Oireachtas Joint and Select Committees

Thursday, 24 February 2022

Select Committee on Health

Estimates for Public Services 2022
Vote 38 - Health (Revised)

Photo of Seán CroweSeán Crowe (Dublin South West, Sinn Fein)
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This meeting has been convened to consider the Revised Estimates for Public Services 2022: Vote 38, Department of Health. While the committee has no role in approving the Estimates, there is an opportunity for it to make the scrutiny of the budgetary performance of the Department more transparent. The briefing prepared for the secretariat illustrates the difference between the previous financial allocations and those for 2022 on a subhead-by-subhead basis within each programme. An additional briefing document provided by the Department goes into more detail, offers further analysis and focuses on the subheads. Is it agreed that the committee consider the Estimates in their entirety within the normal ten-minute speaking slots allocated to each member? Agreed.

I welcome the Minister, Deputy Stephen Donnelly, and the Minister of State, Deputy Mary Butler, and their officials to our meeting to consider the 2022 Revised Estimates. I thank them for providing a briefing note thereon. I propose that the Minister make his opening remarks, after which I will invite members to ask general questions on Vote 38.

Photo of Stephen DonnellyStephen Donnelly (Wicklow, Fianna Fail)
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I thank the Chairman and the other members. I very much welcome this opportunity to meet them to discuss the Revised Estimates for 2022 — Vote 38, Department of Health. I am delighted to be joined by my colleague, the Minister of State with responsibility for mental health and older people, Deputy Butler.

Budget 2021 saw an unprecedented allocation of over €4 billion in additional funding for health. This funded Covid-19 responses, maintaining the existing level of service, but, critically, €1.16 billion of this funded vital capacity and reform measures. This included unprecedented numbers of additional beds, workforce expansion, home care hours and investments in national strategies. We are all aware that 2021 was a difficult year, with significant impacts from Covid and the need to deliver the vaccination programme. This meant that not all of these new measures could be delivered in 2021.

We estimate that approximately €650 million of the €1.16 billion was spent in 2021. However, I am very pleased that, as we enter a new phase in the Covid-19 pandemic and plan to scale back our emergency Covid-19 expenditure, the Government has made the full amount of funding available again this year, together with €319 million in additional funding for new measures. This means there is a further expansion of over €500 million from 2021 new measures still to be delivered in 2022. This brings the total available for additional capacity and reform for this year to over €800 million. This will fund an expansion of our workforce of up to 10,000 staff, over 300 additional acute beds and 3 million additional home care hours. It will also fund the full roll-out of the enhanced community care teams to move delivery of care out of hospital settings into the community.

I have mentioned previously my three priorities, which are also those of the Government, in delivering universal healthcare. These are improving access for patients, improving outcomes for patients and improving affordability for patients. This Revised Estimate continues the work done in delivering on all three.

On patient access, the aim is to address waiting lists by allocating an additional €200 million to the HSE and an additional €50 to the National Treatment Purchase Fund, NTPF, creating an access-to-care fund for this year of €350 million. I am providing funding for additional critical care capacity, with funding to open 19 additional critical care beds. This is on top of the substantial funding of €426 million provided in 2021 for overall bed capacity.

With regard to better outcomes for patients, the level of funding provided will enable the advancement of a number of priorities in 2022, including prioritising funding for women's health.

The level of funding provided will enable the advancement of a number of priorities this year, including prioritising funding for women’s health.

I have allocated an unprecedented €47 million towards investments in women’s health this year. This will allow us to introduce a number of very important measures, including free contraception, initially for women aged 17 to 25 years; and increased investment in a new approach to menopause care. Some €10 million has been provided to the women’s health fund for new targeted projects, such as initiatives to address period poverty. National strategies will be implemented that impact on women’s health with additional funding for maternity, obstetrics, gynaecology services and perinatal genetics, as well as funding in cancer, drugs and mental health.

I was delighted to announce only last week a new plan to reduce waiting times for children and adolescents waiting for orthopaedic care. This includes, of course, children waiting for intervention and help on scoliosis and spina bifida. Funding for the continued implementation of other national strategies is also included this year, including for the cancer strategy, the National Ambulance Service strategic plan and the trauma strategy and for the paediatric model of care, for organ donation and transplant services and for the social care strategies, including in the area of dementia and palliative care. It also funds the introduction of new regulations and legislation to expand the remit of HIQA, the roll-out of InterRAI assessments in nursing homes and more.

In terms of affordability for patients, budget 2022 responds strongly to the programme for Government commitment to introduce more care in the community and to make accessing services more affordable. This will reduce our dependence on the hospital-centric model of care.

In addition to the strategies mentioned above, I will provide for the extension of free GP care for children aged six and seven. This will benefit approximately 80,000 additional children this year. We will reduce the drug payment scheme threshold from €114 to €80, which will benefit approximately 70,000 people.

Actions will also be taken on a phased basis to reduce the financial burden of hospital charges for children. We have provided €30 million for new drugs and a further €36.5 million for a range of measures, including the safe-staffing framework, anti-microbial resistance and infection control and the implementation of the nursing home expert panel recommendations.

There is €37 million in additional funding for mental health services and €10 million designated from the Covid funding for mental health, providing a total of €47 million. There is €30 million to build on investment in older persons and dementia services; an additional €105 million for disability services, with a further €10 million in one-off Covid funding for disability services; an additional €10 million for Healthy Ireland; and an additional €6 million for social inclusion, including the national drugs strategy.

With regard to the financial position and the 2021 outturn, the gross provision for the health Vote in 2021 was €22.1 billion. That comprised €21.1 billion of current expenditure and just over €1 billion capital expenditure. The €21.1 billion represents the gross funding position for both the

Department of Health and the HSE and includes additional funding of €1.8 billion made available for current expenditure in 2021 in response to Covid-19.

The initial 2021 capital allocation was €893 million. In response to Covid-19, an additional €155 million was assigned, to bring the total capital allocation that year to more than €1 billion. The total cost of Covid-19 supports provided by Government to the health service in 2021 was €1.9 billion. These measures continue to be relevant in 2022 as the pandemic continues.

In framing the 2022 budget, the Oireachtas allocated further additional Exchequer funding for the health sector. Gross health funding is €22.2 billion, comprising €21.1 billion in current expenditure and €1.1 billion in capital expenditure. This represents an increase of €51.6 million on the 2021 current expenditure budget, an increase of €1.1 billion or 5.9%, excluding Covid 19 expenditure. It recognises the Government’s commitment to providing a health service that improves the health and well-being of people in Ireland. Some €319 million of this is allocated to new measures. When taken with more €500 million from 2021 and new measures still to be delivered in 2022, it brings the total available for additional capacity and reform to more than €800 million for this year.

The 2022 capital allocation is €12 million above the 2021 figure, which represents a significant increase on pre-Covid-19 allocations and will contribute to the delivery of modern health facilities and equipment throughout the country, both aspects of Sláintecare and Project Ireland 2040 and the mission of universal healthcare.

The year 2021 was another difficult year for those working in healthcare. Our doctors, nurses, health social care professionals and everyone across the health service have been working tirelessly throughout this pandemic. The great success of our vaccine roll-out has allowed us to move back

to a more normal way of living and working. While Covid-19 has highlighted major challenges in our health service, it has also highlighted our strengths, including the resilience, professionalism, courage and innovative spirit of our healthcare workers.

Budget 2022 funds our ongoing Covid-19 response but, more than that, it is also about building capacity, hiring staff and bringing positive permanent change to our health service. The continuing investments made in recent years will mean that, through the reforms being enacted, Ireland will have a better and more resilient public healthcare service.

I will finish off topic. I extend my thoughts and sympathies to the people of Ukraine, as they face an outrageous and illegal invasion by Russia. I am pleased to see that Ireland is making its position known very strongly, including in its role in the United Nations, at this time.

Photo of Seán CroweSeán Crowe (Dublin South West, Sinn Fein)
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We all agree with the Minister's sentiments on Ukraine.

We propose to take members in ten-minute slots. I hope we will all have more than one round.

Photo of Bernard DurkanBernard Durkan (Kildare North, Fine Gael)
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I take the opportunity to echo the words of the Minister with regard to the Ukrainian issue.

I welcome the Minister, the Minister of State and their colleagues to the meeting. The Department of Health has faced many challenges in the past couple of years and in the past year, in particular. It has done well in very challenging circumstances, despite being a Department that received a great deal of criticism. Everybody knows best, everybody sits on the fence and everybody makes the commendation afterwards. The comments usually come afterwards, but not beforehand. I sympathise with the Minister on what he has to do.

This year will be the biggest test of the Department. How will it restore the health services to what the people expect, given the level of expenditure in the health services, the number of patients on waiting lists and bed waiting lists and given orthopaedic requirements? How does one, in the shortest possible time, bring around the Department to face those challenges, put them on the front line and deal with them, as they arise? How does one do so in a way that encourages the public, recognises its concern about the issue and recognises that there is a shortage of nurses in Australia, London and other places?

The message there is that it is a heavy and daunting job. It is a job for people who are dedicated to it. We should recognise the work done by the health service in the daunting jobs over the past couple of years, the jobs people did and how well they did them. However, what we do from here on in is important and it must be recognised that a number of high-profile people resigned over the co-ordination between the proposed Sláintecare programme and the health programme, as it is to be.

The two must converge. There must be an identification of convergence. We do not know what will happen as a result of moving apart from one another. We look for reassurance that the two will converge, the people who had concerns will have had them addressed and that the issues now remaining are within the capacity of the Department, the Minister, the Ministers of State and their officials to deliver.

Photo of Stephen DonnellyStephen Donnelly (Wicklow, Fianna Fail)
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I echo Deputy Durkan's comments about our healthcare workers. They have been the very best of us all over the past two years.

They have been extraordinary, but they are exhausted. Too much is being asked too often of our healthcare workers. I meet our healthcare workers all over the country. I met fantastic healthcare workers from Limerick just last week. They are all tired and need our help. I echo the acknowledgement of the extraordinary work our healthcare workers have done.

Regarding where we go from here, the first thing to say is that we are absolutely focused on and committed to the mission of achieving universal healthcare. It is what the entire programme for Government is framed around and what Sláintecare provides a path to. It is one of the most important projects yet to be finished in our country. We all know that hundreds of thousands of men and women are waiting for care. Just slightly shy of 100,000 children and adolescents are also waiting for care. That is simply not acceptable in our country.

To address the situation, we are mobilising the Department and the public health service, our partners outside the public health service and this budget in order to realise the mission of universal healthcare. In my opening remarks I addressed the three tests of universal healthcare: whether people can get care when they need it; whether consistently high-quality care is received when people do get it; and can people afford it. To that end, this budget has many affordability measures and we are going to introduce more next year. This is all part of a journey.

