HSE annual report and financial statements 2006 (1.24 MB)
Item Type Report
Authors Health Service Executive (HSE)
Rights Health Service Executive
Download date 25/09/2021 17:07:15
Link to Item http://hdl.handle.net/10147/45400
Find this and similar works at - http://www.lenus.ie/hse 543,000 day cases treated 1,269,000 attendances at Emergency Departments
594,000inpatients treated 2,779,000 outpatient attendances 11,431,000 home help hours provided
ANNUAL REPORT AND FINANCIAL STATEMENTS 2006 In 2006 The Health Service Executive (HSE) Delivered:
• Improvements in Emergency Department (ED) waiting times
Number of HSE Patients in ED at 2pm awaiting admission after decision to admit has been made (2005 and 2006)
300
250
200
150
100
50 Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec
2005 2006
• Standardisation of National Procedures to Improve Quality of Services
• National Framework for Emergency Planning
• Nursing Home Inspections
• Value for Money
• National contracts agreed to utilise the purchasing power of the HSE for:
• Drugs and Medicines
• Insurance
• Estate
• Highlights of 2006
• Inpatients treated 594,059
• Day Cases treated 542,671
• Emergency Department attendances 1,268,991
• Outpatient attendances 2,778,602
• Births 62,745
• Home Help Hours delivered 11,430,570
ISBN 978-1-906218-01-0 © 2007 HSE Contents
Introduction
Overview of the Health Service Executive...... 4
Chairman’s Statement ...... 8
Board Membership ...... 10
Chief Executive Officer’s Statement ...... 12
Senior Management Team ...... 14
Legal Reporting Framework ...... 15
Review of 2006
Structure of the Population ...... 19
Population Health ...... 21
Primary, Community and Continuing Care ...... 26
National Hospitals Office ...... 34
Support Services ...... 41
Financial Statements
Operating and Financial Review ...... 53
Board Members’ Report ...... 57
Statement of Board Members’ Responsibilities ...... 60
Statement on the System of Internal Financial Control ...... 61
Report of the Comptroller and Auditor General ...... 65
Financial Statements ...... 67
Accounting Policies ...... 71
Notes to the Financial Statements ...... 75
Appendices to the Financial Statements ...... 91 2006
Health Service Executive, Annual Report 2006 03 Introduction
Overview of the Health Service Executive (HSE)
The HSE is responsible for managing 2. Support Services and delivering health and personal The corporate functions provide support services necessary to enable the organisation to function social services in the Republic efficiently and cost effectively. These include: of Ireland. • Office of the CEO; • Finance; It is the largest employer in the State, employing 70,000 • Human Resources; staff directly and funding a further 36,000 staff. The €12.4bn budget in 2006 is the largest of any public • Information and Communication Technology; sector organisation in Ireland. The HSE provides • Estates; thousands of different acute (hospital) and non-acute services. • Procurement; and • Corporate Planning and Control Processes. These services are wide ranging and include: • treating older people in the community; 3. Strategic Planning Reform and Implementation • caring for children with challenging behaviour; (SPRI)
• performing highly complex surgery; Supports the delivery of the Transformation • controlling the spread of infectious diseases; Programme 2007-2010. • educating people to live healthier lives; and Figure 1: Areas of Operation • planning for potential major emergencies. Health and Personal Social Services At some stage every year, almost everybody in Ireland will use one or more of the services provided. These services are of vital importance to the entire population. Population Health The HSE has three clearly defined areas of operation: Primary, Community and Continuing Care 1. Health and Personal Social Services National Hospitals Office Population Health: Promotes and protects the health of the entire population. Support Primary, Community and Continuing Care (PCCC): Services SPRI Delivers non-acute services in the community through 32 Local Health Offices across the country.
National Hospitals Office (NHO): The Fundamental Purpose of the HSE is: Provides acute hospital and ambulance services throughout the country. To enable people live healthier and more fulfilled lives.
04 Health Service Executive, Annual Report 2006 Organisation Structure of the HSE
Figure 2: Organisation Structure of the HSE
Board
Internal Audit
CEO
Primary, National Population Community and Hospitals Office Health Continuing Care (NHO) (PCCC)
Service Delivery Functions
Corporate Office Information Human Planning of the Finance Communication Estates Procurement SPRI Resources and Control CEO Technology Processes
Support Services Supporting delivery of the Transformation Programme 2007-2010
Health Service Executive, Annual Report 2006 05 Location of HSE’s Four Adminstrative Areas and 32 Local Health Offices
Figure 3: HSE’s Four Adminstrative Areas and 32 Local Health Offices
HSE Administrative Areas Dublin North-East Dublin Mid-Leinster South West Donegal
Sligo/Leitrim
Cavan/Monaghan Mayo Louth Roscommon
North Dublin Meath Longford/Westmeath North West Dublin
Dublin North Central Galway Kildare/ Dublin South City Laois/Offaly West Dun Laoghaire Wicklow Dublin South East Wicklow Dublin South West
Clare Dublin West North Tipperary/ East Limerick
Carlow/Kilkenny
Limerick Tipperary SR Wexford
North Cork Kerry Waterford
North Lee
South Lee West Cork
06 Health Service Executive, Annual Report 2006 Location of HSE’s 52 Acute Care Hospitals
Figure 4: 52 Acute Hospitals
HSE Administrative Areas Dublin North-East Dublin Mid-Leinster Letterkenny South West West/North Western North Eastern Hospitals Group Hospitals Group • Louth County • Letterkenny General Hospital, Hospital Dundalk • Sligo General Hospital Monaghan • Our Lady Of Lourdes • Mayo General Sligo Hospital, Drogheda Hospital, Castlebar • Our Lady’s Hospital, • Roscommon County Cavan Dundalk Castlebar Navan Hospital • Monaghan General • Portiuncula Hospital, Roscommon Drogheda Hospital Ballinasloe • Cavan General • University College Navan Hospital Hospital Galway Mullingar • Merlin Park Regional Hospital, Galway Galway (2) Tullamore Naas Dublin (16) Ballinasloe Portlaoise Mid Western Dublin North East Hospitals Group Ennis Nenagh Hospitals Group • Mater Misericordiae • Mid Western Regional Kilkenny (2) University Hospital, Hospital, Nenagh, Co Dublin Tipperary Limerick (3) Cashel • Beaumont Hospital, • Mid Western Regional Croom Dublin Hospital, Ennis, Co. Clonmel • Connolly Hospital, Clare Tralee Wexford Blanchardstown, Waterford • Mid Western Regional Mallow Dublin Hospital, Dooradoyle, • Rotunda Hospital, Limerick City Dublin • Mid Western Regional Cork (5) • Children’s University Maternity Hospital, Hospital, Temple Limerick City Bantry Street, Dublin • St John’s Hospital, • Cappagh National Limerick City Orthopaedic Hospital, • Mid Western Regional Dublin Orthopaedic Hospital, Croom, Co. Limerick
Southern Hospitals Group South Eastern Hospitals Group Dublin Midlands Hospitals Group Dublin South Hospitals Group
• Cork University Hospital • Wexford General Hospital • Adelaide & Meath & National • St Vincent’s University Hospital, Elm • Erinville Hospital, Cork • Waterford Regional Hospital Children’s Hospital,Tallaght,Dublin Park, Dublin • St Mary’s Orthopaedic Hospital, • St Luke’s General Hospital, Kilkenny • Coombe Women’s Hospital,Dublin • St Michael’s, Dun Laoghaire, Dublin Gurranebraher, Cork • Lourdes Orthopaedic Hospital, • Our Lady’s Childrens Hospital, • St Colmcille’s Hospital, • Mercy University Hospital, Cork Kilcreene, Kilkenny Crumlin, Dublin Loughlinstown, Dublin • South Infirmary-Victoria University • South Tipperary General Hospital, • Naas General Hospital • National Maternity Hospital, Hospital, Cork Cashel • Midland Regional Hospital, Mullingar Holles Street, Dublin • Mallow General Hospital • South Tipperary General Hospital, • Midland Regional Hospital,Tullamore • St Luke’s Hospital, Dublin Clonmel • Kerry General Hospital, Tralee • Midland Regional Hospital,Portlaoise • Royal Victoria Eye and Ear, Dublin • Bantry General Hospital • St James’s Hospital, Dublin
City of Dublin Skin and Cancer, Hume Street Hospital, Dublin closed during 2006. This service is now provided at St Vincent’s University Hospital, Elm Park, Dublin.
Health Service Executive, Annual Report 2006 07 Chairman’s Statement
Service Delivery The HSE’s annual National Service Plan sets out the health and personal social services it is committed to providing each year. The Service Plan for 2006 was adopted by the Board at the start of the year and approved by the Minister for Health and Children. I am happy to report that the HSE delivered on all major requirements of that Plan within the financial resources allocated. In addition, in many areas of service a significant increase in the level of activity was provided in 2006 compared to 2005.
The overall strategy of the HSE Board and Management is to make it easier for people to access appropriate health services when and where they need them. This requires a re-balancing of the system and a redirection of care delivery to the most appropriate settings. The continued development of Primary Care Teams and the provision of out-of-hours General Practitioner services are fundamental to making it easier for people to access care closer to their homes. Reducing the dependency on acute hospitals by improving community services and increasing the availability of more appropriate beds is also of critical importance. I am pleased to say that In relation to Acute Hospitals, good progress was made much progress has been in 2006 towards reconfiguring the national hospital system to improve patient care and safety. The Board made by the HSE during approved the report on hospital services in the North East region and work is underway on its implementation. 2006 and the benefits of a A decision was made on the location for a new National Paediatric Hospital and the project in relation to the co- single national organisation location of private hospitals on public hospital campuses was advanced. for the efficient delivery of In 2006, new developments were initiated in a number of health and social services in services. These include; Radiotherapy services, Renal Services, Mental Health, Disability and services for Older Ireland are becoming People. These are described in subsequent sections of this Annual Report. increasingly evident. This During the year, particular attention was given to the Annual Report details many running of Emergency Departments and a range of initiatives were overseen by the Winter Initiative of the new initiatives and Programme. This resulted in a substantial reduction in the numbers and delay time for people waiting in Emergency improvements in services Departments for hospital admission. This is despite an increase of 3.3% in the numbers who presented at progressed during the year. Emergency Departments.
08 Health Service Executive, Annual Report 2006 Listening to Patients and Service Providers The development of new approaches to performance We are aware of the vital importance of listening to measurement and accountability is providing transparency patients and service providers, and acting on their across the system and will help ensure, for the future, concerns and inputs. Two important initiatives were that funding is applied in the most effective way to benefit started in 2006. patient care.
Firstly, four Expert Advisory Groups (EAGs) were set up Working Together for Patients & Clients to ensure that the experience of those involved in I would like to thank everyone throughout the organisation providing and receiving services is applied in the delivery for their important individual and team contributions to the of services. The EAGs play a central role in the delivery of our health and social services, often in difficult development of operational policy for the HSE. circumstances. The commitment of Management and the Secondly, we also developed a policy and procedures for dedication of all staff throughout the system is greatly the handling of complaints and the designation of appreciated, particularly at a time of significant change Complaints Officers was underway by the end of 2006. and transition. A commitment to improving patient care These and other feedback methods will enable ongoing must remain a key shared value and driver for all of us. service improvements. During the year, the HSE engaged with staff directly and Also during 2006, four Regional Health Forums were through their representative bodies to address important established under Part 8 of the Health Act, 2004. These transformation and reform matters. This is an ongoing Forums make representations to the HSE on service process and one we will continue to work on in the related issues. coming year.
Financial Management Conclusion I am pleased to confirm that in 2006, as in the previous I would like to acknowledge the contribution of my fellow year, the HSE delivered increased levels of service to a Board members throughout 2006. The Board met on 17 growing population within the resources approved by occasions and, in addition, a significant number of Board Dáil Éireann. committee meetings were also held. The Board remains highly committed to delivering on the purpose for which it As a single national organisation, we are now in a strong was established. position to leverage savings and efficiencies across a number of areas and activities. In 2006, important I would like to thank the Minister for Health and Children, initiatives were commenced to deliver improved efficiency Mary Harney TD and the Ministers of State for their and cost reduction. These include a Value for Money continuing strong support and encouragement for the (VFM) programme, a unified approach to Procurement work of the HSE. and a Shared Services plan for key support areas. The establishment of a single Estates function to manage our Despite many challenges and difficulties, 2006 was a year entire property portfolio and capital spending has brought, of real progress and achievement across a broad range of for the first time, a cohesive approach and provided the areas, many of which are referenced in this Annual opportunity to maximise value and leverage from our Report. I look forward in the year ahead to further rapid property assets. progress and implementation of the many initiatives underway for the benefit of our patients and clients. Corporate Governance In 2006, the Board approved a Code of Governance, which is detailed on page 59. The Code, which is a suite of inter-related documents, forms the governance framework for the HSE. Mr. Liam Downey During 2006, the Board also established a Risk Chairman Committee, which assists the Board in fulfilling its duties Health Service Executive (HSE) by providing an independent and objective review, in relation to non-financial risks.
Health Service Executive, Annual Report 2006 09 Board Membership
Mr Liam Downey
Professor Niamh Brennan Dr Donal de Buitleir Professor Brendan Drumm Mr P.J. Fitzpatrick
Dr Maureen Gaffney Mr Joe Macri Mr Eugene McCague Mr Michael McLoone
Professor Michael Murphy Professor John A Murray Professor P Anne Scott
10 Health Service Executive, Annual Report 2006 Mr Liam Downey is the former Chief Executive of Becton Mr Joe Macri is Managing Director of Microsoft Ireland. He is Dickinson Ireland, a medical technology company. He is a a member of the Management Board of ICT Ireland and former President of the Federation of Irish Employers and was IBEC’s National Executive Council and was appointed a Trustee and member of the National Executive Council of Chairman of the Small Business forum by Minister for IBEC. He is a former Chairman of the Irish Medical Devices Enterprise, Trade and Employment, Mr. Micheál Martin TD in Association and until March 2006 was a member of the July 2005. An Australian national, he holds an MBA from Labour Relations Commission. He is a graduate of University Warwick Business School (UK) and a Bachelor of Science College Dublin and a Fellow of The Irish Management Institute. degree from Sydney University (Australia).
Professor Niamh Brennan, a chartered accountant, is Michael Mr Eugene McCague is a solicitor and Chairman of Arthur MacCormac Professor of Management at University College Cox. He is a graduate of University College Dublin and is Dublin. She is Academic Director of the Institute of Directors’ President of the Dublin Chamber of Commerce. Centre for Corporate Governance at UCD. Professor He is a member of the Board of Co-operation Ireland and a Brennan chaired the Commission on Financial Management former chairman of the governing body of the Dublin Institute and Control Systems in the Health Service. of Technology.
Dr Donal de Buitleir is General Manager, Office of the Chief Mr Michael McLoone has been County Manager with Executive of AIB Group. Prior to joining AIB, he was Assistant Donegal County Council since 1994. In 1988 he was Secretary in the Office of the Revenue Commissioners, and seconded to Beaumont Hospital as Chief Executive. was Secretary to the Commission on Taxation 1980-1985. Dr He was appointed Chairman of the Governing Body of de Buitleir was a member of the Commission of Financial Letterkenny Institute of Technology in 1997. Mr McLoone was Management and Control Systems in the Health Service. He Chairman of the Irish Blood Transfusion Board from is Chairman of the Civil Service Performance Verification September 2001 to September 2002. He was a member of Group set up under ‘Towards 2016’ and the Foundation for the Commission on Financial Management and Control Fiscal Studies. He is a Trustee of Eisenhower Fellowships. Systems in the Health Services.
Professor Brendan Drumm is the Chief Executive Officer of Professor Michael Murphy is President of University College the HSE. In 1981 he was appointed as a Consultant Cork and a former Dean of the Faculty of Medicine and Paediatric Gastroenterologist and Assistant Professor at the Health, University College Cork. His academic posts include University of Toronto and in 1989 was appointed as a the Postgraduate Fellowship in Clinical Pharmacology at the Consultant Paediatrician at the Regional Hospital, Limerick. In Royal Postgraduate Medical School, Hammersmith Hospital, 1991 he was appointed Professor and Head of the London and University of London (1980-1984), Faculty at the Department of Paediatrics at University College Dublin and University of Chicago (1984-1992), and Chairman of Clinical Consultant Paediatric Gastroenterologist at Our Lady’s Pharmacology (1989 – 1992) and Director of Hypertension Childrens Hospital, Crumlin. Professor Drumm is a reviewer of Programme (1986-1992). He is a former Chairman of the 20 publications, a member of the editorial board of three Health Research Board of Ireland. publications and has had almost 100 manuscripts, book chapters and reviews published. Professor John A Murray is Professor of Business Studies, School of Business, Trinity College Dublin. He has held Mr P. J. Fitzpatrick is Chief Executive Officer of the Courts positions at business schools in Europe, Asia and America. He Service. He is the first person to hold this position and was President of the Marketing Institute of Ireland, Chairman successfully managed the establishment of the Courts Service of the Board of the Institute of Public Administration and board as a new, independent, statutory agency. He previously held member of St. James’s Hospital. He was a member of the the position of Chief Executive Officer of the Eastern Health Steering Committee for The Audit of Structures and Functions Board. He holds an MSc in Organisational Behaviour from of the Health System undertaken by Prospectus Ltd for the Trinity College Dublin. Department of Health and Children.
Dr Maureen Gaffney is the Chair of the National Economic Professor P Anne Scott is Deputy President of Dublin City and Social Forum (NESF). She is a former Law Reform University and formerly held the post of Professor of Nursing Commissioner; Chair of the National Monitoring Committee and Head of the School of Nursing at DCU. Previously, she for the Programme for Revitalising Areas by Planning, held academic posts at the University of Stirling, Glasgow Investment and Development under the National Development Caledonian University and the University of Glasgow. Plan; Chair of the Council of the Insurance Ombudsman of Professor Scott is currently a member of the Governing Ireland and member of the Council of the ESRI. A psychologist Authority of Dublin City University and of the Board of the by profession, she is a former director of the Doctoral Health Research Board. She was formerly a member of the Programme in Clinical Psychology at Trinity College Dublin. Board of Governors of St. Vincent’s Hospital, Fairview.
Health Service Executive, Annual Report 2006 11 Chief Executive Officer’s Statement
At the outset I would like to thank all staff who are employed directly and indirectly by the HSE for their dedication to enabling the people we serve live healthier and more fulfilled lives.
For many staff, including doctors, nurses, consultants, therapists, administrators and managers, 2006 brought with it many challenges. While this is a natural part of all major transformation programmes, initiatives were introduced during the year to enable staff access the new opportunities that come with change. While this process is not complete, solid progress has been made.
Improvements in Services Against this backdrop of change, thanks to the tremendous commitment and efforts of thousands of staff, we continue to provide many excellent services. Many services have improved and many more will continue to get better.
For example, in 2006 the numbers waiting for admission from Emergency Departments were reduced by up to 60%, even though the number of people While 2005 will be attending increased. This has been driven by the Winter Initiative (see page 33) which has seen unrivalled remembered as the year collaboration and local leadership among local hospital and community services. the HSE replaced 17 80% of people can now see a GP at night and at separate health boards and weekends through the out-of-hours GP service. In North Dublin we opened five fully equipped treatment centres agencies, 2006 was the that are open every night and at weekends to provide urgent GP care, with virtually no waiting time. year we started to introduce During 2006 we initiated a five-year programme to greater consistency and establish 500 Primary Care Teams across the country. They have the potential to provide up to 90% of the accountability. health and social care people will ever need from within their own communities such as GP services, occupational therapy, physiotherapy, social work and so on.
These initiatives have come about from the efforts of staff, GPs and the leadership of representative bodies.
There are hundreds more examples around the country of where staff are providing and improving services. A Speech and Language Centre brought waiting times for initial assessments down from four months to six weeks
12 Health Service Executive, Annual Report 2006 by changing the way staff worked. Orthopaedic waiting New Era lists were reduced by introducing a multi-disciplinary team We are entering a new era in health and social care. It is approach to the assessment of patients with back pain. now accepted that we cannot do things as they have In one of our major hospitals out-patient waiting times been done in the past and at the same time demand were reduced by up to 80% following the introduction of change. We cannot have it both ways. new processes. Consistent measurement, accountability and control are In the area of elder care, in 2006, approximately 5,300 now part and parcel of the way we do business. Our first more people received Home Care Packages, which and foremost responsibility is to be fully accountable to included public health nursing, home help, physiotherapy the public. Only with this disciplined approach can we and occupational therapy, to enable them stay in their ensure that all funding is used to support services that own homes for longer. We also provided long stay care deliver better patient care. for an additional 1,050 people. That is not to say that the path ahead will be without Budgetary Control challenges. But we are now better placed to support each In addition to providing more services, more quickly, we other and work together to achieve our shared vision of a have operated within our allocated budget and exercised world class health and social care service. Our improved control over our employment numbers. Transformation Programme is the blueprint to ensure that we remain true to this ideal. Many benefits of being able to act as a single national purchaser were also realised during the year. Initiatives in In closing I would like to take this opportunity to thank areas such as pharmaceuticals, ambulances and the Board of the HSE for its support and Mr Michael insurance will yield savings of more than €300 million Scanlan, Secretary General of the Department of Health over the next five years. and Children and his officials for their ongoing support and assistance. Transformation Programme One of the most important organisational initiatives introduced during the year was the launch of our Transformation Programme 2007-2010. This will enable us to deliver on our vision which is for everybody to have easy access to high quality care and services that the public has confidence in and we are proud to provide. Professor Brendan Drumm Preparation of the Transformation Programme involved Chief Executive Officer considerable engagement with many stakeholders and Health Service Executive (HSE) clearly sets out what we are here to do, what we want to achieve and how we can get there.
The Programme sets out our six main priorities: • Simplified patient journeys; • Easier access to primary care; • Easier access to excellent hospitals; • More chronic illness programmes; • More transparent and measurable standards; and • Greater staff involvement in transformation.
We are now focused on achieving these priorities by a series of interconnected projects which have specific objectives, measures, milestones and accountabilities.
Health Service Executive, Annual Report 2006 13 Senior Management Team As at 31st December 2006
Professor Brendan Drumm Chief Executive Officer
Mr Aidan Browne Ms Ann Doherty Dr Patrick Doorley Mr Michael Flynn National Director of Primary, National Director of Corporate National Director National Director Community and Continuing Care Planning and Control Processes of Population Health of Internal Audit
Mr Brian Gilroy Mr Tommie Martin Mr Martin McDonald Ms Laverne McGuinness National Director of Estates National Director of the Office National Director of Human National Director of National of the Chief Executive Officer Resources Shared Services
Mr John O’Brien Mr Liam Woods Mr Leo Stronge Mr Damien McCallion National Director of National Director of Finance Head of Procurement Head of Information and National Hospitals Office Communication Technology
14 Health Service Executive, Annual Report 2006 Legal Reporting Framework
Under the provisions of the Health Corporate Plan
Act 2004, the HSE is required to In October 2005, the Minister for Health and Children approved the HSE Corporate Plan 2005-2008. This prepare and submit to the Minister Corporate Plan fulfills a number of roles. It outlines the HSE agenda for the period, identifies its response to the for Health and Children an Annual National Health Strategy (Quality and Fairness), reflects decisions of the Board and also takes account of other Report which includes the following: national policies and priorities. It maps out the future direction for health and personal social services and outlines what needs to be achieved through the annual National Service Plan (NSP) and associated business • A report on the implementation of planning process.
the Corporate Plan; The NSP sets out how the HSE delivers on its Corporate Plan on an annual basis. This is supported by a comprehensive business planning process (inclusive of a • A report on the implementation of performance monitoring framework) to facilitate its delivery by the HSE. the Service Plan;
National Service Plan (NSP) • A report on the implementation of The National Service Plan (NSP) 2006 outlines the level the Capital Plan; of health and personal social services to be provided by the HSE for the year, within the voted allocation of the Oireachtas as published in the Revised Book of • An indication of the Executive’s Estimates, and in accordance with government policy on employment control within the health service. The NSP is arrangements for implementing accompanied by a statement of the HSE’s estimate of income and expenditure relating to the plan, and by the and maintaining adherence to its Capital Plan for the year (as required under Section 31 of the Health Act 2004). Code of Governance (reported on The NSP is supported by detailed business plans, page 59); and identifying how the objectives and actions are achieved at each level of the health delivery system.
• A report on the number and type To ensure robust implementation of, and accountability for the NSP and associated business plans, a standardised of complaints received, their Performance Monitoring Framework was put in place throughout 2006. This Framework ensured that all levels investigation, review and of the HSE were monitored for the achievement of objectives within allocated resources and approved resolution (reported on page 47) employment levels.
The Performance Monitoring Framework details timeframes for completion of monthly and quarterly Performance Monitoring Reports. It also outlines the format of these reports, which includes both a qualitative and quantitative assessment of performance.
