HSE Publishes National Service Plan 2018

Every day in 2018 the HSE will:

  • Spend €30.2 million on delivering services
  • Provide 46,800 home support hours
  • See 3,000 people in GP out of hours services
  • See 3,700  patients in emergency departments

Following approval from Government, the HSE has today, Wednesday December 20th 2017, published its National Service Plan 2018. The Plan sets out the type and volume of health and personal social services to be provided in 2018, within the funding available. It also recognises that underpinning all of these actions is the goal of improving the health and wellbeing of the population and of ensuring that the services delivered are safe and of high quality.

The 2018 budget of €14.5 billion represents an overall increase of €608 million (4.4%) compared to the 2017 allocated budget allocation. The additional investment has allowed us to make a number of significant investments in new services in 2018 including:

  • An investment of €9m to support the expansion of paediatric/adolescent orthopaedic services including scoliosis
  • An investment of €25m in primary care to support the GP contract, GP training, diagnostics, therapies, nursing, Advanced Nurse Practitioner appointments and community nursing
  • An investment of €15m in mental health to support a range of key service developments
  • An investment of €10m for respite care, providing support in 2018 to 400 individuals with a disability and their families.

A total of €40.2m will be invested in acute hospital services.  The HSE will be using this funding to improve access to critical care services along with investment in services for people with Spina Bifida and spinal conditions.    Women and infant health services will be expanded through increased scanning and gynaecology services.

Cancer Services nationally will receive a total of €5.5m and this will allow for the expansion of services including radiotherapy treatment.  This funding will provide ongoing investment in cancer drugs and with the numbers of patients now surviving their cancer following improved treatments and services, there will be further investment in the ongoing care for those who are surviving cancer.

With our population increasingly living longer, the HSE continues to invest in services for older people, with continuing emphasis on maintaining individuals in their own homes and with as much independence as possible. Next year will feature an additional investment of €32m in additional home support, transitional care and bed capacity in rehabilitation settings. Home support and transitional care will be increased over the full year.  This will allow for:

  • €18.25m for home support services to provide 754,000 hours to support 1,170 people to leave hospitals
  • €1.4m for rehabilitation and step down beds in Limerick (four beds) and Cork (30 beds).
  • €0.85m for complex case discharges from acute hospitals
  • €0.65m for an additional six beds in the National Rehabilitation Hospital
  • €0.45m for an out-reach specialist team and day hospital in Our Lady’s Campus, Cashel

Funding has also been provided on an on-going basis to support older people with dementia with high needs to continue to live in their own homes.  A further €9m is being provided for Intensive Home Care Packages (IHCPs).  This follows the innovative investment provided over the past number of years as a joint agreement between Atlantic Philanthropies, the DoH and the HSE and will be sustained on an on-going basis.

The Nursing Homes Support Scheme (NHSS) is anticipating they will support 23,334 people in residential care at year end with a budget of almost €962m.

Within Primary Care an additional investment of €25m will allow for the expansion of Community Intervention Team support and OPAT support (IV care in patients’ homes).  This will mean an additional 4,682 referrals. For children being discharged from hospital, the HSE will provide an additional 60 home care packages representing an investment of €2.1m.  There will also be improved access to Occupational Therapy Services, an expansion of the GP out of hours service and the commissioning of 15 additional primary care centres, with an investment of €10m.

A total investment of €42.6m will allow for the reduction of prescription charges from €2.50 per item to €2 and reduce the monthly cap on prescription charges from €25 to €20 per month. It will further allow for the reduction of the drug payment scheme family threshold from €144 per month to €134 per month; provide for GP Visit Cards for Carers and increase the GP Visit Card income threshold by €25.

Supporting those individuals whose needs are broader than just the health and support services the HSE directly provides, an additional €6.5m will be invested in addition services, with €1.5m invested in Homeless Services along with €1m in primary care services for refugees in emergency reception and orientation centres.

The provision of €2.75m for the National Ambulance Services will allow for developments including an increase in the recruitment and training of additional paramedic staff; the expansion of aeromedical services; the implementation of a clinical hub. The investment will further support the National Transport Medicine Programme.

In the area of Mental Health €15m will be allocated to initiate new development including aimed at enhancing community mental health team capacity, expanding out of hours responses for adult services, expanding specialist responses for patients with severe and enduring mental health difficulties, and the continuing implementation of Connecting for Life.

Speaking at today’s launch, Mr Tony O’Brien, HSE Director General stated: “For several years we have been aware of the need for a shift in health service delivery in order to move from the more traditional focus of treatment and cure, to that of prevention and treatment, when required. The challenges referenced in this service plan are recognised fully in the recent Sláintecare report, which signals a new direction of travel in relation to eligibility, delivery, and funding of health and social care in Ireland into the future.

“The cross-party support for Sláintecare presents a huge opportunity and, appropriately resourced and governed, it has the potential to transform the health and wellbeing of the population, and how and where they access services.”

While the additional level of funding is to be welcomed, the growing cost of delivering core health and social services is such that the HSE faces a very significant financial challenge in 2018 in maintaining the existing level of services. The HSE is fully committed to meeting this challenge. It is estimated that there will be a financial challenge within the operational service areas of approximately €346m brought about by:

  • Changing demographics – Ireland has an ever increasing older population. Forecasting indicates people aged over 65 will increase by 110,000 in the next 5 years.
  • Increased demand for services – this changing demographic brings increased demand for health and social services
  • Increasing costs – including workforce, new and existing drugs, and regulatory requirement costs
  • Our health services model and design, as it currently exists, is no longer fit for purpose and cannot meet the needs of our citizens now and into the future


Commenting on the cost pressures Mr O’Brien added: “As we seek to grow our service levels to a greater extent than our resources are growing, we must continuously strive for operational efficiencies. This is the sign of a mature and ambitious health system that is doing everything it can to deliver the maximum volume of services to patients and service users within the budget we have to work with.”


To mitigate the estimated operational financial challenge for 2018, the HSE has developed a comprehensive Value Improvement Programme which will come into effect from the beginning of 2018. The Value Improvement Programme will be a single over-arching programme, but with three broad priority themes – improving value within existing services, improving value within non-direct service areas, and strategic value improvement. Robust governance and appropriate support arrangements will be established to manage the programme.

Value will be judged in terms of improvement of services and service user experience alongside evidence of economy, efficiency and effectiveness.

The 2018 HSE National Service Plan can be accessed here.