On the provision of high-quality care, it will have been seen that there has been significant investment in our clinical strategies and a new focus on women's healthcare. That is intended to seek to achieve consistently high-quality care and patient outcomes. The aspect which has dominated most of the debate around healthcare is access to services. In that regard, we are doing two things in parallel. Tomorrow, I will be launching the new waiting list plan for this year. It is an ambitious €350 million plan. In addition, we are adding more permanent capacity to the public health service than at any time on record. While we are doing that, we are doing it in the way set out in the Sláintecare policy. I refer to moving care into the community, increasing productivity, deploying new technologies and moving to a regional healthcare system. A combination of increased assets-----

Photo of Bernard DurkanBernard Durkan (Kildare North, Fine Gael)
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Regarding the people who had concerns about the implementation of Sláintecare, and who subsequently resigned from the co-ordinating committee as a result of the lack of progress being made, have their fears been assuaged in the meantime? I refer to their fears having been assuaged to their satisfaction, as opposed, perhaps, to those of the Minister. Equally, do we have sufficient wherewithal to deal with the question of orthopaedics? Given what Mr. Green has said and demonstrated, is it possible to make it happen? Can we make it happen?

The eyes of the community are on the Department of Health now. The question everybody has is whether the Minister can make this transformation happen. It affects us, the Minister, the Chair and everybody here as well. My three questions are aligned with that context. To what extent have the concerns of those people who were worried about the implementation of Sláintecare, and who resigned as a result, had their fears dealt with? To what extent is the orthopaedics' capacity capable of dealing with the issues being experienced? It should be capable of dealing with these needs. Those who specialise in this area believe it is. Finally, can the Minister make Sláintecare happen?

Photo of Stephen DonnellyStephen Donnelly (Wicklow, Fianna Fail)
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I thank Deputy Durkan. Regarding how people feel about their concerns, I cannot speak to whether they feel those concerns have been addressed. To my mind, however, the evidence never backed up those concerns. There were concerns about a lack of implementation, whereas, in fact, the evidence shows more implementation than in any previous year. Therefore, I have always disagreed with the allegation or concern that progress was not being made. We have demonstrated comprehensively that significant progress has been made. We are making progress towards achieving universal healthcare at a level that speaks for itself.

Turning to the Deputy's second issue, he is probably talking specifically about paediatric orthopaedics. In that regard, we just funded and launched a €19 million plan. By the end of the year, that will probably have reached a little over €20 million. It is a combined approach between Cappagh and Crumlin hospitals, and some private operators may also be used. The plan seeks to increase treatment for all children waiting for paediatric orthopaedic procedures, including those with spina bifida and scoliosis. We have set an ambitious target. Regardless of whether we hit that target by the end of the year, my view is that it is important to push the system as far as it can go and beyond its comfort zone, if we are going to get these children treated. They must be treated. The target is that no child would be waiting more than four months for intervention in cases of scoliosis or spina bifida. It is an ambitious aim. Some of the surgeons have raised concerns to the effect that it would be an amazing feat to achieve this objective by the end of the year, given the complexities involved. I am confident, however, that we have a well-funded and serious plan in place. We are working across all the relevant hospital sites.

Moving on to the Deputy's question regarding whether we can make all this happen and implement all these ambitious plans as laid out, it remains to be seen whether we will reach all the targets. The targets we have set are intentionally stretch targets. Their very nature means that we are trying to push the system outside of its comfort zone. I refer to pushing the Department and the public health service, the HSE, beyond what has been achieved before. Regardless of whether we hit all the stretch targets, there is absolute determination in the Department and in the HSE and complete determination and resolution in Government regarding the need to implement the policies on patient affordability, clinical strategies, waiting lists and a permanent increase in the capacity and modernisation of the public health service

Photo of Bernard DurkanBernard Durkan (Kildare North, Fine Gael)
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We wish the Minister well. I thank the Chair.

Photo of Seán CroweSeán Crowe (Dublin South West, Sinn Fein)
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I call Deputy Cullinane.

Photo of David CullinaneDavid Cullinane (Waterford, Sinn Fein)
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I join with the Minister in condemning the Russian invasion of Ukraine. Our thoughts are with the people of Ukraine today. Ireland, as a neutral country, must take a strong stance. I echo the Minister's words on that issue.

To start with some of what the Minister said, there is no disagreement regarding the need for us to improve accessibility and affordability in the context of quality care. I do not think anybody questions the quality of care that people get when they access the health service. The problem is getting access. When people get access, they get good quality care. Obviously, there are areas where we can improve, but, by and large, the quality of care provided by the Irish health service is second to none. Therefore, access and affordability are the two key issues.

Starting with waiting lists, I have several questions that I will come to shortly regarding the targets set in the budgets of 2021 and 2022. Specifically regarding waiting lists, however, the Minister said that the plan being announced tomorrow will be a €350 million package. We have tight time limits, so I ask the Minister to be as precise as he can in answering this question. How much of that amount is new funding that was not included in budget 2022? Is any additional funding being made available that was not already provided for in the budget announcement?

Photo of Stephen DonnellyStephen Donnelly (Wicklow, Fianna Fail)
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No, it is all accounted for in this budget.

Photo of David CullinaneDavid Cullinane (Waterford, Sinn Fein)
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What is this €350 million made up of then?

Photo of Stephen DonnellyStephen Donnelly (Wicklow, Fianna Fail)
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It is made up of the core funding to the NTPF of €100 million. There is also a one-off allocation, which may become multiannual but for this year it is a one-off addition, to the NTPF of €50 million, which brings the total funding for that scheme to €150 million. An additional €200 million is being deployed across a range of measures, some of which may be commissioned by the NTPF, but many of which will be used by the HSE-----

Photo of David CullinaneDavid Cullinane (Waterford, Sinn Fein)
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Yet all of this was already provided for in the announcement made on budget day. That concerns me, because the Minister said earlier that one of the priorities must be access. When we look at the data relating to waiting lists, it is frightening when we see the number of people who are waiting for healthcare. From looking at the figures, sometimes there is an over-reliance or focus on what is happening on the acute side.

It is very important. We have nearly 898,000 on some form of health waiting list when we look at the totality, but the active acute waiting list is about 703,000, which is still huge. There is also the length of time people are waiting. We have nearly 165,000 patients waiting over 18 months on some form of outpatient waiting list. Separate from that, we have 226,000 people waiting for a diagnostic scan, which is a huge number. Although I do not have time, I could talk to the Minister about my own family members and the constituents I have met who have had to go private because they simply could not wait for a diagnosis from the public system. That is a huge number of people on top of the almost 900,000 people waiting for access to a consultant or waiting for treatment.

We then go into the community, where this information is not published. We can go onto the National Treatment Purchase Fund website and we will get all the information we want on the acute side but we cannot get access to similar information publicly for community or for diagnostics. Over a long period of putting in parliamentary questions and getting the full breakdown across home help, orthodontics, psychology, counselling, CAMHS, speech and language therapy, occupational therapy, physiotherapy, podiatry, ophthalmology, audiology and dietetics, I found that some 225,000 people are on waiting lists in the community.

That is almost 900,000 on the acute side, 226,000 waiting for a diagnostic assessment and 225,000 on a community waiting list, yet in this package that the Minister will announce tomorrow, not one single cent is additional funding. It is all funding already provided, with some of it going to the National Treatment Purchase Fund, and we will have to see what that €200 million actually does. I have seen it reported that the Minister is setting very ambitious targets. Does he believe there is any chance of achieving those targets given there is not a cent of additional funding beyond what was provided and given the scale of the waiting lists and the number of people waiting, but also the length of time they are waiting?

Photo of Stephen DonnellyStephen Donnelly (Wicklow, Fianna Fail)
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The situation is not acceptable. As the Deputy quite rightly lays out, it is not acceptable for hospitals, for inpatients, for outpatients, for diagnostics, for adults and children or for community care. The €350 million was put into the budget for exactly this reason. Additional funding is not required at this point because a fund like this has never been created before, to the best of my knowledge. We have €350 million and I would love nothing more than for the system to have fully utilised the €350 million before the end of the year. I would be delighted to be coming back here and to then go back to the Cabinet to say that, actually, we can go further and we can get more people treated. It is a very significant amount of money, so let us see how we go on that.

I absolutely accept the Deputy’s challenge on community. We are not ignoring community and it would be wrong to do so. Part of what we are doing in the plan the Deputy will see tomorrow is that we are looking at diagnostics. The Deputy will be aware we have a very successful initiative regarding GP access to diagnostics. I will have to check the figure but it was something like 138,000 radiology scans last year and we have rolled that over into this year. That is one of the big things we are doing to increase community access to diagnostics and it is going down very well with general practice.

The Ministers of State, Deputies Butler and Rabbitte, have been pushing very hard on other lists and a lot of work has been done on the assessment of need list on disability and on the home care waiting list and the mental health waiting list. One of the big focuses this year is to hire a very large number of community-based health and social care professionals as well. I fully accept that challenge.

Photo of David CullinaneDavid Cullinane (Waterford, Sinn Fein)
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I will stop the Minister there. I am sure he will have a lot of time tomorrow to set out in a press conference all of the details of the waiting list plan. I celebrate and welcome every additional cent that is put into the health service, every single staff member who is recruited and any additional funding on the capital side, and that is all money I will support. However, when we look at the scale of the waiting list challenge, I am not convinced we are going to do enough or that the targets being set will be met. I agree and fully accept that setting ambitious targets is what a Minister for Health should do. I want to go back to some of the targets because they are important when we look at the two budgets just gone. Many of the targets we are trying to meet this year were actually targets that were set in 2021. On the staffing side, what was the target number of full-time equivalent positions that were funded for 2021?

Photo of Stephen DonnellyStephen Donnelly (Wicklow, Fianna Fail)
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I will try to find that for the Deputy.

Photo of David CullinaneDavid Cullinane (Waterford, Sinn Fein)
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Would I be right to say it was 14,700? Some 16,000 was the figure announced on budget day and then a figure of 14,700 emerged.

Photo of Stephen DonnellyStephen Donnelly (Wicklow, Fianna Fail)
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For 2021 and 2022-----

Photo of David CullinaneDavid Cullinane (Waterford, Sinn Fein)
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Just for 2021.

Photo of Stephen DonnellyStephen Donnelly (Wicklow, Fianna Fail)
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For 2021, I do not have the figure but over the two years, there was a total of about 12,500.

Photo of David CullinaneDavid Cullinane (Waterford, Sinn Fein)
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That is not correct. In budget 2021, the Minister set out in his own speech a very ambitious target of recruiting a minimum of 14,700 staff. It was in his budget speech. It was a commitment that was given and we were told they were funded positions. We are here to talk about the Estimates and the money allocated to do certain things. For budget 2021, I am asking what was the target and the number of funded whole-time equivalents who were to be recruited in that year and how many were actually recruited.

Photo of Stephen DonnellyStephen Donnelly (Wicklow, Fianna Fail)
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The total number recruited as permanent roles into the HSE was 6,149.

Photo of David CullinaneDavid Cullinane (Waterford, Sinn Fein)
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It was 6,149.

Photo of Stephen DonnellyStephen Donnelly (Wicklow, Fianna Fail)
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We sometimes forget that, on top of that, several thousand were also hired in the vaccine roll-out and testing and tracing, so the total number was significantly higher than 6,149.

Photo of David CullinaneDavid Cullinane (Waterford, Sinn Fein)
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Is it fair to say it fell far short of the target and the funded positions that were provided for in budget 2021?

Photo of Stephen DonnellyStephen Donnelly (Wicklow, Fianna Fail)
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Yes, far short.

Photo of David CullinaneDavid Cullinane (Waterford, Sinn Fein)
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That is the point. I suggest it was in the region of 7,000 or even 8,000 but the Minister might provide us with the actual figures. In budget 2022, am I right in saying the target was 10,000 additional staff?

