129,334 170,000 170,000 Dublin South West 193,843 47,701 95,506 142,156 194,500 194,500 Dublin West 286,660 61,009 119,663 187,452 266,500 266,500 Kildare/W Wicklow 363,346 96,789 194,942 291,180 392,000 392,000 Laois/Offaly 286,148 80,465 165,282 244,104 333,000 333,000 Longford/Westmeath 286,632 70,908 141,636 217,759 288,500 288,500

Total number in receipt of home help hours (excluding provision of hours from HCPs)

2010 Performance Monthly Level Q1 Target Q2 Target Q3 Target Q4 Target Target 2011 DML 12,076 12,000 12,000 12,000 12,000 12,000 Dun Laoghaire 869 869 869 869 869 869 Dublin South East 826 826 826 826 826 826 Wicklow 1,347 1,347 1,347 1,347 1,347 1,347 Dublin South City 1,295 1,295 1,295 1,295 1,295 1,295 Dublin South West 1,800 1,800 1,800 1,800 1,800 1,800 Dublin West 1,484 1,484 1,484 1,484 1,484 1,484 Kildare/W Wicklow 1,808 1,782 1,782 1,782 1,782 1,782 Laois/Offaly 1,138 1,138 1,138 1,138 1,138 1,138 Longford/Westmeath 1,509 1,459 1,459 1,459 1,459 1,459

DML Regional Service Plan 2011 85

REGIONAL BALANCED SCORECARD (NON ACUTE SERVICES ) - DML

contd.

Total number of people in receipt of Home Care Packages

2010 Performance Target Monthly Level Q1 Target Q2 Target Q3 Target Q4 Target 2011 DML 2,299 2,335 2,335 2,335 2,335 2,355 Dun Laoghaire 266 273 273 273 273 273 Dublin South East 328 334 334 334 334 334 Wicklow 164 170 170 170 170 170 Dublin South City 224 228 228 228 228 228 Dublin South West 317 323 323 323 323 323 Dublin West 274 274 274 274 274 274 Kildare/W Wicklow 159 166 166 166 166 166 Laois/Offaly 270 270 270 270 270 270 Longford/Westmeath 297 297 297 297 297 297

Fair Deal: Percentage of complete applications processed within 4 weeks - New metric in 2011

2010 Performance Target Quarterly Level Q1 Target Q2 Target Q3 Target Q4 Target 2011 DML New PI for 2011 100% 100% Dun Laoghaire New PI for 2011 100% 100% Dublin South East New PI for 2011 100% 100% Wicklow New PI for 2011 100% 100% Dublin South City New PI for 2011 100% 100% Dublin South West New PI for 2011 100% 100% Dublin West New PI for 2011 100% 100% Kildare/W Wicklow New PI for 2011 100% 100% Laois/Offaly New PI for 2011 100% 100% Longford/Westmeath New PI for 2011 100% 100%

Elder Abuse: Percentage of Referrals receiving a first response from Senior Case Workers within 4 weeks - New metric 2011 2010 Performance Target Quarterly Level Q1 Target Q2 Target Q3 Target Q4 Target 2011 DML New PI for 2011 100% 100% Dun Laoghaire New PI for 2011 100% 100% Dublin South East New PI for 2011 100% 100% Wicklow New PI for 2011 100% 100% Dublin South City New PI for 2011 100% 100% Dublin South West New PI for 2011 100% 100% Dublin West New PI for 2011 100% 100% Kildare/W Wicklow New PI for 2011 100% 100% Laois/Offaly New PI for 2011 100% 100% Longford/Westmeath New PI for 2011 100% 100%

DML Regional Service Plan 2011 86

REGIONAL BALANCED SCORECARD (NON ACUTE SERVICES ) - DML

contd.

Palliative Care

Palliative care inpatient beds provided within 7 days 2010 Performance Monthly Level Q1 Target Q2 Target Q3 Target Q4 Target Target 2011 DML New PI for 2011 92% 92% 92% 92% 92%

Social Inclusion

Total number of clients in methadone treatment in Dublin Mid Leinster

2010 Performance Monthly Level Q1 Target Q2 Target Q3 Target Q4 Target Target 2011 DML 4,900 4,900 4,900 4,900 4,900 4,900

The number and percentage of substance misusers for whom treatment has commenced: (a) within one calendar month and (b) later than one calendar month

2010 Performance Quarterly Level Q1 Target Q2 Target Q3 Target Q4 Target Target 2011 < 1 month 71% 78% 85% 92% 100% 100% > 1 month 29% 22% 15% 8% 0% 0%

The number and percentage of substance misusers under 18 years of age for whom treatment has commenced (a) within 2 weeks following assessment and (b) greater than 2 weeks 2010 Performance Quarterly Level Q1 Target Q2 Target Q3 Target Q4 Target Target 2011 < 2 weeks 100% 100% 100% 100% 100% 100% > 2 weeks 0% 0% 0% 0% 0% 0%

No of individual service users admitted to homeless services (providing 24 hour x 7 day services) who have medical cards per HSE Region

2010 Performance Quarterly Level Q1 Target Q2 Target Q3 Target Q4 Target Target 2011 DML new PI for 2011 0% 25% 50% 75% 75%

DML Regional Service Plan 2011 87

KEY RESULT AREAS & DELIVERABLE OUTPUTS – RESPONSIBLE APPOINTMENT HOLDERS Key Result Areas & Deliverable Outputs Responsible Appointment Holders

Quality and Safety

The Lead Integrated Service Area Manager (Lead ISAM) for Quality and Safety will be responsible for the policies relating to the following Key Result Areas (KRAs). The ISAMs, where relevant, will be responsible for the implementation of these policies in their respective areas, as appropriate.

Quality and Risk Management Framework: Building on existing work on quality and risk standards Deliverable Output 2011 Target completion • Review Current Quality Risk and Audit Management Activity within LHO and Q1 NHO Pillars as at end of Dec 2010. • Develop Service Plan and sign off by appropriate group for QRM Framework. Q1 • Establish clearly defined ISA and Regional Unit Governance Structures within Q1 DML.

Clear Accountability Arrangements Deliverable Output 2011 Target completion • Document a map re current staffing within Quality Risk and Audit and associated Q1 functions within DML HSE and associated Dublin Area Teaching Hospitals. • Each ISA Manager to define and present clear management governance Q1 arrangements within ISAs with effect 2011 as an interim basis initially.

Person Centred Care: Service User Involvement; Complaints [Your Service Your Say]; Advocacy Deliverable Output 2011 Target completion • Participate, as appropriate and feasible, in the nationally co-ordinated draft Q2 consultation on the supporting documents on service user involvements and methods of involvement. • Participate, as appropriate and feasible, in the nationally co-ordinated 16 regional Q3 training workshops for acute and non acute services regarding service user involvement, feedback mechanisms, communication skills for healthcare workers,

shared-decision making, health literacy and self-care. Q3 • Participate, as appropriate and feasible, in the nationally co-ordinated launch of the Patients Charter. Q1 • Participate, as appropriate and feasible, in the national consultation on the development of a code of practice for Post Mortem Services.

Safe Care: Serious Incident Management; Medication Safety; Preparedness for Major Emergencies Deliverable Output 2011 Target completion • Develop and define Major Emergency Plans in the context of the new ISA Ongoing

structures and ongoing review. • Develop local ISA plans for HCAI section and monitor as appropriate. Ongoing

DML Regional Service Plan 2011 88

KEY RESULT AREAS & DELIVERABLE OUTPUTS – RESPONSIBLE APPOINTMENT HOLDERS

Primary Care

The Lead Integrated Service Area Manager (Lead ISAM) for Primary Care, working in conjunction with the DML Regional Specialist for Primary Care, will be responsible for the policies relating to the following Key Result Areas (KRAs). The ISAMs, where relevant, will be responsible for the implementation of these policies in their respective areas, as appropriate.

Primary Care Teams (PCTs) and Health and Social Care Networks (HSCNs): Progress the establishment of PCTs and HSCNs Deliverable Output 2011 Target completion • Access to primary care services increased by having 150 Primary Care Teams in Q4 place in DML in 2011. Actions include: ¾ Continued negotiation with service managers to realign existing staff to fill staffing deficits in existing teams and to resource new teams, particularly nursing grades. ¾ Roll out of clinical leadership and service management for teams in operation. ¾ Ensuring that all Teams in place are holding regular Clinical Team meetings with GPs present. ¾ Facilitated standardisation of approach to service delivery via roll out of business processes. • Service integration enhanced through the development of 36 Health and Social Q4 Care Networks in DML, achieved by: ¾ Implementing governance and management structures. ¾ Working with Care Group managers to align specialist and care group services to Teams and Networks. ¾ Rolling out, upon adoption, of general principles of referral and shared care arrangements with secondary care, care group and specialist services. • Co-operation with the National Primary Care Programme in relation to national Q3 research. • Referral systems from primary care to acute sector implemented, when Q4 developed.

