Stephen Donnelly (Wicklow, Fianna Fail) | Oireachtas source

First, the State Claims Agency is saying at this point that the costs relating to the damages payments are going up. The next question is what that means. It is identifying those as being the driver for this year and generally for previous years. It is saying that damages payments account for approximately two thirds of the total costs of the claims. Therefore, approximately two thirds is going to the patient and approximately one third would appear to be involved in legal fees, administration and everything else.

The actuaries for the State Claims Agency have referenced two things and we will be looking further into this. One is a reduction in the real rate of return. The second is that they are quoting considerable volatility in the damages being awarded with regard to catastrophic birth injury. Those are the two issues being referenced now. As we said a few times, and maybe it would be a good session for us to do with the committee, we need to take a rigorous approach to this to minimise and eliminate patient harm and the costs associated and to find non-judicial avenues wherever possible. As we said earlier, only one in 50 claims that are handled by the State Claims Agency end up in the courts.

I will get the Deputy a note on GPs and CervicalCheck. To their credit, the GPs have been doing a lot of additional work through Covid-19. They deserve great credit. Huge changes are happening in that regard. We will get Deputy Durkan a note on that.

I agree with the Deputy in terms of the turnaround time in emergency departments. I believe he was reflecting the fact that some hospitals are very good at this and other hospitals are not as good. First of all, I agree. Do we need more training in terms of patient flow and so forth? I think we do. I can also tell the Deputy that the improvements from the specialist team have been very encouraging. As he will be aware, I directed the HSE to send the specialist team into Limerick in the first instance and more recently into Galway University Hospital, GUH, and Cork University Hospital, CUH. The results from Limerick are promising. The big question is whether they can be sustained. One of the areas the team focused on was the number of patients who were in hospital for more than two weeks. The view going in was that alternatives were available for some of these patients and that was what it found. The average length of stay has gone down. The team did other things like take trolleys off the wards, which was very popular with the nursing staff and patients. As I said earlier, my clear view, which I expressed to the HSE and individual hospitals, is that senior decision-makers need to be on site longer than they are currently. My belief is that we need a combination of better patient discharge, better patient flow through the system and through the hospital, senior decision-makers being on site longer than they currently are and a more comprehensive avoidance approach. Really, it is all of those things.

The Deputy asked a question about whether there are learnings from unforeseen expenditure. Undoubtedly, there are and it is something on which we need to reflect further

. Access to the children's hospital is being looked at. We are all aware it is a congested site. We are all aware of where it is and that it has fewer parking opportunities than some hospitals. The Deputy is quite right about when someone is bringing in a child. I have on more than one occasion been driving around the back streets with a child of mine in the car in a bad way looking for somewhere to park around the estates. You cannot get into the car park in Crumlin and you drive around the estates trying to find somewhere, and then you carry your own kid sometimes quite a long way to bring them into an emergency department. That is the current situation and it must be addressed. Again, we need to acknowledge that it is a challenged site in that regard. It is something they are spending a lot of time looking at. It is a challenged site.

Finally, I concur completely with the Deputy's point around the difference this hospital will make. I do not know if the committee has had a chance to have a tour of the hospital recently. The difference it will make to care is mind-blowing. I can say that Children's Health Ireland, CHI, has been hiring up across its multiple hospitals. It is increasing its resources and getting a lot of extra money for staff so that when they go in, which we hope will be in the second half of 2024, many of the staff will have been hired in anticipation of that.