Photo of Stephen DonnellyStephen Donnelly (Wicklow, Fianna Fail)
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That is right.

Photo of David CullinaneDavid Cullinane (Waterford, Sinn Fein)
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Does the Minister believe we will reach that target?

Photo of Stephen DonnellyStephen Donnelly (Wicklow, Fianna Fail)
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As the Deputy is aware, the HSE has revised its view as to what is achievable this year, and its view is approximately 5,500 whole-time equivalents. However, I would make two points. First, on the 10,000 figure, I am very comfortable setting stretch targets that move the HSE and the Department beyond what they are comfortable trying to achieve. Second, the fact there is now a gap between what they believe is possible and what is funded does leave us opportunities to look at new things. I appreciate we are out of time but I want to make the following point. I was in Limerick last week and one of the things that was very clear to me was that there is an urgent need for more emergency specialists, for example. That hospital has eight and the point was made to me by one of them that the equivalent hospital in Australia would have in excess of 20. The fact we may have some headroom for this year means, and I would be very interested in the committee's view on this through the year, that we can all take this as an opportunity to ask whether there are other areas where we clearly need more clinical workforce that we could move on and sanction.

Photo of David CullinaneDavid Cullinane (Waterford, Sinn Fein)
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I will come back to the Minister later with other questions. It is impossible to deal with everything in ten minutes for Revised Estimates so I will come back on some issues in the second round.

Photo of Róisín ShortallRóisín Shortall (Dublin North West, Social Democrats)
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I welcome the Minister and his officials in presenting the Estimates. It is very hard to discuss the Estimates without referencing the kind of reporting we have seen recently in regard to the views of some of the senior officials within his Department. We know from reporting in The Sunday Business Postthat some of the commentary from senior officials in the Department of Health in regard to the HSE referred to things like chasing fake targets, a recruitment crisis in the HSE, sloppiness around financial reporting and hundreds of millions of euro of adjustments and fundamental errors in past accounts. We could be going into detail about the Estimates and asking questions of the Minister about that but if senior officials in his Department do not have confidence in the HSE’s financial management, are we really wasting our time? What is the Minister's view in regard to those comments that were recorded and reported in The Sunday Business Post?

What kind of issue does he believe need to be addressed as a matter of urgency in relation to financial accountability, if they are the views of staff in his Department?

Photo of Stephen DonnellyStephen Donnelly (Wicklow, Fianna Fail)
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I thank the Deputy for her questions. While I am going to get into the substance of it straight away, I am very uncomfortable with civil servants being secretly recorded, those recordings being given to newspapers and then those civil servants being named in those newspapers. I hope we are all on the same page on this. Civil servants must challenge the agencies, in this case the HSE. They must challenge the Government and Ministers and Ministers of State, like the Minister of State, Deputy Butler, and me. This kind of activity can lead to a chilling effect. It turns out I have been recorded - I think it was reported yesterday - or meetings I was at were recorded. I just wanted to make that point. The substance of this is serious nonetheless. As for some of the reporting, the facts simply do not back it up and some of the comments made were simply inaccurate. I understand some of the material is recordings and some of it is contemporaneous notes of what people say other people had said to them, so it could have been fourth-hand before it got into the newspapers.

On the fake targets, I do not accept that. Deputy Cullinane and I just talked about it. I make no apologies for setting targets for healthcare recruitment that, if I am blunt, potentially make the HSE and the Department uncomfortable. I make no apologies for that. It is part of our job in Government and part of our job in the Oireachtas to push the system beyond what it might be comfortable with in terms of the public health service.

The prior year adjustment was not hundreds of millions of euro as reported. The latest estimate is it will be below €100 million and it is an accounting correction done each year because of cash versus accrual accounting.

The mental health commentary attributed, which the Minister of State, Deputy Butler, is very aware of, was simply inaccurate. The HSE in fact looked for €35 million, that amount was more or less given and then there was a one-off payment of €10 million to address some very serious Covid issues as well.

Nonetheless, significant work is required to modernise financial reporting within the HSE. The most important project is the integrated financial management project. It was launched several years ago. I would like to see it further along and so would the HSE. It was significantly derailed by the cyberattack. Obviously, Covid pulled everything but we must now redouble our efforts to have that system in place. I can tell the Deputy the board also is acutely aware of this. Last year it put in an important innovation in the form of a balanced scorecard for performance right across the HSE.

As much of the detail was simply inaccurate, the core question is do we need to do more urgently on modernising financial reporting within the health service. The answer is we do and the chief executive, the chair, the board, the Secretary General and the Department are all aligned on that need.

Photo of Róisín ShortallRóisín Shortall (Dublin North West, Social Democrats)
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Okay but it is also reported that senior officials in the Minister's own Department do not have confidence in the HSE financial reporting because of the service's weak financial systems. That in turn leads to a lack of confidence on the part of the Department of Public Expenditure and Reform in the whole health Vote, which in turn undermines the confidence of the Taoiseach. When it comes to the health service and particularly the Sláintecare reform programme, we need to have the Taoiseach fully committed. However, if the systems are not in place to provide the credibility and the confidence in the financial arrangements within the HSE, then we are not going to get the ongoing support of the Taoiseach on this. That is something that must be borne in mind.

Nobody is taking from the HSE's handling of Covid, nor that of the Minister or the Department. We need to make that clear from the start. Covid was very well handled, especially the vaccination programme in its entirety. That was well done and the testing services were well done and all of that. However, the financial issues within the HSE existed for many years prior to Covid. Unless they are addressed now as a matter of urgency, we are going to continue to be in this twilight zone about where money is going in the health service. There will be a continuing view it is a black hole and we are not going to have credibility about the spending of moneys in health.

There are fundamental things that need to happen and happen very quickly and I would like the Minister to report on those. These include, as he has already referenced, a fully-integrated financial management system within the HSE. It is just extraordinary that an organisation with a staff of 130,000 and a budget of €21 billion does not have an integrated financial management system, so we do not know where money is going. We do not know if we are getting value for money. We do not know if money is going where it was intended to go.

The second aspect is the individual health identifier, which is an essential tool. A business plan was produced in 2016. There has been very slow progress.

I raise this business of money being allocated on an annual basis for staff in different areas and then when it comes to the end of the year, people put their hands in the air and say they could not recruit consultants or GPs or nurses or allied health professionals. They say it is too bad there is a serious recruitment. What is being done about that? Why has no ongoing workforce plan been produced?

The other point relates to devolution of power from the centre, which is what is proposed in the regional structures, the need for accountability legislation and a population-based approach to service planning. The Minister spoke earlier about progress in the Sláintecare plan. In his own progress report produced last week, his contention there would not be borne out. The scorecard is not good with Sláintecare. I can go through them all but he knows the progress report, on pages 14 and 15, lists all the areas where the situation has disimproved. It is not a very good scorecard. Will he tell us what he is going to do to ensure the four areas I listed will be progressed consistently and rapidly in the coming year?

Photo of Stephen DonnellyStephen Donnelly (Wicklow, Fianna Fail)
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I thank the Deputy. I will answer the questions directly but I might ask the Department to provide a more detailed note for the committee because these are important issues and there is much more detail than I can cover here.

On the financial management system, the detailed design was completed in quarter 2 of last year. The capital budget for the programme is €82 million. That gives a sense of exactly how big it is. The original project timelines targeted about 80% of health expenditure transacted by 2025. I share the Deputy's concern we need to move more quickly on this because we are talking about vast amounts of public money being allocated in what I see as one of the most important areas.

There has been work on unique patient identifiers, which are needed. We will all be aware of some of the concerns - legal concerns and so forth - that were raised before. It is not acceptable that we do not have it. Other countries have them. We created one for the vaccination programme very quickly, when the need arose. There is now work looking at that, so I fully share the Deputy's view. We cannot have integrated patient systems across the country without having this unique patient identifier. In the previous Dáil, the committee spent time hearing evidence that some clinical trials, which our patients need to have access to, cannot happen because we do not have unique patient identifiers.

We are out of time but I am happy to come back later on both the workforce plan and the population-based funding. Alternatively, I can respond in writing; whichever she prefers.

Photo of Róisín ShortallRóisín Shortall (Dublin North West, Social Democrats)
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Okay. I would have much more confidence if the Minister had come in and identified those priority areas rather than talking about €300 million for this and €500 million for that. It is the fundamentals that need to be got right. They are not right at the moment. One can only come to the conclusion the Estimates are fantasy figures if they are not borne out at the end of the year. I thank the Chairman.

Photo of Gino KennyGino Kenny (Dublin Mid West, People Before Profit Alliance)
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I thank the Minister for his statement. It is quite comprehensive, to say the least. Obviously, funding and resourcing our public health service is welcome. Over the past two years, it has been challenged like never before.

It has risen to that challenge, particularly the front-line staff, who have come under the barrage of a virus that we are hopefully seeing recede into the background. There are a lot of positives to be taken from the last two years, particularly around the vaccination programme. The vaccination programme was probably the biggest success the Irish health service has had since the foundation of the State. It was a gargantuan undertaking and a huge number of people helped in that process. We pulled together as a country and it was a fantastic effort that showed what can be done in public health.

I have a number of questions on the recruitment of 10,000 staff. This has been flagged before and over half of the 10,000 people we need in our public health service have been recruited. There are many factors in trying to employ staff, which I will not go through. There are different spokes to employing staff. I ask for short answers to these questions if possible. What is the breakdown of the recruitment of these additional staff into general health and mental health areas?

Photo of Mary ButlerMary Butler (Waterford, Fianna Fail)
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I will come in briefly on mental health. Last year, we hired 53 whole-time equivalents into child and adolescent mental health services, CAMHS. In eating disorder teams, 45 new staff were recruited. I only got those figures this week. Those staff were hired to support the three outstanding teams that were already in place and 19 staff have gone to the three teams that were announced for 2021. That is positive for both those services.

Photo of Gino KennyGino Kenny (Dublin Mid West, People Before Profit Alliance)
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What is the breakdown of medical specialties in the recruitment of those additional staff? On what specialties is the HSE trying to focus its recruitment process?

Photo of Stephen DonnellyStephen Donnelly (Wicklow, Fianna Fail)
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We will look for a note on that. We can give the Deputy a breakdown by different areas, including nursing, midwifery, clinical specialties, non-consultant hospital doctors, NCHDs, health and social care professionals, and management and administrative grades. I am seeking a note on, which I will revert to the Deputy with.

Photo of Gino KennyGino Kenny (Dublin Mid West, People Before Profit Alliance)
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What is the breakdown for recruitment in the different community healthcare organisations, CHOs? Is it possible to provide that information or to detail what the main geographical health regions are in the State? Can the Minister provide figures for that?

Photo of Stephen DonnellyStephen Donnelly (Wicklow, Fianna Fail)
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Yes. I will get the Deputy a note on CHOs and hospital groups, which is the best way to look at it for the acute hospital services.

Photo of Gino KennyGino Kenny (Dublin Mid West, People Before Profit Alliance)
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What are the recruitment targets for the four quarters of this year? Will there be a staggered approach? I know there are barriers to recruitment. For which periods in the year is the HSE aiming to recruit these staff?

Photo of Stephen DonnellyStephen Donnelly (Wicklow, Fianna Fail)
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The different departments, hospitals, CHOs and clinical specialties have timelines against which they would like all of those staff recruited. We will include that information in the note.

