Stephen Donnelly (Wicklow, Fianna Fail) | Oireachtas source

It is great to be back in person at committee and it is another mark, please God, of things returning to a post-Covid world.

I thank the Chairman and members of the committee for the opportunity to meet them this morning concerning the future of Sláintecare. I am joined by the Secretary General of the Department of Health, Mr. Robert Watt.

Members of the committee and others will have been concerned about the resignations of Ms Laura Magahy, as executive director, Professor Tom Keane and other members of the Sláintecare implementation advisory council. I regret their resignations. I pay tribute to their determination to implement the vision of a universal, single-tier health and social care system.

In the first instance, I would like to assure everyone, and those who may be watching today, of my absolute commitment and the commitment of the Government to universal healthcare. That commitment is absolute and unwavering.

Universal healthcare has never been achieved in Ireland and we are still far from it today. Changing that, making universal healthcare a reality, is one of the defining projects of our time. Our goal is clear. It is timely and affordable access to consistently high-quality care for everyone. Sláintecare matters because it provides a pathway for this. Doing it requires very significant funding and we have made a very substantial investment. Investment of more than €1.2 billion in budget 2021 has allowed us to increase capacity, which is fundamental to improving access to care.

I pay tribute to my officials and those working in the HSE for the significant progress and reform that has been delivered in spite of the pandemic and cyberattack. I will not be able to list all of those achievements today but the increase across various areas is substantial.

We have delivered record increases in hospital bed capacity. We have already added around 850 permanent beds to the hospital system this year. That is the equivalent of about two medium-sized hospitals and more will be added between now and the end of the year. In fact, we will have added more permanent beds to the system this year than have been added in any single year in decades.

Some €52 million was also provided this year to increase critical care capacity. We have delivered a record increase in critical care beds. We had 255 critical care beds at the beginning of last year. We now have 296 critical care beds and more will be delivered in the coming months. We plan to have 321 critical care beds in place by the end of this year or very early in 2022. That represents an increase of 66 beds or 25% in total critical care capacity in just two years. To put that in perspective, we delivered an average of six critical care beds per year between 2017 and 2019. We will have gone from an average of six beds a year to 66 beds in just two years. Our plans are ambitious and I have already brought a plan to Cabinet, which has been agreed by Cabinet, aimed at increasing critical care beds to 446 over time. Critically, this will exceed the recommendation of the 2018 health service capacity review.

We have 6,000 more staff working in the health service than we did last summer. That includes almost 1,400 more nurses and midwives, and 1,200 health and social care professionals.

I am bringing proposals to Cabinet in respect of three elective hospitals in Cork, Dublin and Galway. Very significant work has been done on this by the Sláintecare office.

I would like to talk about new patient pathways and care closer to the home. Various initiatives and reforms are ensuring that people receive care closer to their home. Some €25 million was allocated to the GP access to diagnostics initiative this year. It enables GPs to refer patients directly to access diagnostics, including X-rays, MRIs, computed tomography, CT, scans and many more. These are in a community-based setting. I am delighted to be able to share with the committee that we estimate that through this new initiative, which was a core recommendation in Sláintecare, we estimate that about 140,000 additional scans will be carried out by the end of this year. That is very positive.

There has been a dramatic reduction in waiting lists for funding approvals for home care. Thanks to a large increase in funding there are no waiting lists at all for home care packages in some areas thus ensuring that we deliver on our objective to keep people well at home and out of hospital.

I am excited by what we are seeing in respect of the redesign of care pathways and the incredible impact that skilled advanced nurse practitioners are having. Many patients who would otherwise have had to wait for traditional hospital appointments or to attend emergency departments can be treated in the community using these new pathways to care. I will give an example. A pilot service to manage people living with heart failure, provided by specialist nurses in County Donegal, saw waiting times for new patient referrals drop from 18 months to between two and six weeks. The current target, which is to have 2% of the nursing and midwifery workforce, approximately 800 people, working as advanced nurse practitioners or advanced midwifery practitioners, will be reached. I want that to be scaled up and have asked my Department to revert with a plan to that effect. This area has great untapped potential for our healthcare system. It fundamentally redesigns the model of care, bringing specialist care much closer to the patient and keeping it out of the hospital, wherever possible.

