2. Current Service Provision

The 2002 Census of Population indicated that there were 323,707 people, some 8% of the population, with disabilities in Ireland. The Disability Act (2005) makes provision for improved access to public services, including general health services, by people with disabilities. This chapter provides an overview of the services currently provided by the Health Service Executive.

2.1 Overall Goal and Strategic Focus

The Health Service Executive (HSE) came into existence on 1 January 2005 as part of the provisions of the Health Act (2004). The Executive has responsibility for the management and operation of the health services as a unified system.

The overall goal of the HSE is to maintain and improve the health of the entire population, and subgroups of the population, and to reduce inequalities in health between population groups, using a population health approach. This approach recognises that health is a resource, that factors outside the health care system significantly affect health, and that delivery of healthcare is only part of what contributes to health. Population health addresses health issues for people with disabilities along the entire health continuum from prevention and promotion to health protection, diagnosis, treatment, rehabilitation and care, and integrates and balances action between them. All health service providers need to consider the impact of their policies and programmes on the health status of people with disabilities. Adopting this approach means moving towards more integrated service delivery where all services work together towards a common goal.

The HSE has a clearly defined vision: "to consistently provide equitable services of the highest quality to the population we serve." Its mission for the future is to provide high-quality, integrated health and personal social services built around the needs of the individual and supported by effective team-working. Four corporate objectives underpin the planning, delivery and evaluation of these services. These relate to:

  • The promotion of health and empowerment of people to maintain their own health;
  • The provision of easily accessible services;
  • Evidence-based decision making;
  • The delivery of the best possible care within available resources.

The following sections provide an outline of the key structures in the HSE through which services are delivered.

2.2 Primary, Community and Continuing Care Services (PCCC) Estimated Expenditure 2006 - €7.1billion

The Primary Community and Continuing Care (PCCC) Directorate is charged with responsibility for the provision of all health and personal social services available in the community setting through a network of 32 Local Health Offices. At the centre of the PCCC services is a commitment to a partnership approach between individuals, families, communities and a range of providers, agencies and organisations to ensure the delivery of person-centred, needs led integrated services. In addition, services are also provided by independent contractors (e.g. General Practitioners, Pharmacists, Optometrists, Dentists), non-statutory, voluntary and community groups on behalf of the Health Service Executive.

Services Provided by PCCC

  • Primary and Community Care Services
  • Services for Children and Families (including Immunisation, Childcare and Family Support)
  • Services for Older People
  • Mental Health Services (including Child and Adolescent Psychiatry and Old Age Psychiatry)
  • Palliative Care Services and Services for Persons with Chronic Illness
  • Social Inclusion Services (including Homeless, Ethnic Minorities, Travellers and Addiction Services)
  • Services for Persons with Disabilities

2.2.1 Primary Care Services Estimated Expenditure 2006 - €3.2billion

Primary Care Services support and promote the health and well-being of the population by providing locally based, accessible services. A key objective of the HSE is to develop high quality, user friendly primary care services that are based on the assessment of local need and are closely integrated with other health services providers.

Primary Care Services

  • General Practice - including practice based nursing and other services
  • Community Nursing
  • Therapy Services - including physiotherapy, speech & language therapy, occupational therapy, dietetics
  • Entitlement and Benefit Schemes
  • Information services
  • Community Pharmacy
  • Dental
  • Ophthalmology/Optometry
  • Audiology
  • Community Health Services

2.2.2 Children and Families Estimated Expenditure 2006 - €0.5billion

Services for children and families are provided in a variety of community and residential settings including the home, community, schools, health centres and acute hospitals, in partnership with communities, children, young people, families and carers.

These services are provided by a range of statutory, non-statutory, voluntary and community groups. A range of universal health and social services are also provided to the general population of children and young people. Additionally, targeted and specialist services are available to children, young people and their families who are considered to be in need or vulnerable for a variety of reasons and interagency links are critical in this regard. A list of the available services is provided below:

  • Information / Health Promotion
  • GP Services
  • Antenatal education
  • Breastfeeding support
  • Parenting Programmes
  • Primary Immunisation Scheme and Booster Immunisation Programmes
  • Child Health Surveillance and Screening
  • Early Intervention
  • Child Protection
  • Home visiting and family support
  • Health Education and Promotion for children and their carers
  • Generic and Specialised Family Support
  • Pre-School Inspection
  • School Health
  • Fostering
  • Adoption
  • Residential Child Care
  • Young People Out of Home
  • Aftercare
  • Assessment, diagnosis and treatment
  • Inpatient care
  • Support services provided to Special Schools
  • Services to respond to violence against women

2.2.3 Services for Older People Estimated Expenditure 2006 - €1.25billion

Services for Older People aim to support older people to remain at home in independence for as long as is possible, or where this is not possible, in an alternative appropriate residential setting. The principles of partnership, person-centredness and empowerment of service users underpin service delivery. Services are provided to older people across a continuum, from services at home and in the community through to high quality hospital and residential care services when required.