Chronic Disease Management: Cross-directorate planning in delivering integrated chronic disease programmes Deliverable Output 2011 Target completion • Co-operation with the commencement of plans for the management of chronic Ongoing disease in primary care through the roll out of pilot sites in DML as identified nationally.

DML Regional Service Plan 2011 89

KEY RESULT AREAS & DELIVERABLE OUTPUTS – RESPONSIBLE APPOINTMENT HOLDERS

Primary Care / contd.

Enhancement of Primary Care Services: Promoting health; Delivering integrated cancer programmes Deliverable Output 2011 Target completion • Co-operation with planning for the delivery of IV therapy services in community Q4 settings. • Implementation of the Health Promotion Strategic Framework commenced. Q1

• Programmes, as directed nationally, for the following areas implemented through Q3 PCTs: ¾ falls prevention ¾ team based approaches to mental health, including the consultation liaison model as described in Vision for Change ¾ smoking cessation ¾ breast feeding • Specific measures from the Tobacco Control Framework implemented with a Q4 particular focus on DML acute settings, including: ¾ maintaining smoking cessation services at current level ¾ developing a plan to make health service campuses smoke free ¾ expanding the primary care tobacco control training programme developed by Health Promotion/NCCP following the publication of the evaluation. • Roll out of initiatives in DML primary care settings as developed by the cancer Q3 control programme including: ¾ Facilitate the release of Nursing to attend Community nurse education programmes if required. ¾ Roll out of follow-up care programmes in the community for patients who have had cancer in association with the NCCP. ¾ Facilitation of Information / training sessions for DML GPs delivered through ICGP and CME tutor groups.

Audiology Services Deliverable Output 2011 Target completion • Implementation of Phase 1 recommendations of Audiology review to enhance Q4 Audiology services in DML. • Preparation for roll out of Newborn Hearing Screening in DML in line with national Q3 model.

Prescribing Deliverable Output 2011 Target completion • Work with GPs in DML on cost effect prescribing as led by QCCD. Q3

Out Of Hours Deliverable Output 2011 Target completion • Further implementation of recommendations from the General Practice (GP) Co- Ongoing Op review in MiDoc and KDoc.

DML Regional Service Plan 2011 90

KEY RESULT AREAS & DELIVERABLE OUTPUTS – RESPONSIBLE APPOINTMENT HOLDERS

Primary Care / contd.

Oral Health Policy Deliverable Output 2011 Target completion • New orthodontic performance indicators will be implemented across DML in Ongoing 2011. • On-going discussions with the Irish Dental Association/IMPACT have commenced in relation to the implementation of the Independent Strategic Review of the Delivery and Management of HSE Dental Services. Alignment of dental services to ISA areas forms part of these discussions. • When the Oral Health Policy is received from the Department of Health and Children, an implementation plan for oral health services in DML will be developed.

Immunisation Deliverable Output 2011 Target completion • To complete 3rd dose of HPV vaccine in the target group of 16,500 secondary Q2 school girls for school year 2010/2011. • To offer 1st and 2nd dose of HPV vaccine to 8,200 Secondary school girls in Q4 school year 2011/2012.

DML Regional Service Plan 2011 91

KEY RESULT AREAS & DELIVERABLE OUTPUTS – RESPONSIBLE APPOINTMENT HOLDERS

Acute Services and Pre-Hospital Emergency Care

The following Integrated Service Area Managers (ISAMs) (and Assistant National Director) have responsibility for the DML Acute Hospitals outlined below.

Hospital Responsible Appointment Holder Adelaide and Meath Hospital, incorporating the National Children’s Hospital, Tallaght (AMNCH) Mr. David Walsh, Integrated Service Area Manager. Coombe Women and Infants Univ. Hosp. Mr. David Walsh, Integrated Service Area Manager. Mr. James Conway, Assistant National Director, Midlands Hospital Midlands Regional Hospital, Mullingar Group Mr. James Conway, Assistant National Director, Midlands Hospital Midlands Regional Hospital, Portlaoise Group Mr. James Conway, Assistant National Director, Midlands Hospital Midlands Regional Hospital, Tullamore Group Naas General Hospital Mr. David Walsh, Integrated Service Area Manager. Mr. Gerard McKiernan, Integrated Service Area Manager, DML Children’s University Hospital, Temple St. Paediatric Hospitals. Mr. Gerard McKiernan, Integrated Service Area Manager, DML Our Lady’s Children's Hospital Crumlin Paediatric Hospitals. National Maternity Hospital, Holles St. Ms. Martina Queally, Integrated Service Area Manager. Royal Victoria Eye & Ear Hospital Mr. Gerry O’Neill, Integrated Service Area Manager St. Columcille’s Hospital, Loughlinstown Ms. Martina Queally, Integrated Service Area Manager. St. James’s Hospital Mr. Gerry O’Neill, Integrated Service Area Manager. St. Michael’s Hospital, Dun Laoghaire Ms. Martina Queally, Integrated Service Area Manager. St. Vincent's University Hospital Ms. Martina Queally, Integrated Service Area Manager.

The Lead Integrated Service Area Manager (Lead ISAM) for Acute Services, working in conjunction with the DML Hospital Network Offices, will be responsible for the policies relating to the following Key Result Areas (KRAs). The ISAMs, where relevant, will be responsible for the implementation of these policies in the respective hospitals for which they have responsibility.

Medicine: Acute Medicine Programme (AMP) Deliverable Output 2011 Target completion • DML will co-operate with the implementation of the Acute Medicine Programme Q4 (AMP) with regards to the development of Acute Medical Units (AMUs) in accordance with agreed pathways of care set out by the AMP. These will prevent admission in many cases and direct patients into more appropriate avenues of care, such as rapid access clinics and day service units. Senior decision makers will be put in place at weekend.

Critical Care Programme Deliverable Output 2011 Target completion • DML will co-operate with the National Audit Progress for Critical Care. Q3

DML Regional Service Plan 2011 92

KEY RESULT AREAS & DELIVERABLE OUTPUTS – RESPONSIBLE APPOINTMENT HOLDERS

Acute Services and Pre-Hospital Emergency Care / contd.

Emergency Care: Emergency Medicine Programme Deliverable Output 2011 Target completion • DML will co-operate with the implementation of the National Emergency Medicine Q3 Programme. Emergency care will be improved by reducing waiting times for admission, better patient experience and ED avoidance. • DML hospitals will work to complete Patient Experience Time (PET) data set and Q4 work to address any constraints to full reporting. • DML Regional Implementation Group for Emergency Care established. Q1 • Local Joint Implementation Teams for Emergency Care established in DML acute Q1 hospitals.

Surgical Care: Elective Surgery Programme Deliverable Output 2011 Target completion • Continue the shift from in-patient to day case to increase rates of day surgery. Q4 • Support the EMP with regard to decreasing patient length of stay through the roll-out Q4 of selected common elective in-patient surgical procedures. • Support the development of National Standardisation guidelines. Q4 • Support the introduction of a National Audit Programme. Q4 • While emergency admissions will always have to be provided for, DML will strive to Q4 protect in-patient elective beds for elective activity in order to reduce waiting times.

Outpatient Programme: Outpatient data; OPD Service Improvement; Epilepsy; Dermatology; Neurology; Rheumatology and Orthopaedic Deliverable Output 2011 Target completion • Outpatient Data ¾ OPD Data Quality Programme – DML will co-operate with the roll out of the Q4 reformed data set. ¾ Reporting commenced. Q1 • OPD Service Improvement ¾ DML will continue to focus on improvement of OPD service delivery through Q4 the Continuous Waiting List validation, clear focus on reduction of DNA and improving the New to Return Ratio.

• Epilepsy Q1 ¾ Epilepsy Regional Centres in DML to be defined. • Increased new attendances in Dermatology, Neurology and Rheumatology. Q4 ¾ DML will appoint 10 Consultants, including 3 paediatric, on 4 sites (AMNCH, St. James’s Hospital, Our Lady’s Children’s Hospital Crumlin, Midlands Regional Hospital Tullamore) in the areas of Dermatology, Neurology, and Rheumatology.

Chronic Disease Interventions Deliverable Output 2011 Target completion • DML will co-operate and actively engage with programmes in the areas of Stroke, Ongoing Acute Coronary Syndrome, Heart Failure, Diabetes, COPD and Asthma.

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KEY RESULT AREAS & DELIVERABLE OUTPUTS – RESPONSIBLE APPOINTMENT HOLDERS

Acute Services and Pre-Hospital Emergency Care / contd.