Health Service Executive, Annual Report 2006 15 Table 1: Significant Capital Developments in 2006 Performance is monitored by reporting against the objectives and actions outlined in the NSP, activity and performance measures (including the National Acute Non Acute Performance Indicator Suite) and also financial and human resource performance measures. Decisions to proceed with: Acquisition of: • National Paediatric • 350 public long stay A standardised approach to performance monitoring has Hospital beds in the Dublin area enabled the Board to oversee the implementation of the and 200 beds in the • New Regional Hospital Corporate Plan and the NSP, and to provide monthly and Cork/Kerry area to free for the North East quarterly Performance Monitoring Reports in accordance up acute beds in these with its legal obligations to account to the Minister for • Tender for Co-Located areas. Health and Children for the provision of services as Private Hospitals on specified within the Plan. Public Hospital sites. Construction of: • a further 100 beds in Capital Plan Funding was made Cherry Orchard and 250 available to: went out to tender. The capital provision sanctioned by the Department of • construct a series of Finance and included in the Vote for the HSE in 2006 was Admission Lounges to € Planning progressed at 555.5m. The total capital expenditure for the year improve facilities in the: amounted to €457.8m, including €26m in respect of Emergency projects which will accommodate the nursing degree Departments. Seven • National Rehabilitation programme. Additional expenditure was incurred on lounges commenced Hospital operation. capital projects funded by other government departments • Central Mental Hospital including the Department of Community, Rural and Gaeltacht Affairs. • Redevelopment of Planning continued for: Clonbrusk in Athlone. The underspend of €97.7m was partially due to the lack • Mater Misericordiae of anticipated progress on a number of major projects University Hospital Construction work (e.g. Mater Misericordiae University Hospital project and completed at: the National Rehabilitation project). Transition to the new • Wexford General Hospital capital monitoring and management structures also • Breastcheck Units in contributed to the underspend. • Ennis General Hospital Cork and Galway • Naas Hospital Phase 3C • Ballymun Primary Health These issues have been addressed for 2007. This Care Facility • Our Lady of Lourdes process is being actively managed by the Estates • St John’s Community Directorate, Primary, Community and Continuing Care Hospital, Drogheda Emergency Department. Hospital, Wexford (PCCC) and National Hospitals Office (NHO) Capital Steering Committees. • Thurles Community Hospital. The main capital priorities in 2006 were: Construction continued on developments at: • Procurement of individual projects; • Connolly Hospital, • Management of the capital allocation within available Blanchardstown resources; and • Midland Regional • Building of the HSE’s capacity to independently plan Hospital, Portlaoise. and deliver a Capital Plan.
Construction work completed at: • Cork University Maternity Hospital.
16 Health Service Executive, Annual Report 2006 Case Study The Children’s Sunshine Home
The overall winner of the 2006 Innovation Awards was The Children’s Sunshine Home, for the development of palliative care services for children. The Children’s Sunshine Home is a unique service for children with life limiting and life-threatening illnesses. The service offered is a tailor- made programme based on a fully inclusive approach to families in the decision making and care of seriously ill and dying children. Over the last two years The Children’s Sunshine Home has seen an increase in referrals of very ill children requiring support. The very complex needs of these children are met by providing step-down services to children from the acute children’s hospitals and special care baby units of the maternity hospitals. As well as helping families deal with the prognosis, where possible, families are supported to have their child cared for at home. The focus is about quality of life and putting life into a child’s day rather than days into a child’s life. Brenda, Niall and their daughter Vanessa’s story below is just one example of how The Children’s Sunshine Home has made a difference to a child and a family’s life.
Our Daughter Vanessa Just when we reached the point of total burnout in relation to Vanessa (we had managed her at home for more than nine years) we secured a place with The Children’s Sunshine Home. We now feel like a “normal” family. We can go places with Steven and Juliette, plan holidays and not carry the overwhelming burden of a severely disabled child by ourselves. We hope that Vanessa feels The Children’s Sunshine Home is a home as much as our own home. We know she is comfortable and relaxed in the bright and airy surroundings and we hope she can always be part of The Children’s Sunshine Home. Vanessa suffers with a profound mental and physical handicap making her totally dependent. We try to have Vanessa at home with us most weekends, but the fact that this is not an obligation and we can just bring her back into The Children’s Sunshine Home or take time off if things are hectic at home is such a relief. We cannot imagine a family quality of life without the wonderful work of The Children’s Sunshine Home. We find it very useful to be able to talk to our key worker Evelyn or our family support worker Brenda. It’s a great idea and we feel that if there are any problems we can contact these people and feel confident in their ability to follow through on any issues. Chartered Physiotherapists from Waterford Regional Hospital on their Annual Move for Health Day Review of 2006
Structure of the Population
In recent years the structure of the As the population ages, chronic diseases will increase Irish population has changed. and more community-based health services will be This has influenced the range of required so that people can continue to live in their services the HSE provides and how own communities. they are delivered. Table 2: Population by Age 1996-2006 Age 1996 2002 2006 % Change Fastest Growing Population in the European Union Group 1996-2006 The Central Statistics Office 2006 population census 0-9 533,337 541,720 590,577 +10.7% shows that there were 4,239,848 people living in the Republic of Ireland in 2006 compared with 3,917,203 in 10-19 665,623 598,896 564,129 -15.2% 2002. This increase of 8.2% in four years has brought the 20-29 552,399 641,027 715,553 +29.5% population to its highest level since 1861. 30-39 516,605 595,582 671,466 +30.0% Table 2 shows that in the ten years between 1996 and 40-49 465,841 521,588 576,074 +23.7% 2006 our population has increased at an annual average rate of 1.7%. This is the highest population growth rate in 50-59 340,454 428,137 472,396 +38.8% the European Union. 60-69 264,755 287,726 325,123 +22.8%
Ageing Population 70-79 196,639 201,944 211,618 +7.6% Also evident from Table 2 is that the population in every 80+ 90,434 100,583 112,912 +24.9% age group other than for those in the 10-19 age group has increased. The greatest percentage increase has Total 3,626,087 3,917,203 4,239,848 +16.9% been in the 50-59 age group. The increase of 24.9% in Source: Central Statistics Office Census Reports the 80+ years group is important to the health service.
Figure 5: Population by HSE Area 1996-2006
Source: Central Statistics Office Census Reports 1,400,000
1,200,000
1,000,000
800,000
600,000
400,000
200,000
0 1996 2002 2006
Dublin Mid-Leinster South West Dublin North-East
Health Service Executive, Annual Report 2006 19 Smaller Family Sizes Principal Causes of Death As the structure of the population changes, so does the Diseases of the circulatory system are the leading cause population’s health and social status. Smaller family sizes of death in Ireland, followed by cancer, respiratory are likely to reduce the ability of family members to care diseases and injury and poisonings as illustrated in for each other in a way that was possible in times past. Figure 7.
Figure 7: Principal Causes of Death Net Positive Migration There are now more people coming to live in Ireland than Other 17% Circulatory disease 36% there are leaving the country. This net positive migration means that the HSE will need to deliver health and social care services to a more multi-ethnic mix of cultures. Injury and poisoning 5%
Family Structure Other changes affect the sense of well being of adults and children and in turn put pressures on the health and social care services. These changes include: • increased marital breakdown; Respiratory • the need for both partners in a marriage or disease 14% relationship to be in paid employment; and • long journeys to work for many people. Cancer 28% Impact of Demographic Changes on Health Services Population projections from the Central Statistics Office suggest that the population will continue to grow and could reach 5.8 million by 2036. Figure 6 shows the expected change in the population by age group. Of particular interest is the projected growth in the 45-64 and 65+ age groups. The way that the health services develop will need to take the changing population structure into account.
Figure 6: Population Projections 2007-2036, Extrapolated from Central Statistics Office Population Projections
1,800,000
1,600,000
1,400,000
1,200,000
1,000,000
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0 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 2020 2021 2022 2023 2024 2025 2026 2027 2028 2029 2030 2031 2032 2033 2034 2035 2036
0-14 15-24 25-44 45-64 65+
20 Health Service Executive, Annual Report 2006 Population Health
Population Health is responsible for Key Developments in promoting and protecting the health of Population Health in 2006 the whole population, with particular Health Intelligence emphasis on reducing health inequalities. It gathers research and Health Atlas Ireland information about health services Health Atlas Ireland is an innovative project that commenced in 2006 in conjunction with the Information, that the HSE can then draw on to Communication and Technology division. It integrates: make corporate decisions. It also • geographical information system (mapping) works to: technologies; • closely observe, manage and • information on health-related databases; and control infectious diseases; • statistical techniques.
• make sure that there are The coronary care service is just one example of how appropriate plans in place for Health Atlas can be used. It can, for example, map out public health emergencies; the number of coronary procedures against a background of the occurrence of heart disease; showing the location • develop public health policies; of current and planned specialist cardiac facilities and transport networks. This type of information can be used • implement health promotion to make decisions about how to develop the service. programmes; and Alcohol and Road Traffic Accidents • improve the health of the In 2006 the HSE carried out and published the first ever population by working with other in-depth analysis on the role of alcohol in road traffic sectors outside the HSE. accidents in Ireland. It found that there was a need to strictly enforce random alcohol breath-testing programmes. This significantly influenced the attitudes of Government and society in general. Key aspects of its work include: Health Intelligence Website • Health Intelligence; The Health Intelligence website, www.healthintelligence.ie was developed and went live in 2006. It provides: • Health Promotion; • health information and surveillance data; • Health Protection; • evidence-based health care supports; and • research and development support for health • Strategic Planning; and technology assessment. • Emergency Planning. FACTFILE Together with the National Communications Unit, Population Health began developing a FACTFILE website to provide timely, accurate and clear information about the HSE to the general public.
The HSE and An Post collaborated to launch a health information resource for older people. People in the Midlands received a comprehensive information pack on a number of health-related topics when they collected their pensions from their Post Office. In total 15,000 packs were distributed through 92 Post Offices in Laois, Offaly, Longford and Westmeath.
Health Service Executive, Annual Report 2006 21 Advocacy Toolkit Schools Training In collaboration with the Northern Ireland Health and The Health Promotion unit: Social Services Board, Population Health has developed • gave specially designed training in 628 primary an electronic public health advocacy toolkit. It is tailored schools and 149 secondary schools; to the needs of public health practitioners concerned with improving health and well-being and reducing health • assisted in 290 primary and 450 secondary schools to inequalities. These practitioners include those working in: develop at least one health promotion policy; and • health and social care; • organised more than 300 community-based health promotion initiatives. • training and education organisations; and • community and voluntary groups. National Health Promotion Campaigns The division also commissioned and managed national Health Promotion health promotion public awareness campaigns, based on priority areas that need to be addressed in Ireland. The Health Promotion division delivered health promotion projects across the country and developed and funded These priority areas in 2006 were: partnerships with key non-governmental agencies, • alcohol abuse; including the: • quit smoking; • Irish Cancer Society; • breastfeeding; and • Irish Heart Foundation; • sexual health. • National Youth Health Programme; • Irish Osteoporosis Society; and • Irish Sports Council. Health Protection
HSE and External Training Health Care Acquired Infection The Health Promotion division trained 5,000 HSE In 2006 the baseline rate of Healthcare Acquired Infection healthcare workers and 6,000 individuals from external (HCAI) in Ireland was 4.9%, or one in 20 patients. This agencies in health promotion activity. People trained in compared to 8.2% in England. external agencies included: The level of Methicillin Resistant Staphylococcus Aureus • 1,000 from other statutory bodies; (MRSA) was 0.5%, or one in 200 patients. MRSA is a • 500 in the private sector; type of HCAI. The HSE has prioritised this area and plans to reduce HCAI by 20% and MRSA by 30% over the next • 3,500 in the community and voluntary sector; and five years. • 1,000 others. The Health Protection division has further developed and The division also worked with individuals in 150 non-HSE distributed guidelines to healthcare settings on the work places to promote health. prevention and management of HCAIs. This included fact sheets and education and resource materials.
An initiative to increase knowledge and awareness of oral health issues among students in four West Kerry schools took place in 2006. Students were given a presentation on healthy eating and the effects of sugar on teeth. A sugar display was used in conjunction with the food pyramid to display various food items and the current trend in todays teenage diet.
22 Health Service Executive, Annual Report 2006 Detection of Infectious Diseases The first national phone survey to estimate the uptake of In 2006 the Computerised Infectious Disease Reporting influenza and pneumococcal vaccine was conducted. System was extended to cover more than 85% of the Results are shown in Table 4. country. This allows early detection and management of infectious diseases, which reduces their impact on This information enables the specific targeting of high the population. risk groups in future vaccination campaigns.
Table 4: Uptake of Vaccines Survey 2006 Health Protection investigated 10,668 cases of infectious diseases that were reported by Departments of Public Vaccine 65+ 18-64 Health. 314 outbreaks of infectious disease involving more than 5,000 patients were investigated. Influenza vaccine 69% 28% The most common infectious diseases reported are Pneumococcal vaccine 41% 11% outlined in Table 3.
Table 3: Notification of Infectious Diseases 2005 and 2006 Environmental Pollution 2005 2006 Change Fact-sheets were developed relating to environmental pollutants that can damage people’s health. Examples Acute infectious include information about carbon monoxide poisoning gastroenteritis 2,403 2,193 – 210 for General Practitioners and radon and nitrates in Campylobacter drinking water. infection 1,803 1,818 +15 Noroviral infection Strategic Planning (Vomiting Bug) 1,054 1,611 +557 Hepatitis C 1,438 1,215 – 223 Model of Care The Strategic Planning division developed a Population Hepatitis B 899 844 – 55 Health Model of Care to increase the chance of Mumps 1,081 425 – 656 sustaining a healthy population. This new model Salmonellosis 348 421 +73 focuses on: Cryptosporidiosis 569 361 – 208 • rebalancing funding in favour of investment in disease Others 1,632 1,780 +148 prevention; Total 11,227 10,668 – 559 • reducing health inequalities; and • shifting the emphasis from hospital to primary care.
Norovirus Experience internationally suggests that this approach is Norovirus infection outbreaks in acute hospitals and likely to be the least expensive model over time and will community facilities were responsible for 147 outbreaks. maximise the benefit to the population. Active control measures were put in place in all healthcare settings to minimise the impact of these Patient Support Programme outbreaks on the population. These measures were based A National Chronic Disease Management Patient Support on the national guidelines prepared by the Health Programme was developed for the HSE in 2006. Rollout Protection Surveillance Centre. of this programme will commence in 2007.
Childhood Vaccination Heartbeat Programme Childhood vaccination rates are now at 90%. Lower A heart health programme, called Heartbeat, was uptake areas have been identified and targeted for introduced in five hospitals. Heartbeat uses the American special attention. Institute for Healthcare Improvement methodology. It aims to reduce in-hospital mortality from heart attacks by Other Vaccines increasing the percentage of patients who receive all The Haemophilus influenza type b (Hib) vaccine booster components of care. campaign, designed to minimise Hib vaccine failure amongst 220,000 children, was delivered during 2006.
Health Service Executive, Annual Report 2006 23 Radiation Oncology • 30 Emergency Departments now have at least one The division contributed to the national plan for radiation dedicated member of staff to respond to people who oncology and also assessed the needs of radiation present with self-harm. oncology services including: The Cluain Mhuire mental health service in South Dublin • equipment; now has a pilot primary care self-harm and suicide • imaging; support project. It works with GPs to intervene early with vulnerable patients who might self harm. • staffing; and
• inpatient beds. The HSE funded media guidelines that were developed by the Irish Association for Suicidology and the Samaritans This assessment was part of the ‘clinical output on reporting of suicide, and circulated them to the media. specifications’ required to develop the National Plan for Radiation Oncology. The HSE also commissioned research into the link between institutional abuse and self-harm or suicide. The Childhood Obesity aim of the research was to identify risk and protective Guidelines were formally launched to complement the far factors to inform future service developments. reaching recommendations of the 2005 National Obesity Task Force Report. The task force recommends changes in policies for the food industry, education, social, health Emergency Planning and community services. State Agencies Working Together The Children and Young Persons’ Team developed In September 2006, a new framework was published that National Guidelines for Community Based Practitioners details how the different State agencies – HSE, Gardaí on Prevention and Management of Childhood Overweight and Local Authorities – will work together in emergency and Obesity. In compiling these guidelines, young people, management. There is now a standardised and co- parents and professional and academic organisations in ordinated approach to emergency management. Ireland and abroad were consulted. Emergency Management Programme Acute Hospital Inpatient Bed Utilisation Review Structures were put in place for the new HSE function of A national hospital utilisation study aiming to identify the emergency management in the National Hospitals Office extent to which patients occupying acute hospital beds (NHO), in Primary Community and Continuing Care are appropriately placed commenced in 2006. (PCCC) and in Public Health. This will ensure that the This will help the HSE to plan how to develop services in emergency management programme is standardised and the future. co-ordinated and that HSE personnel are better able to respond to crises as they arise. Suicide Prevention In line with Reach Out, The National Strategy for Influenza Pandemic Plan Action on Suicide Prevention, Population Health worked In conjunction with the Department of Health and Children to ensure: a plan was developed to manage an outbreak of pandemic influenza. • 4,000 people were trained in the two-day Applied Suicide Intervention Skills Training programme; and
The Hib Booster Vaccine Campaign continued in 2006. The campaign was designed to offer the Hib booster vaccine to further protect children aged between one and four years against Haemophilus influenza type b (Hib) infection. The booster was made available free to 220,000 children in 2006.
24 Health Service Executive, Annual Report 2006 Case Study
HSE Community Games Sponsorship
In 2006, the HSE sponsored the Community Games for the first time. This sponsorship is an important way to deliver key health promotion messages about nutrition and physical activity to children, parents, volunteers and communities. The Community Games organisation is committed to developing healthy policies on nutrition, tobacco, alcohol and drug misuse and physical activity.
This sponsorship gives direct access to communities. More than 500,000 people took part in the games. In addition, there were 20,000 volunteers and 1.3 million supporters. A key element of the sponsorship agreement is that the Community Games will now adopt and implement health promotion principles throughout its organisation.
Over 200 children from designated communities were sponsored to participate in the community games on the strength of the HSE sponsorship and partnership. Primary, Community and Continuing Care (PCCC)
PCCC provides health and personal Primary Care social services throughout every community and is delivered through Providing care in the home and in local communities is a corner stone of the HSE’s Transformation Programme. 32 Local Health Offices (LHO) The main focus of PCCC during 2006 has been directed across the country. towards achieving this.
When people have their needs met locally, the results are better and the reliance on acute hospitals is The services provided include significantly reduced. services for: Primary Care Teams (PCTs) • Primary Care; Primary Care Teams (PCTs) are designed to ensure that people can easily access a wide range of high quality • Older People; health and social care services in their local communities.
• Mental Health; PCTs deliver non-acute care and cater for populations of between 7,000 and 15,000. All services are delivered by • Childcare; community-based teams of health and social care professionals including: • People with Disabilities; • physiotherapists; • Social Inclusion; • social workers; • Palliative Care; and • public health nurses; • dieticians; • Environmental Health. • GPs; and • support workers.
Ten Primary Care Teams are currently in place. Eighty seven Primary Care Teams were in development in 2006 and up to 127 are planned for development in 2007. The entire country was mapped out in 2006 to identify the facilities and resources that these new teams will require.
PCTs are linked together by Primary and Social Care Networks. Each network generally supports four to five PCTs. The networks include a shared pool of specialised resources, for example: child protection, orthodontics and counselling.
The HSE in partnership with General Practitioners launched the MIDOC GP – out-of-hours service in County Longford in the summer of 2006. The aim of the service is to deliver the highest standards of care to members of the public wishing to avail of a family doctor service during out-of-hours periods (i.e. outside doctor’s normal surgery hours) for urgent medical conditions. The MIDOC service currently operates in Laois, West Offaly and Westmeath.
26 Health Service Executive, Annual Report 2006 All primary care services are linked to: Schemes Modernisation Programme • each other; Medical Card Scheme • the wider health system; Reform continued in standardising the Medical Card • to hospitals; and Scheme and related schemes and the way they were • a number of different agencies. delivered in 2006. Related schemes include the Drugs Payments, Long Term Illness and Dental Treatment Expansion of Out-of-Hours General Practitioner Services Scheme. (GP) Services Out-of-Hours GP services dealt with 750,000 calls in A booklet was published (available on www.hse.ie) 2006 and are now available to 80% of the population in explaining the services in place and eligibility criteria. It 12 centres nationally (see table 5). includes a standard application for GP Visit Cards and Medical Cards. The addition of D-DOC, the GP out-of-hours service in Table 6: Medical and GP Visit Card Holders 2005 and 2006 North Dublin, provides an urgent out-of-hours family doctor service to the 500,000 people living in this area. It 2005 2006 % greatly enhances the options available to those who need Change urgent medical care or advice outside of business hours. Medical Card Holders 1,155,727 1,221,695 +5.7% Table 5: Out-of-Hours GP Services Contact Information GP Visit Card NEDOC 1850 777911 Holders 5,079* 51,760 +1019% Louth, Meath, Cavan and Monaghan * GP Visit Cards were launched in Dec 2005 (Except Dundalk) DDOC 1850 22 44 77 North Dublin City and County 01 4545607 Income Assessment Assessment of income was radically changed in 2006 in DL Doc 01 6639869 dealing with applications for medical cards. Income is now South-West Dublin considered after deduction of tax and PRSI. Allowances EastDoc 01 2094021 are also made for rent or mortgage repayments, for East Dublin childcare expenses and travel to work costs.
LukeDoc 01 406 5158 Community Drugs Scheme Renewed South Dublin City The Community Drugs Schemes was reviewed. The cost K DOC 1890 599362 reductions, on ‘off-patent’ medicines and their generic Kildare and West Wicklow equivalents, secured under the new Irish Pharmaceutical Healthcare Association/Association of Pharmaceutical MIDOC 1850 302702 Manufacturers of Ireland agreements will help to reduce Laois, Longford, Offaly and Westmeath costs in this area. CareDoc 1850 334999 Carlow, Kilkenny, South Tipperary, Wexford, Waterford and South Wicklow (incl Wicklow Town) Older people SOUTHDOC 1850 335999 Cork and Kerry Supporting older people to stay at home and live independently in their own communities for as long as NOWDOC 1850 400911 possible is one of the key aims of the HSE. Where this is Donegal, South Leitrim and North Roscommon not possible, the aim is to provide an alternative WESTDOC 1850 365000 appropriate residential setting. The HSE provides a range Part of Galway, Mayo, Roscommon and Sligo of services including home helps and home care packages in partnership with: SHANNON DOC 1850 212999 Clare, North Tipperary and Limerick (Excluding City) • older people themselves; • families; • carers;
Health Service Executive, Annual Report 2006 27 • statutory agencies; Home Help • non-statutory agencies; Home help is a service provided by the HSE to assist older persons in their own homes. • voluntary groups; and Table 8: Home Help Programme 2006 • community groups. Home Help 2006 Home Care Packages Total Home Help Table 7: People in Receipt of Home Care Packages 2006 hours delivered 11,430,570 2006 Average Home Help hours per month 952,548 People in receipt of home-care packages 5,300* Average monthly number *This figure refers to the number of people in receipt of packages of clients in receipt of at 31 December 2006. This is not a cumulative figure. home help hours 49,500*
*This figure refers to the number of people in receipt of the service In 2006, Home Care Packages were introduced across at 31 December 2006. This is not a cumulative figure. the country. These packages comprise a set of services and supports provided, or arranged, by the HSE for an older person after their needs have been assessed. This A survey carried out in 2006 to review this initiative ensures that the older person can: highlighted how important this person-centred development is to families. Here is an example of the • return home from hospital; or feedback gathered during the survey. • stay in their own home for as long as possible. “My mother now needs 24-hour care. She has Alzheimers This also has the added benefit of reducing pressure on and prior to this there were gaps in her care and she Emergency Departments. walked out of the house and was picked up by the Gardai five miles away. We now have a combination of two carers Depending on the older person’s needs these Home Care and the family providing care around the clock combined Packages can include: with using the Day Care Service. She cannot be left on her own, but now she has a life and gets out and about with • public health nursing; the carers who have become part of our family.” • home help; Figure 8: Home Help Hours delivered per month in 2006 • physiotherapy; 1,200,000 • occupational therapy; and 1,000,000 • attendance at a day care centre. 800,000 In 2006, €55 million was invested in the provision of Home Care Packages to 5,300 people. 600,000
400,000
200,000
0 Jan M ar M ay Jul Sep Nov
Creativity, originality and hard work were the cornerstone of an art based project undertaken at St Oliver Plunkett Hospital, Dundalk. The project took the form of an art mural created by patients and students. The project aimed to provide interaction between young and old, enhance the living environment in St Olivers and to generate a sense of pride.
28 Health Service Executive, Annual Report 2006 Figure 9: Number of clients per month in receipt of Home Help 2006 Considerable changes are currently taking place in Mental Health Services. In May 2006, The Report of the Expert 52,000 Group on Mental Health Policy – A Vision for Change 50,000 was adopted by the HSE. Part 2 of the Mental Health Act, 2001 and the role for Mental Health Services within 48,000 Primary Care Teams commenced in November 2006. 46,000 National Forensic Service (Central Mental Hospital) 44,000 Eight new beds were opened to increase capacity in 42,000 General Adult Psychiatry.
40,000 In 2006, multidisciplinary mental health teams were set up
38,000 JanFeb MarApr May Jun Jul Aug Sep Oct Nov Dec to deliver core mental health services for sector populations of 50,000. Each sector has two consultant - led teams. Standardised Nursing Home Inspection Process A national standardised approach to inspection and Additional Child and Adolescent Community Mental reporting of private nursing homes was developed in Health Teams 2006. This included standardisation of documentation in Eight extra child and adolescent mental health teams were all HSE areas. The results of a number of inspection in development in 2006. reports of private nursing homes are available on www.hse.ie. Child Care Table 9: Nursing Home Statistics 2006
2006 Services for children aim to promote and protect the health and well being of children and families. Services Registered nursing homes 437 are based on best practice delivered with children and Nursing home inspections completed 870 their families, carers, local communities, voluntary and community groups to realise their potential. Services are Number of people who receive also provided for children in high support units with more nursing home subventions 7,609 acute needs.
