Simon Harris (Wicklow, Fine Gael) | Oireachtas source

I will begin by responding to Deputy Louise O'Reilly. I would be interested in following up on Deputy O'Reilly's point about home help and the not-for-profit sector. She has had to leave for understandable reasons but I undertake to do that and engage further with her on that and make my Department officials available to her to further pursue it. We will ask the HSE to revert to her with a breakdown of how much of the homecare budget is spent in the various sectors, voluntary, not-for-profit, public and private. That is certainly worth exploring.

On the day of publication of the hospital waiting list figures, last month's figures showed a significant drop in the number waiting for inpatient day case procedures of more than 2,000. The Deputy chose not to acknowledge that, which is her prerogative, but it means 2,000 fewer people waiting for operations in Ireland last month than the previous month. The figures are still too large but it was a sizable decrease in the numbers. We need a lot more of that. The figures are published by the National Treatment Purchase Fund, NTPF, a statutory agency, but I have no issue with asking them to publish them on a day other than Friday. I was working at 6 p.m. on Friday and through the weekend, as I am sure many Members do, but if it is suitable to have them published on a different day of the week, I will ask the NTPF to do so.

We will revert to the Deputy with a note on the National Advisory Council on Drugs.

On the breastfeeding programme and the baby-friendly hospital initiative, I am informed it underwent a review in 2016 which recommended the need for a revised model to be developed in line with our new maternity strategy as well as the national breastfeeding action plan. The HSE's health promotion and improvement unit is now engaging with a range of stakeholders for the development of a revised model. They have assured me that the focus in developing a revised model is not in any way related to funding or any funding reduction but is aimed at ensuring there is increased engagement across the 19 maternity hospitals in order to increase breastfeeding rates. The HSE is not reducing funding for breastfeeding and the new model, when developed, will be funded by the HSE. It is clear about that.

The Deputy is entirely correct that breastfeeding rates in this country are too low. We need to ensure that we have an initiative that aligns with our maternity strategy and the breastfeeding action plan, and that will get the absolute maximum engagement across all of our 19 hospitals. The HSE has also told me that it continues to support the 19 maternity hospitals in their implementation of the World Health Organization and UNICEF's ten steps to successful breastfeeding. As the Deputy will be aware, the action plan for breastfeeding sets out the priority areas to be addressed over the next five years to support more mothers in Ireland to breastfeed and to contribute to increasing breastfeeding rates. That includes the implementation of policies at hospital level and at community level, investment in breastfeeding training and skills development for health care staff, the promotion of additional lactation specialists posts, and a partnership working to promote a culture that accepts and supports breastfeeding. I will keep in touch with the Deputy in that regard.

On the issue of capital, the director general of the HSE is entirely correct. The health service needs more capital. We have adequate capital to deliver on our projects for this year but we, like other Departments, are engaging with the Department of Public Expenditure and Reform on the capital envelopes that will be announced on budget day but also, excitingly, on the ten-year capital plan. We have not had a ten-year capital plan in this country previously. We have had seven or eight year plans. A ten-year capital plan provides us with an opportunity as a society not only in the health area, but right across the sector, to deliver some important projects that can make a real difference. It could not be coming at a better time for the health service because we now have a ten-year policy plan in Sláintecare and we will shortly have a bed capacity review which will have looked at demographic pressures and bed capacity needs not only in the acute hospital sector, but right across the health service.

On the issue of Crumlin theatre, I do not disagree with any of the Deputies. When I came into this job, the theatre in Crumlin was shut. It was not doing any of these operations. It is open now and operating three days a week. There is an extra consultant and extra theatre nurses in place. More operations have been done in Crumlin and Temple Street combined this year to date than in the entire of last year.

We have put €10 million more into treating scoliosis. It is a major priority. I confirm we are using outsourcing not because we want to, but because we want to provide every opportunity to every possible family that requires this to make the decision that is best for their child. It will not work for some families to go abroad but the ultimate aim is to arrive at a position where we have a sustainable scenario in the public health service in this country and every child can be provided with an operation for scoliosis, or a scoliosis-related issue, within the four-month target. As for where the four-month target comes from, it is international best practice. It is what the NHS does and it is what clinical advice tells us needs to be done. We will not be found wanting in that regard. I note the Deputy has a question to me tomorrow to me in relation to the 68 patients she specifically referred to and I will engage with her on that then.

I agree with Senator Colm Burke on respite and I will ask the HSE and the Minister of State, Deputy Finian McGrath, to engage with the Senator, and, if it wishes, perhaps this committee on the projections for the next two to three years on respite requirements. The Senator was not suggesting, and nor am I, that HIQA standards are in any way bad. It is great that we have standards, but the consequence of those standards in terms of the number of places available for those requiring respite and how we will address that is a legitimate point.

We need to be very careful when members talk about manager numbers because, with respect to those in this room, they would rightly be among the first to give out if they could not get an answer to a parliamentary query, to which they have a democratic right, because included in the manager-administrative figures are the staff who answer those questions. Also included are the staff who process medical cards and those who were taken on to deliver new models of care. The cross-party Sláintecare committee stated that we need more staff to develop e-health and ICT so that we have better data, better decision-making, better processes and more accurate and efficient lists. Included in that are managers and administrators. We need a new financial system so that we can have more intelligent discussions on how the figures are done.