Ambulance Services : Reconfiguration of ambulance services to respond to changing models of service Deliverable Output 2011 Target completion • Improved response times for life threatening emergencies – collection of Q4 performance data to inform setting of performance targets for remaining 4 clinically appropriate response time standards to 112 (999) emergency calls in line with HIQA recommendations: ¾ Templates to allow reporting to DoHC developed and tested Q2 ¾ Data gathered, input onto templates and tested Q2 ¾ Training on systems completed Q1 ¾ Advanced Medical Priority Dispatch System (AMPDS) implemented Q1 ¾ AQUA Audit Tool for AMPDS to guarantee compliance implemented Q1 ¾ Engagement with hospitals re turnaround time of ambulances Ongoing

• Existing resources refocused from non-urgent patient transport services to Q4 improving response times to life threatening 999 emergency calls, in line with HIQA targets: ¾ PHECC dispatch standards implemented Q4 ¾ Dispatch models reviewed and enhanced, i.e. use of community first Q3 responder, rapid response vehicles ¾ Critical/Low acuity Patient Transport models reviewed, i.e. use of Q3 intermediate care vehicle

• Work streams in place to ensure focused targets re the National Command and Q3 Control Project are achieved and project delivered. This is on a national footing (enabled through ICT/Estates/HR) and involves the following: ¾ Digital radio system rolled out ¾ CAD in place ¾ National Integrated Command and Control (ICCS) ¾ Automatic Vehicle Location System ¾ National mapping solution ¾ Satellite navigation solution ¾ HR/Staffing engagement ¾ Procurement and fit out of building

• Local Medical Advisor appointed to assist with quality assurance and best Q1 practice guidelines.

• Ambulance management structures reconfigured to address new priorities and Q2 staffing gaps.

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Acute Services and Pre-Hospital Emergency Care / contd.

Other Service Development Areas Deliverable Output 2011 Target completion • Reconfiguration of DML Acute Services: ¾ Projects will be identified, planned and executed on a phased basis to reflect Ongoing corporate objectives of accessibility, patient safety, clinical standards and quality of services. The continued roll out of the Quality and Clinical Care Directorate programmes, particularly the Acute Medicine Programme, and the need to manage risk and safety issues will all inform this programme of re-configuration and integration. ¾ Continued development of St. James’s ISA project. Ongoing ¾ Continued reconfiguration of paediatric services. Ongoing ¾ St. Vincent’s Hospital/St. Columcille’s Hospital integration project. Ongoing ¾ Development of stronger clinical networks for Midlands hospitals. Ongoing ¾ Scoping of maternity services reconfiguration to co-locate with acute Ongoing hospitals. • Standardised GP referral system for AMNCH, under the aegis of the QCCD Q4 Clinical Programme for Primary Care, piloted. • Cystic Fibrosis: ¾ Newborn screening services - Implementation Phase commenced. Q1 • Enhanced Paediatric Cardiac Programme: ¾ Additional consultant sessions provided in Our Lady’s Children’s Hospital Q1 (initial increase from 3 days/week to 4.5 days/week). ¾ Additional support services provided to meet the needs of paediatric cardiac Q1 patients. • Consultant Work Practices ¾ Implementation of Consultant Contract progressed with further development Q3 of clinical directors and clinical led service development through accelerated and expanded work on clinical care programmes and their integration with regional hospital reconfigurations. ¾ Full benefits of extended working days realised with parallel implementation Q2 of Croke Park Agreement. ¾ Full compliance with public/private mix provisions. Q2 ¾ Complete contract audit rolled out from initial 2010 sites to all hospital sites. Q3 • Funding of selective elective orthopaedic procedures in public hospitals ¾ Continue to engage with NTPF in connection with additional orthopaedic Ongoing capacity, both adult and paediatric. • Renal services ¾ Continue development of renal services/capacity in DML. Ongoing • Treating Tobacco Addiction as a care issue ¾ All hospitals will have drafted plans to make their campuses smoke-free by Q4 2015. ¾ Hospitals will treat tobacco addiction as a care issue by offering smoking Q4 cessation services.

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National Cancer Control Programme

Although the National Cancer Control Programme (NCCP) is not within the remit of the DML RDO, the relevant ISAMs will work with the NCCP in the delivery of cancer services in the respective hospitals for which they have responsibility.

Lung Cancer Services Deliverable Output 2011 Target completion • Monitor throughput of Rapid Access Clinic in St. Vincent’s Hospital. Ongoing • Monitor throughput of Rapid Access Clinic and lung surgery in regional surgical centre in St. James’s Hospital. Ongoing

Urology Cancer Services Deliverable Output 2011 Target completion • Prostate cancer surgery consolidated into one regional cancer centre in DML. Q4 (Centre not identified/finalised as yet)

Pancreatic Surgery Deliverable Output 2011 Target completion • National cancer centre for pancreatic surgery established in St. Vincent’s Q1 University Hospital, with satellite unit in Cork University Hospital. Multi- disciplinary teams (MDTs) established in both centres and care pathways monitored. • Transfer of pancreatic surgery from AMNCH into St. Vincent’s University Hospital Q1 complete.

Rectal Cancer Services Deliverable Output 2011 Target completion • Transfer of all regional rectal cancer surgery into cancer centres in St. James’s Q4 Hospital and St. Vincent’s University Hospital complete.

Upper Gastrointestinal (GI) Cancers Deliverable Output 2011 Target completion • Upper gastrointestinal cancers consolidated in St. James’s Hospital. Q1

Theatre / ICU / Support Deliverable Output 2011 Target completion • Additional theatre ICU support provided to enable cancer surgical throughput in Q1 designated centres (funding to be agreed nationally).

Medical Oncology Deliverable Output 2011 Target completion • Continue to deliver medical oncology, as appropriate, in existing units as close to Ongoing patient’s home as possible in St. James’s Hospital, St. Vincent’s University Hospital, AMNCH, Naas General Hospital and Midlands Regional Hospital Tullamore, unless otherwise decided.

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KEY RESULT AREAS & DELIVERABLE OUTPUTS – RESPONSIBLE APPOINTMENT HOLDERS

National Cancer Control Programme / contd.

Radiation Oncology (Phase 1) Deliverable Output 2011 Target completion • New radiation oncology unit (Phase 1) in St. James’s Hospital fully functional. Ongoing

Radiation Oncology (Phase 2) Deliverable Output 2011 Target completion • Plan to develop Phase 2 radiation services on 6 sites, including St. James’s Q4 Hospital, continued. • Funding mechanism agreed and approved for Phase 2. Q4

Quality Assurance through establishment of formal national quality clinical governance arrangements for common cancers Deliverable Output 2011 Target completion • Lead clinicians to participate in national clinical networks established for common Q2 cancers for purposes of clinical audit, sharing of good practice and problem solving • Representation on national expert groups to advise on evidence based practice Q2 for common cancers. • Implementation of the appropriate parameters defined to devise and monitor Q2 quality domains across lung and prostate.

Gynaeoncology Deliverable Output 2011 Target completion • Planning commenced for consolidation of surgery for gynaecological cancers into Q2 cancer centres.

National Screening Service Deliverable Output 2011 Target completion • Preparation for participation in national colorectal screening programme. Q2

Community Oncology Programme Deliverable Output 2011 Target completion • Existing partnership with ICGP built upon. Q4 • Proportion of electronic referrals increased. Q4 • Community nurse training programmes delivered. Q4 • Brief interventions with smoking cessations with primary care teams developed. Q4

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KEY RESULT AREAS & DELIVERABLE OUTPUTS – RESPONSIBLE APPOINTMENT HOLDERS

Children and Families

The Lead Integrated Service Area Manager (Lead ISAM) for Children and Families, working in conjunction with the DML Regional Specialist for Children and Families, will be responsible for the policies relating to the following Key Result Areas (KRAs). The ISAMs, where relevant, will be responsible for the implementation of these policies, as appropriate.

DELIVERY OF STATUTORY SERVICES

Children in Care and Aftercare Deliverable Output 2011 Target completion • 100% compliance with NSP Targets will be achieved. Q2

Special Care Deliverable Output 2011 Target completion • DML will participate in the review of alternative care capacity, with particular Ongoing emphasis on requirements of Special Care, High Support and Residential services.

Youth Homelessness Deliverable Output 2011 Target completion • DML will ensure implementation of national recommendations. Ongoing

Child Protection and Implementing the Revised Children First Guidelines Deliverable Output 2011 Target completion • The revised Children First guidelines, in line with National policy, will be Q4 implemented.

Adoption Deliverable Output 2011 Target completion • Services will be reorganised in compliance with new legislation. Q4

IMPLEMENTING STRATEGIES TO SUPPORT SERVICE DELIVERY

Implementing the Task Force Report: Further development of the National Child Care Information System Deliverable Output 2011 Target completion • Referral and Assessment Standardised Business Processes will be implemented Q4 in line with National Plan.

