The HSE’s National Service Plan 2012 (NSP) sets out the HSE’s plans for 2012.1 In his introduction to the plan, the CEO of the HSE points out that this is the third consecutive year in which the organisation has taken a cut in its annual budget. Unlike those in previous years, expenditure cuts in 2012 will begin to impact directly on frontline services.2 

The CEO outlines how the HSE plans to minimise this impact by ‘fast-tracking new, innovative and more efficient ways of using a reducing resource’ and by moving to models of care which ‘treat patients at the lowest level of complexity and provide services at the least possible unit cost’. Services in the drugs and alcohol area will not be exempt from these new approaches. 

The strengthening of ‘multidisciplinary complex care’, including the development of protocols signposting referral pathways between specialist addiction/homeless/traveller services and primary care services, is listed as a ‘key result area’ under Primary Care, Demand-Led Schemes and Other Community Schemes (p. 26).   

In the delivery of addiction services (Table 1), which continue to be co-located with homelessness, intercultural health, Travellers’ health, and lesbian, gay, bisexual and transgender (LGBT) health services under Social Inclusion Services, it is planned to monitor treatment outcomes and to analyse methadone waiting lists and exits from the Methadone Treatment List on a quarterly basis; these actions are noteworthy when set against the performance activity report for 2011, which shows that the target of 100% substance misusers over the age of 18 years for whom treatment commenced within one month of assessment was not achieved (Table 2). The HSE also intends to review the operation of the national drugs rehabilitation framework and identify hindrances to care planning/case management at the systemic and individual client level.

Notwithstanding the budget cuts, new initiatives are flagged for 2012. In line with recommendations in the revised HSE Opioid Treatment Protocol, implementation of new clinical guidelines on the treatment of opioid addiction will see less urine testing and a greater clinical focus on the results of drug-test samples. Following publication of the National Substance Misuse Strategy, the HSE will adopt a new addiction training plan, implement quality standards across all addiction services, and develop a series of new information and awareness initiatives. Needle exchange is another new focus for the HSE in 2012. As well as reviewing the effectiveness of all needle exchange provision which it is currently funding, the HSE is aiming to recruit 90 pharmacists to provide the needle exchange programme.   
The target set in last year’s service plan, to complete by the end of 2011 an analysis of addiction services for children nationwide based on best practice, was not met and has been moved out to Quarter 3 of 2012 (p. 60).  This action was identified in response to Recommendation 3 in the Report of the Commission to Inquire into Child Abuse (the Ryan Report), on the provision of counselling and educational services for children, which called on the HSE and the drugs task forces to establish addiction services for children nationwide based on best practice by June 2011.   

1.  Health Service Executive (2012) National Service Plan 2012.  https://www.drugsandalcohol.ie/16767/

2.  For an overview of the 2011 objectives, see Pike B (2011) HSE plan for drug-related services in 2011. Drugnet Ireland, (37): 12–13. www.drugsandalcohol.ie/14994