Stephen Donnelly (Wicklow, Fianna Fail) | Oireachtas source

I welcome this opportunity to address the committee to discuss Further Revised Estimate for 2023 for my Department - Vote 38. I thank the committee for agreeing to defer this appearance until after the transfer of specialist community-based disability services from my Department to the Department of Children, Equality, Disability, Integration and Youth. This transfer took effect from 1 March this year and involves the transfer of approximately €2.650 million of funding from Vote 38 to Vote 40 - essentially the transfer of disability services.

Notwithstanding this transfer, the gross health Vote for 2023 is €21.358 million. This allocation is made up of €20.197 million in current expenditure and €1.161 million in capital expenditure. When compared on a like-with-like basis to the 2022 estimate, excluding disability services and one-off funding provided by means of a Supplementary Estimate, I am very happy to have secured an increase of 7.8% over last year's original allocation. This is an additional €1.454 billion over last year's allocation of €18.743 billion. This allocation reinforces the ongoing commitment of Government to the provision of a health service that seeks to improve the health and well-being people across the country.

In line with our programme for Government commitment to universal healthcare and in line with Sláintecare, budgets 2021, 2022 and now 2023 have provided an unprecedented level of investment. So far this decade, we have seen record levels of recruitment with nearly 20,000 extra staff since Covid arrived. That includes about 6,200 nurses and midwives, more 3,000 health and social care professionals and over 1,800 doctors and dentists. The HSE has opened an additional 970 permanent hospital beds. This does not include critical care beds, which have increased very significantly as well by 25%.

The level of funding provided will enable the advancement of a number of priorities in 2023. These include tackling waiting lists, which are now falling; rolling out ongoing women’s healthcare services, which is going from strength to strength; continuing with patient access and more beds being delivered; extending free contraception scheme to all women aged between 16 and 30; extending State-funded GP care to those on or below the median household income and children aged six and seven; maintaining the drug payment threshold at €80 per month; and abolishing hospital in-patient charges and many other issues that really matter to patients around the country.

Given the success of the vaccine programme, and the movement from pandemic to the endemic phase of Covid-19, I am planning to scale back the emergency Covid-19 expenditure to €757 million. This is to combat the disease and the effects it has had on our healthcare service for patients.

The programme for Government, of course, reaffirms its support for Sláintecare. It is being funded and is on track to improve access, expand eligibility, improve the patient experience and bring care closer to the home and further into the community. The move to a public-only health system is a major priority for Government, and I was very happy to be able to introduce the new public-only consultant contract. It is a really important step forward in the implementation of universal healthcare and of Sláintecare.

A central tenet is that health services will move to being provided free or affordably at the point of delivery. To this end, I am expanding access to State-funded GP care to those on or below the median household income, and maintaining the drug payment scheme at €80 per month. As colleagues will be aware, from 1 April, we have abolished all inpatient hospital charges, which is a really important step.

Regarding women's health, which this Government has put front and centre, the Revised Estimate provides funding for women’s health issues across the board. This includes the extension of the free contraception scheme to women aged 16 to 30; increased investment in a new approach to menopause care, including specialist menopause clinics, more training and service provision by GPs; nearly €5 million towards women’s health hubs, cervical screening and morning sickness drug reimbursement; and the introduction, for the first time, of a State-funded in vitro fertilisation, IVF assisted human reproduction scheme.

We have put a lot of focus as well on clinical excellence and national strategy. Very significant funding has been provided for the continued implementation of a number of national strategies, including the national cancer strategy, the national maternity strategy, and the national trauma strategy, and many other strategies as well. We have five new strategies which are being funded this year, including stroke, diabetes, genetics, neurorehabilitation and obesity. These are really going to help, and my understanding is they are already helping, to provide patients with the care they need, both in hospital and in the community. I know many members of this committee have advocated for a long time around various services, for example, the community-based neurorehabilitation nurses.