Children’s Services Committees Deliverable Output 2011 Target completion • Children’s Services Committees will be established in line with national plan. Ongoing

Implementation of PA Consulting Report – Strategic Review of the Delivery and Management of Children and Family Services Deliverable Output 2011 Target completion • Recommendations will be implemented in line with national direction. Ongoing

REPORT OF THE COMMISSION TO INQUIRE INTO CHILD ABUSE (RYAN REPORT) 2009

Implementing the actions of the Commission to Inquire into Child Abuse Deliverable Output 2011 Target completion

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• Actions will be implemented in line with national direction. Ongoing

Mental Health

The Lead Integrated Service Area Manager (Lead ISAM) for Mental Health Services, working in conjunction with the DML Lead Local Health Manager for Mental Health, will be responsible for the policies relating to the following Key Result Areas (KRAs). The ISAMs, where relevant, will be responsible for the implementation of these policies in their respective areas, as appropriate.

Enhancing Service Provision through Structural Changes; Changes in Procedures and Practices Deliverable Output 2011 Target completion • Continue development of Executive Clinical Directors (ECD) initiative through Q4 completion of Management Teams.

Service Reconfiguration: Reconfiguring services from a model of care predicated on inpatient provision to a community based recovery model; Reinvestment of Exchequer funding Deliverable Output 2011 Target completion • Reduce number of Acute Psychiatric beds further. Q4 • Pilot innovative Recovery and Early Intervention programmes through use of Innovation funding.

Suicide Prevention and Stigma Reduction Deliverable Output 2011 Target completion • Implement nationally developed programmes for suicide prevention. • Continue involvement with SEE CHANGE programme aimed at stigma reduction. Q4

Continuous Service Development through Statutory and Regulatory Measures – Enhancing the Provision of Child and Adolescent Mental Health services Deliverable Output 2011 Target completion Implement measures to increase residential capacity: • Development of 11 bed interim Child and Adolescent Inpatient Unit for St. Ongoing Loman’s, Palmerstown, particularly targeting 16 and 17 year olds. * • Progress plans to replace current In-Patient Unit in Warrenstown. ** Ongoing • Open new Child and Adolescent Day Hospital in Cherry Orchard. *** Ongoing * / ** / *** In conjunction with DML AND (Estates)

National Forensic Services Deliverable Output 2011 Target completion Compliance with the Criminal Law (Insanity) Act through: • Provision of 10-12 bed high support hostel for people granted conditional Q3 discharge by the courts under Criminal Law (Insanity) Act. * • Provision of barricade / siege support to the Gardai in line with Barr Q3 recommendations.

• Progress Design brief for new National Forensic Mental Health Hospital. ** Ongoing * In conjunction with Dublin City Council ** In conjunction with HSE National Estates Office

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KEY RESULT AREAS & DELIVERABLE OUTPUTS – RESPONSIBLE APPOINTMENT HOLDERS

Disability Services

The Lead Integrated Service Area Manager (Lead ISAM) for Disability Services, working in conjunction with the DML Lead Local Health Manager for Disability Services, will be responsible for the policies relating to the following Key Result Areas (KRAs). The ISAMs, where relevant, will be responsible for the implementation of these policies in their respective areas, as appropriate.

VFM and Policy Review Provision Deliverable Output 2011 Target completion • Complete data returns. Q1 • Progress VFM Review recommendations. Q3 • Develop implementation plan for interagency collaboration. Q1

Compliance with Legislation and Quality Standards Deliverable Output 2011 Target completion • Pool resources within Integrated Service Area (ISA). Q1 • Provide Assessment of Need and Service Statements within statutory timelines. Ongoing • Be compliant with Disability Act 2005. Q4

Reconfiguration of Services Deliverable Output 2011 Target completion • Map Disability Services 0-18years. Q2 • Prepare Implementation Plan in collaboration with all stakeholders. Q2 • Develop Guidelines on referral care pathways. Q3 • Develop outline implementation plan in line with VFM and Policy Review. Q4

Neuro-Rehabilitation Strategy Deliverable Output 2011 Target completion • Develop Regional plan for implementation of Neuro-Rehabilitation Strategy. Q4

Development of Information and Data System Deliverable Output 2011 Target completion • Engage with National office in relation to scoping exercise re integrated ICT Q4 system.

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KEY RESULT AREAS & DELIVERABLE OUTPUTS – RESPONSIBLE APPOINTMENT HOLDERS

Older Persons

The Lead Integrated Service Area Manager (Lead ISAM) for Older Persons, working in conjunction with the DML Specialist for Older Persons, will be responsible for the policies relating to the following Key Result Areas (KRAs). The ISAMs, where relevant, will be responsible for the implementation of these policies in their respective areas, as appropriate.

Community Services: Maintain a strong focus on the provision of equitable community based services and home supports. Deliverable Output 2011 Target completion • Procurement processes for Home Care Packages (HCP’s) to be finalised and Q3 implemented in all LHO areas. • National Quality Guidelines for Home Care Services developed and agreed with Q2 DoHC. • Home Help guidelines implemented. Q2 • HCP review implemented. Q3 • National Single Assessment Tool (SAT) to determine access to range of services Q4 for older people, selected and rolled out nationally. • Geriatrician Led Community Outreach Teams targeted at vulnerable older people Q4 developed. • Work with the DoHC on legislative proposals for Community Care. Ongoing

Residential Care: Provide high quality public residential care for older persons who cannot be maintained at home. Deliverable Output 2011 Target completion • Continue implementation of the Nursing Home Support Scheme. Ongoing • Strive to optimise the provision of short and long term residential care in both Ongoing public and private settings by the development of local plans for residential care, to meet local need. • Maximise efficiencies in publicly funded residential care to ensure best value for Ongoing money by reviewing staffing types and levels.

Falls Prevention Guidelines. Deliverable Output 2011 Target completion • Implementation commenced on the recommendations of the Falls Prevention Q4 Strategy in all appropriate older persons services.

Elder Abuse Deliverable Output 2011 Target completion • Elder Abuse Awareness campaigns / Elder Abuse Awareness Day undertaken. Q2 • Senior Case workers for Elder Abuse employed in each Local Health Office. Q2 • Monthly and annual statistical returns collected contributing to national reports on Ongoing Elder Abuse. • Elder Abuse awareness training provided for HSE and non HSE staff. Ongoing

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Palliative Care

The Lead Integrated Service Area Manager (Lead ISAM) for Palliative Care will be responsible for the policies relating to the following Key Result Areas (KRAs). The ISAMs, where relevant, will be responsible for the implementation of these policies in their respective areas, as appropriate.

Report of the National Advisory Committee on Palliative Care, 2001: Access to specialist services and treatment in location of choice where this can be achieved safely, effectively and efficiently. Deliverable Output 2011 Target completion Report of the National Advisory Committee: • Identified priorities progressed on a cost neutral basis Q4

Access to specialist services: • Agreed referral criteria and assessment of need for specialist services Q4 developed. • Service Level Agreements developed to reflect further efficiencies. Treatment in location of choice where this can be achieved safely, effectively Q4 and efficiently: • Care pathways, governance arrangements and clinical guidelines developed to support treatment in location of choice.

Care at End of Life Deliverable Output 2011 Target completion • Care at end of life within both acute and long stay hospitals progressed through Q4 the implementation of projects through the Dignity and Design process.

Children’s Palliative Care Deliverable Output 2011 Target completion Continued implementation of national policy on Children’s Palliative Care: • Consultant and key nursing positions in post. Q3 • Review of respite services for children with life limiting illnesses undertaken. Q3

Minimum Data Set Deliverable Output 2011 Target completion Minimum Data Set progressed through: • First phase of the pilot of MDS completed. Q2 • Day care services and acute hospitals data piloted and collected. Q4 • Review process concluded for intermediate/palliative care support beds. Q4

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KEY RESULT AREAS & DELIVERABLE OUTPUTS – RESPONSIBLE APPOINTMENT HOLDERS

Social Inclusion

The Lead Integrated Service Area Manager (Lead ISAM) for Social Inclusion, working in conjunction with the DML Specialist for Social Inclusion will be responsible for the policies relating to the following Key Result Areas (KRAs). The ISAMs, where relevant, will be responsible for the implementation of these policies in their respective areas, as appropriate.

National Drugs Strategy and National Substance Misuse Strategy Deliverable Output 2011 Target completion • Open harm reduction/needle exchange services in Tullamore and Mullingar. * Q2 • Assist in the Alcohol Public Awareness Campaign. Q2 • Assist in the recruitment of the Clinical Director of Addiction Services post. Q3 * ISA Manager, Midlands

National Homelessness Strategy Deliverable Output 2011 Target completion • Progress the implementation of the Dublin Joint Homelessness Consultative Q4 Forum Action Plan to eliminate homelessness. • Assist in the development of referral pathways between addiction/mental health Q4 and homeless services.