Number of people in receipt Table 10: Child Care Statistics 2006 of enhanced subvention 4,635 2006
Extended Step-Down Facility Children in residential care An extra 1,050 beds were contracted by the HSE to (includes ‘Special Arrangements’) 410 enable discharges from acute hospitals. A project plan Children in foster care was drawn up to develop 860 public extended-care beds (excluding Day Fostering) 3,206 throughout the country. Children in foster care with relatives 1,496 Children in ‘Other’ care arrangements 224 Mental Health Children in care 5,336 Mental Health services span all life stages and include services for children, adolescents, adults, and older persons.
GP Visit Cards entitle people to visit their GP free of charge. It is easy to apply. One application form is now used for both Medical Cards and GP Visit cards and the HSE assesses each application for a full Medical Card in the first instance and then for a GP Visit Card, so only one application is required. The HSE makes allowances for expenses on childcare, on rent and mortgage costs and on travel to work.
Health Service Executive, Annual Report 2006 29 Table 11: Child Care Units 2005 and 2006 Social Inclusion Child Care Units 2005 2006 Social inclusion services are significantly underpinned by High Support Units the National Anti-Poverty Strategy, the National Health Total available bed nights 1,674 1,860 Strategy and Equality legislation. Actual no. of bed nights 1,366 1,434 Beds occupied as a % of The Government’s social inclusion programmes, RAPID beds available 82% 77% and CLÁR, are initiatives aimed at delivering existing resources to areas of maximum need. They were Special Care Units extended to a number of areas throughout the country. Total available bed nights 713 510 Actual no. of bed nights 479 487 Ethnic Minority Services Beds occupied as a % of Consultation sessions took place for the National beds available 67% 95% Intercultural Strategy.
Pilot sites were identified for the Learning, Training and People with Disabilities Support Framework for staff.
Services for people with disabilities seek to enable each A review commenced on PCCC translation services individual with a disability to achieve their full potential and which will support the provision of a consistent service. maximise independence, including living as independently Work began to allow for the National Framework for as possible. interpreting services to be finalised in 2007.
The National Disability Strategy (2004) informs our In recognition of the need to enhance the cultural development of services for people with disabilities and a competency of staff to help ethnic minorities access framework of new supports. health services and also to improve the quality of service they receive, 330 HSE staff completed Asylum The number of people who have a disability increases Seekers/Refugees Awareness Training. significantly with age, from: Addiction Services • 2% in young people aged 0-17 years; to The provision of addiction services includes education, • 7% in the 18-64 years group; to prevention, early intervention and treatment. • 31% in the 65 years and over group. Table 13: Addiction Services 2006 Table 12: Services for People with Disabilities 2006 2006 Disability 2006 Average number of clients receiving People receiving Domiciliary methadone treatment per month 6,821* Care Allowance 19,231* *This figure refers to the number of people in receipt of the service People in sheltered work 6,919* as at 31 December 2006. This is not a cumulative figure. People in rehabilitative training 2,840* People on National Intellectual Disability Database 25,518
*This figure refers to the number of people in receipt of the service at 31 December 2006.
Nurses in the Learning Disability Services, Sligo, were winners of the Derek Dockery Award. They identified a group of individuals with an intellectual disability who expressed a wish to become more empowered in making their own decisions.
30 Health Service Executive, Annual Report 2006 Case Study
Liberties Primary Care Team Dublin Joe is an 80-year-old man living in private housing close to the Liberties Primary Care Centre. He first attended the Liberties Primary Care Team in May 2006 with chronic arthritis and high blood pressure and was seen by a GP. Physical examination and appropriate blood tests were carried out and medication prescribed. Referral was made to the team physiotherapist because of severe arthritic pain and loss of mobility. Joe visited again two weeks later as an emergency “walk- in” patient complaining of anxiety and chest pains. He was triaged by the advanced nurse practitioner and after a joint consultation with a GP it was discovered that he had many social and family problems. After physical examination it was felt that the symptoms were not cardiological. Team referrals were made to the counselling psychologist, the social worker, the occupational therapist and public health nurses. He attended several sessions with the counselling psychologist and then enrolled in the stress management classes run by the psychologist and social worker. His housing problems were assessed by the occupational therapist and grant applications organised by the social worker. “I now feel that I can cope a lot better as a direct result of all the professional help I have received from the Liberties team. Life is a whole lot brighter”. Joe has been referred to a Tai Chi and Health Promotion class run by health professionals. While this has been of significant physical benefit to Joe, it has also increased his opportunity to meet with other local people in similar situations to himself. His mobility has increased as well as his confidence to tackle the normal tasks of living. Meanwhile, his blood pressure remains under good control and his mood and anxiety symptoms are greatly improved.
(Details of this case have been changed to preserve the anonymity and privacy of the person.) Palliative Care National Information Line – 1850 24 1850 A National Information Line was established to give the ‘Palliative care’ is defined as the active total care of public across the country a single lo-call number to patients whose disease is no longer responsive to access all health and related social service information. curative treatment. Control of pain, psychological, social The service provides information on more than and spiritual well being is paramount. 110 topics. Examples of topics included are: service entitlements, eligibility, application forms and The goal of palliative care is to achieve the best possible contact details. quality of life for patients and their families. The service can also be accessed by e-mail at: Table 14: Palliative Care 2006 [email protected]; and by fax at 041-6850330. There is also a Palliative Care 2006 sigma text-pad service available where people with a hearing impairment can text their queries and they Patients treated in specialist will be responded to promptly. It operates from inpatient units 257 8.00am-8.00pm Monday to Saturday. The extended hours Patients accessing Home Care services 2,270 allow members of the public to access the service after 5.00pm and at weekends. Patients accessing intermediate care in community hospitals 90 Table 16: National Information Line Calls 2006
Patients accessing day care 220 Calls Received 2006
GP Visit Card 24,167 Paediatric Palliative Care Medical Card 6,531 A national steering group was set up and began work on a five-year strategy for paediatric palliative European Health Insurance Card 3,937 care. Work was undertaken to develop standards in Nursing Home Queries 3,458 partnership with the National Palliative Care Advisory Council, the Department of Health and Children and Community Care 1,439 voluntary partners. Drug Payment Scheme 1,871 Over 70s Medical Card 1,033 Environmental Health Human Resources 1,920
The Environmental Health division assesses, corrects and Hospital Services 872 prevents factors in the environment that could adversely Community Welfare 648 affect the public health now and in the future. Others 2,041 Table 15: Environmental Health Inspections 2005 and 2006 Total Number of Calls 47,917 Environmental 2005 2006 % Health Change Food Inspections Carried Out 51,995 47,412 -9% Tobacco Act Inspections Carried Out 35,042 32,012 -9% Prosecutions in relation to Tobacco Act 37 37 0%
The HSE infoline 1850-24-1850 was launched in 2006. This infoline gives the public easy access to information on over 110 health and social service topics for less than the cost of a local call. Information is made available via e-mail or fax and the infoline offers a sigma text-pad facility for people with hearing impairment.
32 Health Service Executive, Annual Report 2006 HSE Winter Initiative
Winter is the season when there is the greatest demand for health and social services. In early Autumn 2006 the HSE established a Winter Initiative Project Team to focus on making real improvements in the system and ensuring that the HSE was prepared for these additional pressures of winter. The Winter Initiative is an approach that has been implemented successfully elsewhere and has built on work already underway in several different areas of the healthcare delivery system.
The primary aim was to assist the organisation in working together in a more focused way to address the system-wide issues which manifest in patients unduly waiting in Emergency Departments for admission to hospital. To achieve this, eight teams were set up around the country comprising Hospital and PCCC managers who worked on a range of actions at local level.
The greater level of coordination within the health services is now being reflected in significantly reduced numbers and waiting times in Emergency Departments when compared with last year. The Winter Initiative built on work already underway in several different areas of the healthcare system and focused on three main areas; Hospital Avoidance, Capacity and Promotion/Prevention
Hospital Avoidance: • Extension of GP out-of-hour services to North Dublin; • Improved GP Diagnostic services: GPs now have enhanced direct access to X-Ray and ultrasound, ensuring that patients do not have to be admitted to hospital for certain diagnostic services; • Community Intervention Teams: These teams offer support to carers and families who are trying to care for their relatives at home. They help people to maintain dignity and promote independence in their own home; and • Rapid Access Clinic (Smithfield, Dublin): This service provides rapid access to medical services for elderly people who require care but not emergency care. The service has the capacity to treat up to 4,000 patients per year. Capacity The HSE contracted with the private nursing home sector to provide a total of 1,050 extra beds in 2006.
Admission lounges were established in most hospitals to provide patients with significantly more privacy, dignity and comfort.
New beds have been opened in Naas General Hospital and Wexford General Hospital.
Promotion and Prevention As part of the Promotion and Prevention section of the Winter Initiative, there were four main press campaigns under the ‘Keep Well This Winter’ banner: • Keep Well – Keep Immunised: Highlighting the importance of influenza and pneumococcal vaccination; • Keep Well – Keep Informed: Use the Right Door campaign highlighted the use of pharmacies, GP and GP out-of-hours service first-aid etc; • Keep Well – Keep Warm: Pack containing information on staying warm; GP out of hours services; a temperature card for monitoring room temperature and useful contacts card; and • Keep Well – Keep Safe: leaflet and poster advising older people how to prevent falls and slips and maintain health. National Hospitals Office Table 17: Hospital Statistics 2006 2005 2006 % The National Hospitals Office (NHO) Increase Inpatient manages acute hospital services in discharges 575,476 594,059 3.2% 52 hospitals nationally. It also Day cases 512,034 542,671 6.0% provides pre-hospital emergency ED Attendances 1,228,524 1,268,991 3.3% care services (ambulance and Outpatient emergency response services). Attendances 2,601,950 2,778,602 6.8% Births 58,489 62,745 7.3% In 2006, the NHO continued to focus on Emergency Departments and the In 2006, the NHO’s main focus was on completing the following areas: integration of the acute hospitals around the country into one single system. An integral part of this was the creation of the performance monitoring unit. It has now • Reconfiguration of Hospital developed a standardised performance monitoring system Services; across all hospitals. • Radiotherapy Services; Reconfiguration of Hospital Services
• Renal Services; This is a critical part of the work to be completed by the Casemix; NHO. It ensures that the appropriate services are given in • a safe and equitable manner. • National Review of Laboratory National Paediatric Hospital Medicine Services; Following the commissioning by the HSE of an • Hygiene Audit; independent review of tertiary paediatric services and the resulting report ‘Children’s Health First’, the HSE planned • Pre-Hospital Emergency Care for a new national paediatric hospital, to be located and Ambulance Services. beside an adult teaching hospital. A joint HSE and Department of Health and Children Task Group was set up. It recommended that the hospital should be built on the site of the Mater Misericordiae University Hospital. The resulting report was considered and endorsed by the Board of the HSE and was subsequently approved by Government.
The Second National Hospital Hygiene Audit was carried out in 2006. All acute hospitals nationwide were assessed by independent auditors, Desford Consultancy. All audit visits were random and unannounced and in each hospital a wide range of clinical areas were audited including Outpatients, Intensive Care, Emergency Departments, Medical and Surgical Wards and Specialist Wards (for example Orthopaedics, Paediatrics and Oncology).
34 Health Service Executive, Annual Report 2006 A joint HSE and Department of Health and Children New Regional Hospital Transition Group was set up to initiate the project. It will The Teamwork report recommended that the report in 2007 on a number of short-term actions. These North East should have one regional public hospital. include work to: This recommendation was based on international norms for catchment populations of 300,000-500,000 for • transfer the site from the Mater Misericordiae regional hospitals. University Hospital;
• define a high level framework brief for the In estimating the future catchment population, it was new hospital; assumed that a substantial number of the current North East planned inpatient work would transfer from Dublin • determine the scope and location of the proposed hospitals to a new North East regional hospital. Similarly, urgent care centres; much of the day-case work currently undertaken in Dublin hospitals would transfer to a new regional hospital, and • determine how to co-ordinate policies between the other day case facilities in the North East. new hospital and other hospitals, including those outside Dublin; The regional hospital will provide 24-hour, seven days a • establish a development board for the new hospital; week, specialist support and advice across the region and through the clinical network system. In turn, the regional hospital will be supported by tertiary, highly specialised • consider co-locating maternity services. services outside the region which will provide services to catchments of one to four million people. These North-East Implementation services include: Growth in the population of the North-East has led to the • neurosurgery; need to re-examine the configuration of hospital services. To tackle this, the HSE commissioned a review of acute • cardiac surgery; services by Teamwork Management Services Ltd. • transplant surgery; and Teamwork’s report, ‘Improving Safety and Achieving Better Standards, an Action Plan for Health Services in • certain paediatric services. the North East’, proposed a three-strand action plan. Co-Location of Private Hospitals on Public Sites The plan is designed to improve health service safety and In 2005, the Government issued a policy direction to the standards in the North East by: HSE. It was aimed at freeing up additional beds for public patients in public hospitals and developing private hospital • developing local services – with the existing five facilities on public hospital sites. hospitals and primary and community care providers playing central roles; A procurement process began in 2006 and eight sites • developing a new regional acute hospital; and remain in the process. They are: Waterford Regional Hospital, Cork University Hospital, Limerick Regional • binding these local and regional services together Hospital, Sligo General Hospital, Beaumont Hospital, through a series of clinical networks that are centred Connolly Hospital, St James’s Hospital, and The Adelaide around the needs of patients. and Meath and National Children’s Hospital, Tallaght. A project team was set up to put the action plan in place, as set out in the Teamwork report and under the direction The two remaining phases of the competitive dialogue of the steering group. One of the central proposals is to process will be conducted in 2007. set up clinical networks in specified key areas.
A new Clinical Services building, the centrepiece of the €250m redevelopment project at St. Vincent’s University Hospital, Dublin was officially opened in July 2006. The €60m, 14,000sqm, five storey over-basement building is designed to accommodate the renewal of all the major treatment and diagnostic areas of the hospital and create an Ambulatory Day Care Centre for outpatients‘ one-day procedures. The new building will cater each year for in excess of 40,000 Emergency Department attendances, including 10,000 admissions, 100,000 outpatients and 15,000 day care patients, four million pathology tests and in excess of 120,000 x-rays.
Health Service Executive, Annual Report 2006 35 Radiotherapy Services Whitfield Clinic, Waterford The HSE agreed an interim service level agreement with The National Plan for Radiation Oncology will be put in Whitfield Clinic in Waterford for the provision of place over the next several years. It consists of primary Radiotherapy Services to patients within the South East. radiation therapy centres at:
• St. James’s Hospital, Dublin; Renal Services • Beaumont Hospital, Dublin; There will be significant growth in demand for renal • Cork University Hospital; and services nationally into the future. Services will need to • University College Hospital Galway. continue to be developed each year to provide additional dialysis capacity for up to 200 new patients annually. The national plan will also include two integrated remote As a result of this a number of initiatives have centres. One will be at Waterford Regional Hospital which been undertaken: will comprise two linear accelerators managed by Cork University Hospital. The other will be at Limerick Regional The National Renal Strategy Review Hospital and will comprise two linear accelerators The National Renal Strategy Review continued during integrated with University College Hospital Galway. 2006. Its purpose is: • to make recommendations for a high quality and Other radiation therapy sources patient-centred renal service; In the interim, the NHO has obtained radiation therapy from a number of sources to meet the growing needs • to meet current and projected demand; of patients. • to take account of current best practice; and
Limerick Regional Hospital • to obtain the best use of, and maximum benefit from, In 2006, a unit on the grounds of Limerick Regional the resources available. Hospital had its first full year of service. This unit was built by the hospital’s Trust and operated by the Mater Private Renal Service Developments Hospital. This centre is privately operated in co-operation The HSE received a total of €8m in 2006 for renal with the National Plan for Radiation Oncology. services to support the cost of providing dialysis and a living-related donor renal transplant programme. Funding Belfast City Hospital was allocated to dialysis units so they could expand their The HSE worked with Co-operation and Working Together infrastructure and their provision of dialysis shifts. to enter a service agreement with Belfast City Hospital. This means that patients who are referred for The HSE has been working to expand the existing radiotherapy from Letterkenny General Hospital can capacity and to implement the preliminary choose to receive treatment in Belfast, as an alternative recommendations of the National Renal Strategy review. to Dublin or other radiotherapy units in the State, allowing The Review recommends that all dialysis patients should them to choose a treatment centre that is more be treated within 60 minutes of travel from their home. convenient to where they live. New Capacity Donegal patients have access to accommodation in Cork University Hospital: The expansion of capacity is Belfast City Hospital’s residence for radiotherapy being addressed through a range of initiatives in the outpatients as required. They will be admitted as public and private sectors. An expansion programme was inpatients of the hospital where clinically necessary. funded in Cork University Hospital. This will result in an The agreement provides for up to 50 patients to be additional eight treatment stations opening by July 2007, treated in the first year. one of which will be a dedicated isolation unit.
University College Hospital Galway (UCHG) won accreditation as a Baby Friendly Hospital. The hospital won the award from the Baby Friendly Hospital Initative in Ireland and the Irish National Health Promoting Hospitals Network for its Ten Steps to Successful Breastfeeding programme. UCHG promotes breastfeeding as the healthiest way for a mother to feed her baby with posters and information leaflets displayed in the Obstetrics and Gynaecology Department.
36 Health Service Executive, Annual Report 2006 St Vincent’s University Hospital: A nine-station state-of- Eight additional staff were recruited for the programme in the-art dialysis facility opened in St Vincent’s University 2006. These include three consultants, two medical Hospital. This meant that patients could transfer from scientists, and two Clinical Nurse Specialists – one of the existing unit to the new dedicated acute renal unit for whom is a transplant co co-ordinator. the hospital.
Kilkenny: More than 30 patients were treated in the Casemix private dialysis unit in Kilkenny. This new local service means that these patients no longer have to travel three National Programme of Evidence-Based times a week to Dublin for dialysis. Management Introduced Casemix rewards hospitals that perform well. It is the North Dublin: The HSE has entered into a temporary most internationally accepted ‘performance-related’ acute arrangement to provide dialysis for an additional hospital activity programme. Casemix classifies and 30 patients in North Dublin. This has reduced the categorises hospital outputs. This contributes towards: pressure on Beaumont Hospital, which still operates • equity; a 24-hour service. • efficiency; and Other providers: The HSE launched a tender to establish • transparency. a panel of suitably qualified providers who could be contracted to provide haemodialysis services when and Casemix is used in most countries with a developed where they were needed. healthcare system.
When deciding which providers to contract, the key The Casemix programme incorporates two national factors the HSE will consider are: programmes: • quality of care; • the Hospital Inpatient Enquiry (HIPE) programme; and • value for money; • the Specialty Costing programme. • location; and The HIPE and Specialty Costing programmes are the first • time frame for delivering the service. steps in a major expansion of Casemix. They are a central pillar in the acute hospital funding process. The main benefit of these contracts is that they will enable the HSE to respond quickly to expand capacity The HIPE Programme collects an abstract of clinical and where additional need emerges. demographic activity data in 60 hospitals nationally. Of these, 37 take part in the Specialty Costing and Casemix The HSE plans to expand dialysis capacity throughout the programmes. These 37 hospitals are responsible for country through a mixture of public and private units. 95% of all acute hospital admissions and more than €4bn Patients will, however, remain under the care of their of costs. nephrologist in their referring public hospital. This data is then used for national management. The data Living Donor Programme is also provided to the Organisation for Economic In 2006, the HSE received funding to set up a Living Co-operation and Development and World Health Donor Programme. The programme based in Beaumont Organisation planners. Hospital, is expected to cost in the region of €2m. A total of four living donor transplants were undertaken in 2006.
A new Psychiatric Consultation Liaison Nurse Service was introduced at the Midland Regional Hospital at Mullingar to ensure inpatients requiring mental health services at the hospital can be assessed. A comprehensive mental health assessment is provided to all patients referred to the services. These include liaison, education, support and advice for both staff and patients. A follow-up service is also available to those patients who present with para-suicide and are discharged prior to assessment.
Health Service Executive, Annual Report 2006 37 National Review of Laboratory Medicine Pre-Hospital Emergency Care Services and Ambulance Services
Laboratory medicine services are critical to support the The primary role of Pre-Hospital Emergency Care is to delivery of high-quality patient care. Laboratories provide a clinically appropriate and timely response to themselves need to operate to internationally recognised emergency and urgent calls. The Ambulance Service also standards to ensure the quality and accuracy of their provides a patient or client transport service. This is contribution to patient care. A full review of laboratory designed to meet the identified needs of those who medicine across 41 acute hospitals was undertaken in cannot use standard public transport. 2006 and a proposed model of service delivery has been developed. Sectoral Plan There were 260,242 emergency and urgent calls; patient or client transport calls increased to 640,926. A cross- Hygiene Audit functional group was established in 2006 to develop a national policy framework and needs assessment system. A second national hygiene audit was carried out across all This work will continue in 2007 when the group will acute hospitals. Almost every hospital improved its overall consider the implications arising from the ‘Sectoral Plan, score following the first audit. Some of the most Transport Access for All’. This document was prepared by significant improvements were shown by those hospitals the Department of Transport in line with its that recorded ‘poor’ scores in the first audit. responsibilities under the Disability Act 2005.
Table 18: Hygiene Audit 2005 and 2006 Emergency Medical Technician introduced The Emergency Medical Technician paramedic grade was Category Audit 2005 Audit 2006 introduced into the Pre-Hospital Emergency Care Service. Good 5 32 In 2006 this advanced level of clinical intervention had a significant impact on clinical performance and outcomes. Fair 23 19 It enabled the development of national systems in the Poor 26 2 areas of: • clinical-performance management;
Cleanliness in hospitals is critical. A considerable amount • quality assurance; and of work to improve hygiene standards has been • clinical audit. undertaken at hospital and national level. This work has involved staff from every discipline.
In 2006 the HSE developed National Hygiene Services Standards in partnership with the Irish Health Services Accreditation Board and distributed a National Cleaning Manual to all hospitals.
A new Cardiothoracic Surgery Service was introduced at University College Hospital, Galway. A cardiac theatre, a 10 bed ward, four high dependency beds and three intensive care beds will be provided on a phased basis at UCHG. Funding of €3.29m was provided in 2006.
38 Health Service Executive, Annual Report 2006 Ambulance Service Capital Plan Future Planning Another key development in 2006 was the approval of the A number of programmes were finalised that will shape Capital Plan (2006-2010). Over the period of the plan the the operation and management of the service. These infrastructure will be greatly enhanced. The plans include: include a study that will determine the best way to use the ambulance fleet. • 18 new or replacement ambulance stations;
• major upgrades in a number of other ambulance Senior Managers and a Medical Director were appointed stations; in 2006. They will be responsible for functional areas such as: • new Command and Control Centres; • operations; • enhanced communications systems; and • command and control; • a structured fleet replacement system. • emergency planning; The structured-fleet replacement fund means that a number of vehicles can be bought each year. This • training and development; and ensures that safety risks and maintenance costs can • fleet, equipment and estates. be minimised.
Some 65 ambulances were procured in 2006. These vehicles must comply with the specification as defined in the EC standard (CEN 1789:2000). Seven response vehicles were also purchased and key personnel are using these as part of a managed incident response framework.
A 24 hour free medical advice service for seafarers set up by Cork University Hospital (CUH) has halved the number of helicopter call-outs to injured or sick at sea. Based in the Emergency Department at CUH, Ireland’s only designated “radio medical consultation centre” provides medical advice to seafarers in the Irish “Search and Rescue” region and to Irish seafarers world wide. The service is run in partnership with the Irish Coast Guard.
Health Service Executive, Annual Report 2006 39 Case Study Early Discharge Programme
Two years ago Tom O Shea (not his real name) presented once again at Beaumont Hospital’s emergency Department. As a sufferer of Chronic Obstructive Pulmonary Disease (COPD) he was caught up in a vicious cycle. Shortness of breath led to inactivity which led to a dependent, sedentary lifestyle resulting in increased episodes of shortness of breath. Shortly after arrival he agreed to join the hospital’s innovative COPD Programme. Following assessment, he was prescribed portable oxygen for his low oxygen levels while walking and moving about and he was discharged the same day. As well as keeping a close eye on him over the next few weeks, the team encouraged him to join their Pulmonary Rehabilitation Programme. Now his life has been transformed. The shortness of breath cycle has been broken, he is far less dependent on others and exercises regularly at home using his own exercise bike and weights. Tom is one of over 400 patients who have benefited so far from the outreach scheme. The outreach team provides a “hospital-at-home” service for patients diagnosed with exacerbated COPD. The service consists of a Respiratory Nurse Co-ordinator, a Respiratory Nurse Specialist and a Senior Physiotherapist, all working under the direction of Respiratory Consultants. Under the Early Discharge Programme patients are assessed for suitability within 72 hours of admission. If they agree to participate they are given appropriate medication and a nebuliser if required. GPs are immediately informed of the care plan and the patients are visited by a team member on the day of discharge, if possible, and every day for the next three days. They are visited as frequently as necessary over the first fortnight before being discharged back under the care of their GPs. Follow-up visits are also made at six weeks and three months and patients are referred, if necessary, to the appropriate community services. This programme has had a major impact on the average length of stay in hospital for certain COPD patients. Support Services
The HSE is the largest organisation National Shared Services in the State, with the largest budget and a workforce of more than The development and rollout of the model for the National Shared Services (NSS) Programme is being carried out in 100,000 employees (directly and four main phases: indirectly employed). Support • planning; services play a vital role in the • design; efficient running of the organisation. • build; and They also ensure that the money • deploy. allocated to the HSE by the Government is efficiently and This framework involved devising an operating model to define the scope of service and forming an effectively spent to improve, implementation plan outlining risks, dependencies and promote and protect the health and resource requirements among other considerations. welfare of the public. They allow the Phases 1 and 2 were completed in 2006.