One aspect of universal healthcare that gets less attention than access is quality. There is, understandably, a great deal of focus on access in our country because of the completely unacceptable waiting lists. We will come to that but one of the core components of universal healthcare is a consistently high quality of care. The reality in Ireland is that it can be hard to access parts of the public health system but, when one does, the quality of that care is often excellent. That may not be the case in some cases. There are also parts of the system where the care is good but needs to get better. If we are serious about universal healthcare, we have to be serious about a consistently high quality of care. One of the main routes to this is via our clinical strategies in maternity care, cancer care, trauma, mental health and many more. This year, I allocated funding to ensure these strategies were, for the first time, fully funded. I am delighted to be able to share with the committee that a lot of progress is being made on behalf of patients. I encourage the committee to consider allocating some of its time to invite the clinical leads in these areas in to discuss this progress with them. We have had some productive debates in the Dáil and the Seanad on issue such as maternity care and cancer care. Serious improvements and progress are being made now that the strategies are being funded. It would be great to be able to hear from the clinical leads on that.

As the committee will be aware, the Government approved the Sláintecare implementation strategy and action plan for the period from 2021 to 2023. The Sláintecare programme implementation office prepared a report on progress in the first six months of the strategy. That progress report indicated that, of the 112 deliverables, 109 were on track or on track with minor issues. That means that, even while dealing with the worst public health crisis in 100 years, more than 97% of the Sláintecare projects have been progressing well. The report identified three of the 112 projects, specifically the waiting list, ehealth and regional health areas projects, as facing a significant challenge. Action on these has undoubtedly been severely hampered by the pandemic and the cyberattack, as was clearly stated in the report produced by the Sláintecare office.

Tackling waiting lists is my number one priority. They were terrible before Covid and have worsened substantially since. People are living in pain. The long waits that many of our citizens face to access care are causing immense distress. I am setting up a task force that will tackle waiting lists and funding it appropriately. It will follow the vaccine task force model that has worked so well and will learn from it.

Substantial work has been undertaken over the past several months in progressing regional health areas. Research into international best practice has been completed. Policy options have been drafted. Consultation with stakeholders including patients, clinicians, policymakers, hospital groups and officials in community healthcare organisations, CHOs, has taken place. More is planned in the coming weeks. I am establishing an advisory group on this. We must ensure we arrive at a structure that is owned and respected by those working in our health service.

Our public health system is not where we need it to be when it comes to ehealth. Our healthcare workers are often working on old, antiquated systems, but significant progress was made during the pandemic. A great deal of additional work is required in this area.

In recent weeks, there has been debate about governance structures for Sláintecare. We are making some changes. A new programme board co-chaired by my Secretary General and the chief executive of the HSE, and comprising other members of our senior teams, will be established. This new board will ensure that the drive for universal healthcare is fully embedded in both the Department of Health and the HSE. The board will report to me and the Cabinet committee on health will meet to discuss progress as appropriate.

It has been stated as part of the recent debate on Sláintecare that change is impossible. Not only is change possible, but it is happening at an unprecedented rate. It is being led by people working across the healthcare family, women and men who are rightly proud of their efforts. Many healthcare workers have been galvanised by what our health service has achieved during Covid, with one of the most successful vaccine roll-outs anywhere in the world. There will always be people who will only focus on the negative and what they believe cannot be done. Eight months ago, we were lambasted by some for saying we wanted at least 70% of our adult population to have been offered a vaccine by the end of September. Our health service proved them wrong. We are ambitious. Change and reform is always challenging, but we are up for that challenge. Access to high quality healthcare when it is needed cannot and must not be a privilege for those who can afford it. It must be available to every girl and boy, every woman and man. That is what universal healthcare means. That is what must be delivered. That is our absolute focus.