I am no supporter of extra layers of bureaucracy or management. I believe the HSE needs to be pared back. I want to work with the Sláintecare report in terms of how best to achieve that, but merely taking a headline figure and presuming everybody there is a manager and that, therefore, there is no added value to the health needs of the population is far too simplistic an exercise. In fact, many of the members would be the first to put down PQs to me asking why we have not rolled out this new clinical programme, where are we at with the e-health agenda, what am I doing about the new model of care, and how the Healthy Ireland agenda is going. The answers to all of those questions often involve personnel who would fall into the category of administrator or manager. Let us absolutely have a good scrutiny of the figures, and if the committee wants the HSE here to go through it, let us do that. I would be right beside the member in supporting the assertion that we should not have extra layers of management but let us be clear about what we are discussing.

Let us also be clear - I say this to Senator Colm Burke - that the focus in the HSE on increasing front-line staff is paramount. Often when one hears conversations - stakeholders, interest groups and representative bodies do important work - one would swear that there are fewer staff working in the health service on the front line. It is, quite frankly, not true. The number of consultants employed by the HSE at the end of December 2016 was 2,862. This is an increase of 138 whole-time equivalents in the health service since December 2015 and it is an increase of 731 consultant posts in the past decade. I beg the Chairman's indulgence for one minute on this because this is neither reported nor commented on. In relation to consultant anaesthetists, in 2010, there were 348.35; in 2015, some 349.6; in 2016, some 373, and now there are 374. In relation to consultants in emergency medicine, in 2010 there were 56; in 2015, there were 82; in 2016, some 92, and now we have 93. In relation to consultant medicine, in 2010, there were 518; in 2015, some 675; in 2016, there were 723, and in 2017 there are 727. I could go on and on.

These are figures taken from the personnel census data for medical and dental in all agencies broken down by grade and group for December 2010, 2015, 2016 and up to March 2017. I will share this with the committee. The committee will see that there are some areas, particularly in dentistry, where we need to do much better but there are many areas where we have consistently seen an increase in figures since 2010. We are back to hiring staff and wanting more people to work in the health service on the front line. We are back to investing in the health service also. That does not mean everything is rosy. There are extraordinary challenges but let us not distort the reality. More people are working in consultant positions in the HSE and in the health service today than last year, and certainly significantly more than over the past ten years.

We need to do a great deal more to retain our doctors. That is why we asked Professor Brian MacCraith, president of Dublin City University, to carry out a strategic review of what we need to do to make more attractive career opportunities for the clinicians and medical graduates in this country. I spoke at a medical careers day in Dublin Castle on Saturday last where I met 500 of the new medical graduates and medical interns to talk to them about the importance of them staying in the Irish health service because we need them. It is a case of the chicken and the egg here. We have a ten-year plan for the first time in a long time. We have a cross-party view in relation to health care for the first time ever. We are reinvesting in health but we need the health care professionals to stay here with us so that we can make the improvements. We are working through implementing the three reports and the 25 recommendations of the MacCraith report. To date, five of the progress reports have been published on the Department's website. A number of issues have been addressed, including the HSE doubling the number of family-friendly places over the next three years. Our NCHD numbers continue to increase. A careers and training website has been launched and the majority of our training programmes now offer predefined rotations of at least two years to make it easier for people to plan. We have an online national employment record which has streamlined the process and the paperwork associated with rotation. On foot of a key recommendation, the implementation of higher pay rates for new entrant consultants was sanctioned in 2015. This is an acute area. We have a lot more to do but there is a lot happening in that regard.

I thank Senator Dolan for his comments. The Senator hit the nail on the head in many ways in relation to unmet need and trying to capture what is unmet need not only now, but in the future. There are more patients with chronic diseases being treated in the health service, and there is also the rising phenomenon of people with disabilities thankfully living longer, with the resulting impact on a parent in his or her 70s, 80s or even older of having a son or daughter with a disability in his or her 40s, 50s or 60s. The issue is how the State meets those needs, and there are a number of ways that is done. I do not dispute that resourcing is one part, but also better models, of which Senator Dolan is a supporter, is a big part. I will give the example of a very small but important thing we did this year with the group, An Saol. This is a group of people who have loved ones with acquired brain injuries. They went off - I do not want to misrepresent their position - and did an analysis of the support that the State was providing to their loved ones on paper and basically asked if we could let them reconfigure that support.

We do not want our loved ones, including those in their 30s, which is around my age, to be in nursing homes. If we were given control of that budget, which is already being spent on our loved ones, we could put it to much better use in order to give our loved ones a much more purposeful life, more rehabilitation and a better chance of getting back to the potential which we want them to reach. We need to do much more of that.

The Senator is correct about the fair deal scheme. Criteria obviously have to be met before a person can be admitted to a nursing home but it is concerning that we have a statutory scheme for nursing home care with the weight of a legal framework and all that comes with it in the context of entitlement and resourcing. Almost €1 billion is spent each year in that area and yet we have community supports, home care supports, home help packages and respite care which are not underpinned by statute. It varies on a geographic basis. Many people are afraid that if their mother, father or other loved one gets ten hours one week, it might go down to perhaps eight hours the next week; and it never seems to be 11 hours. These are real concerns. The Government and I fully agree with the Senator about the need to underpin this in statute. He is right that this is not going to happen overnight, nor should it since it could be very detrimental if we got it wrong. We do not want a situation where people staying at home-----