Services Provided for Older People in the Home and Community

  • Information/Health Promotion
  • General Practice including practice based nursing and other services
  • Community Pharmacy
  • Public Health and Home Nursing
  • Dental/Aural/Ophthalmics
  • Chiropody
  • Home Help and Home Care Assistant
  • Meals-on-wheels
  • Day Centres/Clubs
  • Support for Carers
  • Additional Home Supports - Packages
  • Assessment, supply and fitting of medical appliances
  • Occupational Therapy
  • Physiotherapy
  • Speech and Language Therapy
  • Continence Advice
  • Nutritional Advice
  • Grant Aid to Voluntary Organisations
  • Special Housing Aid for the Elderly Scheme (Dept of the Environment)
  • Boarding Out
  • Respite Care
  • Short-term Convalescent Care
  • Community Rehabilitation

Hospital and Continuing Care Services for Older People

  • Acute services; including departments of medicine for older people
  • Rehabilitation care
  • Day hospitals for older people
  • Public long-term residential care
  • Private nursing homes
  • Discharge co-ordination

2.2.4 Mental Health Services Estimated Expenditure 2006 - €0.85billion

Mental Health Services span all life stages and include services for children and adolescents, adults and older persons as well as rehabilitation, liaison and forensic psychiatric services. The services have a strong focus on the promotion of positive mental health and maintain a close working relationship with the National Office for Suicide Prevention. Services are provided with an emphasis on partnership with persons with mental health needs, their families, carers, statutory, non-statutory, voluntary and locally based community groups.

Mental Health Services are provided across a continuum, from home and community based services to high quality community and inpatient acute mental health services and residential care services when required. The broad range of Primary and Community based services are accessed as well as specialised services, which include:

  • Mental Health Promotion
  • Acute Inpatient Care
  • Outpatient Clinics
  • Community based residences
  • Rehabilitation
  • Liaison services
  • Day hospitals
  • Day centres
  • Child & adolescent psychiatry
  • Old age psychiatry
  • Mental health services for homeless persons
  • Community psychiatric nursing
  • Accident & emergency crisis intervention nursing
  • Detoxification
  • Peer support groups
  • Provision of appropriate responses to both suicide and parasuicide
  • Forensic psychiatry - including assessment, treatment, rhavilitation, satellite, outpatient and prison in-reach services
  • Outreach/home care services

People with mental health disabilities can access the broad range of acute, primary and continuing care services as well as specialist services for mental health.

2.2.5 Services for People with Chronic Illness and Palliative Care Services for People with Chronic Illness

Services for people with chronic illness aim to promote quality of life and independence for people with chronic illness/conditions by ensuring they receive coordinated care and support that is planned in partnership with them, around their needs and choices. These services are provided in both the Acute Hospital and Primary, Community and Continuing Care settings relative to disease and symptom presentation. As chronic conditions can present along the life cycle, depending on aetiology, services are provided accordingly within the current care group structure.

Palliative Care

The HSE has a statutory responsibility for planning and commissioning palliative care services on a national basis in conjunction with the voluntary sector in Ireland. The provision of services encompasses a broad range of interventions in multiple locations ranging from acute and sub-acute specialist palliative care inpatient units to home and community based supports and bereavement supports. Services are accessed in a number of ways across the delivery system.

Palliative Care Services

  • Specialist Palliative Care Inpatient Units
  • Home Care
  • Day Services
  • Specialist Palliative Care in Acute General Hospitals
  • Community and other intermediate level of inpatient care in Community Hospitals
  • Bereavement Support
  • Education and Research

2.2.6 Social Inclusion Services

The aim of Social Inclusion services, underpinned by the National Anti-Poverty Strategy and Equality Legislation, is to improve access to mainstream and targeted health services, address inequalities in health between social groups and enhance the participation and involvement of socially excluded groups and local communities in the planning, design, delivery, monitoring and evaluation of health services. Services target the following groups;- Homeless people, Minority Ethnic Communities; Asylum Seekers; Refugees; Migrant Workers; Travellers; Drug Users, those from the Lesbian, Gay, Bisexual, Transsexual/Transgender communities, people with problematic and/or dependent alcohol use, people with HIV/AIDS and people with disabilities. Social inclusion also includes the range of Community Welfare Services.

