Stephen Donnelly (Wicklow, Fianna Fail) | Oireachtas source

I welcome this opportunity to address the Chairman and members of the select committee on the Revised Estimates for 2021 for my Department, which is Vote 38. Unlike other Votes, the Health Vote is not configured along programme lines. My Department continues to work towards the development of programme budgeting and changing the structure of the Health Votes to reflect this. It is going to take some time as financial systems in the HSE have to be adapted to allow for this in the context of a financial reform programme that is under way. In line with Government policy, and in the context of Covid-19, budget 2021 provided an unprecedented level of investment. The investment supports the resilience and preparedness of the health service to increase capacity and permanent staffing levels, to progress the implementation of a number of national strategies, and to advance the Sláintecare vision of universal healthcare.

I am delighted to have secured a further €4.039 billion in funding on top of the 2020 allocation. The level of funding provided will enable the advancement of a number of important priorities this year, including the protection of vulnerable groups, service users, patients, health care workers, and the wider public in the face of Covid-19, in line with national and international public health guidance; the delivery of increased levels of healthcare to our people in community and primary care settings, encompassing the mainstreaming of the Sláintecare integration fund initiatives; the delivery of the ambitious capacity enhancement and reform plan in line with the health service capacity review of 2018; improving access to mental health services, including progressing the implementation of the Sharing the Vision policy; improving access and enhancing specialist disability services with a focus on implementation of the Transforming Lives programme; continuing projects, including the development and adoption of an integrated financial management system by all statutory and larger executive-funded voluntary services, alongside further development of activity-based funding for hospitals and community services, together with enhancing procurement governance and systems.

The provision for the Health Vote in the 2021 Revised Estimates allows for a significant expansion of the health sector workforce, with an increase of 16,000 whole-time equivalents over the original January 2020 estimate of public service numbers. The allocated pay budget has increased from €7.95 billion to €9.055 billion in 2021. The impact of the latest Covid-19 surge in the first quarter of this year has had an obvious impact on service delivery. Some areas, such as additional home support hours, are behind where we would have hoped they would have been at this point, but the HSE is working to bring these back on track. Demand for the nursing home support scheme is also down on estimates, but this has not impacted on waiting times for applicants. It is expected that, all things remaining as they are, certain pent-up demand will see expenditure reach estimated levels by the end of the year.

The Health Act 1947 was amended to provide for a system of mandatory quarantine at designated facilities. This system of mandatory hotel quarantine is necessary to prevent and mitigate the risk of Covid-19, particularly variants of concern.

The Government has established a proportionate and carefully balanced system for mandatory quarantine, which is necessary to address the risk posed by travel from states where there is known to be sustained human transmission of Covid-19 and, in particular, variants of concern, or from which there is a high risk of importation of infection or contamination with Covid-19 and, in particular, variants of concern. This is necessary to protect the public, our health system and our vaccination programme.

The cost of mandatory quarantine was originally estimated at €7 million with costs to be recouped from the people placed in quarantine. However, as further capacity and hotels are added this estimate will inevitably increase. Funding to meet these costs is being provided from within the departmental allocation and will not impact on the allocation to the HSE.

The programme for Government reaffirmed its support for universal healthcare via Sláintecare. Sláintecare is being funded and is on track to improve access, expand eligibility, improve the patient experience and bring care closer to home. In 2021, there is continued commitment to Sláintecare with €1.353 billion being provided to fund programme reforms, including increased acute and community bed capacity, providing enhanced community, social and primary care services and improving access to care including a new access to care fund.

The move to a public-only health system is a key priority for the Government and central to the Sláintecare vision of universal healthcare. The programme for Government provides for the introduction of the Sláintecare contract. Arrangements are currently being finalised to facilitate the introduction of the contract in the coming months, following the enactment of the Public Service Pay Bill 2020, currently referred for Committee Stage. My officials will write to the representative bodies shortly inviting them to discussions on the contract.

There has been significant growth in consultant numbers recently, with numbers increasing by more than 200 in the past year to 3,470 but I recognise that further progress is required. I want doctors to stay in the Irish health system and for those who have emigrated to return home. As part of budget 2021 nearly 600 additional consultant posts are being created. The introduction of the Sláintecare contract will give us an opportunity to grow consultant numbers and move towards universal healthcare in a public-only system. The introduction of the contract also represents a significant opportunity to address the current number of temporary and unfilled consultant post and I have requested the HSE to develop a plan to achieve this.

Following intensive engagement, my Department, the HSE and the Irish Medical Organisation, IMO, have reached an agreement to the introduction of a fundamentally reformed and strengthened model for public health in Ireland in line with international best practice. This will require the implementation of a consultant-led and consultant-delivered public health model. Implementation of this model will enable recruitment and retention of public health consultants. It will deliver an agile, dynamic, intelligence-led public health medicine service to protect the population from health threats, promote health, improve health services and tackle inequalities in health.