All-Ireland Traveller Health Study Deliverable Output 2011 Target completion • Develop and implement the regional plan to address five priorities agreed Q4 Nationally.

National Intercultural Health Strategy Deliverable Output 2011 Target completion • Support the implementation of the development of emergency multilingual aid Q3 tool-kits for staff. • Assist in the completion of the Intercultural Health Guide. Q3 • Assist in the national plan to implement the ethnic identifier field in core data. Q2

LGBT Framework Deliverable Output 2011 Target completion • Support national guidelines as they emerge and co-operate with the development Q4 of policy and guiding principles.

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APPENDIX 1

Appendix 1 Financial Information

DML Agency Budgets 2011 Budget 2011 €m Voluntary Providers (DML) Hospitals Children's University Hospital, Temple Street 75.143 The Adelaide & Meath Hospital, incorporating the NCH, Tallaght 176.088 Coombe Women and Infants University Hospital 46.607 Our Lady's Children’s Hospital, Crumlin 120.662 St James's Hospital 313.104 St Vincent's University Hospital 200.831 St Michael's Hospital, Dun Laoghaire 26.467 National Maternity Hospital, Holles Street 43.994 St Luke's Hospital (NCCP) - Royal Victoria Eye & Ear Hospital 20.365 Hospital Total 1,023.261 Community National Rehabilitation Hospital 24.621 Dublin Dental School and Hospital 6.193 Leopardstown Park Hospital 11.615 Sisters Of Charity of Jesus and Mary, Moore Abbey 16.381 The Royal Hospital Donnybrook 18.922 The Drug Treatment Centre 8.175 Our Lady's Hospice 27.859 St John of God 87.341 Cheeverstown House 22.187 KARE 14.272 Sunbeam House Services 20.140 Peamount 24.515 Stewarts Hospital 43.170 The Children's Sunshine Home 3.731 Community Total 329.122 Total Voluntary Providers DML 2011 1,352.383

Statutory Providers (DML) Hospitals St Columcilles General Hospital, Loughlinstown 37.374 Naas General Hospital 56.428 Midlands Regional Hospital Mullingar 56.159 Midlands Regional Hospital Tullamore 78.707 Midlands Regional Hospital Portlaoise 42.853 Other – Contracts and Once-off 16.062 Hospital Total 287.583 Community Dublin South Central 271.260 Dublin South East and Wicklow 244.053 Dublin South West and Kildare/West Wicklow 222.359 Midlands 294.868 DML Central 44.394 Total Community 1,076.934 Total Statutory Providers DML 2011 1,364.517

Overall Total DML Provider Budgets 2011 2,716.900

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APPENDIX 2 Appendix 2

a) Additional DoHC Funding Allocation for HSE National Priority Services Funding Target Key Result Area Deliverable 2011 WTE €m Completion National Cancer Care Programme Radiation Oncology Full year cost of opening new radiation units in Beaumont and St. James. €8m 0 Q4 Theatre/ICU/ Support Additional theatre, ICU and support staff provided to enable cancer surgical €1.5m 28 Q1 throughput in designated centres National Screening 20 candidate ANPs appointed in colonoscopy with a view to 15 graduations in €0.5m *20 Q2 Service 2013. (See also section below outlining €0.9m gap to support this action) Sub Total €10m 48 Children and Families Ryan Report Continue to support the full implementation of the recommendations outlined in €7m 0 Q4 the Ryan Report Social Work Service Appointment of additional Social Workers (See also section below outlining €2m *60 Q3 €1.8m gap to support this action) Sub Total €9m 60 Mental Health Suicide Prevention Focus on increasing the number and range of training programmes, improve €1m 0 Q4 our response to deliberate self harm presentations, develop our ability to respond in primary care and coordinate and improve our helpline availability Sub Total €1m 0 Disability Day, Residential, Address demographic pressures in the provision of Day, Residential, Respite, €10m 0 Q4 Respite, Personal Personal Assistance and Home Support Services. This funding will be Assistance and Home distributed equitably across the HSE Regions, based on emerging need during Support Services 2011 Sub Total €10m 0 Older Persons Fair Deal Deliver additional residential care placements €6m 0 Q4 Home care packages Enhance home care through additional care packages €8m 0 Long Stay repayments Address outstanding claims and close off scheme in 2011 €12m 0 Sub Total €26m 0 Total €56m 108

b) HSE National Strategic Priorities Funded: Internal Resource Realignment Funding Target Key Result Area Deliverable 2011 WTE €m Completion Primary Care Enhancement of Primary Planning for delivery of IV therapy services in community settings undertaken. €4m 0 Q4 Care Services Primary Care Teams and Electronic referrals systems from primary care to acute sector developed. €0.35m 0 Q4 Networks Audiology Services Audiology services enhanced through the implementation of Phase 1 of €1.8m 5 Q4 Audiology Review recommendations. Newborn Hearing Screening further rolled out in line with national model €1.9m 0 Q3 Sub Total €8.05m 5 Acute Services

Programmes: Implementation plan for AMP finalised and implementation commenced with an €8.5m 34 Q4 ƒ Acute Medicine initial focus on Acute Medical Units (AMUs) functioning in 12 sites. Programme (AMP) ƒ Critical Care Audit process for critical care. €1.4m 15 Q3 Programme

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APPENDIX 2

Funding Target Key Result Area Deliverable 2011 WTE €m Completion ƒ Emergency Emergency Medicine Programme introduced €3.5m 14 Q3 Medicine Programme ƒ Elective Surgery Audit programme introduced to monitor outcomes of process and to audit €1.34m 6 Q4 Programme surgical mortality. Outpatient programmes: ƒ Epilepsy Regional Epilepsy Centres defined – see 2c) below also. €0.6m 6 Q1 ƒ Dermatology Increase of 30% in new dermatology outpatient attendances over 12 months €7.5m 30 Q4 Jan-Dec 2011 based on reformed data set. ƒ Neurology Increase of 30% in new neurology outpatient attendances over 12 months Jan- Dec 2011 based on reformed data set. ƒ Rheumatology and 12 musculo-skeletal physiotherapy led clinics in place. €1.75m 19 Q2 Orthopaedic Chronic Disease Interventions: ƒ Stroke Stroke Units meeting defined criteria in 9 new sites. €4.2m 45 Q4 ƒ Acute Coronary Primary PCI centres identified and 4 centres functioning. €1.5m 6 Q3 Syndrome ƒ Diabetes Retinopathy Screening Programme initiated with IT systems in place. €4m 11.5 Q4 National foot care programme introduced. €1m 16 ƒ COPD Structured programmes operational in 12 acute hospitals - see 2c) below also. €0.75m 10 Q3

ƒ Asthma Asthma Education Programmes initiated. €0.3m 0 Q2

Ambulance services To support the reconfiguration of hospital services €3m 60 Q4

Other Services: Critical care additional capacity opened in Our Lady’s Children’s Hospital. €2.25m 25.5 Q3 ƒ Paediatric services ƒ Cystic Fibrosis Newborn screening for cystic fibrosis commenced and integrated into the 0 7 Q2 National Newborn Bloodspot Screening Programme ƒ Renal services Maintain / increase number of renal transplants performed by National Renal €4.5m 2 Q4 Transplant Programme National Programme - €0.6m, 2 WTE / Home haemodialysis programme implemented nationally - €0.7m / Increased local haemodialysis capacity achieved by continued development of Satellite Renal Dialysis Units and Parent Renal Dialysis Units - €3.2m Sub Total €46.09m 307 National Cancer Care Programme National Screening To support full year costs of screening programme €0.9m * Q4 Service *WTE requirements addressed in DoHC funded priorities Sub Total €0.9m 0 Children and Families Social Work Service Support the costs for appointment of 60 additional Social Workers – See above €1.8m * Q3 *WTE requirements addressed in DoHC funded priorities Sub Total €1.8m 0 Mental Health Child and Adolescent DNE: St Vincent’s Fairview capital project €0.8m 10 Q3 Mental Health Services DML: Development of 11 bed interim Child and Adolescent Inpatient Unit €3m 30 Q4 National Forensic DML: Provide a 10-12 bed high support hostel for people granted conditional €1.2m 0 Q3 Services Compliance with discharge by the courts under Criminal Law Insanity Act the Criminal Law (Insanity) DML: Provision of barricade/siege support to the Gardai in line with Barr Q3 Act recommendations Sub Total €5m 40 Palliative Care Specialist Palliative Care Ambulatory and day care in Milford €1.3m 1.5 Q4 Sub Total €1.3m 1.5 Total €63.14m 353.5

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APPENDIX 2

c) HSE National Strategic Priorities: Internal Reconfiguration through Existing WTEs and Funding Funding Target Key Result Area Deliverable 2011 WTE €m Completion Acute Services ƒ Epilepsy Regional Epilepsy Centres defined – see 2b) above also €1.8m 35 Q1 Chronic Disease Interventions: ƒ Heart failure Structured heart failure programme available in 12 acute hospitals €1.6m 24 Q4 ƒ COPD Outreach programmes operational in 12 acute hospitals - see 2b) above also €1.4m 19 Q3 Total €4.8m 78

Note: The allocation of funding outlined in appendices b) and c) is subject to approved business cases and evidence of implementation of change management programmes for each KRA.