Photo of Gino KennyGino Kenny (Dublin Mid West, People Before Profit Alliance)
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Private hospitals are an integral part of public healthcare and I disagree with that. Universal healthcare should be untiered. The Minister would be of the opinion that universal healthcare is the best road to provide healthcare for the country. I refer to private healthcare capacity this year compared with before the pandemic. What kind of resources from the overall budget will go towards private hospitals and healthcare?

Photo of Stephen DonnellyStephen Donnelly (Wicklow, Fianna Fail)
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There are a few areas where we will be spending more but it will be funding public patients. The aim of us using capacity from the private or independent sector is purely with a view to treating as many public patients as possible. As the Deputy will be aware, there have been several safety net agreements put in place. This means that when the capacity within the HSE hospital system is put under a lot of pressure by Covid we can activate capacity within the private or independent sector. There is a fourth safety net agreement being put in place at the moment for exactly that reason. Our hospitals have individual relationships with private hospitals that they use for operating theatres, bed capacity and sometimes for critical care capacity. An example is paediatric orthopaedics. Children’s Health Ireland sometimes uses capacity in the Blackrock Clinic to make sure children can get treated, which is an example of a local arrangement. The big one is the NTPF. Last year, the allocation for that was €100 million and this year the allocation is €150 million.

I know some member are uncomfortable with the money going into and being paid out to private providers but there are two points to make. First, last year the majority of the NTPF money went into public hospitals. Some might think it is all spent on the private sector but it is not. I have a figure of 60% in my head for the proportion of funds that were used for insourcing last year. This concerned people working longer hours in the public hospitals and so forth. Second, I agree with the Deputy’s comment, in that we are investing so much money in the public health service because, in time, it will be able to handle all of our population’s requirements. Universal healthcare as an ideology remains neutral on which hospital someone gets care in and it is about the patient rather than the provider. Ireland, the UK, Germany and Canada all have different models for providing this. Some are largely public, some are a mix and some are independent and non-profit trusts. In Ireland, this Government and, I think, all Members are committed to a public health service that has sufficient capacity to treat all patients in the Republic.

Photo of Gino KennyGino Kenny (Dublin Mid West, People Before Profit Alliance)
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My next question is on the recruitment of additional neurological nurses. Some 57 extra neurological nurses are needed in Dublin alone and a further 43 are needed outside Dublin. Is there an overall plan for the recruitment of neurological nurses?

Photo of Stephen DonnellyStephen Donnelly (Wicklow, Fianna Fail)
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I will get the Deputy a detailed note on that.

Photo of Gino KennyGino Kenny (Dublin Mid West, People Before Profit Alliance)
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I have a question on staff retention, which is one of the most important issues the health service faces. One statistic shows that in the past three years, there has been a 44% increase in the number of doctors leaving the State after graduating. It is very concerning that graduate doctors are leaving the State. People leave the State after graduating for all sorts of reasons but among the reasons they leave are pay and conditions. We do not want graduates believing they cannot go back into the Irish health service, even though they want to do so. They feel they will get burnt out, which is very concerning. How can the Minister address that leakage? He cannot address it fully because there are multiple reasons that this happens.

How can we prevent Irish graduate doctors who have been educated to a very high standard in this country from leaving the State?

Photo of Stephen DonnellyStephen Donnelly (Wicklow, Fianna Fail)
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One of the things we must do is treat our non-consultant hospital doctors much better than we currently do. I do not believe the current training path they are asked to pursue on their way to becoming consultants is appropriate. It needs to be completely changed. I met recently with a group of NCHDs and I was shocked by what they told me about their reality. They have to travel around the country every year for potentially ten years and are not supported in doing so. Their working week is far too long and they do not receive some basic supports that they should receive. On the back of that meeting, I contacted the Irish Medical Organisation, IMO, and have invited it in for talks. I have asked the Department to put together for me an approach for how we do this. We must start by listening very carefully to the doctors themselves. I heard a lot of things last week that are simply not acceptable.

We have already taken some measures. The Deputy may be aware that last year I removed the restriction on non-EU NCHDs training as specialists. We need to keep moving with that. We also need to significantly increase the number of training posts. We do not have enough. This is tied in with an increase in the number of consultants. Ireland has one of the lowest, if not the lowest, ratio of specialists to population in the EU. It is not acceptable. We need a significant increase in our consultant workforce.

I understand Deputy Kenny is referring mainly to NCHDs. We need to see serious change in how they are treated, their conditions of work and the training opportunities available to them in order that they can lead a decent and reasonable life in the six, eight or ten years they are training to be specialists. Too many of them do not have that opportunity based on what is asked of them.

Photo of Gino KennyGino Kenny (Dublin Mid West, People Before Profit Alliance)
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Following his engagement with junior doctors and graduate doctors and having listened to some of their testimony, what one change would the Minister make?

Photo of Stephen DonnellyStephen Donnelly (Wicklow, Fianna Fail)
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There are a few changes I would make and we will be talking to the NCHDs and their representative bodies about them. The idea that they can be moved to any part of the country, with very little notice, sometimes relocating with their partners and children every year for ten years, is simply not acceptable. It is not acceptable for us to ask that of them. I am also very uncomfortable with some of the reports on working hours. We have European Union working time directives in place and they need to be followed. There may be some exemptions available but the directives need to be followed.

It is an issue of giving non-consultant hospital doctors a bit of stability in their lives and allowing them to do more than just be in a hospital working and training for 60, 70 or 80 hours per week. That is not a reasonable ask, particularly in the modern world. I also want to see a gender analysis done. Many women go in to train as non-consultant hospital doctors and the conversion rate to specialists should be maintained but it is not being maintained. It is in some specialties but, on average, across the consultant population it is not. The first thing I want to do is to listen carefully to the doctors themselves.

Photo of Colm BurkeColm Burke (Cork North Central, Fine Gael)
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I thank the Minister for his presentation. He is very much focused on recruiting more staff. The figures I have show that in December 2014 there were 103,000 whole-time equivalent staff working in the HSE. In October 2021, this figure stood at 131,000. The biggest complaint I am hearing from consultants is that they cannot get access to theatre time. A number of consultants have told me that whereas before they had access to theatre for a full day each week, they are getting one half-day each week. One consultant, for example, tries to get three operations done in the one afternoon session in theatre provided each week. The consultant in question would normally list three people for operations but is finding that if the patient is not in theatre by 4 p.m., the operation must be cancelled and the consultant ends up doing two of the three scheduled operations in that week.

It is great to talk about recruiting staff but many of these highly specialised consultants who have trained in Ireland may have worked in the UK, the United States or Canada where they had access to theatre for at least one full day per week. In some places, they had two days of theatre time each week. When they come back to Ireland they find they are lucky to get one half-day a week. I heard of one case recently where a consultant was in theatre with a full complement of staff, there were empty beds in the ward on which they normally work, yet the consultant was advised that they could not do any elective surgery on that particular day. What is being done in hospitals to deal with the issue whereby facilities are available but someone, for some reason, is taking the decision at administrative level about what can and cannot be done?

Photo of Stephen DonnellyStephen Donnelly (Wicklow, Fianna Fail)
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I share the Deputy's concern entirely. For example, we have paediatric surgeons who do not have sufficient operating theatre time. There are children who need to be operated on and we have doctors who want to operate on them and they cannot get access to operating theatres. It is not acceptable. We are doing a few things at the same time. We are increasing the number of operating theatres. We also have to look at how often those operating theatres are open. In too many of our hospitals the operating theatre is open from 9 a.m. to 5 p.m. from Monday to Friday. In private hospitals, the operating theatres are open from 7 a.m. to 7 p.m. and they are opening them on Saturdays and Sundays. While I do not have data to verify this, I consistently hear from surgeons that throughput in some of the private hospital operating theatres are simply higher for operational reasons.

Photo of Colm BurkeColm Burke (Cork North Central, Fine Gael)
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A clear example of that is the gynaecological services in Cork where there were 4,500 people on the waiting list. The consultants had a difficulty opening the operating theatre in the Cork University Hospital maternity unit and ended up renting space in the Mater Private Hospital. The consultants moved down to the Mater Private Hospital to deal with public patients, mainly for day procedures. They cleared a large part of the backlog. What needs to be done to open up theatres in public hospitals? The facilities are there. I am aware of one hospital where the theatre has been in place for more than ten years and has yet to be opened.

While it is fine to say we are allocating money for capital projects, in January 2021 funding was provided for two new operating theatres to be built in a particular facility. The work was to start in March at the latest. The contracts were not signed until November. The theatre, which was expected to open in September 2021, will be delayed by between 12 and 14 months and it is now expected that it will not be open until November 2022. Surely something must be done about the roll-out of projects. Why is there such a delay in getting projects up and running once funding has been allocated?

Photo of Stephen DonnellyStephen Donnelly (Wicklow, Fianna Fail)
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On the Deputy's second question on operating theatres, I do not know what the specifics are but if he sends me the details, I will take a look at them. Regardless of what they are, I agree that it takes the State too long to add facilities to the public health service. It takes too long to add critical care beds and operating theatres and to build hospitals.

It is something the Department and the HSE are looking at. I accept it may not apply in this case but what the hospitals say to me is that one of the factors that slows this is planning, the environmental impact statements and so forth. They can take a huge amount of time. We also have quite an onerous set of steps that the State must go through in terms of capital appraisal and business cases, particularly when we get over €100 million. At that stage we are into a whole different process that really takes a long time. We are looking at ways to speed that up and I absolutely share the Deputy's concern.

The Deputy made a very important point on the operating theatres. We need more operating theatres and we must be able to run the ones we have longer. To do that, we must invest and grow the workforce, particularly around theatre nurses. There is a case to be made for an assistant role within theatres. I am aware the Irish Nurses and Midwives Organisation and possibly others do not agree with that position but there is a case to be made for it. We must invest in more theatre nurses. The HSE is doing much work and the chief nursing officer in the Department is doing much work on that but one of the keys to this is the group of theatre nurses. We must be creative. For example, I met representatives of Children's Health Ireland in the past two or three weeks to speak about paediatric orthopaedics. We are funding a fifth operating theatre at Temple Street hospital and much work at Cappagh. We need more theatre nurses. One of the things the director of nursing said to me was that one of the biggest challenges in Dublin is cost of living and nurses finding accommodation. We need to be creative and if that is ultimately what is stopping us hiring nurses, we need to look, for example, at the State, the HSE or whatever it may be taking over and providing accommodation. Ultimately, this comes down to treating patients waiting too long for care.

Photo of Colm BurkeColm Burke (Cork North Central, Fine Gael)
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I will move to the junior doctor issue, which has been raised. There is a problem with getting junior doctors in many smaller hospitals such as Letterkenny, Mayo, Drogheda or even Clonmel. Going outside the major centres such as Cork, Limerick, Galway and Dublin, many of the hospitals are finding it difficult to get junior doctors. In previous schemes there may have been a rotation of doctors from one hospital to another. They started at the bigger hospital and move to the smaller hospital. Many of the rotations did not work out and people stayed in bigger hospitals and never came to the smaller hospitals. If we are doing something with junior doctors, we must do it in a planned way so smaller hospitals do not lose out.