Services are provided across a continuum, from prevention services at home and in the community through to high quality hospital and residential care services when required. Specialist services are provided for people with specific needs arising from marginalisation. Services are provided in partnership with service users, their families and carers and a range of statutory, non-statutory voluntary and community groups.

2.2.7 Specialist Disability Services Estimated Expenditure 2006 - €1.3billion

Specialist disability services are provided in a variety of community and residential settings in partnership with service users, their families and carers, and a range of statutory, non-statutory, voluntary and community groups.

The integral role of the non-statutory, voluntary and community groups is of particular relevance in this sector. These agencies provide a very significant and broad range of services in partnership with and on behalf of the HSE. It is acknowledged that because of the historic manner in which services for people with disabilities have developed, many of these agencies were to the forefront in identifying needs in the community and developing responses to them.

Services delivered include:

  • Early childhood/family support services
  • Residential care
  • Respite care
  • Day services
  • Services for persons with autistic spectrum disorder
  • Specialist day and residential brain injury services
  • Rehabilitative training
  • Sheltered workshops
  • Community-based medical, nursing and therapy services
  • Aids and appliances
  • Home support services
  • Financial allowances
  • Other services including counselling, advisory, advocacy, information and general support service

A more comprehensive description of these services is available in Appendix 2.

People with physical, sensory and intellectual disabilities and people with autism can also access the broad range of Acute, Primary and Community Care Services as well as specialist services for disabilities. Additional information regarding service provision, including numbers accessing services, is included in the Annual Reports of the National Disability Databases and the 2006 Annual Service Plan for the HSE (see References).

2.3 National Hospitals Office Estimated Expenditure 2006 - €4.7billion

The role of the National Hospitals Office (NHO) is to manage and co-ordinate the delivery of acute hospital services in the 53 statutory and non-statutory acute hospitals and to manage the Ambulance and Pre-Hospital Emergency Care Services.

Public acute hospitals provide a comprehensive range of assessment, diagnosis, treatment and rehabilitation services on a regional, supra-regional or national basis. Designated national specialist services incorporate areas of care such as heart / lung transplantation, liver transplantation, cochlear implants, metabolic screening, bone marrow transplants, adult cystic fibrosis, spinal injuries, paediatric cardiac services, medical genetics, renal transplantation and haemophilia. Supra-regional services include neurosurgery and cardiac surgery, as well as complex cancer surgeries and radiotherapy. Acute hospitals play a key role in undergraduate and post graduate training and education for medical and health service professionals. Hospitals are also involved in clinical and related research activities, involving close links with universities and other third level institutions.

In addition to direct service provision, there are a number of arrangements in place with other service providers in Ireland and abroad for the delivery of specific services. These include agreements to provide clinical services such as renal dialysis, paediatric cardiothoracic surgery, lung transplantation and radiotherapy.

The NHO also has responsibility for the management and delivery of the Ambulance Service. The provision of high quality ambulance services requires the National Ambulance Service to operate in partnership with a wide range of statutory and private organisations. It also involves working closely with other health care providers at primary and community level, and in both acute and community care settings.

2.4 Population Health

The Population Health Directorate of the HSE leads, informs and supports the population health approach within the Executive. Part of this role involves the provision of knowledge, information and evidence to support corporate decision making and strategic planning as well as supporting the re-engineering of service delivery in a manner which increases its impact on health and social well being and the achievement of value for money. It will also develop equality based and culturally appropriate responses to the new and emerging needs of a diverse population, widespread inequalities in health, key health challenges including obesity, alcohol and drug misuse, an ageing population and the growing burden of chronic diseases.

The Population Health Directorate is responsible for a number of key functions within the health service.

Population Health Services

  • Strategic Planning
  • Health Intelligence, including Health Information and Surveillance, Evidence Based Health Care, Research and Development, Health Technology Assessment, and knowledge management
  • Health Promotion, including mental health promotion, sexual health promotion, tobacco control, alcohol use, drug use, physical activity, nutrition and accident prevention
  • Emergency Planning
  • Environmental Health
  • Health Protection
  • Suicide Prevention

2.5 Corporate Functions and Supports

The HSE also manages a number of corporate functions and supports which contribute to the promotion of good health among the population and the provision of services.