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APPENDIX 3

Appendix 3 DML HR Information

The opening DML Employment Ceiling for 2011 is 32,229 WTEs.

Following adjustments for reductions under the VER/VRS 2010 schemes and the ECF and National Recovery Plan and the addition of WTEs in respect of staff in former health board companies not previously counted, the provisional End of 2011 Employment Ceiling is 31,604. This will be subject to revision when the WTE reduction due to the transfer of Community Welfare Services to the Department of Social Protection is known.

The breakdown of the DML 2011 Employment Ceiling is as follows:

Break-down of DML Employment Ceiling for 2011

Region & Service DML Employment Ceiling 2011

Dublin Mid-Leinster TBC Acute Hospital Services TBC Ambulance Services TBC Primary and Community Services TBC Portion of Ceiling to be allocated TBC

Health Service Personnel Census, December 2010 (DML) Grade Total WTE December 2010 Medical / Dental 2,617 Nursing 11,024 Health and Social Care Professionals 5,479 Management/ Admin 4,823 General Support Staff 3,179 Other Patient and Client Care 5,823 Total 32,946

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APPENDIX 4

Appendix 4 DML Capital Projects 2011 by Programme

This appendix includes those capital projects that are either: ƒ Completed in 2010 but did not become operational in 2010 ƒ Due to be built and/or completed by Estates in 2011 ƒ Projected to become operational in 2011

Capital Cost €m 2011 Implications Project Q Fully Additional Replacement Sub Programme Facility Project Details Revenue Completion Q operational Beds Beds 2011 Total WTEs Costs €m Dublin Mid Leinster Primary Care Naas, Kildare To be provided by means of the Primary Care 2010 Q2 0 0 0.35 0 0 0 Strategy. By lease agreement. Primary Care Longford Primary Care Centre. By lease agreement. 2010 Q2 0 0 0 0 0 0

Primary Care Inchicore Primary Care Centre. Q3 Q4 0 0 4.0 8.7 0 0

Primary Care Portarlington Primary Care Centre. By lease agreement. Q2 Q3 0 0 0.3 0 0 0

Primary Care Mountmellick Primary Care Centre. By lease agreement. 2010 Q1/Q2 0 0 0.1 0 0 0

Primary Care Churchtown Primary Care Centre. By lease agreement. Q4 Q1 2012 0 0 0.3 0 0 0

Primary Care Wicklow Primary Care Centre. By lease agreement. Q4 Q1 2012 0 0 0.4 0 0 0

Primary Care Kilbeggan Primary Care Centre. By lease agreement. Q4 Q1 2012 0 0 0.25 0 0 0

Primary Care Kilcullen Primary Care Centre. By lease agreement. Q3 Q4 0 0 0.3 0 0 0

Primary Care Greystones Primary Care Centre. By lease agreement. Q4 Q1 2012 0 0 0.4 0 0 0

Total 0 0 6.4 8.7 0 0

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APPENDIX 4

Facility Project Details Project Q Fully Additional Replacement Capital Cost €m 2011 Implications Sub Programme Completion Q operational Beds Beds Revenue 2011 Total WTEs Costs €m

Acute and Pre-hospital Care

Dublin Mid Leinster Infection Control AMNCH Laboratory Expansion - Cat 3 Microbiology Q3 Q3 0 0 1 2.5 0 0 Room and Blood Transfusion Unit. Infrastructure Upgrade St. James's Upgrade of the main, campus wide, electrical Q1 Q1 0 0 0.3 0.9 0 0 distribution to facilitate current developments. Maternity Coombe Emergency upgrade works Q1 Q1 10 0 0.5 6.23 0 0 (Cots not beds) Paediatric Care OLCH Crumlin The provision of 4 additional Paediatric Q2 Q2 4 13 1.7 8.22 25.5 2.25 Intensive Care Unit (PICU) and High Dependency Unit (HDU) beds and the Additional requirements to refurbishment of 13 existing beds (incl open Cardiology expansion) Acute Temple St Theatre Upgrade Q2 Q3 0 0 0 2.4 0 0

Total 4 (+ 10 cots) 13 3.5 20.25 25.5 2.25

Sub Programme Facility Project Details Project Q Fully Additional Replacement Capital Cost €m 2011 Implications Completion Q operational Beds Beds Revenue Costs 2011 Total WTEs €m

Dublin Mid Leinster Mental Health Ballyfermot and St. Lomas The provision of community facilities providing Q3 Q4 34 0 2.58 8.0 0 0 Rd 34 places Mental Health St. Marys Flat / Lyons Villa Replacement 15 beds Q2 Q3 0 15 0.6 0.7 0 0 New addition Replacement of 15 beds Mental Health Cherry Orchard Child and Adolescent Mental Health Day Q4 Q1 2012 0 0 5.0 9.2 0 0 Hospital Mental Health St Mary’s Mullingar Continuing Care provision for service users Q4 Q1 2012 0 50 5.6 8.25 0 0 from St Loman’s Total 34 65 13.78 26.15 0 0

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APPENDIX 4

Sub Programme Facility Project Details Project Q Fully Additional Replacement Capital Cost €m 2011 Implications Completion Q operational Beds Beds 2011 Total WTEs Revenue Costs €m Dublin Mid-Leinster

Older Persons Inchicore The provision of a new 50 bed Community Q3 2010 Q1 0 50 0.6 9.45 0 0 Nursing Unit on the same campus as the Primary Care Centre. To replace beds in Bru Caoimhin. Older Persons St. Mary's Mullingar 100 bed community hospital to accommodate Q4 2011 Q1 2012 0 50 5.6 8.25 0 0 50 replacement beds from the existing St Mary's unit Older Persons Riada House, Tullamore, Co. Provision of an 20 Bed Unit Q1 2010 2011 dependent 0 20 0 7.62 0 0 Offally on staffing

transfers being secured Older Persons Clonskeagh Provision of 94 replacement beds Q2 2010 Q1 2011 0 94 0 16 0 0 subject to HIQA

registration Total 0 214 6.2 41.32 0 0

DML Regional Service Plan 2011 111

APPENDIX 5 Appendix 5 Acute Hospitals in HSE Dublin Mid-Leinster (including specialties)

• St. James’s Hospital ¾ Specialist Cancer Centre ¾ Plastics, Burns, Reconstructive Surgery ¾ Haemophilia Services ¾ Bone Marrow Transplant Unit ¾ Maxillo-Facial Surgery ¾ National Medicines Information Centre ¾ National Pharmaco-Economics Centre ¾ National Dementia Information and Development Centre ¾ National MRSA Reference Laboratory ¾ National TB Reference Laboratory Supra-Regional Specialties /Services ¾ Genito-Urinary Medicine/Infectious Diseases ¾ Oesophageal Surgery ¾ Cardiac Surgery ¾ Vascular Surgery ¾ Cardiology ¾ Gastro-Intestinal Medicine • St. Vincent’s University Hospital ¾ Specialist Cancer Centre ¾ Liver Transplantation ¾ National Pancreatic Centre ¾ Cystic Fibrosis (National Adult Referral Centre) • St. Michael’s Hospital, Dun Laoghaire • St. Columcille’s Hospital, Loughlinstown ¾ Specialist Obesity Service • National Maternity Hospital, Holles Street ¾ National Neo-natal Transfer • Royal Victoria Eye & Ear Hospital • AMNCH (Tallaght Hospital) • The Coombe Women & Infants University Hospital • Our Lady’s Children’s Hospital, Crumlin with National Specialities of: ¾ Haematology/Oncology, ¾ Cardiology and Cardio Thoracic Surgery, ¾ Gastroenterology, ¾ Rheumatology, ¾ Medical Genetics, ¾ Cystic Fibrosis ¾ Burns. • The Children’s University Hospital, Temple Street ¾ National Centre for Inherited Metabolic Disorders ¾ National Centre for Paediatric Ophthalmology ¾ Paediatric Renal Transplant and Haemodialysis Centre ¾ Craniofacial Service ¾ National Airways Management Centre ¾ Neurosurgery under 6 yrs. ¾ Cochlear implant under 6 yrs. ¾ National Neonatal Screening Lab. ¾ National Meningococcal Ref. Lab. • Naas General Hospital • Midland Regional Hospital Tullamore • Midland Regional Hospital Mullingar • Midland Regional Hospital Portlaoise • (St. Luke’s Hospital, Rathgar) under the control of the NCCP

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APPENDIX 6

Appendix 6 Public Service Agreement - DML Action Plan

LHO/Hospital Area Description of Initiative Implementation Summary of Service PSA Priorities: Timeframe/Progress Improvement(s) 1. Extended day and 5 over 7 working 2. Optimising staff/service levels 3. Reduction in in-patient days 4. Extended delivery of service on a day basis and in community settings 5. Reconfiguration of services (including ISAs) 6. Compliance and EWTD 7. Centralisation of non- front line functions/activities Dublin South City Addiction Services- Project group developed. Maximise use of existing 1,2,4,5 & Dublin West Reconfiguration of Strategic plan presented resources and facilities for addiction services through to unions. Peer review client needs amalgamating clinics (and with colleagues in Dublin satellite services), and North East in place to developing opening hours ensure commensurate appropriate to client needs processes. Current and effective service actions due for development with due completion Q4 2011 regard for VFM.