On the junior doctor matter there is also the question of stamp 4. This cuts across the Department of Health and others; it may take in three Departments. My understanding is a person must be in Ireland for five years and it was agreed that stamp 4 permits would be given to anybody who was here for two or more years. What progress has been made in implementing that?

Photo of Stephen DonnellyStephen Donnelly (Wicklow, Fianna Fail)
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There are several pieces to this. The first was to remove the ban on non-EU doctors training as specialists, and that was received well by those doctors. We are looking at the stamp 4 matter, as the Deputy outlined, and it takes in the Departments dealing with health, justice and perhaps foreign affairs. I want to see this moved quickly. The Deputy has correctly point out that we have non-EU doctors who have had the training stipulation removed but are still caught with the stamp 4 element. I will get the Deputy a detailed update on that.

More broadly with the non-consultant hospital doctors we are increasing the number of training posts and we must increase it further. That partly involves increasing the consultant body workforce because there tends to be one-to-one training relationships there as well.

Photo of Colm BurkeColm Burke (Cork North Central, Fine Gael)
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I have raised the stamp 4 matter over the past two months. Everybody is telling me it is progressing but nobody is telling me the timeline. Are we talking about the end of June or July? Are we talking about next December? There are many people staying here in the hope they can get sorted out but they are finding if this is not sorted by July, for example, when they are applying for the next round of jobs, they will have to leave rather than stay. They will say they have been promised a resolution but eight months later it has not been delivered.

Photo of Seán CroweSeán Crowe (Dublin South West, Sinn Fein)
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We are talking about Estimates.

Photo of Colm BurkeColm Burke (Cork North Central, Fine Gael)
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I am aware of that but this relates to staffing.

Photo of Stephen DonnellyStephen Donnelly (Wicklow, Fianna Fail)
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I appreciate we are out of time but my understanding is the matter is almost resolved. We are nearly there on it and it is something of which we are very aware. We want to get it sorted. I will provide the committee with a note on it. The advice I have is we are almost there.

Photo of Cathal CroweCathal Crowe (Clare, Fianna Fail)
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I welcome the Minister, Deputy Donnelly; and the Minister of State, Deputy Butler. I have been following this remotely and I will have to go again shortly because I am due in the Dáil Chamber. It is one of those mornings juggling a few things.

This week marks the first meeting of this health committee since the winding back of restrictions. Many times in this forum we have thanked and paid tribute to our nurses, doctors, vaccinators and front-line staff. We should also pay tribute to the Minister and Ministers of State, as well as departmental officials. In the months to come we will be judged on two elements; how the economy was managed through the Covid-19 pandemic but, far more important, how the health service was managed. Nothing was perfect and I will not whitewash things this morning but a damn good job was done collectively in this country to manage us through those past two really miserable years.

A sum of €1.58 was million allocated for the recruitment of 24 additional lactation consultants. Is there any information on that or has the money been spent? When is it envisaged that all those positions will be filled?

Photo of Stephen DonnellyStephen Donnelly (Wicklow, Fianna Fail)
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I will get an update for the Deputy. The last advice I had on this was that the process was progressing well and, critically, these 24 posts are to provide national cover for the first time. I have visited some of the clinics and met some of the lactation consultants and women using the service. They are certainly saying very positive things about it. I will get the Deputy a detailed note on exactly where we are at.

Photo of Cathal CroweCathal Crowe (Clare, Fianna Fail)
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I thank the Minister. We had representatives of Bainne Beatha before our committee some months ago and they engaged with the Minister as well. It is a really good group for giving advice and a guide to the Department. It should maintain those links and keep contact as the Department continues to fill the positions.

I will revert to the elective hospitals. We saw before Christmas that the Cabinet approved the progression of elective hospitals for Cork, Dublin and Galway. I admit I was devastated to see the mid-west left out. I know this has come from a recommendation system but the Minister visited the mid-west just six days ago, visiting University Hospital Limerick, the one hospital in Ireland that has incessantly the highest numbers of people on trolleys. It is under pressure every day and at a crisis point most weeks. There is a real feeling in the mid-west, both in healthcare staff currently in the hospital system but also in many retired people in the HSE and the hospital system who now have the liberty to speak a little more freely. They have said in the media, including on Clare FM and Limerick radio, that the solution to this must be an elective hospital in the mid-west to ease the burden and the pressures faced by University Hospital Limerick.

I brought up this matter just last week with Mr. Robert Watt and Mr. Paul Reid. The area should still be in the mix. I also believe there is a potential solution because there is a private hospital on the cusp of being developed in the small village of Coonagh, which sits right on the Clare and Limerick border. It is so accessible to the entire region. There will be a private 150-bed hospital built there. I have chatted to the Minister privately about this but I would like the Department to scope a little about getting some public capacity there to bring elective procedures out of University Hospital Limerick to this new facility.

Photo of Stephen DonnellyStephen Donnelly (Wicklow, Fianna Fail)
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The Deputy's first point concerned the elective hospital strategy and, as he said, that is a plan for three very large elective hospitals covering approximately 500 procedures. It takes in Cork, Galway and Dublin. There was a significant change made recently and we got a Government decision on it. The proposal that came to me was that the elective hospitals would take day cases only and there was a very significant challenge to that from Members of the Oireachtas and local clinical communities. They said they wanted inpatient services as well so we changed the approach on that basis.

We will now do it in two phases. We will start with day cases, diagnostics and outpatients. This will be very important. Critically, the design of the hospitals will be for both, including phase 2, which will have inpatient services. If and when we go to inpatient, it will be fully integrated and will not just be an add-on. We are proceeding with them. The Department has received the revised business cases to take account of the inpatient phase as well. We will be sending them to the Department of Public Expenditure and Reform shortly, which will then do its work. We need to move this along very quickly. I know it is of particular interest to many members of the committee. That deals with the first issue.

The second issue is Limerick and that area. The Cork, Galway and Dublin electives are regional electives. They can and are intended to treat patients from the Limerick area as well. However, it is very clear that the University Hospital Limerick, UHL, is being asked to take on too much of the heavy lifting-----

Photo of Cathal CroweCathal Crowe (Clare, Fianna Fail)
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Correct.

Photo of Stephen DonnellyStephen Donnelly (Wicklow, Fianna Fail)
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-----for hospital care for the region. That is very clear to me. I was in the emergency department, as the Deputy will be aware, around midnight. I was back in the emergency department the next morning. The staff are incredible, but too much is being asked of them and far too many patients are not getting access to ward beds when they need them. It is not a sustainable or acceptable situation. It is something that is very dear to the heart of every person working in that hospital. I met the nurses, the non-consultant hospital doctors, the consultants and the management. They are all working night and day to resolve that situation.

I was in Croom, where there is absolutely incredible work being done in orthopaedics. They have the most advanced operating theatres anywhere in Ireland and their throughput is higher now. It was really amazing stuff to see. The Deputy quite rightly raised the issue of whether there can be an elective site for the Limerick area. I believe there can be. The three elective hospitals-----

Photo of Cathal CroweCathal Crowe (Clare, Fianna Fail)
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Could the Minister give the Sláintecare committee, which steered it to this point, new terms of reference and ask it to look at that mid-west problem and whether there is scope, potential or possibility for a new elective hospital in that region? It is going to need a bit of political input. Those on the Sláintecare committee have said that the job is done, they made their recommendations and it has gone to the Cabinet which has agreed it. New terms of reference need to be put to that committee so that it examines the significant problem in the mid-west.

Photo of Stephen DonnellyStephen Donnelly (Wicklow, Fianna Fail)
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That was a group that did a piece of work and has now disbanded. It was brought together to do that single piece of work, which it has done. However, the Department is looking at this. Officials are looking at capacity deficits across the country. For example, there will be a new elective hospital in Cork but that is not enough. There is a significant deficit in beds that needs to be addressed at the same time. The same is true in Galway. The elective hospital in the Galway area will not solve all the problems. In regard to the University Hospital Galway system, more beds are needed anyway. It is the same case in Limerick. These pieces of work are going on at the same time.

I believe that the elective approach is very strong because any doctor, nurse or health and social care professional working in an acute hospital will tell one that, with the best will in the world, the operating lists get knocked all the time with people coming in through the emergency departments. In Limerick, the question of whether we expand Croom hospital was raised with me. It does not only do elective work, but it does a lot of elective work.

Photo of Cathal CroweCathal Crowe (Clare, Fianna Fail)
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It takes the pressure.

Photo of Stephen DonnellyStephen Donnelly (Wicklow, Fianna Fail)
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I know the HSE is engaged on a proposal from UPMC. I know St. John's is interested.

Photo of Cathal CroweCathal Crowe (Clare, Fianna Fail)
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The UPMC is the one I referred to. Will the Minister excuse me because I want to get quickly through other questions?

Photo of Stephen DonnellyStephen Donnelly (Wicklow, Fianna Fail)
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Sorry, go ahead.

Photo of Cathal CroweCathal Crowe (Clare, Fianna Fail)
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When the Minister travelled to UHL last Thursday, which was very much appreciated in the region, he made a journey but the management of UHL also made a journey to the hospital because in the past year or two they upped sticks from the hospital campus. They moved their offices to about 2 km away. They are no longer based in the hospital. Before I was a Deputy, I was a teacher. I have never heard of a school principal based outside a school. I have never heard of a Garda inspector or sergeant based a 1 km away from their station. It is unbelievable for a hospital system, in particular, UHL and its surrounding hospitals, that have been at crisis point so many times in the past two years. It is unthinkable. It is unbelievable.

It is unfathomable that the management personnel would be based in an industrial estate in an office block up the road from the acute services of a hospital. There cannot be proper oversight if management is based remotely, away from the hospital. The Minister will probably say that is an operational matter with which he cannot interfere. He has got to. These are the helms people of UL Hospitals Group. I ask that the Minister and the Department at least write or talk to them to say that the Minister has major concerns because they are not based in the hospital campus and tell them to get back down there again. That oversight is needed.

We have heard stories over the years of when there were ministerial visits. I do not know what happened on the Minister's visit, but I know when the Minister, Deputy Harris, visited years ago, trolleys were brought to the morgue corridor. They were pushed there - out of sight, out of mind. No problems here. We got back to normality again because this place is really well managed. They need to be on site. I ask that the Minister intervene in this.

I have one final issue that perhaps the Minister would wrap up with in his response. During Covid, some services were stripped back from local health centres such as those in Broadford and Kilrush, County Clare. Dental services are no longer provided. They must be reinstated. I hope the Minister will wrap up some of these issues in the time we have left.

Photo of Stephen DonnellyStephen Donnelly (Wicklow, Fianna Fail)
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If there are specific areas and services the Deputy would like me to look into within the region, be it dental services in a particular primary care centre or, indeed, anything else, he should let me know and we will engage with the HSE on it.

With regards to where the management are working, I am not familiar with exactly who is working where and why. Maybe they have plans to come back. Maybe it was a response to the extraordinary pressures of Covid, but certainly it is something we can look into.

Photo of Cathal CroweCathal Crowe (Clare, Fianna Fail)
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All I ask is that a phone call be made expressing outright concern, the concern we, the elected representatives of the region, have. The staff in the hospital and people who live in the region have significant concerns about this. All I ask is that the Minister takes a strong position and relays that to them in the coming days. They need to be back on the hospital campus. That is all I ask. It is a simple manoeuvre. There are desks and office suites in the top floor of the hospital. They can easily come back there. Only then will they have proper oversight of what is really happening in the bowels of the hospital.