HSE to discharge its accountability Phase 1 to the Minister, the Oireachtas and Phase 1 of the National Shared Services Project began in the general public in an appropriate February 2006. It looked at three key areas: and timely way. • the business case; • the operating model; and HSE Support Services comprise a • the organisation design. number of Directorates including: It was completed at the end of June 2006.
• National Shared Services; Phase 2 Phase 2 – the Detailed Design – began in September • Human Resources; 2006. It included a rigorous examination of the conclusions reached in Phase 1 and the options for • Information and Communication implementing Shared Services within the HSE in the future. Technology; Phase 2 also involved preparing the final business case • Finance; for the project and detailed how the project would be put in place. In taking account of the need to minimise risk • Procurement; and maximise benefits it was concluded that in the absence of single organisation-wide IT systems, the • Estates; and appropriate implementation for Shared Services was • Office of the CEO.
The HSE launched a new Procurement Policy in 2006 for its expenditure on supplies, works and services. Under this new policy, all purchases made by the HSE will be made using a single, unified and standardised approach. With the HSE’s annual estimated expenditure on supplies and services in excess of €3bn, these revised guidelines have the potential to generate millions in savings which can be applied to front-line patient services.
Health Service Executive, Annual Report 2006 41 through each of the functional directorates. This is Primary Care Teams similar to implementation approaches in other Major initiatives such as the recruitment process for large organisations. additional dedicated Primary Care Teams and associated training and organisational design interventions, were a National Shared Services will enable the HSE to: feature of HR activities in 2006. • reduce duplication; Employment Control • enable economies of scale; The HSE is committed to ensuring that it has the right number of staff, with the right qualifications and in the • create centres of knowledge; right locations to deliver the quality of service expected • facilitate shared expertise; and by the population. • achieve consistency in the way things are done. In 2006, a National Employment Monitoring Unit (NEMU) Next Steps was set up to manage the HSE’s Employment Control Following adoption by the Board of the recommendations Framework. The unit provides an integrated approach for from Phase 2, work will continue in 2007 in implementing the co-ordination of information with the delivery systems, Shared Services in the functional directorates. The four Finance and HR functions. It also ensures that there functional directorates are: is an effective, standard approval system for filling staff vacancies. • Human Resources;
• Finance; This is critical because it ensures that whole-time equivalents (WTEs) and funding are linked to service • Information and Communication Technology; and developments. It also ensures that the HSE can comply • Procurement. with Government targets on employment numbers.
The process will be overseen by a National Shared Table 19 shows the numerical and percentage change Services Governance Committee. between 2005 and 2006 in employment levels for the each of the staff categories within the HSE.
Human Resources The HSE has also set up an employment monitoring framework to robustly manage the filling of all posts in the The Human Resources (HR) structure of the HSE was HSE. This framework includes: finalised in 2006. The HSE is the largest single employer • HSE corporate posts; in the State and the HR structure reflects its need as the key strategic partner in the delivery of health services. • posts affected by the reform process; and • replacement of approved and funded posts not Key Achievements affected by the reform process.
More than 500 Nurses and Midwives Recruited The HSE assesses and develops the employment control HR has delivered in key areas such as recruitment and systems in conjunction with the Department of Health and organisation training supports. For example, in 2006 the Children. This ensures effective management of HSE recruited more than 500 nurses and midwives employment levels in the health services. internationally and these frontline staff were deployed throughout the country. Detailed analysis of Health Services Employment figures in 2006 are shown in Table 20.
Health workers at St Mary’s Hospital Phoenix Park celebrated a Cultural Diversity evening with more than 15 nationalities represented. One of the aims was to promote an understanding of the culture of all colleagues and to enrich Irish culture.
42 Health Service Executive, Annual Report 2006 Table 19: Health Service Employment (wholetime equivalents) at 31 December 2005 and 2006 Hospital Consultant Contract Negotiations on new Hospital Consultant contracts Service 2005 2006 Change % recommenced in 2006. Intense consultation resulted in a Category Nos Nos Nos Change resumption of talks in the latter part of 2006. This contract Medical/ is of fundamental importance in transforming the health Dental 7,266 7,710 444 +6 service requiring flexibility in working hours. Nursing 35,248 36,745 1,497 +4 The HSE tabled a new draft contract which formed the basis Health and of a continuation of the talks for the remainder of the year. Social Care Professionals 13,952 14,929 977 +7 Irish Nurses Organisation (INO)/ Psychiatric Nurses Management/ Association (PNA) Administrative 16,699 17,254 555 +3 In December 2005 the Irish Nurses Organisation and the General Psychiatric Nurses Association served eight claims on the Support Staff 14,945 12,877 -2,068 -14 HSE which continued during 2006. These included a Other Patient reduction in the working week and an increase in salary. and Client Care 13,867 16,757 2,890 +21 Total 101,977 106,272 4,295 +4 The dispute was referred to the Labour Relations Commission and subsequently to the Labour Court in June 2006. The Labour Court issued its recommendation in November 2006 endorsing the role of Benchmarking as Industrial Relations a fair mechanism for public sector employees to consider European Working Time Directive (EWTD) issues of pay and conditions and was accepted by In 2006, the National Implementation Group on the the HSE. European Working Time Directive gave approval for 18 pilot projects to investigate practical means to reduce NCHD working hours and achieve compliance with the Information and Communication Technology EWTD. The projects covered a wide range of specialities and included suggestions such as changes in skill-mix and Integrated Patient Management System practice, expanding cross-cover, developing a bleep The integrated patient management system was the policy, reorganising handover and developing primary programme put in place in 2006. opportunities to move a proportion of the workload completed at night into the daytime or into an extended working day.
Table 20: Health Service Employment (wholetime equivalents) at 31 December 2006 Analysed by Service Category
Service Category National Primary Corporate Population Total Hospitals Community & & Support Health Office Continuing Care Services Nos. Nos. Nos. Nos.
Medical/dental 5,801 1,794 24 92 7,710 Nursing 20,032 16,581 119 12 36,745 Health and social care professionals 5,971 8,856 39 63 14,929 Management/administrative 7,943 6,654 2,347 311 17,254 General support staff 6,981 5,449 445 1 12,877 Other patient and client care 4,581 12,115 15 46 16,757 Total 51,309 51,449 2,988 524 106,272
* Small variances in totals are due to rounding
Health Service Executive, Annual Report 2006 43 It was set up in more than 20 hospitals, which included: The required work will be undertaken over the next four years. Meanwhile, a significant application of capital funds • all the acute hospitals in the North East was made to maintain our existing ICT infrastructure hospital network; within the HSE. This will also assist other voluntary and • Cork University Hospital; non-statutory bodies funded by the HSE. • Kerry General Hospital; and • Letterkenny General Hospital. Finance
The programme involved installing computer software to The HSE Finance Directorate provides service support to cover admissions and outpatients; and clinical areas such the wider HSE organisation and provides regular financial as theatre management. information to the CEO, who is also the Accounting Officer for the Vote, and to the Board of the HSE. Finance Telesynergy manages all key internal and external relationships that Continued support for the Telesynergy (radiation oncology affect HSE resources. tele-medicine) project was made possible through Capital Information funding. Telesynergy enables remote sites to In 2006 the Finance Directorate commenced Phase 1 of a link to regional cancer centres for consultation. project to develop National Financial Regulations, covering the “purchase to pay” cycle. This phase was completed Health Atlas and launched in October 2006. Significant progress was made on the Health Atlas project in conjunction with Population Health. It will As part of the implementation programme for Phase 1, a facilitate the use of geospatial (mapping and location) number of communication events took place across the data for public health investigations, service delivery country, supported by senior Finance and Service and planning. Directorates. They were attended by about 1,200 staff.
Human Resources Business Solutions Phase 2, covering topics such as the cash and income A thorough review of the PPARS (Personnel Payroll and cycle, payroll and staff costs is planned for 2007. Related System) was completed in 2006. This confirmed that the current PPARS system is providing a HR system The aim of the project is to develop a single common set for much of the HSE and is paying about 30,000 staff. It of National Financial Regulations. They will reflect and also concluded that much more work is required to underpin a robust internal control environment within the stabilise the payroll element of the system and identified health service. the areas in which this needs to be done to maximise its benefits. As the original design was developed in the In 2006, a review of internal controls was conducted by a context of the old Health Board structures, the review project team comprising Senior Managers who had also confirmed that further evaluation is necessary to specific expertise in the areas of finance, audit and define the specific HR/business requirements for the control. The project team was advised and assisted by the unified HSE structure. Institute of Public Administration. The review focused on: • the effectiveness and efficiency of operations; Arising from this review, a Human Resources Business Solutions Project group was established in October 2006 • the reliability of financial reporting and associated to carry out these tasks. It will report during the Summer accounting systems; and in 2007. In the interval, further rollout of PPARS remains • compliance with applicable laws and regulations. on hold. The review included a control-effectiveness checklist and Infrastructure bilateral interviews with 90 Senior Managers. These A large-scale review of the HSE’s ICT infrastructure was interviews included the full Corporate Management completed during the year. ICT infrastructure includes all Team and other managers randomly selected from across of the networks, computer hardware and software that the organisation. provide a platform for our key information systems. It also provides basic services such as email and internet access The report of the project team concluded that the control to the 40,000 computer users in the HSE. systems in the HSE were basically sound; and that most controls required to address the key risks were present
44 Health Service Executive, Annual Report 2006 • Awarded from mini-competitions; and working appropriately. A number of recommendations were made which should lead to a further strengthening of 1. Acute inpatient bed utilisation review; the effectiveness of the system of internal control within 2. National bed capacity review (Acute Services); the HSE. and Budget 2005 and 2006 3. Acute services review in the Southern and Mid Table 21 shows how the estimate provision in each year West areas; has been allocated to services as part of the HSE’s • International recruitment of therapy grades; internal budgetary allocation process. The percentage of overall budget spent on support services is 4.84%. It is • Ambulances; and the objective of the HSE to manage expenditure in order • Drugs and medicines - agreement with to maximise resources available to front line services. pharmaceutical industry.
Procurement B) Procurement Contracts - Work Currently During 2006 the HSE launched its Procurement Policy. in Progress • Co-location of private hospitals; The policy demands and requires strong cross-sectoral working in bringing forward both value for money and • Legal services; quality based solutions for the HSE and its patients • Chronic disease management; and clients. • Provision of forensic nursing training; The procurement directorate of the HSE was involved in • Electricity and natural gas; the selection and issuing of contracts right across the organisation. These contracts are crucial to the delivery of • Waste services (domestic); service. By operating a standard policy, in a unified way, • Review and audit of medical records; the HSE ensures that it gets the best value for money. Some of the contracts the procurement directorate has • Decontamination equipment; been involved in are outlined below. • Agency nursing services;
A) National Contracts Awarded • Stem-cell equipment; and • Insurance services; • Banking services. • Medical consultancy framework – four contracts;. A key example of the progress made by procuring on a • Dialysis services; national basis was the agreement on drugs and medicines with the pharmaceutical Industry. This agreement will
Table 21: Budget 2005 and 2006
2005 2006 €’000 % €’000 % National Hospitals Office 3,628,820 33.06% 3,955,907 33.44% Primary, Community & Continuing Care including PCRS 6,206,712 56.55% 6,689,205 56.54% Population Health 66,140 0.60% 69,280 0.59% Support Services 530,799 4.84% 573,009 4.84% Income generated by the HSE 543,010 4.95% 543,200 4.59% Total Revenue 10,975,481 100.00% 11,830,601 100.00% Capital Services 564,063 558,056 Total Estimate Provision 11,539,544 12,388,657
Health Service Executive, Annual Report 2006 45 deliver savings to the health system of €300m over the Parliamentary Affairs life of the agreement. The Parliamentary Affairs Division of the HSE deals with information requests from members of the Oireachtas, in Estates accordance with Section 79 of the Health Act, 2004. The Estates Directorate is responsible for the strategic Table 23 outlines the number of parliamentary questions development and management of the healthcare estate. the HSE dealt with in 2005 and 2006. This includes the management and implementation of the Table 23: Questions Referred by the Minister to the HSE Capital Plan (see page 16) and all property transactions.
2005 2006 % It manages the existing public healthcare estate, Change infrastructure and facilities which have a replacement value in excess of €10bn. Number of Questions Office of The CEO referred by the 2,645 3,504 +32% Minister to The role of the Office of the CEO Directorate is to the HSE represent, advise and support the CEO. The office has a number of key corporate functions including: Regional Health Offices, Parliamentary Affairs, Consumer Affairs, Quality and Risk and Communications. It also deals with a The Division compiled information for debates and range of cross directorate, governance and policy discussions in both Houses of the Oireachtas and for development functions including; Expert Advisory Groups, committees of the Oireachtas. It also supported the CEO Medical Education, Training and Research, Consultant in discharging his accountability to the Oireachtas. Appointments and cross-border relations. Area Briefings for Oireachtas Members Public Representation In 2006, the HSE set up area briefing meetings, In accordance with Section 42 of the Health Act, 2004 administered by the four Regional Health Offices, for four Regional Health Forums were established in 2006. members of the Oireachtas. These briefings are designed Each forum makes representations to the HSE on a range to provide Oireachtas members with relevant information of health and personal social services provided within on health and personal social services issues in their each area. geographic area. The briefing meetings are held in Leinster House and each one is chaired by a member of The Regional Health Forums comprise nominees from the the Oireachtas. In 2006, eight such meetings were held. city and county councils in their geographic area. Each forum meets a maximum of six times per year. Each Consumer Affairs forum has a maximum of two committees, and each Management of complaints in the HSE committee meets a maximum of four times per year. Part 9 of the Health Act 2004 outlines legislative requirements to be met by the HSE and relevant service Table 22: Activities of the Regional Health Forums in 2006 providers in the management of complaints. The Activity 2006 provisions of the Act were implemented with effect from 1 January 2007. Meetings of the Forums 24 Meetings of the subcommittees The regulations include requirements such as: of the Forums 32 • designation of Complaints Officers and Questions submitted to the Forums Review Officers; and answered 223 • development of procedures by the HSE and service Motions approved by the Forums providers for the management of complaints; and forwarded to the Office of the CEO 72 • timeframes for the management of complaints; and • review process.
Following an extensive consultation process in 2006, the policy and procedures for the management of complaints
46 Health Service Executive, Annual Report 2006 in the HSE were finalised in line with the regulations. The Consumer Affairs Statistics 2006 process of nominating Complaints Officers throughout the Table 25: Appeals 2006 HSE commenced in November 2006. It is envisaged that over 500 Complaints Officers will be designated in 2007. Appeals 2006
Consumer Participation Supplementary Welfare ‘Your Service, Your Say’ leaflets and posters were Allowances 6,501 designed, explaining to service users how comments or HSE Schemes 4,102 complaints can be made to the HSE. The distribution of leaflets and posters to all HSE locations began in December 2006. The appeals service gives people who are unhappy with a decision of the HSE a right of independent review in Table 24: Complaints 2005 and 2006 relation to schemes and services including: Complaints 2005 2006 % Supplementary Welfare Allowance Payments, Nursing Change Home Subventions, Medical Cards, Mobility Allowance, Motorised Transport Grant and Housing Aid for the Acute Hospitals 2,241 2,764 +23% Elderly. All applicants are granted the right to appeal. In Mental Health 271 138 -49% respect of Supplementary Welfare Allowance in 2006 there were approximately 120,000 recipients of PCCC 784 892 +14% Supplementary Welfare Allowance with payments of Others 353 104 -70% approximately €630m made.
Total 3,649 3,898 +7% Table 26: FOI Requests 2005 and 2006
2005 2006 % Change National Survey of Consumer Experience FOI Requests 3,895 3,439 -12% of Emergency Departments The national survey of the ‘Patient’s Experience of Emergency Departments’ was conducted in November 2006. Quality and Risk The HSE set up a Quality and Risk division during 2006. The survey was carried out by an independent The key developments include: organisation: the Irish Society for Quality and Safety in • commencing a risk-assurance framework; Healthcare, in partnership with the Royal College of Surgeons in Ireland and Ipsos MORI, Ireland (a specialist • developing a corporate safety statement; research company). • setting up a Cross Directorate Quality and Risk steering group; The results reflect the dedication and commitment of staff who operate in an environment, that, by the nature of the • putting in place incident review procedures; services provided, can be personally and professionally • commencing a national risk register; and demanding. The results also highlight areas where improvements can be made and where further research • holding the HSE’s first ever National Quality and is required. Safety Awards which showcased excellent practice and raised awareness in management of risk.
The HSE is committed to ensuring that services are consumer focused. One of the key objectives of Consumer Affairs is to develop robust systems and policies that ensure that the voice of the consumer is heard. A project team was established to develop and implement the HSE Policy and Procedure for the Management of Complaints. Consumer friendly literature, brochures, leaflets, handbooks, and posters to enable ease of understanding and access to the complaints management system were distributed nationwide at the end of 2006. In October 2006, 26 trainers from all areas of the HSE were trained in the key principles of complaints management.
Health Service Executive, Annual Report 2006 47 Communications As a result the CEO set up a Medical Education, Training The National Communications Unit (NCU) of the HSE and Research (METR) Committee in 2006 under the was established in 2006. The NCU ensures that the aegis of the National Director of the Office of the CEO. strategic objectives of the HSE and their implementation are communicated effectively to the organisation’s The METR Committee, chaired by an external expert, employees, stakeholders and the public it serves. It Prof. M. Fitzgerald, includes representatives from the provides direct communications support and advice to NHO, PCCC, Population Health, HR and the Office of the senior management and staff across the organisation. CEO. Its terms of reference include: developing a strategic vision and policy framework for the HSE in The NCU is committed to developing effective, timely and respect of medical education, training and research, appropriate communications with the people who receive advising on the appropriate structures and governance services from the HSE; between the HSE and other arrangements and examining the implications of the agencies and among the staff who deliver services. Fottrell Report, Buttimer Report, and the revised Medical Practitioners Act, and the appropriate response of the The key communications achievements in 2006 were: HSE in the context of Government policy. This Committee works with the Board’s Committee on Education, Training • setting up the National Communications Unit; and Research. • responding to 18,000 media queries and issuing more than 200 news releases; In addition to its strategic role, the Committee in 2006 was the governance structure for the administration of • providing media briefings including regular Emergency ring fenced funding allocated for the first time directly to Department updates; the health services for medical education and training. In • producing four editions of the HSE staff magazine 2006, the following key activities were undertaken by the “Health Matters”; HSE METR Group officials: • supporting and developing the launch of the • €1.37m was approved in revenue grants to the Transformation Programme and the staff recognised Postgraduate Training Bodies; induction pack; • €0.5m was approved in minor capital grants to the • producing the first HSE Annual Report; recognised Postgraduate Training Bodies; • developing and distributing service directories for • €1.6m was approved in capital grants to clinical sites each of the 32 Local Health Offices; and for education and training facilities; • implementing and co-ordinating public information • €60,000 grant was approved for the Medical Council campaigns including; the Winter Initiative, GP Visit to support the Intern Co-ordinators Network; Cards and Clean Hands campaigns. • €220,000 grant was approved for the HSE Librarians Group to extend the availability of certain electronic Medical Education, Training and Research databases and journals to all HSE employees; The HSE has been identified as a key player in the organisation, structure, delivery, management and co- • €152,000 grant was approved for the RCSI, RCPI ordination and funding of undergraduate and postgraduate and ICGP for career advice and the development of medical education and training. This followed the mentoring structures; publication and subsequent Government adoption of the • 10 new academic clinician posts funded jointly by the Fottrell Report, the Buttimer Report and the publication of HSE and HEA were approved in principle for the five the draft Heads of the new Medical Practitioners Bill. medical schools; and
The Transformation Programme was launched in 2006. It was prepared following extensive consultation with staff and is the guide for change to lead to better care and service for patients, clients and carers.
48 Health Service Executive, Annual Report 2006 • A preliminary audit of medical education and training On 31 December 2006 there were 2,144 approved facilities on clinical sites was undertaken which permanent consultant posts in the public sector in Ireland. identified a number of issues and constraints on During 2006, the HSE approved a total of 188 consultant clinical sites. posts. Of these, 125 were new posts and 63 were replacement posts. The 125 represents the largest Expert Advisory Groups (EAGs) number of additional consultant posts ever approved in The EAGs provide a central platform for clinicians and the Irish Health Service in one year. Of the 188 posts health professionals, patients, clients, managers and approved, 12 were approved as Category 2 posts and carers to be actively involved in the development and 176 were approved as Category 1 posts. transformation of specific health and social care services. The distribution of the 125 new posts in 2006 by HSE These groups will ensure that expertise from those administrative area was as follows: 38 in Dublin-Mid directly involved in providing and receiving services is Leinster, 18 in Dublin/North East, 35 in the South and 34 applied to the delivery of services in specific areas. in the West.
Table 27: New Consultant Posts Approved by Speciality in 2006 Four EAGs were established to advise on the organisation and development of health and personal 2006 social services in the following areas: Anaesthesia 13 • children; Medicine 27 • diabetes; Obstetrics/Gynaecology 11 • mental health; and Pathology 11 • older people. Paediatrics 7 Each group, of up to 20 people, under the chairmanship Psychiatry 31 of a senior clinician, has developed priority areas to focus Radiology 13 on in 2007. The groups will play a central role in the HSE’s Transformation Programme and the development of Surgery 12 operational policy for the HSE. Total New Consultant Posts 125 Medical Consultant Staffing The functions of Comhairle na nOspidéal were transferred to the HSE pursuant to Section 57 of the Health Act 2004. Applications for consultant appointments are considered by the HSE in the context of published Government policy on the health services generally, the approved HSE Service Plan and published reviews on specific specialty areas, such as reviews commissioned by the Department of Health and Children, HSE and reports published by Comhairle na nOspidéal and other bodies.
Expert Advisory Groups (EAGs) established by the HSE in 2006 will help patients, doctors, nurses, managers and carers become actively involved in the development and transformation of specific health and social services. The first four groups established in 2006 focus on services for Older People, Children, Mental Health and Diabetes. EAGs advise the HSE on the organisation and development of health and personal social services.
Health Service Executive, Annual Report 2006 49 Figure 10: Annual net increase in consultant posts:1987 - 2006 Some examples of innovative cross-border initiatives under way include: 125 123 120 • cross-border ear nose and throat services; • cross-border renal networks; and
99 • cross-border GP out-of-hours pilot. 93
Cross-Border Public Health Protection Plans Cross border control plans have now been developed to 72 72 investigate and manage Legionnaire’s Disease and also
61 food-borne illnesses in co-operation with safefood. 54 52 Mental Health and Young People To assist young people to improve their own mental 35 health awareness, CAWT developed a youth-led 30 emotional well-being initiative called Getting it Together. 22 22 Young people from both sides of the border in the North 19 17 16 West worked alongside representatives from the National 12 Children’s Bureau to develop a visually striking resource 5 0 pack which can be used by young people on their own or 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 in groups. It can also be used by parents, adults and professionals who meet or work with young people.
Cross-Border Working The HSE continues to foster links with Northern Ireland’s health service through the Co-operation and Working Together (CAWT) cross border health and social- care partnership.
There is an increasing awareness of the importance of enhancing cross border co-operation in health and social care in order to assist with the delivery of an accessible and equitable health service throughout the Island of Ireland.
During 2006, the HSE along with the Western and Southern Health and Social Services Boards in Northern Ireland have managed a total of 37 cross-border, European Union funded initiatives, which are directly benefiting border communities. These projects span all HSE service areas.
The All Island Community Nutrition and Dietetic Partnership launched its inaugural framework document in 2006. This document set out how community dieticians on both sides of the border plan to work more closely together. They will develop shared approaches to promoting key nutritional messages for the population of Ireland within the context of European and WHO nutritional mandates.
50 Health Service Executive, Annual Report 2006 Case Study New Country, New Job, First Impressions
By Olawale Olanrewaju, Senior Physiotherapist, North Clarence Street Dublin
‘Finally, I had made the journey out of the wilderness into a land of opportunity!’; these were the words I told myself, not knowing what awaited me at the other end. I had just crossed the great divide, and only two things were in my head: ‘find a job and get more education’.
The first thing that hit me was the cold and then nostalgia, not knowing when I was going to see my family again and of course the tropical sunshine. It was 5am and I had to catch the 6am bus to work. This wasn’t a problem as I was used to waking up early back at home to avoid heavy traffic on route to work. My first day at work was interesting, as I was familiar with the setting and modalities. The major difference was in the model of the modalities which were comparatively more advanced than the ones back at home, but the same principle of treatment applied. My colleagues at work were cordial and my induction was brief because they needed the help they could get.
It was my third day and all I could remember was sitting alone at my table in the canteen and watching my colleagues eat at the other end of the room. I guessed my welcome party was over and missed my friends at that point, but luckily a Chinese house officer joined me not long after for a brief chat.
Physiotherapy in Nigeria had two major problems, one specific, and the other ubiquitous.
