Building a Better Health Service Annual Report and Financial Statements 2016 Building a Better Health Service ANNUAL REPORT AND FINANCIAL STATEMENTS 2016 Contents Part I Statement from the Director General 2 Our Health Service Our Corporate Plan 6 Values in Action 7 Our Organisation 8 Our Population 16 Implementing Healthy Ireland 18 Listening to our Service Users 20 Improving Quality and Delivering Safe Services 25 Integrated Care 28 Excellence in Delivering our Health Services 31 Community Healthcare Health and Wellbeing 38 Primary Care 42 Mental Health 46 Social Care 50 Community Healthcare Organisations 56 Pre-Hospital and Hospital Services National Ambulance Service 70 Acute Hospital Services 74 Hospital Groups 82 Supporting Service Delivery 92 Appendices Appendix 1: Membership of the Directorate and Leadership Team 100 Appendix 2: Organisational Structure 101 Appendix 3: Performance Against National Service Plan 2016 Performance Indicator Suite 102 Appendix 4: Capital Projects 119 Appendix 5: Annual Energy Efficiency Report 127 Part II Financial Governance Operating and Financial Overview 130 Directorate Members’ Report 135 Statement of Directors’ Responsibilities in Respect of the Annual Financial Statements 141 Statement on Internal Financial Control 142 Comptroller and Auditor General Report for Presentation to the Houses of the Oireachtas 154 Financial Statements 156 Accounting Policies 161 Notes to the Financial Statements 165 Appendices Appendix 1: Revenue Grants and Capital Grants 189 HSE Annual Report and Financial Statements 2016 1 Statement from the Director General small way to significant improvements in treatment and care provided by the health service. Unfortunately, a large proportion of this age group is living with two or more chronic conditions which make many of our older people more vulnerable. Healthcare is a constantly changing environment. Our practices and models of care continue to evolve to meet these changing requirements. The real value is how we change what we do and rethink how we deal with each other to improve the quality of healthcare. Improving the quality of healthcare Bringing to life our values of Care, Compassion, Trust and Learning provides better experiences for patients and service users as well as providing a better workplace for our staff. A peer to peer approach to effect this culture change has begun called Values in Action – this is about shaping our culture around our values, translating them from words into actions and behaviours so that they are evident every day in every workplace. As the needs of the population change and demand for Our aim is to provide a health service health services grows, introducing innovation and better which becomes world class and is available to ways of working is an important step towards ensuring people where they need it and when they need we can meet those needs into the future. This year, it. But we are not there yet. We are continuing we had 426 entrants for the Health Service Excellence our efforts to improve services and health Awards, showing the enthusiasm and appetite across outcomes, while also focusing on the cost and the health services for new ways of working that can sustainability of services, ensuring that we are lead to real improvements for patients/service users achieving the best value for money for both the and the public as a whole. public and our service users. We are proactively ensuring that service user and staff engagement is at the centre of service delivery, informing 2016 was the second year in which an additional how we plan and deliver our services. Listening sessions budget allocation was made available to the were held for both the services for older people and health service. Following the years of austerity, mental health. A service user was appointed as the this additional funding is particularly welcome. new Head of Service User, Family Member and Carer Engagement for mental health services. A National Demand for health and personal social care Patient Experience Survey has been developed with the services continues to grow each year. Today Department of Health and the Health Information and our population is older and it is expected that Quality Authority which will be implemented across the number of people over 65 years of age will acute services by mid-2017. A second national staff increase by nearly 110,000 people in the next engagement survey was carried out – Your Opinion five years. This is great news and is due in no Counts – to seek the views of staff on a range of 2 HSE Annual Report and Financial Statements 2016 Statement from the Director General themes. A guide Communicating Clearly with Patients of capital funding is required in our health services and Service Users was developed to support everyone over the next ten years in order to overcome existing in the health services in ensuring our written and spoken deficiencies. communication is clearly understood. A revised Performance and Accountability Framework was implemented during the year strengthening Health Reform personal responsibility and accountability at all levels of the organisation including the service delivery unit Health services are provided across the country in level. large urban centres and smaller local communities. These services must be organised in a way that ensures they are capable of responding to the needs of their communities. Thank you On behalf of the Directorate, I would like to thank The establishment of seven Hospital Groups and nine Mr Jim Breslin, Secretary General of the Department Community Healthcare Organisations (CHOs) is part of of Health, together with his officials, for their support, our significant reform programme aimed at increasing encouragement and assistance during the year. access, quality and integration of care, with services dealing with health needs as they arise, in locations I would like to acknowledge the leadership of the that meet the best clinical and service standards. Minister for Health, Mr Simon Harris TD, and his predecessor Mr Leo Varadkar TD, who along with The Programme for Health Service Improvement is the Minister of State with special responsibility for enabling and supporting the delivery system to make Disabilities, Mr Finian McGrath TD, the Minister this happen through supporting and strengthening of State for Communities and the National Drugs both the Hospital Groups and CHOs. Improvements Strategy, Ms Catherine Byrne TD, the Minister of State are being made in national services also, including for Health Promotion, Ms Marcella Corcoran Kennedy the development of the Individual Health Identifier, TD, the Minister of State for Mental Health and Older implementation of the haemochromatosis model People, Ms Helen McEntee TD, and Ms Kathleen Lynch, of care and service developments in the National formerly Minister of State with special responsibility Ambulance Service. for Mental Health, Primary Care and Social Care, for steering policy at Government level. Clinical programmes and integrated care programmes continue to lead the development of integrated I also wish to thank all members of the Directorate care across our health system. This is a long term and Leadership Team, the CHOs, Hospital Groups programme of improvement and change and and all their staff for their dedication and commitment involves people at all levels of the health service, throughout year. working together to create improved experiences and outcomes for people in their care. I would like to especially acknowledge and thank our staff for their commitment in delivering quality health While significant reform continued in 2016, much services to those who need them. Their resilience and still needs to be done to ensure our health service is perseverance is exemplary and deserves recognition. more responsive. However, this requires a decisive The impact of all this work can be seen in the service shift towards primary care away from the most developments and improvements reflected throughout expensive form of treating and caring for people – this Annual Report. the acute hospital system. Such a shift will require additional resources and also a remodelling of how services are funded to allow this take place over a number of years while maintaining existing levels of services to all parts of the health services. Progress is also underway in reforming our capital infrastructure. Major projects are progressing including the National Children’s Hospital, the National Forensic Tony O’Brien Mental Health Services Hospital (Dublin) and the Director General National Rehabilitation Hospital (Dublin). A review of Health Service Executive capital requirements in 2016 provided details of the funding required to progress other projects and to ensure the upkeep, repair or replacement of many existing buildings and equipment. A significant injection Statement from the Director General HSE Annual Report and Financial Statements 2016 3 Our Health Service Our Corporate Plan Mission People in Ireland are supported by health and social care services to Values achieve their full potential Vision We will try to live People in Ireland can access safe, A healthier Ireland with our values every day compassionate and quality care a high quality health when they need it and will continue to service valued by all develop them People in Ireland can be confident that we will deliver the best health outcomes and value through optimising our resources Care Compassion Trust Learning The Corporate Plan 2015-2017 sets out our aim to improve our health service over a three year period, Promote health and wellbeing providing a health service which becomes world Goal 1 as part of everything we do so class, is available to people where they need it and that people will be healthier when they need it. It should provide people with the very best outcomes which can be achieved, as this is what users of our services expect. Our vision is to Provide fair, equitable and timely Goal develop a healthier Ireland with a high quality health 2 access to quality, safe health service valued by all.