Photo of Bernard DurkanBernard Durkan (Kildare North, Fine Gael)
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My first question is if we can we deliver this. That will be the most telling point in the next 12 months. Can we deliver to restore public confidence in the hospital system, to ensure the public have confidence in that system to the extent that they will support it? The question remains, can we deliver. I know the Minister has stated that he hopes to deliver and hopes to exceed our delivery. Can we deliver?

Photo of Stephen DonnellyStephen Donnelly (Wicklow, Fianna Fail)
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It is one of the most important questions. We have plenty of plans. We have programmes for Government. We have clinical strategies. We have a load of these things but they do not mean anything unless we can actually deliver for patients.

I believe we can deliver and are delivering. The committee has acknowledged, for which I thank it, the work the health service and the Department have done in terms of the response to Covid. It has been broadly welcomed and appreciated. We know the health service can not only deliver on Covid but deliver to one of the highest standards anywhere in the world. What we have seen and acknowledged is an extraordinary operational response to Covid. Where else do we need to deliver? We need to deliver on the affordability measures, including for six-year-olds and seven-year-olds, drugs payment schemes and so forth. All those areas are being and will be delivered this on year. Healthcare will be more affordable throughout the year. Free contraception for 17- to 25-year-olds will be delivered on.

We then come to the clinical strategies. It is my view that we have not been delivering at the level we should have been delivering for some years on the clinical strategies. Partly, that comes down to funding. Last year, I allocated full funding to the strategies. The national cancer strategy, which got €20 million, the ambulance strategy, the maternity strategy, and the trauma strategy were fully funded and they have been fully funded again this year. They have the money. The clinical leads are dedicated. There are some very important measures that are going on below the radar. I will give an example from the national cancer strategy. I was in the Mater Hospital. They have hired a psycho-oncology team. They have increased the workforce. Up until last year, patients actively being treated for cancer who got really sick, which happens regularly, had to come in through the emergency department. Sometimes they had to sit on a chair for hours in an emergency department in a pandemic, while completely immunosuppressed, and wait for care. Now, patients phone the Mater to say they are coming in.

They are then taken then into the cancer ward and cancer units and are treated there.

There are some amazing things happening in the national maternity strategy. I visited Our Lady of Lourdes Hospital Drogheda where they showed what we might call the traditional birthing suites there and, then, the new ones. One would be so proud of what the health service, the midwives, and the obstetricians are doing in modern patient-led care where, if a woman wants midwifery-led care, she gets it.

On the clinical strategies there are some very important things happening. I am launching the waiting list plan tomorrow. It is very ambitious and must deliver. In the final three months of last year, we launched the initial phase of the waiting list plan and it worked well. Over those three months the total numbers waiting fell by nearly 5.5%. That was due, in part, to tens of thousands of adults and a smaller number of children being treated as part of that.

On permanent capacity, it is a mixed bag. We have all talked about, and Deputy Cullinane alluded to the fact that 14,000 staff were funded for last year and a little over 6,000 were hired. Some 10,000 staff are funded for this year and the HSE is saying that perhaps 5,500 will be hired. We can look at that in two ways. One is that we are significantly below our ambition, which is true. It is also the case, however, that the two years with the highest number of additions to the health workforce since the foundation of the HSE were last year and the year before.

Photo of Mary ButlerMary Butler (Waterford, Fianna Fail)
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I will come in on home care because I know that the committee has examined this over the past number of weeks. Last year, the HSE provided 20.46 million hours of home support. Some 7.5 million hours were provided directly by the HSE and 12.9 million hours were provided by private providers, as we have seen increased demand for home care. Some 55,000 people receive home care. We are currently challenged because the budget of €666 million is sufficient to deliver home care but the problem is that currently approximately 5,300 people are waiting for home care because we do not have the staff to deliver it. We have approximately 2,000 more people this year looking for home care than needed it last year.

Photo of Bernard DurkanBernard Durkan (Kildare North, Fine Gael)
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How does the Minister of State propose to get the staff?

Photo of Mary ButlerMary Butler (Waterford, Fianna Fail)
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We have put a strategic workforce planning group in place. There was some criticism that it took a while to get this group up and running. This is not going to be just a talking shop. We are looking at everything in respect of recruitment retention, how attractive it is to go into home care as a profession, and, for example, how we cannot drop any standards. People have to have a level 5 qualification, to be Garda-vetted-----

Photo of Bernard DurkanBernard Durkan (Kildare North, Fine Gael)
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How quickly can we fill the posts with the particular types of people nowadays who can fill those positions?

Photo of Mary ButlerMary Butler (Waterford, Fianna Fail)
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People must take eight modules to do a level 5 qualification, but if someone has started it, a person can be accepted very quickly into home care, even if he or she has not completed the course.

The strategic workforce planning group is meeting next week for the first time. I have engaged with both the HSE and the private sector. Over the past two weeks I have met the area lead for older people across the eight of the nine CHOs - I have one more to do - to talk to them about the specifics on the ground. We are challenged at the weekends and in rural areas. Every Deputy hears about this in his or her constituency office. Currently, we have to prioritise the most vulnerable, so that people at end-of-life and with chronic medical needs have to be prioritised first.

As I said, 2.9 million more hours were delivered last year so more people are being referred to us. We are trying to think outside the box and to do everything we can to encourage more people to consider home care as a career.

Photo of Bernard DurkanBernard Durkan (Kildare North, Fine Gael)
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Some 2.9 million extra hours have been created. How many hours in total have then been created?

Photo of Mary ButlerMary Butler (Waterford, Fianna Fail)
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Last year, 20.5 million hours were delivered and I have the funding to do more. Those 5,300 people who are waiting at the moment for home care are not waiting because of a funding issue but because of a service delivery issue. The private capacity is even nearly maxed out at the moment. Currently we have rolling recruitment campaigns across all of the HSE and the CHOs. In CHO 5, we will have five rolling recruitment campaigns. This is ongoing down in counties Cork and Kerry and all over the country but we are also trying to build capacity.

Photo of Bernard DurkanBernard Durkan (Kildare North, Fine Gael)
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This committee and the health service received much criticism on a number of issues in general throughout the country, and in counties Kerry and Donegal in particular, in respect of children with special needs and accommodation. Complaints against the system were not followed up on in what people viewed was an appropriate manner. We discussed this yesterday in the committee with the Minister of State’s colleague. I accept that great work is being done but I cannot accept that if an issue is raised, it is not dealt with immediately where the public is concerned about their families, vulnerable people and vulnerable people under constant attack. Have we the capacity and the willingness in place to deal instantly with these issues at the coalface where they should be dealt with? That is what the public is looking for.

Photo of Mary ButlerMary Butler (Waterford, Fianna Fail)
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Currently, the funding is there to provide 24 million home care hours. We do not have the staffing capacity currently to do that. That is why we have put this strategic workforce planning group in place.

On the other issue raised by the Deputy, I presume he is referring to when the Minister of State, Deputy Rabbitte, was before the committee during the week. When dealing with people who have mental health illness, difficulties or challenges, there can sometimes be issues around consent. Sometimes, if the person does not give his or her consent, an answer from the HSE cannot be explored in respect of the care that person may or may not be receiving.

Photo of Bernard DurkanBernard Durkan (Kildare North, Fine Gael)
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I am watching my speaking time allocation which is now coming to an end. The only problem there is that we do not seem to gain any headway on a couple of issues.

First, there are the CHOs in the various areas, including in my area, where people were being referred to prison because there is no space for them. These were people with special needs, an addiction, or an addiction plus something else. There was no space available for them and there is still no space available for them. People are being referred to prisons as a means of accommodating them because they present a danger to themselves or to somebody else. In such circumstances we need to advance developments in those areas in such a way as to ensure that we do not have a situation whereby somebody has to go to prison.

How advanced is the Minister on in the capital programme for the year? Is it being dealt with adequately or will we be dealing with it as a postponed year?

Finally, there was a reference to administration costs, which increased by the precise amounts by which grants have been reduced. I am a very simple country boy and the Chairman is as aware of this as much as I am. My simplicity amazes even myself, sometimes. The amount for administration increased by the precise amount of the grants that were ceasing. I will accept written replies, or whatever, but I need a reply on this issue, please.

Photo of Mary ButlerMary Butler (Waterford, Fianna Fail)
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I thank the Deputy.

Photo of Seán CroweSeán Crowe (Dublin South West, Sinn Fein)
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Is that okay with the Minister of State? Yes, she will furnish a written reply to the Deputy. I call Deputy Cullinane.

Photo of David CullinaneDavid Cullinane (Waterford, Sinn Fein)
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I thank the Chairman. I want to make one broad point first and I then have a number of specific questions on targets that were set. Equally, specific issues are referred to in the Minister’s own briefing document.

As I said earlier, it is very important to set ambitious targets. I would hope, if I was in the same position as the Minister for Health, that I would want to push the system to its limits and would want to get as much done as quickly as I could. That would involve recruiting as many staff, opening as many beds and getting as much capital funding and capacity into the system as possible. Obviously there will always be situations where targets simply may not been met for whatever reason. There is a big difference between setting ambitious targets and setting targets that the Minister may know simply cannot be met. People see that then as a wish list and it undermines confidence. That is why there is commentary on some of the staffing commitments that were given on bed numbers, for example, and on acute inpatient beds going back to 2021, when a target of 1,146 beds announced. I do not believe that we are even going to reach that target by the end of this year. That creates problems for people across the board.

We have touched on where we have people who cannot get access to home helps because the staff are not there. That is the reality. The funding has been made available but the staffing is not there to provide a great deal of the services. We see this in respect of children with special needs who cannot get access to speech and language therapy, occupational therapy, physiotherapy or child psychology, because, again, the posts are not there.

There must be a joined-up approach. The targets being set must actually be deliverable and matched with workforce planning. Otherwise, they are fake targets and wish lists, which undermines confidence. I hope that, in whatever plan comes tomorrow, the targets are actually real and that we are not again setting targets we know in our hearts will not be met. People now expect we will meet the targets we set as opposed to the targets we set not being met, which we have seen so often with health targets.

I will turn to one specific issue the Minister mentioned earlier, the issue of paediatric orthopaedics and the total funding package he recently announced. What was the total figure?

Photo of Stephen DonnellyStephen Donnelly (Wicklow, Fianna Fail)
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It was a little more than €19 million. My sense is this will increase through the year. That is the initial amount but there are-----

Photo of David CullinaneDavid Cullinane (Waterford, Sinn Fein)
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How much of that is additional funding that was not budgeted for?

Photo of Stephen DonnellyStephen Donnelly (Wicklow, Fianna Fail)
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It is all budgeted for either within increases in core funding to Children's Health Ireland, CHI, or through the waiting list fund.

Photo of David CullinaneDavid Cullinane (Waterford, Sinn Fein)
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At the end of last year, I attended CHI and was given a presentation by the CEO. At that point, funding had been provided for a theatre expansion and scoliosis supports of €5.35 million. There were also to be an additional 24 beds for CHI, including eight beds that opened in Temple Street in January, a new MRI scanner, €1.9 million in funding for Cappagh Kids and more. Is all of that part of that €19 million?

Photo of Stephen DonnellyStephen Donnelly (Wicklow, Fianna Fail)
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I would need to see the list but some of it is.