Dublin South City Addiction Services - Project group being Maximise use of 2,7 & Dublin West Revise governance developed. Action due management and structure of Addiction for completion Q4 2011. administrative resources Services (and also administration support) and develop a single structure for the region

Dublin South City Older Persons- Project group in place. Maximise use of quality 2,5 & Dublin West Reconfigure residential Strategic plan presented facilities to meet patient care so that the service is to unions. Engagement needs delivered from quality with staff to ensure facilities, involving closure appropriate match of of Bru Chaoimhin and skills to new roles redesignation of service to developing. Action due Cherry Orchard, Belvilla for completion Q2 2011 and Meath Community Unit.

Dublin South City Support Services- Project group in place. Maximise use of 7 & Dublin West Integrate HR, Finance, Engagement with staff to administrative resources purchasing, complaints, identify opportunities for FOI functions for both integration. Union areas consultation in place. Action due for completion Q2 2011

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APPENDIX 6

contd.

LHO/Hospital Area Description of Initiative Implementation Summary of Service PSA Priorities: Timeframe/Progress Improvement(s) 1. Extended day and 5 over 7 working 2. Optimising staff/service levels 3. Reduction in in-patient days 4. Extended delivery of service on a day basis and in community settings 5. Reconfiguration of services (including ISAs) 6. Compliance and EWTD 7. Centralisation of non- front line functions/activities Dublin South City Children and Family 2 & Dublin West Services- test site for implementation of PA report process review to commence shortly.

Dublin South City Allied Health 2 & Dublin West Professionals- Integrate major services e.g. social work, public health nursing, therapies

Kildare West Support Services- Project group Maximise use of 7 Wicklow and Naas Develop a unified HR, developing, and administrative resources Hospital Finance and purchasing engagement and function for community consultation process services in Kildare & West planned. Action due for Wicklow and Naas completion Q1 2012 Hospital

Kildare West Allied Health Engagement process in Maximise use of health 2,4 Wicklow and Naas Professionals- Develop place to identify professional resources Hospital referral pathway fro commonalities to which service users between efficiencies can be Naas Hospital and brought. Action due for Community Services to completion Q4 2011 address waiting lists/times for particular services Occupational Health, Speech & Language, Social Work etc.

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APPENDIX 6

contd.

LHO/Hospital Area Description of Initiative Implementation Summary of Service PSA Priorities: Timeframe/Progress Improvement(s) 1. Extended day and 5 over 7 working 2. Optimising staff/service levels 3. Reduction in in-patient days 4. Extended delivery of service on a day basis and in community settings 5. Reconfiguration of services (including ISAs) 6. Compliance and EWTD 7. Centralisation of non- front line functions/activities Kildare West Palliative and Older Consultation process Maximising use of 2, 5 Wicklow and Naas Persons Care- with local managers in management and facilities Hospital Reconfigure Older place. Strategic plan to resources for enhanced Persons and Palliative be developed. Action care Care Services under the due for completion Q3 direction of the Director of 2011 Nursing Naas and reconfigure older persons’ beds into palliative care beds. Kildare West Older Persons Care- Maximise use of 7 Wicklow Develop a single administrative resources processing office for older persons’ assessment for those seeking residential care in Dublin Mid Leinster in line with Fair Deal Naas Hospital Naas Hospital develop Improve services for and implement patient patients and maximise focused continuous human resources improvement framework.

DML Regional Service Plan 2011 115

APPENDIX 6

contd.

LHO/Hospital Area Description of Initiative Implementation Summary of Service PSA Priorities: Timeframe/Progress Improvement(s) 1. Extended day and 5 over 7 working 2. Optimising staff/service levels 3. Reduction in in-patient days 4. Extended delivery of service on a day basis and in community settings 5. Reconfiguration of services (including ISAs) 6. Compliance and EWTD 7. Centralisation of non- front line functions/activities DML Disability Disability services for 0- Regional lead appointed Maximise effective 2, 4, 5, 7 Services 18 year olds-realigning and coordinating group delivery of disability existing statutory and non- in place. Local Children’s services for child welfare statutory resources to Disability Services purposes. achieve an integrated and Groups convened in sustainable model of each ISA/LHO. A service delivery under detailed project plan for Progressing Disability the region is prepared. Services for 0 -18 Year Engagement planned Olds. The implementation with service providers, plan also encompasses schools, staff, etc. the ongoing work in Ongoing project. coordination and reorganising early intervention services

Dublin SW St Brigid's Home - explore skill mix in the context of support staff.

Dublin SW St. Loman's Mental Maximise use of staff pool Health Service - explore & introduce staffing levels based on occupancy not capacity. - engage with staff on redeployment opportunities due to the closure of Rehabilitation Centre.

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APPENDIX 6

contd.

LHO/Hospital Area Description of Initiative Implementation Summary of Service PSA Priorities: Timeframe/Progress Improvement(s) 1. Extended day and 5 over 7 working 2. Optimising staff/service levels 3. Reduction in in-patient days 4. Extended delivery of service on a day basis and in community settings 5. Reconfiguration of services (including ISAs) 6. Compliance and EWTD 7. Centralisation of non- front line functions/activities Dublin SW Parnell Road Health Centre- explore the transfer of services to improved fit for purpose premises.

Dublin SW Clerical Administration Maximise staff resource -explore & engage with staff re service improvement & flexible working opportunities in order to operate extended working day e.g. 8am to 8pm.

Dublin SW Medical Cards centralise Maximise staff resource function to PCRS & engage with staff re primary care team redeployment opportunities.

Dublin South Central Mental Hospital, Sep-10 Attendants will be 1 Dundrum explore & available for patient care. engage with staff re service improvement & efficiency opportunities.

Dublin South Dalkey Unit for the Dependant on Improved in terms of 1 Elderly redeployment of staff quality and quantity of - increase staffing & from other units which services through reduce agency/overtime may be reduced in consistent deployment of by exploring internal capacity or closed. staffing rather than a deployment options from variety of inputs from other long stay agency resources. units/hospitals or LHOs.

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APPENDIX 6

contd.

LHO/Hospital Area Description of Initiative Implementation Summary of Service PSA Priorities: Timeframe/Progress Improvement(s) 1. Extended day and 5 over 7 working 2. Optimising staff/service levels 3. Reduction in in-patient days 4. Extended delivery of service on a day basis and in community settings 5. Reconfiguration of services (including ISAs) 6. Compliance and EWTD 7. Centralisation of non- front line functions/activities Dublin South National Counselling End 2010 Improved/enhanced client 2 Service focused quality service - re-organise services & delivery. functions into a single structure.

Dublin S, SE & Older Persons & Long Improved use of staff 2 Wicklow Stay Units Review needs, resource for patient care capacity and all aspects of provision with view to amalgamation across 3 LHOs in East Coast.

Dublin S. E. & To review Community 2 Wicklow Medical Services with a view to rationalisation and making best use of available resources in context of overall National review of Community Medical Services.

Dublin S, SE & Dental Services Dependant of staff Improved use of staff 2 Wicklow explore & engage with willing to work across resource for patient care staff in reviewing current current boundaries. provision and establishing service across 3 LHOs, Wicklow, Dublin South and Dublin South East.

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APPENDIX 6

contd.

LHO/Hospital Area Description of Initiative Implementation Summary of Service PSA Priorities: Timeframe/Progress Improvement(s) 1. Extended day and 5 over 7 working 2. Optimising staff/service levels 3. Reduction in in-patient days 4. Extended delivery of service on a day basis and in community settings 5. Reconfiguration of services (including ISAs) 6. Compliance and EWTD 7. Centralisation of non- front line functions/activities Dublin S, SE & Pre School Service Improved use of staff 2 Wicklow In context of decision to resource for patient care regionalise pre-school service explore & engage with staff on best way to amalgamate service across the 3 LHOs in East Coast.