The first problem was lack of funding which didn’t only affect physiotherapy but the entire health system. The rich few could afford to travel to the developed world for expensive treatment while the others were left with unaffordable and dilapidated health care. The second problem which seems universal is the strive for validation and evidence-based practice which requires a lot of funding and research resources. This is also present in Ireland.
My life and experience took a significant turn when I found a job against the odds of immigration, competition and with the support of a manager who believed in me.
After four months, I was glad to be working in an area of interest which was neurology and geriatrics.
Finally it is worth mentioning that I have wonderful colleagues, clients and recently resumed studies. So how does this small town boy end up in one of the most vibrant economies in the world? It is at this point I remember my mother’s words in our own dialect; ‘remember the son whom you are’ (translated verbatim) meaning know where you’re coming from and where you’re heading in life. Cork University Maternity Hospital construction completed in 2006. Financial Statements
Operating and Financial Review
Overview This Operating and Financial Review looks at the main trends and factors underlying the development, performance and position of the HSE during 2006, and those which are likely to affect the HSE’s future development and position.
In 2006 the HSE continued to deliver on its accountability requirements by managing its resources within its Vote on both the Revenue and Capital programmes. However, the Revenue Income and Expenditure Account (I&E) shows a deficit of €78m in 2006 (€53m surplus in 2005). The difference between the income and expenditure position in the Annual Financial Statements and the Vote position in the Appropriation Accounts is due to expenditure in the financial statements accounted for under the accruals basis, whereas the Vote is accounted for on a ‘cash’ accounting basis as required by Government Accounting rules. Net annual funding from the Exchequer as reported in both the Annual Financial Statements and Appropriation Accounts represents the HSE’s net recourse to the Exchequer to fund payments made, as distinct from expenditure incurred in the reporting period. As a result, the balances on the income and expenditure accounts do not represent normal surpluses or deficits, as they are largely attributable to the difference between accruals expenditure and cash-based funding.
A number of income (appropriations-in-aid) categories such as Recovery of Costs from the Social Insurance Fund, Income from Services Provided under EU Regulations and Recovery from the UK Department of Health and Social Security are outside the direct control of the HSE. The annual estimates for these categories are set by the Department of Health and Children and the Department of Finance. If the amount of appropriations-in-aid received by the HSE falls below the level specified in the Estimate, as was the case in 2006, the HSE must manage gross expenditure in line with the reduction in appropriations-in-aid to avoid an Excess Vote. In circumstances where actual income in these categories exceeds the Estimate the surplus cannot be used for additional expenditure and must be refunded to the Exchequer. Prior approval of the Dáil must be obtained by means of Supplementary Estimate for any increase in the Vote.
Business Environment The HSE operates within a very challenging business environment. Limitations on resources, and constant changes in demand and treatment regimes present significant challenges to deliver an increased level and quality of service to a growing population base. Refocusing the legacy of the Health Board structure within a unified HSE also presents significant challenges in operational terms.
Set against this background the HSE has commenced the implementation of a major Transformation Programme 2007-2010, encompassing both Service Transformation Programmes and Infrastructure Transformation Programmes.
Strategy and Objectives With regard to Infrastructure, the HSE has in place a five-year capital plan, 2007-2011. A detailed capital plan is prepared annually addressing the priorities within any single year. Projects are prioritised from the views and experience of frontline services and estates management, overlaid and informed by strategic input at NHO and PCCC, corporate level, and approved by the HSE Management Team in light of deliberations with regard to policy and strategy.
Health Service Executive, Annual Report 2006 53 In addition to completing work in hand under existing special initiatives including Disabilities, Nurse Education, Emergency Departments etc, the initiation of a specific capital programme in the area of Primary Care commenced in 2006 with the objective of supporting projects that reflect an integrated multi- practitioner base, augmented by appropriate allied health professional capacity and care-group elements, particularly in the areas of Mental Health and Services for Older People.
In both 2005 and 2006 the HSE under spent its capital Vote. However, the HSE is fully committed to developing internal structures to ensure that capital is fully spent going forward.
While the HSE, as an organisation, has been engaged in many Value for Money (VFM) initiatives a senior staff member has recently been appointed with overall responsibility for coordinating VFM at the strategic and operational levels. A key focus of the VFM strategy is to leverage the purchasing power of the HSE as a unitary organisation through the aggregation of national contracts. Another element of the VFM strategy is the establishment of a National Shared Service incorporating Finance, HR, Procurement, Estates and ICT functions.
In line with Government policy the HSE is establishing a number of private hospitals on the grounds of public/voluntary acute hospital sites.
A number of strategies are being put in place to address specific areas of service pressure. These include an increased focus on: • The delivery of comprehensive Primary Care Services • Addressing care related issues specific to Older People • The needs of the Disability Sector, and • Implementing the recommendations of the ‘Vision for Change’ report on Mental Health.
The HSE is also responsible for administering the Health Repayment Scheme, relating to the repayment of nursing home charges. The issue of past interest retained on Patient Private Property accounts is also being addressed.
Summary Financial Results
Table 28: Revenue Income and Expenditure Account 2005 and 2006
Revenue Income and Expenditure Account 2006 2005 % €’000 €’000 Change
Total Income 11,959 11,054 8.19% Pay Expenditure 4,406 4,030 9.33% Non Pay Expenditure 7,631 6,971 9.47%
The HSE derives most of its income from Exchequer funding, with patient charges and other income making up the balance. Exchequer funding is voted annually by Dáil Éireann.
The increase in pay expenditure is driven by both pay awards under National Pay Agreements and increases in headcount. HSE staffing numbers increased by 5% year on year in primary care, hospital and population health sectors
Within non pay expenditure, the most significant increases in 2006 were in primary care and medical card schemes, housekeeping (specifically energy and cleaning costs) and patient transport and ambulance services, accounting for an increase in these expenditure headings of between 10% and 12% over 2005.
54 Health Service Executive, Annual Report 2006 Table 29: Balance Sheet 2005 and 2006
Balance Sheet 2006 2005 % €’000 €’000 Change
Fixed Assets 4,610,376 4,640,355 (0.65%) Current Assets 353,821 352,820 0.28% Net Current Liabilities (978,271) (882,632) 10.84% Total Assets 3,557,411 3,671,187 (3.10%)
There were significant disposals of land during 2006 which account for the decrease in fixed assets. On establishment of the HSE, land of predecessor bodies was included at valuation. Land valuations were based on rates per hectare/square metre supplied by the Department of Health and Children following consultation with the Valuation Office. There were three disposals of land during 2006. Land at Cherry Orchard was transferred to Dublin City Council for €6.65m for the provision of social housing. Another plot of land was leased to Cherry Orchard Football Club under a ninety-nine year lease agreement for the provision of community, sport and recreation amenities. The final disposal comprised lands at Connolly Hospital, transferred in 2006 for €2.34m, which was sold by tender on the open market prior to the establishment of the HSE as part of a larger sale agreement.
The increase in stocks compared with 2005 is mainly attributable to the purchase of antiviral vaccines as part of the HSE’s preparedness for avian and pandemic influenza.
The increase in net current liabilities is primarily attributable to an increase in creditors which reflects the underlying rate of increase in expenditure year on year.
Risks and Uncertainties A principal risk for the HSE surrounds the annual increases in the costs of ‘Demand Led Schemes’ such as ‘Long Term Illness’ and the ‘Drug Payments Scheme’. These schemes come within the Primary Care and Medical Card Schemes. By their nature demand for these schemes is unpredictable, and this, along with price increases, has led to budgetary pressures year on year.
In 2006, payment for Pharmaceutical Services amounted to €1.654bn, an increase of €235m over the 2005 spend on the same services. Similarly, capitation payments for older persons increased from €420m in 2005 to €485m in 2006; a 15.48% increase. While the HSE attempts to minimise the adverse financial effects of these schemes through stringent monitoring and control procedures, there is no doubt that increased demand volume and costs represent a significant challenge to the organisation in delivering its accountability responsibilities.
Health Service Executive, Annual Report 2006 55 Performance Monitoring Report As part of its commitment to the development and promotion of a performance management culture within the organisation, the HSE introduced a monthly Performance Monitoring Report (PMR) in 2006. In addition, a quarterly report on progress against service deliverables set out in the National Service Plan (NSP) and a quarterly indicators/measures report were developed in 2006, for roll out in 2007.
The monthly PMR includes a key performance summary, which is supported by a suite of additional measures against which our performance is monitored, showing progress against targets in the NSP, together with a high level summary of significant achievements and issues/pressures, with corrective action identified.
In addition to the monthly and quarterly reporting against the NSP, a Corporate Performance Measurement report was in development during 2006, for pilot in 2007 with full implementation in 2008. This report is based on an analysis of 25 indicators, which provides a status report on achievement against 12 measures. This in turn presents a sample of performance against the HSE’s Corporate Objectives and Transformation priorities.
Collectively, these initiatives will significantly enhance the accountability framework of the HSE. Over time, this should lead to more effective use of resources and enhanced delivery of services within those resources.
56 Health Service Executive, Annual Report 2006 Board Members’ Report
The Board is the governing body of the HSE. The Board consists of 11 non-executive members (including the Chairman and 10 ordinary members), who are appointed by the Minister for Health and Children, in accordance with Section 11 of the Health Act 2004. The Chief Executive Officer of the HSE is also a member of the Board.
Members The current Board members are listed on page 10.
Committees of the Board The Health Act 2004 provides for the establishment by the Board of committees to provide assistance and advice to it in relation to the performance of its functions. The Board determines the membership and terms of reference of each Committee.
The Board currently has three standing committees: Audit Committee, Remuneration Committee and the Risk Committee (the latter was established at the end of 2006).
Audit Committee Members of the Audit Committee are Professor Niamh Brennan (Chair), Mr PJ Fitzpatrick, and Mr Joe Macri. Mr Adrian Waters has been appointed an external member of the Committee.
The Committee reports to the Board on all aspects of financial reporting and reviews the effectiveness of the HSE’s system of internal financial control and risk management. The HSE’s external auditors meet with the Committee to review results of the HSE’s Annual Financial Statements.
Remuneration Committee The Remuneration Committee comprises Dr Donal de Buitleir (Chairman), Professor John Murray, Dr Maureen Gaffney and Mr Liam Downey. The Remuneration Committee is responsible for making recommendations to the Board on matters of remuneration in the HSE.
Risk Committee The membership of the Risk Committee consists of: Professor Anne Scott (Chair), Mr Eugene McCague, Professor Michael Murphy and Mr Michael McLoone.
The Risk Committee focuses principally on assisting the Board in fulfilling its duties by providing an independent and objective review of non-financial risks, particularly clinical risk.
Other Committees A joint Management/Board Committee has been established to develop proposals on Education, Training and Research. Membership of this Committee include: Professor Michael Murphy, Mr Michael Mc Loone and Professor Anne Scott.
The Board also has in place a Committee to consider issues arising from the Consultants contract negotiations. The members are Professor Brendan Drumm, Mr Liam Downey, Dr Donal de Buitleir, Dr Maureen Gaffney, Professor Michael Murphy, Mr Eugene McCague and Mr Michael McLoone.
Support to the Board and its Committees is provided by the Secretary of the Board.
Health Service Executive, Annual Report 2006 57 Meetings of the Board and its Committees In accordance with Schedule 2 of the Health Act 2004, the Board is required to hold no fewer than one meeting in each of 11 months of the year. There were 17 meetings of the Board held in 2006. The Audit Committee met on 11 occasions; and both the Remuneration and Risk Committees met on three occasions in 2006.
The attendance at Board meetings and its Committees is set out in the Table 30.
Table 30: Attendance at meetings of the Board and its committees
Board Audit Remuneration Risk Meetings Attendance Meetings Attendance Meetings Attendance Meetings Attendance
L Downey 17 17 3 3 N Brennan 17 17 11 11 D de Buitleir 17 15 3 3 B Drumm 17 15 PJ Fitzpatrick 17 14 11 9 M Gaffney 17 12 3 2 J Macri 17 12 6* 4 E McCague 17 12 3 3 M McLoone 17 9 3 1 M Murphy 17 14 3 3 J Murray 17 13 3 3 A Scott 17 14 3 3
* Mr Joe Macri was appointed to the Committee in April 2006
58 Health Service Executive, Annual Report 2006 Code of Governance The Health Act, 2004 sets out the legal requirements for the HSE regarding its Code of Governance. Following its enactment, the HSE began the process of developing its Code of Governance.
The Board of the HSE adopted the Code of Governance for the HSE in September 2006 and submitted it to the Minister for Health and Children for approval.
The Code of Governance comprises a suite of 12 inter-related documents that together form the governance framework. The documents are:
1 Framework for Corporate and Financial Governance
2 Board Terms of Reference
3 Audit Committee Terms of Reference
4 Internal Audit Function
5 Remuneration Committee Terms of Reference
6 Risk Committee Terms of Reference
7 Code of Standards and Behaviour
8 Good Faith Reporting
9 Policy Statement on Fraud
10 Integrated Risk Management Policy
11 Procurement Policy
12 Customer Charter/Complaints Procedure
Many aspects of the code are currently being implemented. Once the Code has been approved by the Minister, work will commence on implementing the remaining elements.
Internal Audit Internal Audit is one of the key elements of HSE’s corporate governance framework. Internal Audit is responsible for reviewing and evaluating the HSE’s system of internal controls and risk management in order to assist management in improving the HSE’s procedures and processes and to ensure that the principles of efficiency, effectiveness, quality, probity and value for money are applied in HSE operations.
An independent function within HSE, the Internal Audit Directorate is headed by a National Director who reports to the HSE Audit Committee. The National Director also has a close working relationship with the Chief Executive Officer and the Senior Management Team.
The National Director meets with the Audit Committee on a regular basis to report on Internal Audit’s assessments and recommendations to improve HSE’s system of internal control, risk management and governance.
Health Service Executive, Annual Report 2006 59 Statement of Board Members’ Responsibilities in Respect of the Annual Financial Statements
Year ended 31 December 2006
The members of the Board are responsible for preparing the annual financial statements in accordance with applicable law.
Section 36 of the Health Act 2004 requires the HSE to prepare the annual financial statements in such form as the Minister for Health and Children may direct and in accordance with accounting standards specified by the Minister.
In preparing the annual financial statements, Board members are required to:
• select suitable accounting policies and then apply them consistently;
• make judgements and estimates that are reasonable and prudent;
• disclose and explain any material departures from applicable accounting standards; and
• prepare the financial statements on a going concern basis unless it is inappropriate to presume that the HSE will continue in business.
The Board members are responsible for ensuring that accounting records are maintained which disclose, with reasonable accuracy at any time, the financial position of the HSE. The Board members are also responsible for safeguarding the assets of the HSE and hence for taking reasonable steps for the prevention and detection of fraud and other irregularities.
Signed on behalf of the HSE
Mr. Liam Downey Chairman, Health Service Executive.
9 May 2007
60 Health Service Executive, Annual Report 2006 Statement on the System of Internal Financial Control
Responsibility for the System of Internal Financial Control The Health Service Executive (HSE) was statutorily established by Ministerial Order on 1 January 2005 in accordance with the provisions of the Health Act 2004. The Act provides for the dissolution of Health Boards and certain other specified bodies and the transfer of their functions, employees, assets and liabilities to the HSE at that date. The HSE must comply with directives issued by the Minister for Health and Children under the Act.
The Board of the HSE is the governing body with authority to perform the functions of the HSE. The Board may delegate any of its functions to the Chief Executive Officer (CEO). The Board may establish committees to provide assistance and advice to it in relation to the performance of its functions. The Board has established a number of Committees including an Audit Committee and a Risk Committee which comprise both Board and other non-executive members.
The Chief Executive Officer’s functions include the implementation of Board policy, the oversight and management of performance, the management of effective control systems and the reporting on performance, as required. The CEO is the Accounting Officer for the HSE. He must also supply the Board with such information (including financial information) relating to the performance of his functions as the Board may require.
The Board together with the CEO acknowledges its responsibilities for the System of Internal Financial Control in the HSE. A System of Internal Control is designed to reduce rather than eliminate risk. Such a system can provide only a reasonable and not an absolute assurance that assets are safeguarded, transactions authorised and properly recorded and that material errors or irregularities are either prevented or would be detected in a timely manner.
The Board, the Chief Executive Officer and the Management Team have clear responsibility for the implementation and maintenance of the System of Internal Financial Control and this is accorded a high priority.
Basis for Statement I as Chairman of the Board of the HSE make this statement in accordance with the Code of Practice for the Governance of State Bodies. In making this Statement on the System of Internal Financial Control the Board has relied on the Statement made by the CEO as Accounting Officer in the 2006 Appropriation Accounts.
Financial Control Environment Maintaining the system of internal financial controls is a continuous process and the system and its effectiveness are kept under ongoing review. Since establishment, the HSE has undergone a period of transition with the significant challenge of amalgamating 17 former health agencies, each of whom operated their own system of financial control. Throughout 2006 the systems and procedures continued to evolve, the organisational structures continued to be refined and appointments were made to key management positions. The Service and Capital Plan was adopted by the Board early in 2006 and approved by the Minister within the statutory timeframe. During 2006 monitoring and evaluation of performance and budgets against Service Plan objectives was carried out. Financial and other policies and procedures were revised, updated, and/or developed as appropriate and were communicated throughout the organisation.
During the year, each constituent part of the HSE representing a former health agency continued to operate a separate financial reporting system which was amalgamated into the 2006 financial statements of the HSE. The HSE is planning to implement a fully integrated financial system in the coming years. The challenge here remains significant. In the meantime, the current systems will continue to operate while controls and procedures will be streamlined and standardised where appropriate.
Health Service Executive, Annual Report 2006 61 The following is a description of the key processes, which are in place across the Health Service Executive to provide effective internal financial control:
• There is a framework of administrative procedures and regular management reporting in place including segregation of duties, a system of delegation and accountability and a system for the authorisation of expenditure.
• A project to develop a single set of financial regulations throughout the HSE providing a common framework for the enhancement of the effectiveness of the System of Internal Financial Control was commenced to standardise policies and procedures of predecessor bodies following the establishment of the HSE in 2005. The regulations developed in the first phase of the project have been approved by the HSE Management Team and reviewed by the HSE Audit Committee. They promote standards of best practice and are adopted throughout the health service and form an important part of the wider governance systems in operation within the Health Service Executive. This first phase of the project covering the ‘Purchase to Pay’ processes including compliance with public procurement policies/directives and other legal and requlatory obligations was launched by the CEO in September 2006. National financial regulations covering other processes will be developed and launched in 2007.
• The HSE is required to comply with public procurement policies/directives and other legal and regulatory obligations.
• The HSE has a comprehensive planning and financial reporting process. In 2006 monthly expenditure and activity was monitored against plan at each service level. Regular monthly and periodic reports were presented to the Management Team and the Board for consideration and appropriate action. These reports are regularly reviewed.
• A devolved budgetary system was in place with senior managers charged with responsibility to operate within defined accountability limits and to account for significant budgetary variances.
• A detailed standardised appraisal process is conducted for all capital projects costing in excess of €0.5m. The process involves the presentation of a project brief setting out service need in the context of capital priorities as expressed in the Corporate and Service Plans and the Health Strategy. A cost-benefit analysis of all proposed capital projects costing in excess of €30m is carried out in accordance with Department of Finance 2005 Guidelines for the Appraisal and Management of Capital Expenditure Proposals in the Public Sector. Board reviews of the capital programme were introduced in 2006.
• The HSE has an Internal Audit function with appropriately trained personnel which operates in accordance with a written charter/terms of reference which the Board has approved. The work of the Internal Audit function is informed by analysis of the financial risks to which the HSE is exposed and its annual Internal Audit plans, approved by the Audit Committee, are based on this analysis. These plans aim to cover the key controls on a rolling basis over a reasonable period. The Internal Audit function is reviewed periodically by the Audit Committee, which reports to the Board. Procedures are in place to ensure that the reports of the Internal Audit function are followed up.
• An Audit Committee chaired by a Board member other than the Chairman of the Board is in place. It comprises three Board members and an external nominee. The Committee reports directly to the Board. The Committee operates under agreed Terms of Reference and sat on eleven occasions in 2006.
• A Risk Committee chaired by a Board member other than the Chairman of the Board was established in 2006. The Committee reports directly to the Board. The Risk Committee of the HSE operates under agreed Terms of Reference and focuses principally on assisting the board in fulfilling its duties by providing an independent and objective review, in relation to non-financial risks. The Risk Committee sat on three occasions in 2006. Full liaison between the Audit and Risk Committees of the Board is essential to the proper functioning of these two inter-related board committees.
62 Health Service Executive, Annual Report 2006 • The monitoring and review of the effectiveness of the system of internal control is informed by the work of the Internal Audit function, the Audit Committee and the Managers in the HSE with responsibility for the development and maintenance of the financial control framework. The comments made by the Comptroller and Auditor General in his management letters or other reports have also been taken into account.
• In accordance with good practice, management and control arrangements, and the provisions of the Health Act 2004, the Board prepared corporate and service plans which were formally submitted for approval to the Minister for Health and Children. These plans set the medium and longer term priorities of the HSE.
Section 35 of the Health Act 2004 sets out the requirements for a HSE code of governance. In particular, the section requires the HSE, as soon as practicable after it is established, to submit to the Minister of Health and Children for approval, a code of governance to include: a) The guiding principles applicable to the HSE, b) The structure of the HSE, including the roles and responsibilities of the Board and the Chief Executive Officer, c) The methods to be used to bring about the integration of health and personal social services, d) The processes and guidelines to be followed to ensure compliance with the reporting requirements, e) The HSE’s internal controls, including its procedures relating to internal audits, risk management, public procurement and financial reporting, and f) The nature and quality of service that persons being provided with or seeking health and personal social services can expect.
Section 35 of the Health Act 2004 also requires the HSE to review the Code periodically, to take account of Ministerial directions, to publish the Code and to indicate in the HSE annual report its arrangements for implementing and maintaining adherence to the code of governance. The HSE’s Governance Framework was approved by the Board in 2006 and forwarded to the Minister as required by Section 35 of the Health Act 2004.
Procedures for property acquisitions and disposals by the HSE comply with the legal obligations set out in sections 78 and 89 of the Health Act 1947, as amended by the Health Act 2004. The Board has delegated authority to the CEO to approve property acquisitions up to a limit of €2,000,000. Transactions in excess of this delegated amount must be formally approved by the Board based on recommendations from the CEO.
Health Service Executive, Annual Report 2006 63 Review of the Effectiveness of the System of Internal Finacial Control In 2006 the Chief Executive Officer commissioned a review of the effectiveness of the system of internal control in the HSE. This review was conducted by a project team comprising senior managers who have specific expertise in the areas of finance, audit and control. The project team was advised and assisted by the Institute of Public Administration. The approach incorporated the development of a control effectiveness checklist and bilateral interviews with ninety senior managers including the full corporate management team and other managers randomly selected from across the organisation. The report of the project team was published in January 2007. This report was reviewed and discussed by the Audit Committee at its January 2007 meeting. The report concluded that the control systems in the HSE are basically sound and that the majority of controls required to address the key risks are present and working appropriately. A number of recommendations were made which should lead to a further strengthening of the effectiveness of the system of internal control within the HSE. Management are following up on recommendations made in the report.
This Statement on the System of Internal Financial Control represents the position in place in the HSE in the year ended 31 December 2006.
Signed on behalf of the HSE
Mr. Liam Downey Chairman, Health Service Executive.
9 May 2007
64 Health Service Executive, Annual Report 2006 Report of the Comptroller and Auditor General for presentation to the Houses of the Oireachtas
I have audited the financial statements of the Health Service Executive for the year ended 31 December 2006 under Section 36 of the Health Act, 2004.
The financial statements, which have been prepared under the accounting policies set out therein, comprise the Accounting Policies, the Revenue Income and Expenditure Account, the Capital Income and Expenditure Account, the Balance Sheet, the Cash Flow Statement and the related notes.
Respective Responsibilities of the Executive and the Comptroller and Auditor General The Executive is responsible for preparing the financial statements in accordance with the Health Act, 2004 and for ensuring the regularity of transactions. It prepares the financial statements in accordance with accounting standards specified by the Minister for Health and Children. The accounting responsibilities of the Members of the Board of the Executive are set out in the Statement of Board Members’ Responsibilities.
My responsibility is to audit the financial statements in accordance with relevant legal and regulatory requirements and International Standards on Auditing (UK and Ireland).
I report my opinion as to whether the financial statements give a true and fair view, in accordance with the accounting standards specified by the Minister for Health and Children. I also report whether in my opinion proper books of account have been kept. In addition, I state whether the financial statements are in agreement with the books of account.
I report any material instance where moneys have not been applied for the purposes intended or where the transactions do not conform to the authorities governing them.
I also report if I have not obtained all the information and explanations necessary for the purposes of my audit.
I review whether the Statement on Internal Financial Control reflects the Executive’s compliance with the Code of Practice for the Governance of State Bodies and report any material instance where it does not do so, or if the statement is misleading or inconsistent with other information of which I am aware from my audit of the financial statements. I am not required to consider whether the Statement on Internal Financial Control covers all financial risks and controls, or to form an opinion on the effectiveness of the Executive’s risk and control procedures.
I read other information contained in the Annual Report, and consider whether it is consistent with the audited financial statements. I consider the implications for my report if I become aware of any apparent misstatements or material inconsistencies with the financial statements.