Photo of David CullinaneDavid Cullinane (Waterford, Sinn Fein)
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The question then is what is additional. It was announced that additional funding was being made available to enhance capacity. I understand some of it is to increase surgical theatre capacity to get more from the theatres we have. Very ambitious targets have been set, including reducing the number of scoliosis patients waiting for treatment from 94 to zero and the number waiting overall from 224 to 128 and treating an additional 107 children with spina bifida. I believe these are the targets the Minister set out in his plan. The question is, how much of that €19 million is funding that was not previously committed and that arose on the back of the Minister's visit and what have CHI and the National Orthopaedic Hospital Cappagh asked for in light of recent events where children unfortunately had to go to the media and go on national television to plead for the system to provide more resources? I am trying to figure out how much of that €19 million is additional funding.

Photo of Stephen DonnellyStephen Donnelly (Wicklow, Fianna Fail)
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I will get the Deputy a detailed note but, from memory, approximately €3.4 million relates to a new ask from Cappagh hospital. He will have heard and will be aware of some of the representations made in that regard. Some of it is funded through increases in the budget. That is important because it is recurring funding. This relates to, for example, MRI beds and so forth. Some of it is additional one-off funding, although I know CHI will look for some of that one-off funding to become recurring funding. With regard to the total package, the additional funding for this year in comparison with last year, which is a mixture of access to care funding, core funding and capital expenditure funding, is approximately €19 million.

Photo of David CullinaneDavid Cullinane (Waterford, Sinn Fein)
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The Minister will appreciate the point I am making. I know it happens all of the time but, when an announcement is made, all sorts of funding that was already in place, including some that has already been spent and some that is already in train, is packaged into the new package of measures. People see €19 million in new funding coming for new measures when, in fact, the vast majority of this was already committed. CHI was already planning how to spend this funding. The Minister is now saying that €3.4 million in additional funding has been allocated to Cappagh hospital. I am looking for a breakdown of what that will do. Is it separate from anything that was already committed because, again, I was told €1.9 million had been approved for Cappagh Kids? Is that €3.4 million separate from the €1.9 million?

Photo of Stephen DonnellyStephen Donnelly (Wicklow, Fianna Fail)
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I will get the Deputy a full breakdown as to what exactly is core funding, what is one-off funding and what may have already been committed.

Photo of David CullinaneDavid Cullinane (Waterford, Sinn Fein)
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Some of that €19 million is one-off funding.

Photo of Stephen DonnellyStephen Donnelly (Wicklow, Fianna Fail)
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Yes. For example, the €3.4 million for Cappagh hospital is being provided through the access to care fund. This fund is, by its nature, single year funding. However, Cappagh hospital has made the point that, from its perspective, that €3.4 million needs to become recurring funding so that it can continue this work. I am certainly very positively disposed to that view. However, what I have to do is to allocate the money I have this year. As the Deputy says, it is funding for Cappagh hospital, operating theatres, beds and so forth.

Photo of David CullinaneDavid Cullinane (Waterford, Sinn Fein)
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The Minister might send me a detailed note. Obviously, that funding needs to be made permanent and part of the baseline because there is no point putting in an injection of short-term funding. While that would, of course, help in the short term and while we need to get treatment for as many children with scoliosis or spina bifida as possible, we cannot simply provide funding for one year and then find ourselves back at square one next year or in two or three years' time. The money needs to be baselined.

When are we going to see the issue of the dental treatment service scheme resolved? When will talks conclude? I received a response to a parliamentary question. As the Minister will know, I have been tracking this issue for some time. Officially, more than one third of dentists have now left the scheme. There are many more who are registered with the scheme but who are simply not operating it. The Irish Dental Association says there may be as few as 600 dentists now operating the scheme. Medical card patients, including both children and adults, are not getting services because of the crisis in the system. The official figures say there are 1,100 dentists on the scheme. When are we going to see a new arrangement and a new contract put in place?

Photo of Stephen DonnellyStephen Donnelly (Wicklow, Fianna Fail)
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There are two different things with two different timelines involved. We have allocated €10 million as a recognition that, as the Deputy rightly says, several hundred dentists have left the scheme since the start of the Covid pandemic. It is my view this €10 million is to increase some of the fees, which is necessary to attract dentists into the scheme, and to add in things like scale and polish services. There is an ongoing conversation between the Department and the Irish Dental Association. They have had two meetings and they are having another in approximately two weeks' time. At the same time, we need a root-and-branch reform of the dental scheme more generally. Talks need to start on that this year. My view, and I believe the Deputy shares the same concern, is that the area of dentistry and oral health is one of the sharpest ends of the issue of affordability of healthcare and people not getting the care they need because of the costs.

Photo of David CullinaneDavid Cullinane (Waterford, Sinn Fein)
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I agree with that but I have two other questions I want to ask and I know that others may want to come back in again. This is a very important issue because dentists are leaving the scheme. Regardless of their motivations or of the rights and wrongs of the matter, they are voting with their feet and are leaving the scheme in big numbers. The consequence of this is people are not getting treatment. I have been given information on the waiting times for children's orthodontic treatment. It is horrific. Some of them are waiting more than four years. We have a dire shortage of orthodontists throughout the country. In Deputy Butler's constituency, which is also mine, and right across the south east, there are real pressures with regard to orthodontic waiting times. We need a new plan, a new strategy and a new contract.

Photo of Stephen DonnellyStephen Donnelly (Wicklow, Fianna Fail)
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If I may add to that very quickly, not only are children waiting too long but parents are faced with bills of €2,000, €4,000, €6,000 or €10,000 for that orthodontic treatment. It is simply not a sustainable position.

Photo of David CullinaneDavid Cullinane (Waterford, Sinn Fein)
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Okay, but Deputy Donnelly is the Minister. We have had a session on this. I believe it was the middle of last year when we put a focus on the dental treatment service scheme. The Irish Dental Association and the HSE lead came before us. At that point, we were told this was a priority, but I have not seen any movement. What I am seeing is more dentists leaving the scheme. It is great the Minister agrees with me, the Irish Dental Association and the patients waiting for treatment, but with respect, what we want to see is a resolution of the issue.

Photo of Stephen DonnellyStephen Donnelly (Wicklow, Fianna Fail)
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Just to be clear, I am doing more than agreeing. I have allocated an extra €10 million this year. It is a sizeable increase.

Photo of David CullinaneDavid Cullinane (Waterford, Sinn Fein)
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This is not about that funding pot. That is a separate funding pot for a separate issue. This is about the dental treatment service scheme, DTSS, contract. Dentists are leaving and children cannot get access to services.

Photo of Stephen DonnellyStephen Donnelly (Wicklow, Fianna Fail)
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That €10 million is for the DTSS contract.

Photo of David CullinaneDavid Cullinane (Waterford, Sinn Fein)
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I know, but dentists are not in the scheme. That is the point.

Photo of Stephen DonnellyStephen Donnelly (Wicklow, Fianna Fail)
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That is the problem, yes.

Photo of David CullinaneDavid Cullinane (Waterford, Sinn Fein)
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I will address two more quick issues before finishing up, if I may. I spoke earlier about children waiting for access to speech and language therapy and occupational therapy. I am talking about children with special needs and disabilities. If we go back to the Disability Act 2005, there are two issues. There is the assessment of need on the one hand and the provision of services on the other. I have done a bit of work on this area. I got the full breakdown of how long children are waiting for access to services.

We all accept it is horrific. We do not have enough therapists. This again goes back to workforce planning. Section 13 of the Act states there should be a report that specifies the aggregate needs in all of the assessment reports. It states that report should specify the number of persons for whom services were identified in assessment reports but where they have not received services. It states such a report would be submitted to the Minister six months after the end of each year. It would have the aggregate needs identified in the assessment reports. The logic of it is that it would enable the Minister to plan. How many such reports have been submitted since 2005 when the Bill was enacted?

Photo of Stephen DonnellyStephen Donnelly (Wicklow, Fianna Fail)
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I will have to take a look.

Photo of David CullinaneDavid Cullinane (Waterford, Sinn Fein)
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I think the answer is zero.

Photo of Stephen DonnellyStephen Donnelly (Wicklow, Fianna Fail)
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I will get back to the Deputy with a note.

Photo of David CullinaneDavid Cullinane (Waterford, Sinn Fein)
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This is one of the problems here. We have an Act which all of us signed and approved. It clearly sets out that a child is entitled to an assessment of need. Many children are not getting an assessment of need, as we know. AsIAm and other disability groups have published information on this. They have gone out to their members and done audits. A total of 79% of children who have an assessment of need do not have access to services. The point of the reporting, which is legally provided for in the Act, is that it enables the Minister to plan but I cannot get access to any of the reports. Will the Minister come back to the committee on why this is happening? Am I right that the number of reports is zero? If there are such reports, can we be furnished with them? This goes right to the heart of the disjointed element I am speaking about. It makes perfect sense. I am sure it will make perfect sense to the Minister. We have all of these assessments of need. We have children who have been assessed as needing services but cannot get access to them. The logic of the report is to have an aggregate view of what the need is so we can start planning and recruiting. That is not happening.

Photo of Stephen DonnellyStephen Donnelly (Wicklow, Fianna Fail)
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I know we are out of time but could I ask the committee's permission-----

Photo of Seán CroweSeán Crowe (Dublin South West, Sinn Fein)
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We are flexible enough if the Minister wants to expand.

Photo of Stephen DonnellyStephen Donnelly (Wicklow, Fianna Fail)
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I thank the Chair.

Photo of Seán CroweSeán Crowe (Dublin South West, Sinn Fein)
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Deputy Durkan has indicated-----

Photo of David CullinaneDavid Cullinane (Waterford, Sinn Fein)
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I have one more question.

Photo of Seán CroweSeán Crowe (Dublin South West, Sinn Fein)
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I have a couple of questions also.

Photo of David CullinaneDavid Cullinane (Waterford, Sinn Fein)
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I have one more question that I hope the Minister can respond to.

Photo of Seán CroweSeán Crowe (Dublin South West, Sinn Fein)
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That is grand.

Photo of Stephen DonnellyStephen Donnelly (Wicklow, Fianna Fail)
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It is a concern I and the Ministers of State, Deputies Butler, Feighan and Rabbitte, share. What happened was that towards the end of 2020 we allocated almost €8 million specifically for assessments of need. To her credit, the Minister of State, Deputy Rabbitte, took it on and drove around the country making sure the money was spent on assessments of need. A huge amount of work was done. The figures are that in June 2020 there were 6,558 overdue assessments of need. By the end of December, believe it or not, the backlog had been reduced from 6,500 to 330.

Photo of David CullinaneDavid Cullinane (Waterford, Sinn Fein)
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I want to come back very quickly on this.

Photo of Stephen DonnellyStephen Donnelly (Wicklow, Fianna Fail)
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Can I just answer-----

Photo of David CullinaneDavid Cullinane (Waterford, Sinn Fein)
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It is an important point I want to make.

Photo of Stephen DonnellyStephen Donnelly (Wicklow, Fianna Fail)
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Absolutely, but if I could just respond. There was a reduction of 95% in the backlog. This has to be acknowledged as very positive. However, the next point the Deputy quite rightly raised was that before the backlog was cleared, too many children were waiting too long for services. Now, more than 6,000 children have moved from assessment of need to waiting on services. What the Minister of State, Deputy Rabbitte, has been doing with the HSE is rolling out a new network of health and social care professionals teams. Many of them were hired last year. A lot more recruitment is required. I fully share the concern and urgency regarding the point the Deputy has raised. We have made huge inroads on assessment of need but that only matters if the services are there for the children afterwards.