Dublin S, SE & Therapy Managers Improved use of staff 2 Wicklow Explore & engage with resource for patient care staff re the amalgamation of management of therapy services between statutory and non statutory services.

Dublin South East Sir Patrick Duns & in progress Improved Service for 2 Baggot Street Hospital patients Reconfiguration of daycare services for older persons from both of these to improved fit for purpose unit. In Clonskeagh.

Wicklow Extended working hours Oct-10 Improvement in public 3 explore & engage with opening times staff re Community Services Lunchtime opening (all health centres)

Wicklow Older Persons Units Dependant on More appropriate service 2 - explore & optimise redeployment of staff delivery. potential for patients & staff in amalgamating Older Persons Units.

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APPENDIX 6

contd.

LHO/Hospital Area Description of Initiative Implementation Summary of Service PSA Priorities: Timeframe/Progress Improvement(s) 1. Extended day and 5 over 7 working 2. Optimising staff/service levels 3. Reduction in in-patient days 4. Extended delivery of service on a day basis and in community settings 5. Reconfiguration of services (including ISAs) 6. Compliance and EWTD 7. Centralisation of non- front line functions/activities Laois Offally Redeployment Improved use of staff 1 opportunities resource for patient care - explore & determine redeployment opportunities across service locations e.g. Riada House and Alverina. Laois Offally Meat Processing Unit Staff available for 1 - cessation of non core redeployment business

Laois Offally Older Persons -explore & Redeployment of nurses 2 develop a social elderly and into frontline services day care model in and the and appropriate partnership with the upskilling of staff to voluntary organisations continue manage quality e.g.Offaly x 2. service explore & engage with staff on redeployment opportunities. Laois Offaly Back office Functions - centralise non-front line functions e.g. account processing function.

Laois Offally Administration Function -reorganise & optimise administration functions to reduce overheads e.g. patient private property & hospital & community payroll.

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APPENDIX 6

contd.

LHO/Hospital Area Description of Initiative Implementation Summary of Service PSA Priorities: Timeframe/Progress Improvement(s) 1. Extended day and 5 over 7 working 2. Optimising staff/service levels 3. Reduction in in-patient days 4. Extended delivery of service on a day basis and in community settings 5. Reconfiguration of services (including ISAs) 6. Compliance and EWTD 7. Centralisation of non- front line functions/activities Laois Offaly Administration Function Maximise use of clerical - map & evaluate current administrative staff administration roles to optimise service provision/delivery functions by engaging with staff about the restructuring of roles/responsibilities e.g. Tullamore, PCCC, Portlaoise and Mental Health.

Laois Offaly ID Sector - explore & Enhanced quality of life for 2 identify optimum service residents for Alvernia residents, e.g. community service provided by a voluntary agency.

Laois Offaly explore & engage with Improved public access to 3 staff re the service services improvement & flexible working opportunites in order to operate extended working day e.g. 8am to 8pm.

Laois Offaly Registration of births Improved public access to 3 deaths & marriages services (Mon-Fri 9-5pm) -explore & evaluate need & potential to provide weekend service.

Laois Offaly Extended working week Improved public access to 3 -explore & engage with services staff re potential for extended working week i.e. 5/ 7 working.

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APPENDIX 6

contd.

LHO/Hospital Area Description of Initiative Implementation Summary of Service PSA Priorities: Timeframe/Progress Improvement(s) 1. Extended day and 5 over 7 working 2. Optimising staff/service levels 3. Reduction in in-patient days 4. Extended delivery of service on a day basis and in community settings 5. Reconfiguration of services (including ISAs) 6. Compliance and EWTD 7. Centralisation of non- front line functions/activities Laois Offaly Rosters & Skill Mix - Improved public access to 3 explore & engage with services staff re revised rosters that includes appropriate skill mix. - explore & engage with staff to provide optimal roster arrangements e.g. Older Persons, Disabilities, Mental Health & Child Care Residential Services Longford Loughloe House Closing Improved Quality 2 Westmeath with agreed redeployment of staff to St. Vincent’s Hospital Athlone.

Longford St. Mary’s Mullingar and Improved Quality 2 Westmeath St Joseph’s Longford - explore & engage with staff & public re the reconfiguration of optimum older persons services.

Longford ID Sector - explore & Improved Quality 2 Westmeath identify optimum service for Lough Sheever residents e.g. community houses.

Longford ID Sector- perform a Improved Quality 2 Westmeath review of respite services.

DML Childcare- explore Pilot in one LHO/ISA Clarity on roles, 1 optimum Child Care over next 12 months and responsibilities. Clear

Management structures. full roll out thereafter. governance and quality focus.

DML Regional Service Plan 2011 122

APPENDIX 6

contd.

LHO/Hospital Area Description of Initiative Implementation Summary of Service PSA Priorities: Timeframe/Progress Improvement(s) 1. Extended day and 5 over 7 working 2. Optimising staff/service levels 3. Reduction in in-patient days 4. Extended delivery of service on a day basis and in community settings 5. Reconfiguration of services (including ISAs) 6. Compliance and EWTD 7. Centralisation of non- front line functions/activities DML Childcare- implement Uniform approach across 2 standardised business entire system. processes for child welfare/protection system. - I.T. deployment to start in tandem with implementation.

DML Childcare- implement By year end 2010 Improved service access/ 2 extended working day in coverage during out of social work services. hours periods.

DML Childcare- complete Quarter 4 2010 Improved standards, 2 procurement process for proper private providers of oversight/governance childcare services (e.g. arrangements. Enhanced residential care etc). placement options.

DML Childcare- complete Quarter 3 2010 Maximum use of available 2 implementation of resources including those residential childcare provided by private sector. placement panel.

DML Childcare- complete Consistent approach to implementation of foster foster care throughout care placement panel on a DML regional basis.

DML Childcare- implement Ongoing following Consistent approach to Children First as per publication of revised foster care throughout national guidance. guidelines. DML

DML Regional Service Plan 2011 123

ABBREVIATIONS

Abbreviations

ALOS Average Length of Stay ISP Integrated Services Programme AMNCH Adelaide Meath National Children’s Hospital KGH Kerry General Hospital AMP Acute Medicine Programme LGBT Lesbian, Gay, Bisexual and Transgender AMU Acute Medical Unit LHO Local Health Office ANP Advanced Nurse Practitioner MAU Medical Assessment Unit BGH Bantry General Hospital MDS Minimum Data Set CAMHS Child and Adolescent Mental Health Services MDT Multi-Disciplinary Team CEO Chief Executive Officer MHC Mental Health Commission CME Continuing Medical Education MMR Measles, Mumps, Rubella vaccine CMH Central Mental Hospital MRSA Methicillin-resistant Staphylococcus Aureus CMHT Community Mental Health Team MUH Mercy University Hospital CNU Community Nursing Unit NCCIS National Child Care Information System CPP Crisis Pregnancy Programme NCCP National Cancer Control Programme CUH Cork University Hospital NCHD Non-Consultant Hospital Doctor DNA Did Not Attend NCR National Cancer Registry DML Dublin Mid Leinster NHSS Nursing Homes Support Scheme DNE Dublin North East NQS National Quality Standards DOF Department of Finance NRS National Recruitment Services DOHC Department of Health and Children NSP National Service Plan DTSS Dental Treatment Services Scheme OLCH Our Lady’s Children’s Hospital EAG Expert Advisory Group OPD Outpatient Department ECD Executive Clinical Director PCI Percutaneous Coronary Intervention ED Emergency Department PCRS Primary Care Reimbursement Scheme EMP Emergency Medicine Programme PCT Primary Care Team ESP Elective Surgery Programme PHN Public Health Nurse GI Gastrointestinal PI Performance Indicator GMS General Medical Service PR Performance Report GP General Practitioner PSA Public Service Agreement HCAI Health Care Associated Infection PTS Patient Transport Service HCP Home Care Package QCC Quality and Clinical Care HIQA Health Information and Quality Authority RT Rehabilitative Training HPV Human Papilloma Virus RTA Road Traffic Accident HR Human Resources SAT Single Assessment Tool HSCN Health and Social Care Network SIVUH South Infirmary Victoria University Hospital HSE Health Service Executive SLA Service Level Agreement ICGP Irish College of General Practitioners STEMI ST Elevation Myocardial Infarction ICRU Intensive Care Rehabilitation Unit VER Voluntary Early Retirement ICT Information Communication Technology VRS Voluntary Redundancy Scheme ICU Intensive Care Unit VFM Value for Money ICV Intermediate Care Vehicle WTE Whole Time Equivalent IDU Intravenous Drug User ISD Integrated Services Directorate

DML Regional Service Plan 2011 124

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DML Regional Service Plan 2011 125

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