Health Service Executive, Annual Report 2006 65 Basis of Audit Opinion In the exercise of my function as Comptroller and Auditor General, I conducted my audit of the financial statements in accordance with International Standards on Auditing (UK and Ireland) issued by the Auditing Practices Board and by reference to the special considerations which attach to State bodies in relation to their management and operation. An audit includes examination, on a test basis, of evidence relevant to the amounts and disclosures and regularity of the financial transactions included in the financial statements. It also includes an assessment of the significant estimates and judgments made in the preparation of the financial statements, and of whether the accounting policies are appropriate to the Executive’s circumstances, consistently applied and adequately disclosed.
I planned and performed my audit so as to obtain all the information and explanations that I considered necessary in order to provide me with sufficient evidence to give reasonable assurance that the financial statements are free from material misstatement, whether caused by fraud or other irregularity or error. In forming my opinion I also evaluated the overall adequacy of the presentation of information in the financial statements.
Without qualifying my opinion, I draw attention to the basis of accounting in the Accounting Policies which explains how the accounting standards specified by the Minister for Health and Children differ from Generally Accepted Accounting Practice in Ireland.
Opinion, including a reference to expenditure not in compliance with the proper authorities
All expenditure of the Executive which is met out of moneys voted by Dáil Éireann requires the sanction of the Minister for Finance. In 2006 the Minister sanctioned expenditure in respect of certain non-capital information and communications technology (ICT) costs subject to a limit of €58.4 million. The Executive has estimated that at least €63 million was spent under this heading in 2006. However, the HSE’s accounting systems, which it inherited from its predecessor bodies, are not configured to produce information on non-capital ICT expenditure in a way that makes the total amount involved readily ascertainable. Therefore, I was unable to be satisfied that further non-capital ICT expenditure in excess of the amount sanctioned has not been incurred.
In my opinion, the financial statements give a true and fair view, in accordance with the accounting standards specified by the Minister for Health and Children, of the state of the Executive’s affairs at 31 December 2006 and of its income and expenditure for the year then ended.
In my opinion, proper books of account have been kept by the Executive. The financial statements are in agreement with the books of account.
John Purcell Comptroller and Auditor General.
9 May 2007
66 Health Service Executive, Annual Report 2006 Financial Statements Revenue Income and Expenditure Account
For year ended 31 December 2006
Notes 2006 2005 €'000 €'000 Income Exchequer Revenue Grant 3 9,548,118 8,987,010 Receipts from certain excise duties on tobacco products 167,605 0 Health Contributions 1,188,481 1,116,692 Income from services provided under EU regulations 396,769 448,575 Recovery of costs from Social Insurance Fund 26,506 0 Patient Income 4 245,450 203,136 Other Income 5 386,163 298,550 11,959,092 11,053,963 Expenditure Pay Clinical 6 & 7 2,815,354 2,584,890 Non Clinical 6 & 7 1,107,293 1,019,878 Other Client/Patient Services 6 & 7 483,761 424,819 4,406,408 4,029,587 Non Pay Clinical 8 689,183 641,335 Patient Transport and Ambulance Services 8 52,007 46,765 Primary Care and Medical Card Schemes 8 2,849,283 2,547,732 Other Client/Patient Services 8 3,186,828 2,942,364 Housekeeping (catering, crockery, linen, etc.) 8 216,629 197,284 Office and Administration Expenses 8 555,014 516,099 Long Stay Charges Repaid to Patients 8 13,382 0 Other Operating Expenses 8 68,916 79,342 7,631,242 6,970,921
Net Operating (Deficit)/Surplus for the Year (78,558) 53,455 Balance at 1 January (784,574) (838,029) Balance at 31 December (863,132) (784,574)
All gains and losses with the exception of depreciation and amortisation have been dealt with through the Revenue Income and Expenditure Account and the Capital Income and Expenditure Account. The primary financial statements of the HSE comprise the Revenue Income and Expenditure Account, Capital Income and Expenditure Account, Balance Sheet and Cash Flow Statement on pages 67-70.
______Chairman Chief Executive Officer
Health Service Executive, Annual Report 2006 67 Capital Income and Expenditure Account
For year ended 31 December 2006
Notes 2006 2005 €'000 €'000 Income Exchequer Capital Funding 443,724 513,739 EU Funding 674 483 Revenue Funding Applied to Capital Projects 666 883 Application of Proceeds of Disposals of Fixed Assets 0 1,227 Government Departments and Other Sources 7,407 20,147 452,471 536,479
Expenditure Capital Grants to Voluntary Agencies (Appendix 2) 19(b) 194,322 183,520 Capital Expenditure on HSE Capital Projects 19(b) 263,480 351,297 457,802 534,817
Net Capital (Deficit)/Surplus for the Year (5,331) 1,662 Balance at 1 January (184,499) (186,161)
Balance at 31 December (189,830) (184,499)
All gains and losses with the exception of depreciation and amortisation have been dealt with through the Revenue Income and Expenditure Account and the Capital Income and Expenditure Account. The primary financial statements of the HSE comprise the Revenue Income and Expenditure Account, Capital Income and Expenditure Account, Balance Sheet and Cash Flow Statement on pages 67-70.
______Chairman Chief Executive Officer
68 Health Service Executive, Annual Report 2006 Balance Sheet
As at 31 December 2006
Notes 2006 2005 €'000 €'000 Fixed Assets Tangible Assets Land and Buildings 9 4,245,567 4,275,937 Other Tangible Fixed Assets 10 364,806 364,320 Investments Financial Assets 11 3 98
Total Fixed Assets 4,610,376 4,640,355
Current Assets Stocks 12 120,215 96,670 Debtors 13 212,179 196,008 Paymaster General and Exchequer Balance 14 8,155 54,230 Cash at Bank or in Hand 13,272 5,912
Current Liabilities Creditors 15 1,332,092 1,235,452
Net Current Liabilities (978,271) (882,632)
Creditors falling due after more than one year 16 (60,126) (71,378) Deferred income 17 (14,568) (15,158) Total Assets 3,557,411 3,671,187
Capitalisation Account 18(a) 4,610,373 4,640,260 Capital Reserves 18(b) (189,830) (184,499) Revenue Reserves 18(c) (863,132) (784,574) Capital and Reserves 3,557,411 3,671,187
The primary financial statements of the HSE comprise the Revenue Income and Expenditure Account, Capital Income and Expenditure Account, Balance Sheet and Cash Flow Statement on pages 67-70.
______Chairman Chief Executive Officer
Health Service Executive, Annual Report 2006 69 Cash Flow Statement
For year ended 31 December 2006
Notes 2006 2005 €'000 €'000
Net Cash Inflow from Operating Activities 20 691 154,849
Returns on Investments and Servicing of Finance Interest paid on loans and overdrafts (232) (195) Interest paid on finance leases (1,781) (1,657) Equity dividends received 9 13 Interest received 2,582 1,916
Net Cash Inflow from Returns on Investments and Servicing of Finance 578 77
Capital Expenditure Capital expenditure - capitalised (201,869) (275,984) Capital expenditure - not capitalised (255,933) (258,832) Payments from revenue re: acquisition of fixed assets (net of trade-ins) (22,811) (39,019) Revenue funding applied to Capital 666 883 Receipts from sale of fixed assets (excluding trade-ins) 8,336 12,236 Amounts refunded to the Exchequer (19,658) (36,640) Net Cash Outflow from Capital Expenditure (491,269) (597,356)
Net Cash Outflow before Financing (490,000) (442,430)
Financing Capital grant received 443,724 513,739 Capital receipts from other sources 8,080 20,630 Payment of capital element of finance lease and loan repayments (690) (5,742) Net Cash Inflow from Financing 451,114 528,627
Net Cash Flow (38,886) 86,197
(Decrease)/Increase in cash in hand and bank balances in the year 21 (38,886) 86,197
The primary financial statements of the HSE comprise the Revenue Income and Expenditure Account, Capital Income and Expenditure Account, Balance Sheet and Cash Flow Statement on pages 67-70.
______Chairman Chief Executive Officer
70 Health Service Executive, Annual Report 2006 Accounting Policies
Basis of Accounting The financial statements have been prepared on an accruals basis, in accordance with the historical cost convention. Under the Health Act 2004, the Minister for Health and Children specifies the accounting standards to be followed by the HSE. The HSE has adopted Generally Accepted Accounting Principles (GAAP) in accordance with the accounting standards issued by the Accounting Standards Board subject to the following three exceptions specified by the Minister:
1. Depreciation is not charged to the Revenue Income and Expenditure Account, rather it is charged to a reserve account: the Capitalisation Account. Reserve accounting is not permitted under Generally Accepted Accounting Principles (GAAP). Under those principles, depreciation must be charged in the revenue income and expenditure account.
2. Grants received from the State to fund the purchase of fixed assets are recorded in a Capital Income and Expenditure Account. Under Generally Accepted Accounting Principles (GAAP), capital grants are recorded as deferred income and amortised over the useful life of the related fixed asset, in order to match the accounting treatment of the grant against the related depreciation charge on the fixed asset.
3. Pensions are accounted for on a pay-as-you go basis, and the provisions of FRS 17 Retirement Benefits are not applied.
Basis of Preparation In accordance with FRS 2 Accounting for Subsidiary Undertakings, the results of wholly owned HSE subsidiaries have not been consolidated in the annual financial statements on the basis that they are not material. Details of staff numbers employed by HSE subsidiaries are included in Note 7 to the financial statements.
A detailed exercise was undertaken in the reporting period to standardise the categorisation of staff grades across the organisation. To facilitate year on year comparison, prior year pay expenditure and employee numbers have been reanalysed by employment category and by Area of Operation, consistent with 2006 classifications. It should be noted that the total for prior year pay expenditure has not been adjusted and the reanalysis has no effect on financial results in current or prior reporting periods. The employee numbers are now disclosed by reference to employee numbers at the year end rather than average numbers employed during the year.
Income Recognition (i) The HSE is funded mainly by monies voted annually by Dáil Éireann in respect of administration, capital and non-capital services. The amount recognised as income in respect of voted monies represents the net recourse to the Exchequer to fund payments made during the year. Income in respect of administration and non-capital services is accounted for in the Revenue Income and Expenditure Account. Income in respect of capital services is accounted for in the Capital Income and Expenditure Account.
Revenue funding applied to meet the repayment of monies borrowed by predecessor agencies and which were used to fund capital expenditure is accounted for in the Capital Income and Expenditure under the heading Revenue Funding Applied to Capital Projects.
(ii) Patient and service income is recognised at the time service is provided.
(iii) Superannuation contributions from staff are recognised when the deduction is made (see pensions accounting policy below).
(iv) Income from all other sources is recognised on a receipts basis.
(v) The amount of income, other than Exchequer grant, which the HSE is entitled to apply in meeting its expenditure is limited to the amount voted to it as ‘Appropriations-in-Aid’ in the annual estimate. Other income received in the year in excess of this amount must be surrendered to the Exchequer. Other income is shown net of this surrender.
Health Service Executive, Annual Report 2006 71 Capital Income and Expenditure Account A Capital Income and Expenditure Account is maintained in accordance with the accounting standards laid down by the Minister for Health and Children.
Exchequer Capital Funding is the net recourse to the Exchequer to fund payments made during the year in respect of expenditure charged against the Capital Services subheads in the HSE’s vote.
Capital funding is provided in the HSE’s vote for construction/purchase of major assets, capital maintenance and miscellaneous capital expenditure not capitalised on the balance sheet. In addition, capital funding is provided in the HSE’s vote for payment of capital grants to outside agencies. An analysis of capital expenditure by these categories is provided in Note 19 to the Financial Statements.
Balance on Income and Expenditure Accounts Most of the income in both the Revenue and Capital Income and Expenditure Accounts is Exchequer Grant which is provided to meet liabilities maturing during the year as opposed to expenditure incurred during the year. A significant part of the remaining income is accounted for on a receipts basis. However, expenditure is recorded on an accruals basis. As a result, the balances on the income and expenditure accounts do not represent normal operating surpluses or deficits, as they are largely attributable to the difference between accruals expenditure and cash-based funding.
Grants to Outside Agencies The HSE funds a number of service providers for the provision of health and personal social services on its behalf. Before entering into such an arrangement, the HSE determines the maximum amount of funding that it proposes to make available in the financial year under the arrangement and the level of service it expects to be provided for that funding. This funding is charged, in the year of account to the income and expenditure account at the maximum determined level for the year, although a certain element may not actually be disbursed until the following year.
Leases Rentals payable under operating leases are dealt with in the financial statements as they fall due. The HSE is not permitted to enter into finance lease obligations under the Department of Finance’s Public Financial Procedures. However, where assets of predecessor bodies have been acquired under finance leases, these leases have been taken over by the HSE on establishment. For these leases, the capital element of the asset is included in fixed assets and is depreciated over its useful life.
In addition to the normal GAAP treatment for assets acquired under finance leases, the cost of the asset is charged to the Capital Income and Expenditure Account and the Capitalisation (Reserve) Account is credited with an equivalent amount.
The outstanding capital element of the leasing obligation is included in creditors. Interest is charged to the income and expenditure account over the period of the lease.
Capital Grants Capital grant funding is recorded in the Capital Income and Expenditure Account. In addition to capital grant funding, some minor capital expenditure is funded from revenue. The amount of this revenue funding expended in the year in respect of minor capital is charged in full in the Revenue Income and Expenditure Account in the year. This accounting treatment, which does not comply with Generally Accepted Accounting Principles, is a consequence of the exceptions to Generally Accepted Accounting Principles specified by the Minister.
72 Health Service Executive, Annual Report 2006 Tangible Fixed Assets and Capitalisation Account Tangible fixed assets comprise Land, Buildings, Work in Progress, Equipment and Motor Vehicles. Tangible fixed asset additions since 1 January 2005 are stated at historic cost less accumulated depreciation. The carrying values of tangible fixed assets taken over from predecessor bodies by the HSE are included in the opening balance sheet on establishment day, 1 January 2005, at their original cost/valuation. The related aggregate depreciation account balance was also included in the opening balance sheet.
In accordance with the accounting standards prescribed by the Minister, expenditure on fixed asset additions is charged to the Revenue Income and Expenditure Account or the Capital Income and Expenditure Account, depending on whether the asset is funded by capital or revenue funding.
All capital funded asset purchases are capitalised, irrespective of cost. Revenue funded assets are capitalised if the cost exceeds certain value thresholds; €2,000 for computer equipment and €7,000 for all other asset classes. Asset additions below this threshold and funded from revenue are written off in the year of purchase. A breakdown of asset additions by funding source is provided in Note 19 (a) to the Financial Statements.
Depreciation is not charged to the income and expenditure account over the useful life of the asset, instead, a balance sheet reserve account, the Capitalisation Account, is the reciprocal entry to the fixed asset account. Depreciation is charged to the Fixed Assets and Capitalisation Accounts over the useful economic life of the asset.
Depreciation is calculated to write-off the original cost/valuation of each tangible fixed asset over its useful economic life on a straight line basis at the following rates:
• Land: land is not depreciated.
• Buildings: depreciated at 2.5% per annum.
• Modular buildings (i.e. prefabricated buildings): depreciated at 10% per annum.
• Work in progress: no depreciation.
• Equipment-computers and ICT systems: depreciated at 33.33% per annum.
• Equipment - other: depreciated at 10% per annum.
• Motor vehicles: depreciated at 20% per annum.
On disposal of a fixed asset, both the fixed assets and capitalisation accounts are reduced by the net book value of the asset disposal. An analysis of the movement on the Capitalisation Account is provided in Note 18 to the Financial Statements.
Proceeds on disposals of fixed assets are considered as Exchequer Extra Receipts under the Department of Finance’s Public Financial Procedures. The HSE is not entitled to retain these sales proceeds for its own use and must surrender them to the Exchequer.
Stocks Stocks are stated at the lower of cost and net realisable value. Net realisable value is the estimated proceeds of sale less costs to be incurred in the sale of stock.
Accounting for Bad and Doubtful Debts Known bad debts are written off in the period in which they are identified. Specific provision is made for any amount which is considered doubtful. General provision is made for patient debts which are outstanding for more than one year.
Health Service Executive, Annual Report 2006 73 Pensions Eligible HSE employees are members of various defined benefit superannuation schemes. Pensions are paid to former employees by the HSE. The HSE is funded by the State on a pay-as-you-go basis for this purpose. The vote from the State in respect of pensions is included in income. Pension payments under the schemes are charged to the income and expenditure account when paid. Contributions from employees who are members of the schemes are credited to the income and expenditure account when received. In previous years, no provision was made in respect of accrued pension benefits payable in future years under the pension scheme. This continues to be the treatment adopted by the HSE following the accounting specifications of the Minister.
Patients’ Private Property Monies received for safe-keeping by the HSE from or on behalf of patients are kept in special accounts separate and apart from the HSE’s own accounts. Such accounts are collectively called Patients’ Private Property accounts. The HSE is responsible for the administration of these accounts. However, as this money is not the property of the HSE, these accounts are not included on the HSE’s balance sheet. The HSE acts as trustee of the funds. Patients’ Private Property accounts are independently audited each year. The audits of these accounts are either completed or in the process of completion for the year ended 31 December 2006.
74 Health Service Executive, Annual Report 2006 Notes to the Financial Statements
Note 1 Segmental Analysis by Area of Operation
National Primary, Corporate Total Total Hospitals Community and Office and National Continuing Shared Care Services
2006 2006 2006 2006 2005* €'000 €'000 €'000 €'000 €'000
Expenditure Pay Clinical 1,378,464 1,409,072 27,818 2,815,354 2,584,890 Non Clinical 382,535 569,287 155,471 1,107,293 1,019,878 Other Client/Patient Services 158,154 323,328 2,279 483,761 424,819
1,919,153 2,301,687 185,568 4,406,408 4,029,587 Non Pay Clinical 440,214 242,110 6,859 689,183 641,335 Patient Transport and Ambulance Services 34,324 17,495 188 52,007 46,765 Primary Care and Medical Card Schemes 141,354 661,244 2,046,685 2,849,283 2,547,732 Other Client/Patient Services 1,685,380 1,474,373 27,075 3,186,828 2,942,364 Housekeeping 95,587 116,168 4,874 216,629 197,284 Office Expenses 130,870 271,622 152,522 555,014 516,099 Long Stay Charges Repaid to Patients 0 0 13,382 13,382 0 Other Operating Expenses 12,705 50,645 5,566 68,916 79,342
2,540,434 2,833,657 2,257,151 7,631,242 6,970,921
Gross expenditure for the year 4,459,587 5,135,344 2,442,719 12,037,650 11,000,508 Total Income (not analysed by area of operation) 11,959,092 11,053,963
Net Operating (Deficit)/ Surplus for the Year (78,558) 53,455 Balance at 1 January (784,574) (838,029)
Balance at 31 December (863,132) (784,574)
* 2005 pay figure has been re-analysed by employment category consistent with 2006 classification.
Health Service Executive, Annual Report 2006 75 2006 2005 €'000 €'000 Note 2 Net Operating (Deficit)/Surplus
Net operating (deficit)/surplus for the year is arrived at after charging: Audit fees 565 545 Executive board member's remuneration 453 244 Non-executive board members' remuneration 204 260
The sole executive member of the board is the Chief Executive Officer. Of the €204,000 remuneration paid to non-executive board members in 2006, €58,000 accounts for arrears. The amount of €260,000 in 2005 for non-executive board members remuneration represents fees in respect of two years, 2004 and 2005. Fees for 2004 relate to payments made to the members of the board of the Interim HSE.
Note 3 Exchequer Revenue Grant
Net Estimate voted to HSE (HSE Vote 40) 10,356,853 9,554,739 Less net Surplus to be surrendered (Note 22) (365,011) (53,990) Net recourse to Exchequer 9,991,842 9,500,749 Less: Capital services funding from the State (HSE Vote 40) (443,724) (513,739) Exchequer Revenue Grant 9,548,118 8,987,010
Note 4 Patient Income
Maintenance Charges 145,740 133,927 Inpatient Charges 24,189 22,223 Outpatient Charges 10,248 9,352 Road Traffic Accident Charges 4,719 5,299 Long Stay Charges 55,142 24,335 Other Patient Charges 5,412 8,000 245,450 203,136
76 Health Service Executive, Annual Report 2006 2006 2005 €'000 €'000 Note 5 Other Income
Superannuation Income 179,143 166,257 Other Payroll Deductions 6,092 4,162 Agency/Services 14,143 16,977 Canteen Receipts 13,424 12,982 Recovery from the UK Department of Health and Social Security 0 705 Other Income 173,361 122,344 Excess Appropriations-in-Aid surrendered to the Exchequer 0 (24,877) 386,163 298,550
Note 6 Pay Expenditure
Clinical Medical/Dental 644,300 583,322 Nursing 1,456,684 1,357,744 Paramedical 501,804 447,411 Superannuation 212,566 196,413 2,815,354 2,584,890
Non Clinical Management/Administration 535,798 492,798 Maintenance/Technical 56,705 53,126 Support Services 441,026 399,019 Superannuation 73,764 74,935 1,107,293 1,019,878 Other Client/Patient Services Support Services 449,741 395,990 Superannuation 34,020 28,829 483,761 424,819
Total Pay Expenditure 4,406,408 4,029,587
2005 pay figure has been re-analysed by employment category consistent with 2006 classification.
Health Service Executive, Annual Report 2006 77 2006 2005
Note 7 Employment The number of employees at 31 December by Area of Operation was as follows (in whole time equivalents (WTEs)):
National Hospitals Office 29,431 28,160 Primary, Community and Continuing Care 37,380 35,958 Population Health 524 517 Corporate (including National Shared Services) 2,988 3,065 Total HSE employees 70,323 67,700 Voluntary Sector - National Hospitals Office 21,879 20,962 Voluntary Sector - Primary, Community and Continuing Care 14,070 13,315 Total Voluntary Sector employees 35,949 34,277 Non-consolidated HSE subsidiary undertakings (see Note 26) 309 309 Total Employees 106,581 102,286
The 2005 employee WTE figure has been re-analysed by Area of Operation consistent with 2006 classification. The figure of 101,042 quoted in the 2005 annual report represented average employee WTEs during 2005 excluding subsidiaries. The 2005 figures have been restated to represent WTEs at 31 December 2005, which is consistent with the basis on which 2006 figures are reported.
2006 2005 €'000 €'000 Employment costs charged in income and expenditure account Wages and Salaries 3,746,690 3,423,544 Social Welfare Costs 339,368 305,866 Pension Costs 320,350 300,177 4,406,408 4,029,587
Clinical Non Other Total Total Clinical Client/Patient Services Services
2006 2006 2006 2006 2005 €'000 €'000 €'000 €'000 €'000 Summary Analysis of Pay Costs
Basic Pay 1,940,824 852,651 336,214 3,129,689 2,855,593 Allowances 79,958 20,903 10,573 111,434 100,617 Overtime 159,133 21,438 23,082 203,653 180,676 Night duty 50,018 8,196 4,918 63,132 62,677 Weekends 117,071 38,290 31,791 187,152 180,278 On-Call 50,880 1,951 600 53,431 50,724 Arrears (National Pay Agreements, etc) 29,379 11,149 4,217 44,745 34,816 Employers PRSI 175,525 78,951 38,346 292,822 264,029 Superannuation 212,566 73,764 34,020 320,350 300,177 2,815,354 1,107,293 483,761 4,406,408 4,029,587
HSE Pay Costs above relate to HSE employees only. Pay costs for employees in the voluntary sector are accounted for under Non Pay Expenditure (Revenue Grants to Outside Agencies). See Note 8 and Appendix 1. Pay costs of HSE do not include costs for subsidiary undertakings which are not consolidated on the basis that they are not material.
78 Health Service Executive, Annual Report 2006 2006 2005 €'000 €'000 Note 8 Non Pay Expenditure
Clinical Drugs & Medicines (excl. demand led schemes) 178,920 175,724 Blood/Blood Products 32,602 31,921 Medical Gases 7,788 7,389 Medical/Surgical Supplies 207,129 188,213 Other Medical Equipment 74,333 68,258 X-Ray/Imaging 25,727 23,947 Laboratory 73,167 66,511 Professional Services 89,517 79,372
689,183 641,335 Patient Transport and Ambulance Services Patient Transport 42,549 37,855 Vehicles Running Costs 9,458 8,910
52,007 46,765 Primary Care and Medical Card Schemes Doctors' Fees and Allowances 417,628 448,257 Payments to Former District Medical Officers/Dependents 7,132 6,249 Pharmaceutical Services 1,653,614 1,418,988 Dental Treatment Services Scheme 56,360 52,964 Community Ophthalmic Services Scheme 18,496 17,168 Cash Allowances (Fostering Allowances, etc) 211,078 183,607 Capitation Payments 484,975 420,499
2,849,283 2,547,732
Other Client/Patient Services Revenue Grants to Outside Agencies (Appendix 1) 3,157,392 2,915,062 Grants funded from other Government Departments/State Agencies (Appendix 1) 29,436 27,302
3,186,828 2,942,364 Housekeeping Catering 64,402 63,297 Heat, Power & Light 57,068 48,646 Cleaning & Washing 64,816 55,813 Furniture, Crockery & Hardware 14,243 13,524 Bedding & Clothing 16,100 16,004 216,629 197,284
Health Service Executive, Annual Report 2006 79 2006 2005 €'000 €'000 Note 8 Non Pay Expenditure (Continued)
Office and Administration Expenses Maintenance 56,981 64,727 Bank Loan & Finance Leases 660 786 Bank Interest and Charges 3,399 3,032 Insurance 27,013 32,658 Audit 565 545 Legal and Professional Fees 52,974 44,162 Bad & Doubtful Debts 10,909 10,747 Education & Training 105,166 86,560 Travel & Subsistence 85,233 83,364 Vehicle Costs 2,608 3,372 Office Expenses/Rent & Rates 155,710 143,980 Computers and Systems Maintenance 53,796 42,166 555,014 516,099 Long Stay Repayments Scheme Long Stay Charges Repaid to Patients (see Note 30) 13,382 0 13,382 0 Other Operating Expenses Miscellaneous (Appendix 3) 68,916 79,342 68,916 79,342
80 Health Service Executive, Annual Report 2006 Land Buildings* Work in 2006 Progress Total €'000 €'000 €'000 €'000 Note 9 Tangible Fixed Assets Land and Buildings Cost/Valuation At 1 January 2006 2,104,456 2,043,378 482,923 4,630,757 Additions/Transfers from Work-in-Progress 1,418 221,797 (104,963) 118,252 Disposals (86,225) (8,324) (1,578) (96,127) At 31 December 2006 2,019,649 2,256,851 376,382 4,652,882
Depreciation Accumulated Depreciation at 1 January 2006 0 354,820 0 354,820 Charge for the Year 0 52,580 0 52,580 Disposals 0 (85) 0 (85) At 31 December 2006 0 407,315 0 407,315
Net Book Value At 1 January 2006 2,104,456 1,688,558 482,923 4,275,937 At 31 December 2006 2,019,649 1,849,536 376,382 4,245,567
* The net book value of fixed assets above includes €45.8m (2005: €47m) in respect of buildings held under finance leases; the depreciation charged for the year above includes €1.2m (2005: nil) on those buildings.