Women’s health is a priority for the Government. Commitments made in the programme for Government include specific support for the women’s health task force and the development of a women’s health action plan. Budget 2021 allocated a dedicated multi-annual €5 million women’s health fund to implement a programme of actions from the work of the women’s health task force and appropriate activity is being identified for implementation and funding. The first two funded proposals, which were announced last week, are €1.4 million for two community-based ambulatory gynaecology services governed by Tallaght University Hospital and University Maternity Hospital Limerick and €.6 million for the expansion of the endometriosis service at Tallaght University Hospital, which creates specialist service for very complex cases. These proposals will significantly increase access to these services for women and support their care at the earliest point.

Some €20 million is being provided to progress the implementation of the national cancer strategy, including surgical and medical oncology; rapid access clinics and early diagnosis and radiotherapy. The national cancer control programme is allocating initial "once-off" funding to each hospital group to assist with the costs associated with their efforts in service recovery and continuity. This funding will support measures to increase resilience and address clinic backlogs.

I now turn to the 2020 outturn. The gross provision for the Health Vote in 2020 was €20.875 billion, comprising €19.801 billion in current expenditure and €1.074 billion in capital expenditure. This €20.875 billion represents the gross funding position for both the Department of Health and the HSE and includes additional funding of €1.777 billion made available for current expenditure in 2020 in response to Covid-19 and €547.5 million granted by means of a Supplementary Estimate.

The initial 2020 capital allocation was €854 million. In response to Covid-19, an additional allocation of €220 million was made bringing the total capital allocation that year to €1.074 billion. The total cost of Covid-19 supports provided by Government to the Health service in 2020 was €2.5 billion. Among the key measures covered by this expenditure was testing and tracing; supporting nursing homes and home support; enhanced GP services; community assessment hubs; caring for people in acute services; private hospital capacity; expanding and protecting our health workforce and essential workers; expanding physical infrastructure including isolation facilities; and maintaining access to essential health products, equipment and services. These measures continue to be relevant in 2021 as the pandemic continues

In framing the 2021 budget, the Oireachtas allocated significant further additional Exchequer funding for the health sector. I thank committee members for their support in this. In 2021, gross health funding is €22.13 billion comprising €21.081 billion in current expenditure and €1.048 billion in capital expenditure. This represents an increase of €1.28 billion, 6.5%, on the 2020 post-supplementary current expenditure budget and recognises the Government’s commitment to providing a health service that seeks to improve the health and well-being of the people of Ireland.

While the 2021 capital allocation is €26 million below that of the final 2020 figure, it represents a significant increase on pre-Covid-19 allocations and reflects continuing investment to meet the infrastructural challenges in responding to the pandemic. The capital funding for health in 2021 will contribute to the delivery of modern health facilities and equipment to improve and expand service provision and capacity across the country, both key aspects of Sláintecare and Project Ireland 2040. While the scale of this funding is significant, the value of the investment in protecting our people in the face of the Covid-19 is unquantifiable. This Government is steadfast in our commitment to protect everyone and to enhancing the resilience of our health service. This commitment is evident in the level of funding made available in 2021.

The issue of health funding is a major policy challenge internationally, as committee members will be very well aware. Despite welcome funding increases over recent years, the need for effective financial management remains crucial. The health service is dealing with a larger and older population, with more acute health and social care requirements, increased demand for new and existing drugs and the increasing costs of health technology. The costs associated with these service pressures will increasingly need to be managed, not solely through annual increased Exchequer allocations, but also through improved efficiencies, productivity and value from within the funding base in 2021 and beyond.

Demographic pressures, including a rise in chronic diseases and ageing populations, are major challenges to health funding internationally. The additional funding secured over recent years provides a substantial basis for the health service to maximise the level and quality of service delivery while also implementing the Sláintecare programme.

A significant increase in funding for the health services has been achieved this year. Much of the recent increases have been Covid-19 related. The health system responded quickly and efficiently to the Covid-19 emergency. Additional spending has facilitated the necessary and rapid introduction of testing, provision of essential personal protective equipment; enhanced support to critical health services; and the introduction of additional hospital capacity and community services. Oversight structures are in place to ensure this significant investment is approved, monitored and reported in line with agreed sanctioning processes and financial procedures.

The programme for Government places a major focus on health service reform and investment in our public health system. Building upon and learning from the Covid-19 response will be central to the Government’s approach. In addition to Covid-19, dealing with a growing and ageing population, more acute health and social care requirements, increased demand for new and existing drugs and the increasing costs of health technology, will all continue to pose a financial challenge into the future.

Improving the way services are organised and delivered and reducing costs in order to maximise the ability of the health service to respond to growing needs must remain important points of focus. It is essential that those managing and delivering the service continue to demonstrate good practice in the year ahead by delivering the best possible healthcare within the limits of resources that have been made available by the Government. I thank my colleagues and the Chairman.