Stephen Donnelly (Wicklow, Fianna Fail) | Oireachtas source

I am happy to be before the committee to consider the Revised Estimates for the Department of Health for 2024. I will be joined shortly by my colleague, the Minister of State, Deputy Naughton. She sends her apologies. She is taking a Private Member's Bill in the Dáil at the moment. I am joined by officials from my Department, Ms Louise McGirr, Mr. Kevin Colman, Mr. Patrick McGlynn, Ms Aonraid Dunne and Mr. Trevor Moore.

Over the past four years, the Government has delivered record levels of investment to the health service. This has led to a significant increase in the number of healthcare professionals we now have working in our public service. In fact, there are now more than 26,000 more healthcare professionals than there were at the start of 2020, which is a 22% increase. It includes more than 8,000 additional nurses and midwives, more than 4,000 health and social care professionals, and almost 3,000 more doctors and dentists, including approximately 1,000 hospital consultants. We have increased our acute hospital bed capacity by 1,126 beds since the start of 2020. This significant investment was badly needed, and certainly our healthcare professionals are putting it to good use on behalf of patients. In the post-emergency pandemic phase, we, like many other countries, have seen extraordinary increases in demand for services. Unfortunately, we are seeing this against a backdrop of high inflation, especially in the healthcare world. Of this year’s funding allocation, the majority is focused on absorbing price inflation and meeting growing patient demand.

Looking forward to this year, the priorities continue to be the reduction of waiting lists and delivery of ongoing improvements to urgent and emergency care, particularly reducing the number of patients on trolleys. Last year was the second year in a row that hospital waiting lists fell, with 1.74 million patients treated and removed from waiting lists. More than 177,000 more patients were removed from our waiting lists last year compared with the year before, 2022. I fully acknowledge we have a way to go, but important progress is now being made year by year. It is fair to say the figures that matter most to us are the agreed Sláintecare figures, that is, the number of people who are waiting more than the agreed ten to 12 weeks. That is our core focus in all our waiting list activity. We set a target last year for a 10% reduction in the number of people waiting more than ten to 12 weeks. It was an ambitious target and I am pleased to be able to report to the committee that we have exceeded that target. We have had an 11% reduction. It equates to 57,000 fewer men, women and children waiting for hospital care than at the end of 2022. It is great to see. Since the pandemic peak, there has been a 27% reduction in the number of people waiting longer than the agreed Sláintecare targets. That is approximately 170,000 people. I pay tribute to the extraordinary efforts of healthcare workers who have worked extremely hard by working additional sessions, later hours and weekends, innovating to treat people in the community and so much more. We are really seeing the benefits for patients of all the work of our healthcare workers. Significant funding has been allocated this year to further reduce waiting lists. We will also continue to prioritise and invest in reducing the number of patients on trolleys and, more broadly, in building a robust responsive national urgent and emergency care service.

While we face real challenges in some of our hospitals, it is important to acknowledge that many of our hospitals are performing well in reducing the number of patients on trolleys. Nationally, the number of patients on trolleys in the second half of last year was down by 20% compared with the same period in 2022. I am by no means suggesting the job is done. It is not. We see constant pressures in certain hospitals but we are moving quickly in the right direction at a national level and we are focusing more and more on the hospitals that are under the most pressure.

We will continue to invest in our workforce this year, including the full roll-out of safe nurse staffing, the expansion of student nurse and medical education places, and the ongoing roll-out of the public-only consultant contract. The latest figure I got last night is that 1,700 consultants have now signed up to the new contract. I was reporting 1,500 only two weeks ago. There is a lot of appetite early this year, which is great to see.

We will also be prioritising the ongoing expansion of health infrastructure, which is badly needed. As colleagues will be aware, I have committed to funding staff and capital for six new surgical hubs, 162 additional hospital beds, 22 ICU beds, which are of importance, and 160 community beds.

We are increasing our investment in digital health. Ireland is a laggard in digital health. It is an area we need to improve. A new patient app will begin to allow patients to see their information for the first time in this way. We are investing in virtual wards, the use of more telehealth and progressing e-health initiatives such as shared care records. All these projects will have a real impact for patients and healthcare providers in providing the best possible care as quickly as possible.

I am also pleased to announce that we are substantially increasing our investment in mental health services again. I am acutely aware, as are colleagues, of the pressures on our youth mental health services, especially on CAMHS for those who need the widest interventions and deepest supports. This year we have put an additional €44 million into mental health services. The Minister of State, Deputy Butler, and I announced an additional recurrent fund of €10 million specifically for youth mental health with a clear focus on CAMHS and continuing to reduce those waiting lists.

I am funding a range of other measures including: free contraception up to the age of 31, which will bring our significant investment in the free contraception scheme up to around €43 million for 2024; better and wider availability of PrEP; progressing the diabetes patient register; and progressing our genetics capacity with the continued build-out of genetics and genomics in healthcare delivery. This investment prioritises the recruitment of specialist staff and will increase the accessibility of genetic and genomic medicine service for patents across the country. This is a very exciting area of medicine in terms of being able to do more and more for people.

To support the incredible levels of activity and to address some of the financial challenges in 2024, the health service has been allocated additional non-core funding of €1.032 billion. This funding will increase population protection from Covid through vaccination programmes and ongoing monitoring. It will reduce our waiting lists through in-sourcing and the use of additional private capacity and will increase our capacity to help us manage our patient flow. This is going very well in some hospitals but others have a way to go. The additional funding will also support community groups in areas of mental health, older persons, and social inclusion. Approximately €432 million of this money will be allocated to our health resilience fund to provide for the cost of additional goods and services in acute hospitals as well as investment in technology and information systems, particularly the integrated financial management system, IFMS. Despite the provision of a significant amount of additional non-core funding, it is entirely possible that there will be a substantial supplementary Estimate required later this year due to inflation and growing patient demand. We flagged this at budget time and are flagging it again now as we look to the Revised Estimates.

On reform and productivity, I am committed to delivering a significant programme of savings and improved productivity. I recently established a productivity and savings task force, which has started to meet. The purpose of the task force is to ensure the most efficient use of existing funding and to provide as many services to as many patients as possible, while at the same time meeting the needs of a growing and aging population. While we have succeeded in substantially increasing activity in our hospitals, with better outcomes for people, this has come at an increasing cost. Investment in acute hospital care has increased by more than 80% over the past seven years, from €4.4 billion in 2016 to €8.1 billion in 2023 and now makes up over a third of our overall spending. The quality of care has undoubtedly improved. We can see this through improved outcomes and experiences for patients. While activity has increased, the number of patients treated needs to keep up with the additional funding but I am not yet satisfied this is the case. In fact, we have pretty clear information showing that the volume of patient care is not keeping up with the increases in funding. The increase in funding is not matched by increases in the level of patient care, and that will be the core focus of the productivity task force. Even accepting improvements in outcomes, there is a significant divergence between resourcing and activity and this is something we are going to address. Indeed, addressing this productivity puzzle will be a top priority for me, the Government, my Department and the HSE this year.