Motor Equipment 2006 Vehicles Total €'000 €'000 €'000 Note 10 Tangible Fixed Assets Other Than Land and Buildings Cost/Valuation At 1 January 2006 71,584 845,667 917,251 Additions 6,450 99,978 106,428 Disposals (4,035) (4,144) (8,179) At 31 December 2006 73,999 941,501 1,015,500
Depreciation Accumulated Depreciation at 1 January 2006 50,641 502,288 552,929 Charge for the Year 8,771 96,507 105,278 Disposals (3,796) (3,717) (7,513) At 31 December 2006 55,616 595,078 650,694
Net Book Value At 1 January 2006 20,943 343,379 364,320 At 31 December 2006 18,383 346,423 364,806
Health Service Executive, Annual Report 2006 81 2006 2005 €'000 €'000 Note 11 Investments Unquoted Shares 3 98 3 98
Note 12 Stocks Medical, Dental and Surgical Supplies 34,884 30,307 Laboratory Supplies 6,749 5,852 Pharmacy Supplies 20,264 18,301 High Tech Pharmacy Stocks 19,576 16,437 Pharmacy Dispensing Stocks 2,590 2,416 Blood and Blood Products 1,363 1,367 Vaccine Stocks 23,215 10,944 Household Services 8,570 8,408 Stationery and Office Supplies 2,283 2,083 Sundries 721 555 120,215 96,670 Note 13 Debtors Patient Debtors 68,373 56,630 Prepayments and Accrued Income 25,171 31,244 Other Debtors 118,635 108,134 212,179 196,008
Note 14 Paymaster General and Exchequer Balance Paymaster General Bank Account 40,738 59,738 Net Liability to the Exchequer (32,583) (5,508) 8,155 54,230
Note 15 Creditors Finance Leases 1,123 1,037 Non Pay Creditors 171,356 168,104 Accruals for Pay and Non Pay 1,019,156 924,317 Income Tax and Social Welfare 108,050 125,671 Lottery Grants Payable* 2,589 1,690 Sundry Creditors 29,818 14,633 1,332,092 1,235,452
*The HSE administers the disbursement of National Lottery grants for local programmes under the National Lottery's Health and Welfare Funded Schemes.
82 Health Service Executive, Annual Report 2006 Land and Other Total Total Buildings 2006 2006 2006 2005 €'000 €'000 €'000 €'000 Note 16 Creditors (amounts falling due after more than one year) (a) Finance lease obligations After one but within five years 2,096 3 2,099 1,686 After five years 38,548 0 38,548 39,084 40,644 3 40,647 40,770
(b) Liability to the Exchequer in respect of Exchequer Extra Receipts after one but within five years Proceeds of disposal of fixed assets are considered as Exchequer Extra Receipts (EERs) under the Department of Finance's Public Financial Procedures. The HSE is not entitled to retain these sales proceeds for its own use and must surrender them to the Exchequer.
2006 2005 €'000 €'000
Gross Proceeds of all disposals in year 8,341 12,684 Less: Net expenses incurred on disposals (5) (447) Net proceeds of disposal 8,336 12,237 Less application of proceeds (Capital Income and Expenditure Account) 0 (1,225) Less refunded to the Exchequer (19,658) (36,640) At 1 January 30,561 56,236 Balance at 31 December 19,239 30,608
Bank Loans 171 0 Sundry Creditors 69 0 Total Creditors (amounts falling due after more than one year) 60,126 71,378
Note 17 Deferred Income Deferred income comprises (i) unspent income arising from donations and bequests where donors have specified the purposes to which money may be applied but the related expenditure has not been incurred and (ii) income from sales of land which have not been concluded.
Health Service Executive, Annual Report 2006 83 2006 2005 €'000 €'000 Note 18 Capital and Reserves (a) Capitalisation Account At 1 January 4,640,260 4,511,084 Additions to fixed assets in the year 224,679 311,862 Less: Net book value of fixed assets disposed in year (96,707) (23,498) Less: Depreciation charge in year (157,859) (159,188) Balance at 31 December 4,610,373 4,640,260
(b) Capital Reserves At 1 January (184,499) (186,161) Net Operating (Deficit)/Surplus for the year (5,331) 1,662 Balance at 31 December (189,830) (184,499)
(c) Revenue Reserves At 1 January (784,574) (838,029) Net Operating (Deficit)/Surplus for the year (78,558) 53,455 Balance at 31 December (863,132) (784,574)
Note 19 Capital Expenditure
(a) Additions to Fixed Assets Additions to Fixed Assets (Note 9) Land and Buildings 118,252 169,097 Additions to Fixed Assets (Note 10) Other than Land and Buildings 106,428 142,765 224,680 311,862
Funded from Capital 201,869 272,843 Funded from Revenue 22,811 39,019 224,680 311,862
(b) Analysis of expenditure charged to Capital Income and Expenditure Account Expenditure on HSE's own assets (Capitalised) 201,869 275,983 Expenditure on HSE projects not resulting in Fixed Asset additions 61,611 75,314 Total expenditure on HSE Projects charged to capital 263,480 351,297 Capital grants to outside agencies (Appendix 2) 194,322 183,520 Total Capital Expenditure per Capital Income & Expenditure Account 457,802 534,817
84 Health Service Executive, Annual Report 2006 2006 2005 €'000 €'000 Note 20 Net Cash Inflow from Operating Activities Revenue Reserves at 31 December (863,132) (784,574) Opening Revenue Reserves at 1 January (784,574) (838,029) (Deficit)/Surplus for the current year (78,558) 53,455 Capital element of lease payments charged to revenue 690 5,742 Less Interest and dividend income (2,591) (1,929) Purchase of equipment charged to Revenue Income and Expenditure 22,811 39,019 All interest charged to Revenue Income and Expenditure 2,013 1,852 (Increase)/Decrease in Stock (23,548) (10,660) (Increase)/Decrease in Debtors (16,171) (8,323) Increase/(Decrease) in Creditors 96,640 66,439 Increase/(Decrease) in Creditors (falling due after more than one year) (100) (5,904) Increase/(Decrease) in Deferred Income (590) 15,158 (Increase)/Decrease in Investments 95 Net Cash Inflow from Operating Activities 691 154,849
Note 21 Reconciliation of Net Cash Flow to Movement in Net Funds Change in net funds resulting from cash flows Net funds at 1 January 60,142 (26,055) Movement in net funds for the year from cash flow statement (38,886) 86,197 Net funds at 31 December 21,256 60,142
Note 22 Drawdown of Vote Exchequer disbursements during the year are based on annual amounts voted by Dáil Éireann. Any part of the amount voted which has not been expended by 31 December in accordance with Government accounting rules must be surrendered to the Exchequer. It is a fundamental objective of the Board of the HSE that no overspending of the Vote takes place. In practice it is almost impossible to achieve an actual outturn which matches the exact Vote amount. As a result, it is inevitable that this prudent approach will result in small surpluses. The surplus to be surrendered amounts to €365.011m, which represents 3% of the total Vote of the HSE.
Per the HSE's Appropriation Account, prepared under Government Accounting rules:
Total funding to HSE from the State (HSE Vote 40) 10,356,853 9,554,739 Appropriation account outturn for the year 9,991,842 9,475,872 Surplus to be surrendered 365,011 78,867
Surplus Appropriations-in-Aid 0 24,877 Net surplus to be surrendered 365,011 53,990 365,011 78,867
Health Service Executive, Annual Report 2006 85 Note 23 Pensions Eligible staff employed in the health service on establishment of the HSE are members of a variety of defined benefit superannuation schemes. Under Section 23 of the Health Act, 2004, the HSE is required to establish a new scheme in respect of new staff employed from 1 January 2005. The HSE has developed a new scheme which has been submitted to the Minister for approval. Superannuation entitlements (i.e. pensions) of retired staff are paid out of current income and are charged to the income and expenditure account in the year in which they become payable. No provision is made in the financial statements in respect of future pension benefits. Superannuation contributions from employees who are members of these schemes are credited to the income and expenditure account when received. To date, no formal actuarial valuations of the HSE's pension liabilities have been carried out.
2006 2005 €'000 €'000 Note 24 Capital Commitments Future tangible fixed asset purchase commitments: Within one year 497,008 562,197 After one but within five years 1,257,397 2,226,358 After five years 00 1,754,405 2,788,555
Contracted for but not provided in the financial statements 332,105 299,275 Authorised by the Board but not contracted for 1,422,300 2,489,280 1,754,405 2,788,555
The HSE has multi-annual capital investment framework which prioritises expenditure on capital projects in line with strategic objectives in the Corporate Plan and Annual Service Plan. The commitments identified above are in respect of the total cost of projects for which specific funding budgets have been approved at year end. These commitments may involve costs in years after 2007 for which budgets have yet to be approved. Additional commitments will arise as funding is approved for further projects. The Board has approved a Capital Plan which along with the commitments above brings the total HSE planned expenditure figure for the period from 2007 to post 2011 to €5.8 billion (€4.6 billion as at 31 December 2005). It is expected that this expenditure will be funded over the life of the National Development Plan 2007-2013.
The comparative figure for 2005 has been restated in line with the analysis for the current year.
86 Health Service Executive, Annual Report 2006 2006 2005 €'000 €'000 Note 25 Operating Leases Operating lease rentals (charged to income and expenditure account) Land and Buildings 27,526 30,284 Motor Vehicles 102 67 Equipment 113 76 27,741 30,427
Land and Other Total Total Buildings 2006 2006 2006 2005 €'000 €'000 €'000 €'000 The HSE has the following annual lease commitments under operating leases which expire:- Within one year 2,851 77 2,928 1,638 In the second to fifth years inclusive 6,124 6,124 12,248 7,753 In over five years 18,002 0 18,002 18,453 26,977 6,201 33,178 27,844
Note 26 Subsidiary Undertakings
Abbey Wreaths Limited - a company limited by guarantee and not having a share capital. Established to undertake the running of certain services in Ballina to meet the training and rehabilitation needs of people with disabilities.
Aontacht Phobail Teoranta - a company limited by guarantee and not having a share capital. Set up to promote the economic and social integration of people with disabilities.
Bradóg Trust Limited - a company limited by guarantee and not having a share capital. Established to provide housing and associated amenities for persons in deprived circumstances and to provide for relief of poverty and deprivation caused by poor housing conditions and homelessness or other social and economic circumstances.
Dolmen Clubhouse Limited - a company limited by guarantee and not having a share capital. Established to provide educational, social and employment opportunities for people who experience mental ill health.
Dolmen Rainbows Limited - a company limited by guarantee and not having a share capital. Established to undertake the running of certain services in Ballina to meet the training and rehabilitation needs of people with disabilities.
Eastern Community Works Limited - this company is limited by guarantee and is engaged in improving the living conditions of the elderly.
EVE Holdings Limited - engaged in the provision of rehabilitative programmes in the form of training and quality supported and sheltered employment.
Tolco Limited - set up in 1975 for the purposes of providing services to the then Eastern Health Board. These services include residential care and training facilities for persons with special needs.
The results of these subsidiary undertakings have not been consolidated in the financial statements on the basis that they are not material.
Health Service Executive, Annual Report 2006 87 Note 27 Taxation The HSE has been granted an exemption in accordance with the provisions of Section 207 (as applied to companies by Section 76), Section 609 (Capital Gains Tax) and Section 266 (Deposit Interest Retention Tax) of the Taxes Consolidation Act, 1997. This exemption which applies to Income Tax/Corporation Tax, Capital Gains Tax and Deposit Interest Retention Tax, extends to the income and property of the HSE. The exemption is subject to review by the Revenue Commissioners and, if conditions as specified are not met, the exemption may be withdrawn from the date originally granted.
Note 28 Insurance The HSE is insured against employers liability and public liability risks up to an indemnity limit, under both retro-rated and flat-rated bases. Under the retro-rated basis, the final premium is not determined until the end of the coverage period and is based on the HSE's loss experience for that same period. The retro-rated adjustment payable by the HSE is subject to maximum and minimum limits. At 31 December 2006 it was not possible to accurately quantify the liability, if any, which may arise as a result of future retro-rating. The maximum liabilities for retro-rated claims still outstanding, based on agreed levels of each insurable risk is €224,861 and €7,160,847 for employers liability and public liability respectively. All insurance premiums from 1 January 2001 have been paid on a flat basis only and no retro-rating applies to cover from this date forward.
Note 29 Contingent Liabilities - Past Interest Retained Interest on investment of patients' private monies has in the past been retained by former Health Boards and used to partially cover the significant costs incurred in administering the 15,000 patients' private property accounts spread over more than 150 locations. Former Health Boards operated on the basis of various legal advices which indicated either that they were entitled as bailors to retain any interest, or as trustees to levy a charge to recoup their costs with costs exceeding the interest. Interest amounts retained by former Health Boards since 1976 are estimated at approximately €31m.
Following legal advices obtained, subsequent clarifications received and discussions with relevant parties, it is now considered appropriate that the HSE disclose a potential obligation in respect of this matter. It is not practicable to reliably estimate the likely value of this potential obligation, on the basis that our investigations to date indicate that, due to the passage of time, there will be significant gaps in the availability of records that are sufficiently detailed to facilitate the identification of the amount of interest to be repaid to individual patients or the identity of individuals or estates of deceased patients in a significant number of cases. However, it is expected that this possible obligation, if crystallised, will be material in the context of the accounts. The HSE is seeking to obtain further operational and legal clarity on this issue to facilitate the adoption of a policy that can be implemented practically to address it.
Contingent Liabilities - General The HSE is involved in a number of claims involving legal proceedings which may generate liabilities, depending on the outcome of the litigation. The HSE has insurance cover for public and employers liability, fire and specific all risk claims. In most cases such insurance would be sufficient to cover all costs, but this cannot be certain. The financial effects of any uninsured contingencies have not been provided in the financial statements.
88 Health Service Executive, Annual Report 2006 Note 30 The Health (Repayment Scheme) Act, 2006
The Health (Repayment Scheme) Act provides the legislative basis for the repayment of what has been referred to as 'long stay charges' which were levied on persons with full eligibility prior to 14 July 2005. The scheme allows for the repayment of charges to the following people:
• Living people who were wrongly charged at any time since 1976
• The estates of people who were wrongly charged and died on or after 9 December 1998
Under the provisions of the Act, the HSE appointed an external third party to act as scheme administrator. A special account is set up which is funded by monies provided by the Oireachtas and from which repayments are made. An amount of €340m was set aside in 2006 by way of a supplementary estimate for this purpose. The best estimate of the total cost of repayments, based on the terms of the scheme as set out in the Act, is up to €1bn, with repayments expected to be made to approximately 20,000 living patients and to the estates of approximately 40,000 to 50,000 deceased former patients.
2006 2005 €'000 €'000
Pay 312 0 Repayments to Patients (see Note 8) 13,382 0 Payments to Third Party Scheme Administrator 1,203 0 Advertising 824 0 Legal and Professional Fees 486 0 Office Expenses 142 0 16,349 0
Note 31 Post Balance Sheet Events No circumstances have arisen or events occurred, between the balance sheet date and the date of approval of the financial statements by the Board, which would require adjustment or disclosure in the financial statements.
Health Service Executive, Annual Report 2006 89 Note 32 Related Party Transactions In the normal course of business the Health Service Executive may approve grants and may also enter into other contractual arrangements with undertakings in which HSE Board members are employed or otherwise interested. The Health Service Executive adopts procedures in accordance with the Department of Finance's Code of Practice for the Governance of State Bodies 2001, the Ethics in Public Office Act 1995 and the Standards in Public Office Act 2001, in relation to the disclosure of interests of Board members. These procedures have been adhered to by the Board members and the HSE during the year. During 2006 an agency in which a Board member declared an interest was approved a grant of €694,125. The Board member concerned did not receive any documentation on the transaction nor did the member participate in or attend any Board discussion relating to this matter. Another Board member has declared an interest in a partnership which trades from time to time with the HSE on terms which are negotiated on an arm’s length basis. This interest has been reported to the Board which has concluded that it is not material.
Note 33 Approval of Financial Statements The financial statements were approved by the Board on 9 May 2007.
90 Health Service Executive, Annual Report 2006 Appendices to the Financial Statements Appendix 1 – Revenue Grants and Grants Funded by other Government Departments/State Agencies Analysis of Grants to Outside Agencies in Note 8
Name of Agency Revenue Grants Grants Funded by Total Grants other Government Departments/State Agencies 2006 2006 2006 €000s €000s €000s
Total Grants Under €100,000 (3,206 Grants) 30,146 1,274 31,420 Abode Hostel and Day Centre 328 419 747 Addiction Response Crumlin 328 419 748 Adelaide and Meath Hospital, Dublin Incorporating the National Children's Hospital 202,899 0 202,899 Adoption Authority of Ireland 1,308 0 1,308 Adult Victims of Past Abuse (AVPA) Service 2,127 0 2,127 Aftercare Recovery Group 132 0 132 Age Action Ireland 638 0 638 Age and Opportunity 652 0 652 AIDS Fund Housing Project 401 0 401 AIDS Help West 273 0 273 Aiseiri 290 0 290 Aislinn Centre 440 0 440 ALJEFF Treatment Centre Ltd 120 0 120 All In Care 110 0 110 Alliance 155 0 155 Alpha One Foundation 164 0 164 Alzheimer Society of Ireland 5,755 0 5,755 Ana Liffey Children's Project 120 0 120 Ana Liffey Drug Project 254 0 254 Anne Sullivan Foundation for Deaf Blind 949 0 949 Aosóg 208 0 208 APT Tullamore 2,602 0 2,602 Aranmore Social Services 207 0 207 Aras Mhuire Day Care Centre 290 0 290 ARC Cancer Support Centre 220 0 220 Ard Aoibhinn Centre 2,061 0 2,061 Ardee Day Care Centre 289 0 289 Arlington Novas Ireland 1,289 0 1,289 Arrupe Society 261 0 261 Arthritis Ireland 220 0 220 Aspire Horizon Ltd 274 0 274 Associated Charities Trust 226 0 226 Athlone Community Services Council Ltd 621 0 621 Athlone Community Task Force 164 0 164 Autism Alliance UK 150 0 150 Autism West Ltd 646 0 646 Aware 185 0 185 Baile Mhuire Recuperative Unit for the Elderly 157 0 157 Balcurris Boys Home Ltd 586 0 586 Ballinasloe Social Services 171 0 171 Ballincollig Senior Citizens Club Ltd 273 0 273 Ballyboden Children's Centre 114 0 114 Ballyfermot Home Help 1,112 0 1,112
Health Service Executive, Annual Report 2006 91 Name of Agency Revenue Grants Grants Funded by Total Grants other Government Departments/State Agencies 2006 2006 2006 €000s €000s €000s
Ballyfermot Star Ltd 98 241 339 Ballymun Day Nursery 277 0 277 Ballymun Home Help 1,162 0 1,162 Ballymun Residential Project 633 0 633 Ballyowen Meadows Childrens Residential Centre 835 0 835 Barnardos 6,743 132 6,875 Barretstown 214 0 214 Barrow Valley Enterprises for Adult Members with Special Needs Ltd 254 0 254 Bawnogue Youth and Family Support Group 142 88 230 Beaufort Day Care Centre 141 0 141 Beaumont Hospital 249,573 0 249,573 Before 5 Nursery & Family Centre 141 0 141 Belvedere Social Service 634 0 634 Bernard Van Leer Foundation 115 0 115 Blakestown and Mountview Youth Initiative 570 0 570 Blanchardstown & Inner City Home Helps 2,135 0 2,135 Bloomfield Hospital 689 0 689 Bluebell Development Project Ltd 11 90 101 Bodywhys The Eating Disorders Association of Ireland 233 0 233 Bon Secours Sisters 2,041 0 2,041 Bonnybrook Day Nursery 236 0 236 Brainwave - Irish Epilepsy Association 844 0 844 Bray Cancer Support Centre 103 0 103 Bray Lakers Social & Recreational Club Ltd 111 0 111 Brothers of Charity 153,917 0 153,917 Cairde 373 0 373 Cairdeas 218 68 286 Camphill Communities of Ireland 544 0 544 Cancer Care West 200 0 200 Cappagh National Orthopaedic Hospital 27,783 0 27,783 Capuchin Friary 108 0 108 Care of the Aged, West Kerry 105 0 105 Carers Association Ltd 2,743 0 2,743 CARI Foundation 313 0 313 Caring and Sharing Association 189 0 189 Caring for Carers Ireland 461 0 461 Caritas 2,059 0 2,059 Carlow Regional Youth Services 167 0 167 Carlow Social Services 396 0 396 Carmichael Centre for Voluntary Groups 417 0 417 Carnew Community Care Centre 126 0 126 Carrickmacross Parent & Friends Association 476 0 476 Casadh 0 120 120 Cavan Centre 235 0 235 Cavan Drug Awareness (CDA) Trust Ltd 101 0 101 CDVEC 62 56 118 Central Remedial Clinic 16,708 0 16,708 Centres for Independent Living 8,144 0 8,144
92 Health Service Executive, Annual Report 2006 Name of Agency Revenue Grants Grants Funded by Total Grants other Government Departments/State Agencies 2006 2006 2006 €000s €000s €000s