There is much focus on capacity. We are in the middle of probably the greatest expansion of infrastructure and workforce capacity within our public health services in a long time. The budget for this year makes funding available for an additional 6,000 people working in the HSE. This continued growth will bring the health sector up to an estimated 143,000 people this year. If we add 6,000 people this year, and more than 1,000 have already been added of that 6,000, we would be looking at an increase from the start of Covid-19 of about 24,000 or 25,000 whole-time equivalent people.

Improving access for patients obviously requires us to continue to grow bed capacity. Around 250 further beds will be delivered this year, and that is before we look at the plans we have in progress for an additional 1,500 beds, which will be delivered through an accelerated building programme.

The capital funding for this year will contribute to the delivery of modern healthcare facilities and equipment. It will improve and expand service provision and capacity right across the country, and some of the many priority projects are: progressing the new national children's hospital; progressing the new national maternity hospital; continuing with the opening of primary care centres. I think I am opening three more later this week. It has been really successful; a very extensive national equipment replacement programme, which I know members of this committee have, for a long time, quite rightly called for; and progressing the elective hospitals.

I will turn now to the financial position. The final gross provision for the health Vote for last year was €23.585 billion, which comprises €22.435 billion for current expenditure, and €1.15 billion for capital expenditure. It includes additional funding of €1.392 billion made available in supplementary funding for one-off expenditure last year. The outturn for last year also included €2.549 billion for specialist, community-based disability services, which my Department was responsible for last year, but, as was said, has now been transferred to the Minister for Children, Equality, Disability, Integration and Youth, Deputy Roderic O'Gorman's Department.

The initial 2022 capital allocation was €1.06 billion. In response to Covid-19, an additional €90 million, which was held in contingency, was made available, bringing the total for last year to €1.15 billion. The total funding provided by Government to the health service last year for Covid-19 was €1.878 billion.

I will now turn to this year's budget and the framing for the budget. In the framing, the Oireachtas has allocated significant additional Exchequer funding for the health sector. I would like to thank committee members for their support for that. This year, gross health funding is €21.358 billion, and that is €20.197 billion current, and €1.161 billion capital. It represents an increase of nearly 8%, or €1.454 billion, on last year's current expenditure, which obviously does not include disability and the one-off supplementary. It recognises the Government's commitment to providing a health service that works for everybody in the country.

The capital allocation for this year is just over €100 million above the original figure for last year, which represents a very significant increase on the pre-Covid-19 allocations. Again, that is before any agreement may be reached around the additional 1,500 beds through a rapid build programme. The capital funding for this year is already contributing to the delivery of the type of modern health infrastructure that we really need to see.

In conclusion, essentially what I and the Government have been trying to do in the budget for this year and over the last two years is to mobilise the resources of the State, and mobilise reform, investment and activity across the health services to achieve our goal of universal healthcare. What colleagues will see is funding allocation this year building on that over the last three years, and aimed primarily at achieving three things: reducing costs for patients and families; increasing speed of access for patients and families; and rolling out more services, always at a higher quality. These are the three tests of universal healthcare. We are doing that in many different ways, partly through a very significant expansion in capacity, and through much reform, integrated care, community-based care, bringing any health measures, moving to the regional health areas,and so forth.

Between doing all of that, what we are achieving in Ireland right now is not unique internationally but is rare internationally. What we are seeing, at the same time the country is dealing with the after-effects of Covid-19 and its additional health burden, is that Ireland is reducing costs for patients. We are rolling out additional infrastructure, and critically, the waiting lists are now falling. Last year saw the waiting lists fall for the first time since 2015. This will be the second year, and in fact I am very happy to report to colleagues that just in the last month, the number of patients waiting longer than the agreed Sláintecare targets has fallen by 5%. That is around 55,000 fewer people than even a month ago. Good progress is being made this year on that core goal of having nobody waiting longer than the Sláintecare targets. I thank the committee.