Ms Catherine Keogh:

Fórsa trade union welcomes the opportunity to address the Oireachtas Joint Committee on Health on the subject of the ongoing and persistent overcrowding crisis in our hospitals. Our delegation today consists of me and my colleague at our national health office, Chris Cully.

Fórsa represents more than 30,000 health workers in our hospitals, community health system and residential and social care settings, as well as at the corporate centre of health service planning and delivery. We represent workers in direct public service employment, such as the HSE and the section 38 voluntary hospitals, as well as section 39 agencies and in the private sector. Our members include health and social care professionals and clerical, administrative, management and technical staff. We consider it one of the many strengths of this union that our members are central to the delivery of the full array of health and welfare services in Ireland.

Public discourse around our health services is frequently driven by headlines alerting us all to the hazards of growing waiting lists and the numbers of patients on trolleys. The discourse is, consequently, always stuck in crisis mode, and this contributes to a wider sense of understandable anxiety about access to healthcare when people need it. While lists and trolley numbers are useful statistical information because they illustrate the symptoms of an underlying problem, it is Fórsa’s view that it is the underlying problem that urgently needs to be addressed. The only way to tackle the ongoing and persistent overcrowding crisis in our hospitals and the underlying problems that drive it is to ensure Sláintecare and, in particular, the 96 new community healthcare networks that will allow the health service to provide appropriate care through health and social care professionals working in the community are implemented fully and without delay.

One of the eight fundamental principles of the Sláintecare report of 2017 is that patients should access care at the most appropriate, cost-effective service level, with a strong emphasis on prevention and public health. In the recently launched Sláintecare Implementation Strategy & Action Plan 2021-2023, seven projects are listed to achieve the aims of Reform Programme 1: Improving Safe, Timely Access To Care, and Promoting Health & Wellbeing. Project 1 is to implement the Health Service Capacity Review 2018, including healthy living, enhanced community care and hospital productivity. That review sets out the staffing and physical infrastructure required to meet the Sláintecare waiting time targets and outlines the necessity for the shift of care out of acute hospitals into the community and closer to a person’s home, where safely possible. The only way to avoid hospital admissions and reduce pressure on acute hospitals is through initiatives that will see care delivered within the community.

Project 7 of the Sláintecare strategy states:

The removal of private practice from public hospitals is a core principle of Sláintecare, ensuring that public healthcare facilities are used for public patients only, and that public patients can access public hospitals based on clinical need. The Sláintecare Consultant Contract, which will only permit the carrying out of public care in public hospitals from the date of implementation, is central to the delivery of the goal of universal, single-tier healthcare in Ireland.

The transition to public-only contracts for hospital consultants and State-employed general practitioners is necessary. Fórsa trade union is unequivocally on the record as being a strong supporter of the community health intervention and servicing model proposed by the Sláintecare report. Fórsa and our members played a pivotal role in the process that established community health networks, and we are actively engaged in the introduction of the enhanced community care networks.

Another ongoing cause of pressure on the hospital system is the cultural default position of GP referrals to the acute hospital system. Direct GP referral to community radiology is an example of one of the stated measures to be implemented as part of the Sláintecare implementation strategy. This would alleviate hospital waiting lists.

A final consideration Fórsa wishes to highlight is that a properly resourced home support service is a necessary component of a functioning health service. A reduction in delayed discharges can only happen when the appropriate supports exist in the community. A new report, The Irish State Post Pandemic, was commissioned by Fórsa, produced by the TASC think tank and published last month. Among other key recommendations, this report called for the provision of greater integration of Government agencies such as home care and health services.

From Fórsa’s perspective, we believe the answer to the ongoing and persistent overcrowding crisis in our hospitals is clear. The Sláintecare report and subsequent implementation plans provide both a durable solution and the roadmap to same. Sláintecare has cross-party support, citizens’ support and workers’ support. We ask the committee to consider what are the real inhibitors to its implementation. Why, five years since the publication of the initial report, are there still the same unrelenting pressures on hospitals and on our members working in those hospitals?

I thank the committee for the invitation and the opportunity to address it today. We will endeavour to answer any questions members may have