Charleville Care Project Ltd 103 0 103 Cheeverstown House Ltd 22,388 0 22,388 Cheshire Ireland 21,832 37 21,869 Children's Sunshine Home 3,980 0 3,980 Citi Hostels (Sancta Maria) 221 0 221 City & County Childcare Committees 1,015 0 1,015 City of Dublin Skin and Cancer Hospital 3,161 0 3,161 Clann Housing Association 994 0 994 Clare Accessible Transport 123 0 123 Clarecare Ltd Incorporating Clare Social Service Council 4,915 0 4,915 Clareville Court Day Centre 139 0 139 Clondalkin Addiction Support Programme 603 94 697 Clones Branch of the Mentally Handicapped 173 0 173 Clonmany Mental Health Association 119 0 119 Clontarf Home Help 1,780 0 1,780 Clonturk House Home for Adult Blind 782 0 782 CLR Home Help 1,292 0 1,292 CLUB 91 (Formerly Chez Nous Service) 130 0 130 CoAction West Cork 4,781 0 4,781 Cobh General Hospital 1,325 0 1,325 Coiste Cu Chulainn 126 0 126 Community Awareness of Drugs 107 50 157 Community Games 450 0 450 Community Partnership Youth Lynx Project 119 0 119 Community Response, Dublin 272 177 449 Congregation of the Little Sisters of the Poor 117 0 117 Console 250 0 250 Coolmine Therapeutic Community Ltd 722 406 1,128 Coombe Women's Hospital 45,616 0 45,616 COPE Foundation 42,986 0 42,986 Cork Association for Autism 1,889 0 1,889 Cork City Council 244 0 244 Cork Social and Health Education Project 274 0 274 County Wexford Community Workshop, Enniscorthy/New Ross Ltd 3,473 0 3,473 Crisis Pregnancy Agency 32 325 390 Crosscare 3,563 0 3,563 Crumlin Home Help 1,852 0 1,852 Cuan Mhuire 1,053 0 1,053 Cumas Teo 274 153 427 CURA 171 0 171 Dara Residential Services 1,682 0 1,682 Darndale Day Nursery 365 0 365 Darndale Family Centre 376 0 376 Darndale/Kilmore Home Help 334 0 334 Daughters of Charity 32,262 0 32,262 Daughters of Charity Family Centres 1,651 0 1,651 Daughters of Charity of St Vincent de Paul 58,311 0 58,311 Daughters of Charity Springboard Projects 2,524 0 2,524
Health Service Executive, Annual Report 2006 93 Name of Agency Revenue Grants Grants Funded by Total Grants other Government Departments/State Agencies 2006 2006 2006 €000s €000s €000s
Dawn Court Day Care Centre Ltd 123 0 123 Day Activation Unit for Children and Windmill Therapeutic Training Unit 417 0 417 Day Care Services, Newport Social Service 233 0 233 De Paul Trust 1,243 0 1,243 Deansrath Family Resource Centre 181 0 181 Delta Centre Carlow 2,230 0 2,230 Dental Health Foundation Ireland 233 0 233 Disability Federation of Ireland 1,712 0 1,712 Dóchas 468 35 503 Dolmen Clubhouse Ltd 100 0 100 Don Bosco Teenage Care Housing Association 1,479 0 1,479 Donegal Youth Services 105 0 105 Donnycarney Youth Project Ltd 315 0 315 Donnycarney/Beaumont Home Help 834 0 834 Drogheda Community Services 170 0 170 Drogheda Homeless Aid Association 185 0 185 Dromcollogher & District Respite Care Centre 465 0 465 Drug Treatment Centre Board 8,750 0 8,750 Drumcondra Home Help 689 0 689 Drumlin House 274 0 274 Dublin AIDS Alliance Ltd 402 0 402 Dublin City Council Homeless Agency 969 144 1,113 Dublin Dental Hospital 6,832 0 6,832 Dun Laoghaire Home Help 703 0 703 Dun Laoghaire/Rathdown Outreach Project 201 0 201 Eastern Community Works Ltd 6,127 4,112 10,239 Eastern Vocational Enterprises Ltd 6,536 0 6,536 Edenmore Day Nursery 252 0 252 Edward Worth Library 200 0 200 Enable Ireland 30,955 0 30,955 Errigal Truagh Special Needs Parents & Friends Ltd 145 0 145 Extern Ireland 3,550 0 3,550 Extra Care for the Elderly 437 0 437 Family & Community Resource Centre, Ballyhaunis 133 0 133 Family Resource Centre Hill Street 100 0 100 Fatima Home, Tralee 317 0 317 Ferns Diocesan Youth Services 115 0 115 Ferrybank Football Club 0 100 100 Fingal Association for the Handicapped 346 0 346 Fingal Home Help Services Ltd 2,818 0 2,818 Finglas Home Helps 1,291 0 1,291 First Step 284 0 284 Focus Ireland 3,942 0 3,942 Fold Ireland Cherryfields Housing with Care Facility 255 0 255 Foróige 3,458 59 3,517 Foyle Trust 164 0 164 Galway City & County Childcare Strategy Group 229 0 229 Galway County Association for Mentally Handicapped Children 20,451 0 20,451
94 Health Service Executive, Annual Report 2006 Name of Agency Revenue Grants Grants Funded by Total Grants other Government Departments/State Agencies 2006 2006 2006 €000s €000s €000s
Galway Hospice Foundation 3,053 0 3,053 Gay HIV strategies 104 0 104 Gheel Autism Services 4,510 0 4,510 Good Shepherd Centre Kilkenny 155 0 155 Good Shepherd Sisters 2,885 0 2,885 GROW 1,136 0 1,136 Hail Housing Association for Integrated Living 315 0 315 Hand Research Board, Cork University Hospital 0 414 414 Headway the National Association for Acquired Brain Injury 2,467 0 2,467 Health Atlas Ireland 0 208 208 Health Services National Partnership Forum 1,970 34 2,004 Heartbeat Trust 695 0 695 Holy Angels Carlow, Special Needs Day Care Centre 566 0 566 Holy Family Hostel Kilkenny 886 0 886 Holy Family School 279 0 279 Holy Ghost Hospital 116 0 116 Home Again (Formerly Los Angeles Society) 2,152 0 2,152 Home Youth Liaison Service 204 0 204 HomeCare North East Bay Ltd 430 0 430 Homeless Girls Society Ltd 774 0 774 Homestart Blanchardstown 103 0 103 Homestart Family Support Services 152 0 152 Hope House 135 0 135 Housing Aid for the Elderly Scheme 0 8,361 8,361 Inchicore Community Drugs Team 270 0 270 Inchicore Home Help 972 0 972 Inclusion Ireland 710 0 710 Incorporated Orthopaedic Hospital of Ireland 5,626 0 5,626 Individual Clients in Community 594 0 594 Irish Advocacy Network 622 0 622 Irish Association for Spina Bifida and Hydrocephalus 1,165 0 1,165 Irish Association of Suicidology 100 0 100 Irish Association of Young People in Care 221 0 221 Irish Blood Transfusion Services Board 100 0 100 Irish Family Planning Association 761 0 761 Irish Foster Care Association 368 0 368 Irish Guide Dogs for the Blind 715 0 715 Irish Haemophilia Society 598 0 598 Irish Heart Foundation 515 0 515 Irish Kidney Association 246 0 246 Irish Motor Neurone Disease Association 252 0 252 Irish Osteoporosis Society 133 0 133 Irish Pre-School Playgrounds Association 273 0 273 Irish Society for Autism 2,997 0 2,997 Irish Sudden Infant Death Association 257 0 257 Irish Travellers Movement 5,991 111 6,102 Irish Wheelchair Association 28,614 0 28,614 ISPCC 496 0 496
Health Service Executive, Annual Report 2006 95 Name of Agency Revenue Grants Grants Funded by Total Grants other Government Departments/State Agencies 2006 2006 2006 €000s €000s €000s
Jack & Jill Childrens Foundation 576 0 576 Jobstown Assisting Drug Dependency Project 212 84 296 K Doc - GP Out of Hours Service 1,620 0 1,620 KARE 13,958 0 13,958 KASMHA 919 0 919 Kerry Parents & Friends 6,635 0 6,635 Kilbarrack Coast Community Programme Ltd 287 0 287 Kilbarrack/Foxfield Day Centre 126 0 126 Kildare Youth Services 933 0 933 Kilkenny Community Action Network 186 0 186 Killinarden - KARP 284 0 284 Kilmaley Voluntary Housing Association 117 0 117 L'Arche Ireland 2,547 0 2,547 Leitrim Association of People with Disabilities 470 0 470 Leopardstown Park Hospital 12,336 0 12,336 Liberties & Rialto Home Help 890 0 890 Liberty Creche 271 0 271 Lifestart Foundation 1,303 0 1,303 Limerick Network Against Racism 105 0 105 Limerick Social Service Council 849 0 849 Limerick Youth Service Community Training Centre 362 0 362 Link (Galway) ltd 150 0 150 Little Angels Hostel Letterkenny 122 0 122 Local Community Drugs Teams 145 58 203 Local Drugs Task Forces 1,332 7,574 8,906 Lochrann Ireland Ltd 156 0 156 Longford Community Resources Ltd 103 0 103 Longford Social Services Committee 241 0 241 Lorcan O' Toole Day Care Centre 105 0 105 Loughboy Child Care Project 172 0 172 Lourdes Day Care Centre 156 0 156 Mahon Family Resource Centre 245 0 245 Marian Court Welfare Home Clonmel 142 0 142 Marian Day Nursery and Family centre 177 0 177 Marino/Fairview Home Help 409 0 409 Mater Dei Institute of Education 421 0 421 Mater Misericordiae University Hospital Ltd 228,333 0 228,333 Matt Talbot Adolescent Services 1,248 0 1,248 Mayo Roscommon Hospice Foundation 149 0 149 Mead Village Day Care Centre 237 0 237 Mental Health Commission 0 2,235 2,235 Mental Health Association of Ireland 973 0 973 Merchant's Quay Ireland 1,984 43 2,027 Mercy Family Centre 445 46 491 MIDWAY Meath Intellectual Disability Work Advocacy You Ltd 953 0 953 Migraine Association of Ireland 163 0 163 Millennium Carving Ltd 236 0 236 Miss Carr's Housing Association Ltd 1,214 0 1,214
96 Health Service Executive, Annual Report 2006 Name of Agency Revenue Grants Grants Funded by Total Grants other Government Departments/State Agencies 2006 2006 2006 €000s €000s €000s
Moatview Day Nursery 118 0 118 Molyneaux House for the Blind 875 0 875 MooreHaven Centre (Tipperary) Ltd 1,105 0 1,105 Mountview/Blakestown Community Drugs Team 300 0 300 Mrs Smyly's Homes and Schools 1,881 0 1,881 MS Ireland - Multiple Sclerosis Society of Ireland 2,794 0 2,794 Muintir na Tire Ltd 130 0 130 Mulhuddart/Corduff Community Drugs Team 277 0 277 Muscular Dystrophy Ireland 1,235 0 1,235 National Association for Deaf People 4,755 0 4,755 National Association of Housing for the Visually Impaired Ltd 491 0 491 National Council for the Professional Development of Nursing and Midwifery 0 548 548 National Federation of Voluntary Bodies in Ireland 267 0 267 National Maternity Hospital 45,420 0 45,420 National Network of Women's Refuge and Support Services 7,487 0 7,487 National Rehabilitation Hospital 24,659 0 24,659 National Suicide Research Foundation 1,025 0 1,025 National University of Ireland, Galway 291 0 291 National Virus Reference Laboratory 8,791 0 8,791 Nazareth House 4,682 0 4,682 Nenagh Community Network 106 0 106 New Ross Community Hospital 295 0 295 Newbury House Family Centre 145 0 145 No Name Youth Club Ltd 146 0 146 North and West Connemara Rural Project t/a Forum 166 0 166 North Tipperary Community and Voluntary Association 320 0 320 North West Alcohol Forum 100 0 100 North West MS Therapy Centre 180 0 180 North West Parents & Friends Association 1,753 0 1,753 Northside Community Health Initiative 320 0 320 Northside Homecare Services Ltd 487 0 487 Northside Inter-Agency Project 131 0 131 Northwest Hospice 820 0 820 O' Connell Court Residential & Day Care 153 0 153 Open Door Day Centre 442 0 442 Open Heart House 172 0 172 Order of Malta 344 0 344 Ossory Youth Services 116 0 116 Our Lady of Lourdes Social Services Centre 877 0 877 Our Lady's Children's Hospital, Crumlin 120,992 0 120,992 Our Lady's Hospice, Harold's Cross 28,524 0 28,524 Our Lady's Nursery Ballymun Ltd 376 0 376 Outhouse Ltd 226 0 226 Outreach Project Network - OASIS Project 391 0 391 Oznam House 154 0 154 Parenting Support Project 179 0 179 Parents for Justice Ltd 330 0 330 Partnership Care West 111 0 111
Health Service Executive, Annual Report 2006 97 Name of Agency Revenue Grants Grants Funded by Total Grants other Government Departments/State Agencies 2006 2006 2006 €000s €000s €000s
Peacehaven Trust 534 0 534 Peamount Hospital 25,310 0 25,310 Peter Bradley Foundation 4,735 0 4,735 Phoenix Community Resource Centre 111 0 111 Polio Fellowship of Ireland 426 0 426 Positive Action 592 0 592 Positive Age Ltd 104 0 104 Post Polio Support Group (PPSG) 396 0 396 Praxis Care Group 1,514 0 1,514 Presentation Sisters 369 0 369 Prosper Fingal Ltd 4,403 0 4,403 Rape Crisis Network Ireland 2,884 0 2,884 Rathmines Home Help 372 0 372 RCCN Caring Ltd T/A Community Care 205 0 205 Red Ribbon Project 279 0 279 Rehab Group 29,695 0 29,695 Religious Sisters of Charity 12,181 0 12,181 Respond Housing Association 860 0 860 Rialto Community Development 130 0 130 Rialto Community Drugs Team 264 0 264 Rialto Community Network 112 0 112 Right of Place Second Chance Group 357 0 357 Ringsend & District Response to Drugs 273 45 318 Roscommon Support Group Ltd 292 0 292 Roscrea 2000 Ltd 301 0 301 Rotunda Hospital 45,051 0 45,051 Rowlagh Day Nursery 183 0 183 Royal College of Surgeons in Ireland - Irish Cervical Screening Programme (ICSP) 2,174 0 2,174 Royal Hospital Donnybrook 20,099 0 20,099 Royal Victoria Eye and Ear Hospital 22,200 0 22,200 Ruhama Women’s Project 139 57 196 S H A R E 221 0 221 Sacred Heart of Jesus & Mary Sisters 1,081 0 1,081 Salesian Youth Enterprises Ltd 354 0 354 Salvation Army 4,002 0 4,002 Samaritans 197 0 197 Sandymount Home Help 331 0 331 Saoilse 118 0 118 SAOL Project 244 0 244 Schizophrenia Ireland Lucia Foundation 1,389 0 1,389 Seirbhísí Cúraim Lae Tyman Bawn 203 0 203 Sevenoaks Nursery 220 0 220 Shalamar Emergency Housing Project 130 0 130 Shanakiel Hospital 105 0 105 Shanakill Family Resource Centre 129 0 129 Shannon Community Workshop 195 0 195 Shanty Educational Project Ltd 847 81 928 Simon Commuities of Ireland 6,657 82 6,739
98 Health Service Executive, Annual Report 2006 Name of Agency Revenue Grants Grants Funded by Total Grants other Government Departments/State Agencies 2006 2006 2006 €000s €000s €000s
SIPTU National Health and Local Authority HR Development Project 250 0 250 Sisters of Charity 2,632 0 2,632 Sisters of Charity of Jesus & Mary, Moore Abbey 38,144 0 38,144 Sisters of Charity St Mary's Centre for the Blind and Visually Impaired 4,639 0 4,639 Sisters of La Sagesse, Cregg House 17,731 0 17,731 Sisters of Mercy 309 0 309 Sisters of the Bon Sauveur 8,197 0 8,197 Sisters of the Sacred Hearts of Jesus and Mary 13,772 0 13,772 Skerries Home Help 761 0 761 Sligo Social Service Council Ltd 881 0 881 Social Inclusion 261 0 261 Society of St Vincent de Paul 2,934 0 2,934 Sophia Housing Association 465 0 465 South Tipperary Hospice Movement 108 0 108 Southside Outreach Team Autistic Children 222 0 222 Special Olympics Ireland 102 0 102 Spinal Injuries Ireland 329 0 329 SPIRASI 331 0 331 St Aengus' Community Action Group 162 0 162 St Aidan's Services 3,081 0 3,081 St Andrew's Home Help Service 281 0 281 St Andrew's Resource Centre 68 39 107 St Anne's Day Nursery Ltd 182 0 182 St Anne's Youth Centre Ltd 323 0 323 St Benedict's Community Centre 363 0 363 St Bridget's Centre 113 0 113 St Brigid's Drumkeerin 104 0 104 St Carthage's House Lismore 155 0 155 St Catherine’s Association Ltd 5,450 0 5,450 St Christopher's Services, Longford 5,903 0 5,903 St Cronan's Association 796 0 796 Ruhama Women’s Project 139 57 196 St Fiacc's House, Graiguecullen 136 0 136 St Francis' Hospice 6,603 0 6,603 St Gabriel's Mental Health Association 963 0 963 St Helena's Day Nursery 171 0 171 St Hilda's Services for the Mentally Handicapped, Athlone 3,849 0 3,849 St James' Hospital 338,644 0 338,644 St James' Unit for the Elderly 711 0 711 St John Bosco Youth Project 152 65 217 St John Of God Hospitaller Services 126,334 0 126,334 St John's Hospital 20,902 0 20,902 St Joseph's Foundation 8,490 0 8,490 St Joseph's Home for the Elderly 970 0 970 St Joseph's School for the Deaf 1,767 0 1,767 St Joseph's School for the Visually Impaired 4,170 0 4,170 St Kevin's Home Help 229 0 229 St Laurence O' Toole SSC 534 0 534
Health Service Executive, Annual Report 2006 99 Name of Agency Revenue Grants Grants Funded by Total Grants other Government Departments/State Agencies 2006 2006 2006 €000s €000s €000s
St Lazarian's House, Bagenalstown 206 0 206 St Luke's Hospital 163 0 163 St Luke's & St Anne's Hospital 34,750 0 34,750 St Luke's Home 4,850 0 4,850 St Mary of the Angels 2,893 0 2,893 St Mary's Day Care Centre 163 0 163 St Mary's Day Nursery 203 0 203 St Mary's Hospital and Residential School, Baldoyle 6,223 0 6,223 St Michael's Day Care Centre Cappamore 137 0 137 St Michael's Hospital, Dun Laoghaire 30,828 0 30,828 St Michael's House 66,264 0 66,264 St Monica's Community Development Committee 353 0 353 St Monica's Nursing Home 2,761 0 2,761 St Oliver's - Meath Association for Mentally Handicapped 726 0 726 St Patrick's Special School 129 0 129 St Patrick's Hospital 7,686 0 7,686 St Patrick's Wellington Road 8,819 0 8,819 St Vincent's Day Nursery 190 0 190 St Vincent's Hospital Fairview 12,472 0 12,472 St Vincent's University Hospital, Elm Park 198,461 0 198,461 Star Project Ballymun Ltd 152 0 152 Stella Maris Facility 117 0 117 Stewart's Hospital 44,193 0 44,193 Streetline 678 0 678 Sunbeam House Services 19,099 0 19,099 Tabor House Trust Ltd 127 0 127 Tabor Lodge 189 0 189 Tabor Society 694 0 694 Tallaght Home Help 977 0 977 Tallaght Partnership 0 202 202 Tallaght Rehabilitation Project 102 0 102 Tallaght Welfare Society 134 0 134 Teach Iosa -Youth for Peace Ltd 201 0 201 Teach Trasna 106 0 106 Teen Challenge Ireland Ltd 4 169 173 Temple Street Children's University Hospital 67,824 0 67,824 Templemore Community Social Services 183 0 183 Terenure Home Care Service Ltd 584 0 584 The Cottage Home Child & Family Services 1,607 0 1,607 The Guardian Ad Litem and Rehabilitation Office 128 0 128 The National Council for the Blind of Ireland 7,669 0 7,669 Third Age Active Retirement Group Ireland 107 0 107 Thurles Community Social Services 340 0 340 Tipperary Association for Special Needs 398 0 398 Tir An Droichead Housing Agency 108 0 108 Tir na nÓg Day Nursery 104 0 104 Togher Pre School & Family Centre 115 0 115 Transfusion Positive 468 0 468
100 Health Service Executive, Annual Report 2006 Name of Agency Revenue Grants Grants Funded by Total Grants other Government Departments/State Agencies 2006 2006 2006 €000s €000s €000s
Treoir 183 0 183 Trinity College Dublin 8,121 80 8,201 Turners Cross Social Services Ltd 105 0 105 Union of Our Lady of Charity 176 0 176 Unit 1, 2, 6, 7, St Stephen's Hospital 4,030 0 4,030 University College Cork 0 200 200 University College Dublin 7,524 0 7,524 Urban Ballyfermot Ltd 45 194 239 Valentia County Hospital 589 0 589 Vergemount Housing Fellowship 186 0 186 Vincentian Housing Partnership 320 0 320 Vita House Family Centre, Roscommon 118 0 118 Walkinstown Association for Handicapped People Ltd 2,644 0 2,644 Walkinstown Greenhills Resource Centre 0 259 259 Waterford Association for Mental Handicapped 1,282 0 1,282 Waterford Community Based Drug Team 171 0 171 Welfare Home Callan/Kilmoganny 157 0 157 Well Women Clinic 267 0 267 Wellsprings 627 0 627 West Cork Carers Support Group Ltd 101 0 101 West of Ireland Alzheimer Foundation 915 0 915 Westdoc- GP Out of Hours Service 204 0 204 Western Care Association 26,837 0 26,837 Wexford Mental Health Association 169 0 169 White Oaks Housing Association Ltd 300 0 300 Wicklow Child & Family Project 337 0 337 Wicklow Community Care Home Help Services 3,805 0 3,805 Women's Aid 1,010 0 1,010 YMCA 476 0 476 Youth Action Programmes 955 0 955 Youth Advocacy Programme 1,552 0 1,552 Youth Work Ireland 311 0 311
Total Grants to Outside Agencies (see Note 8) 3,157,392 29,436 3,186,828
Health Service Executive, Annual Report 2006 101 Appendix 2 Analysis of Capital Grants to Outside Agencies (Capital Income and Expenditure Account)
Name of Agency Capital Grants 2006 €000s
Total Grants Under €100,000 (91 Grants) 3,127 Adelaide and Meath Hospital, Dublin Incorporating The National Children's Hospital 7,146 Alzheimer Society of Ireland 2,000 Athlone Institute of Technology 266 Beaumont Hospital 11,882 Bessborough Care Centre 180 Brothers of Charity Services Ireland 6,680 Cairde Le Cheile 130 Camphill Communities of Ireland 346 Cancer Care West 350 Cappagh National Orthopaedic Hospital 2,751 Central Remedial Clinic 682 Cheeverstown House 765 Cheshire Foundation Ireland 519 Children's Sunshine Home 200 Coaction West Cork 180 Coolmine Therapeutic Communities Ltd 210 Coombe Women's Hospital 2,596 Cope Foundation 2,090 Cork City Council 170 Cork University Dental School & Hospital 2,266 County Wexford Community Workshop Enniscorthy Ltd 201 Daughters of Charity 1,868 Desmond Ability Resource Complex Ltd 500 Drug Treatment Centre Board 253 Dundalk Institute of Technology 1,099 Enable Ireland 2,591 Fhist Housing Association 100 Fold Ireland 1,926 Galway County Association For Mentally Handicapped Children 608 Galway Mayo Institute of Technology 314 Gheel Autism Services Ltd 1,450 Institute of Technology Tralee 344 Irish College of Ophthalmologists 135 Irish Wheelchair Association 633 KARE 1,000 Kerry Hospice Foundation 416
102 Health Service Executive, Annual Report 2006 Name of Agency Capital Grants 2006 €000s
Knocklofty Project, Residential Development 140 L'Arche Ireland 111 Leitrim Association of People with Special Needs 100 Leopardstown Park Hospital 685 Local Drugs Task Forces 1,035 Mater & Children's Hospital Development Ltd 7,169 Mater Misericordiae University Hospital 6,971 Mental Health Ireland 217 Mercy Family Centre Ltd 100 Mercy University Hospital, Cork 6,142 Midway - Meath Intellectual Disability Work Advocacy You Ltd 212 Moorehaven Centre Tipperary Ltd 260 National Association for Deaf People 105 National Council for the Blind of Ireland 164 National Maternity Hospital 1,605 National Rehabilitation Hospital 481 National University of Ireland Galway 6,892 Neighbourhood Youth Project (School On Stilts) 120 North-West Parents and Friends Association 174 Our Lady's Children's Hospital, Crumlin 8,948 Peamount Hospital 4,630 Peter Bradley Foundation 851 Praxis Care Group 128 Rehab Group 3,048 Rotunda Hospital 2,105 Royal College of Surgeons In Ireland 164 Royal Hospital Donnybrook 320 Royal Victoria Eye & Ear Hospital 1,813 Scéim Tithíochta Inacmhainne 100 Sesame Pre-School Day Activation Unit for Children and Windmill Therapeutic Training Unit 1,022 Simpson's Hospital Nursing Home 318 Sisters of Charity 863 Sisters of Charity, Jesus & Mary, Moore Abbey 257 Sisters of La Sagesse Services 480 SOS (Kilkenny) Ltd Special Occupation Scheme 748 South Doc GP Co-Operative 755 South Infirmary Victoria University Hospital 4,859 St Aidan's Day Care Centre, Gorey 152 St Angela's College, Sligo 7,484 St Anne's Services, Roscrea 150
Health Service Executive, Annual Report 2006 103 Name of Agency Capital Grants 2006 €000s
St Catherine's Association Ltd 150 St Christopher's Services Ltd 500 St Clare's Nursing Home 170 St Hilda's Services for the Mentally Handicapped Athlone 200 St James’s Hospital 17,074 St John of God Hospitaller Services 2,619 St John's Hospital 1,861 St Joseph's Foundation 606 St Joseph's School For Blind 415 St Luke's Hospital 605 St Mary's Aid Ltd (Area Integrated Development) 120 St Mary's Senior Citizens, Knocknaheeny Youth Project 120 St Michael's Hospital, Dun Laoghaire 300 St Michael's House 2,325 St Patrick's Hospital 187 St Vincent's Hospital, Fairview 159 St Vincent's University Hospital, Elm Park 22,951 Sunbeam House Services 1,150 Temple Street Children's University Hospital 1,980 Trinity College Dublin 1,501 University College Cork 2,051 University College Dublin 2,233 University of Limerick 2,442 Valentia Community Hospital 110 Waterford Association for the Mentally Handicapped 127 Waterford Institute of Technology 1,406 Western Care Association 1,108 Total Capital Grants to Outside Agencies (Note 19(b)) 194,322
104 Health Service Executive, Annual Report 2006 Appendix 3 Miscellaneous (Analysis of Miscellaneous Expenditure in Note 8)
Name of Agency 2006 2005 €000 €000
Maintenance Farm and Grounds 2,013 1,903 Security 7,910 7,296 Fluoridation 1,123 1,026 Memberships 86 107 Licences 468 607 Subscriptions 583 984 Sundry Expenses 15,589 21,141 Training and Education 6,057 6,650 Burial Expenses 94 111 Secondment Charges 1,421 1,193 Recreation (Residential Units) 690 142 Materials for Workshops 2,916 4,361 Home Adaptations 325 412 Meals on Wheels Subsidisation 2,136 1,987 Home Care Packages 15,883 3,684 Health Protection projects 2,896 224 Contract Care 7,024 5,860 Payments to patients under the scheme of ex gratia payments re: long stay charges 12 8,797 Client Services 878 923 Refunds 695 785 Neo Natal Services 0 1,149 Total Miscellaneous Expenditure (see Note 8) 68,916 79,342
Health Service Executive, Annual Report 2006 105 Health Service Executive, Oak House, Limetree Avenue, Millenium Park, Naas, Co.Kildare Email: [email protected] Telephone: 045-880400 / 01-6352500
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