Photo of David CullinaneDavid Cullinane (Waterford, Sinn Fein)
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Very quickly, if I can come back on that. I have spoken to many parents in recent weeks. I have spoken to legal people taking court cases on the very assessments the Minister is speaking about. I have spoken to advocacy groups which are also raising concerns about the figure of 6,000 and what has happened. As the Minister knows, the Act provides for assessments of need. The Act clearly states the assessment of need should determine whether a child has a disability, the extent and nature of the disability and the services the child needs. What actually happened was the HSE created a new assessment of needs process through the standard operating procedure. Most children get a 20-minute screening. It is not even an assessment. Quite rightly, it is referred to by parents and advocacy groups as a screening. I have been in GP surgeries for as long as 20 minutes. How in God's name is someone meant to determine the nature and extent of the disability of a child in 20 minutes?

I will set out what happens so the Minister is aware of it. Children with autism apply for an assessment of needs, which we know should be provided within six months. The children get this screening as opposed to an assessment. If it is determined they may have a disability or may need more of an assessment, they go on a separate waiting list. We are creating waiting lists within waiting lists. While 6,000 people have had this assessment of need under the standard operating procedure, which in essence many would describe as screening, many of them are not getting their service statement which states the services they need. This is simply because 20 minutes will not cut it.

There are fundamental problems with the assessment of need. What is crucial is the provision of services. The Minister might be aware, although perhaps he is not, that there is a case in the Court of Appeal on the standard operating procedure. It is challenging precisely what I have just said about the nature of the assessment being done. Does the Minister accept a child with autism or special needs having a 20-minute screening? Does he accept it would be almost impossible to determine the level of services and the nature and extent of a disability a child has in a 20-minute screening? Does he accept as a layperson that this simply would not be appropriate?

Photo of Stephen DonnellyStephen Donnelly (Wicklow, Fianna Fail)
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I thank the Deputy. There has been a lot of debate within the service around the assessment of need. The position two years ago was that every child, or the majority of children, went through a significant assessment of many hours. One of the results of this was that we had more than 6,500 children waiting for an assessment. The clinical advice we got was that many of those children did not need the entire assessment, while some did. The expert view, and it is an approach used in Northern Ireland, for example, is there is an initial assessment where experienced professionals assess whether a child quite clearly needs one service, be it occupational health, speech and language or physiotherapy. There are other children who need much more rigorous assessment. It is a triage process. For those who are deemed to have more complex needs and need a multidisciplinary assessment, one is provided. This is the change that was made. Not everyone agrees with this. Not all of the healthcare professionals-----

Photo of David CullinaneDavid Cullinane (Waterford, Sinn Fein)
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The problem is the six-month statutory wait time does not apply to the more in-depth assessment. This is the problem. Quite rightly, many parents state we have a situation whereby we have set out in statute that the assessment has to identify whether the child has a disability, the extent and nature of the disability and the services the child would need because of the disability. The Minister can read the Act himself. From memory, I am very clear about what it says. What is laid out does not happen and cannot happen in the initial screening and assessment. The six-month clock ticks for this screening, which the Minister says is a screening, after which some may need an assessment and others may not.

Photo of Stephen DonnellyStephen Donnelly (Wicklow, Fianna Fail)
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No, to be clear-----

Photo of David CullinaneDavid Cullinane (Waterford, Sinn Fein)
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The point is the six months only kicks in for the standard operating procedure. If children need to go on for a more in-depth assessment of need, the six-month period does not apply, or at least the HSE is not applying it. This is one of the problems here. Parents are now waiting. The initial screening or assessment of need for children with autism is 20 minutes. They are in and out and told they need to go on another list and they are waiting again. Surely the Minister understands how problematic and difficult this is.

Photo of Stephen DonnellyStephen Donnelly (Wicklow, Fianna Fail)
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To be clear the initial assessment is an assessment. Children are assessed. Coming out of that, they are directed to services.

However, those with more complex needs who require a more detailed assessment are referred for that. I am very open to taking a look at the gap between the initial assessment and those children who need a more rigorous assessment.

Photo of David CullinaneDavid Cullinane (Waterford, Sinn Fein)
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And he number of children who go for an initial assessment and who are referred for a more fulsome assessment.

Photo of Stephen DonnellyStephen Donnelly (Wicklow, Fianna Fail)
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Yes.

Photo of David CullinaneDavid Cullinane (Waterford, Sinn Fein)
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We cannot get those numbers.

Photo of Stephen DonnellyStephen Donnelly (Wicklow, Fianna Fail)
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I am very open to looking at that.

Photo of David CullinaneDavid Cullinane (Waterford, Sinn Fein)
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I thank the Minister for that.

Photo of Seán CroweSeán Crowe (Dublin South West, Sinn Fein)
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I have a few questions. The proposed allocation of funds to projects under the national children's hospital come under subhead M2 What is the proposed allocation? When members of the board of the hospital appeared before the committee we asked them what the final cost of the hospital will be but we did not get any satisfactory answers. Does the Minister have a sense of what the final cost of it will be at this stage?

Photo of Stephen DonnellyStephen Donnelly (Wicklow, Fianna Fail)
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The officials will provide me with information on the capital budget allocation for the national children's hospital for this year. With regard to the total final price, as the Chairman will be aware, there is an ongoing relationship between the board and the contractor. The contractor has submitted more than 1,000 substantiated claims. The reported value of those is in excess of €500 million. Obviously, that is not indicative of the outcomes and the board has very successfully fought those to date. The approved capital budget for the project is €1.433 billion and €924 million of that has been drawn down to date. With regard to the final cost to the State, there is a variability because of the uncertainty around the claims. Certainly from the State’s perspective, it is very reluctant to give final estimated figures because, as we would all appreciate, they would then just become targets for the contractor. As to whether the final cost will be in excess of €1.4 billion, we have all known for some time that this is true but as to the exact amount, it will depend in part on the outcomes of the awards for the judgments made on the various claims.

Photo of Seán CroweSeán Crowe (Dublin South West, Sinn Fein)
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Under another subhead, there has been a slight increase in the allocation for legal fees and settlements in 2022. Is there any significance in that?

Photo of Stephen DonnellyStephen Donnelly (Wicklow, Fianna Fail)
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Is the Chairman pointing specifically to legal fees with regard to the hospital?

Photo of Seán CroweSeán Crowe (Dublin South West, Sinn Fein)
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Legal fees and settlements is what is stated in the Revised Estimates.

Photo of Stephen DonnellyStephen Donnelly (Wicklow, Fianna Fail)
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With regard to the hospital?

Photo of Seán CroweSeán Crowe (Dublin South West, Sinn Fein)
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Not specifically that hospital but across the board.

Photo of Stephen DonnellyStephen Donnelly (Wicklow, Fianna Fail)
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Therefore, that would be the State Claims Agency or legal fees. I will get the Chairman a note on that.

Photo of Seán CroweSeán Crowe (Dublin South West, Sinn Fein)
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There has been increase in the spend on ICT under subhead A5. There was an increase in expenditure on cybersecurity in 2022. The difficulties with respect to ICT following the cyberattack were raised by many groups that appeared before the committee. Has the Minister a sense of what that expenditure involves?

Photo of Stephen DonnellyStephen Donnelly (Wicklow, Fianna Fail)
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I will get the Chairman a detailed note on that. Subhead A5 covers Department of Health ICT. I will revert to him with a detailed note on exactly to what that additional funding is being allocated.

Photo of Seán CroweSeán Crowe (Dublin South West, Sinn Fein)
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When some groups involved in the drugs task forces appeared before the committee they spoke of the challenges facing many community due to crack cocaine crisis.

Photo of Stephen DonnellyStephen Donnelly (Wicklow, Fianna Fail)
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Can the Chairman repeat that?

Photo of Seán CroweSeán Crowe (Dublin South West, Sinn Fein)
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I am referring to the crack cocaine and drug crisis. The figures show a reduction in the allocation for the drugs initiative under subhead B3. Can the Minister provide more information on funding allocated for the national drugs strategy? Many of the groups that appeared before the committee said the crack cocaine epidemic is impacting on many communities and those communities have described it as a throwback to the heroin epidemic that ravaged many inner city areas of Dublin. However, the preponderance and availability of not only cannabis but other drugs throughout the country are causing difficulties. Many of drugs task forces are seeking additional resources to tackle emerging needs. The figures suggest there has been a decrease rather than an increase in that respect. Could the Minister provide us will more information on that? He need not provide it today but it would be useful to have those figures.

In his opening statement, he referred to the continued implementation of organ donation and transplant services. We know through contact with the relevant groups that the waiting lists are getting longer. People are hoping and praying that their loved one will get access to an organ transplant but we know people on those waiting lists are dying. The Minister referenced continued implementation of the services but has he any new plans? He referred to addressing this issue. What message can he send to those families who have loved ones on those waiting lists? Will things be done differently? Will more transplant surgeries be done this year and in future years? A big change will be the increase in access to organ donors with respect to indication on one's driver licence and so on. Has the Minister any new plans in that regard? There is a cost implication but it is about having a strategy to ensure more donor organs are available for people who need them.

Photo of Stephen DonnellyStephen Donnelly (Wicklow, Fianna Fail)
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I thank the Chairman for the various questions he raised. Funding for the drug task forces under the national drugs strategy has increased by €1 million. I appreciate there is an accounting issue with what appears to be a €10 million reduction, which it to do with different subheads, but the total funding has increased. I share the Deputy’s concern. Deputy McAuliffe and myself met community workers about the crack cocaine problem some time ago. The Chairman referenced the heroin epidemic. They point they made to us was that they had been the community workers during the heroin epidemic and that the crack cocaine epidemic blew it out of the water. They had never seen anything like the desperation, the level of addiction, the violence, the organised crime, the intimidation and moneylending associated with it. I am aware of it in my constituency in Wicklow. When I meet various community groups they report a level of violence and intimidation they have never seen before. Some of the accounts of intimidation and violence being visited upon the families of people in addiction are like nothing we have ever seen previously and, therefore, we need to need to do more. Additional funding has been allocated. I know the Minister of State, Deputy Feighan, would be very happy, as would I, to engage further with the committee on that. Part of it a health response and part of it is a justice response but an awful lot needs to be done.

Organ donation and transplant services are part of one of the fully funded strategies for this year. Critically, I will introduce the human tissue Bill soon. There is more that we can do. People are waiting for organ transplants for longer than they should. The Bill will help, as will the opt-out process. I think it is one that is broadly supported politically. It is on the agenda to introduce this year. I know it is something the committee will also seek to process.

Photo of Seán CroweSeán Crowe (Dublin South West, Sinn Fein)
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The Minister praised the work of staff during the Covid-19 pandemic and he also said they were exhausted. We have heard from the Irish Nurses and Midwives Organisations and other groups that staff are exhausted. We have heard the incidence of assault on hospital staff has increased and the importance of ensuring hospitals are safe zones. The hospital footprint should be a safe zone not only for staff but for patients.

As part of these Estimates, what signal can the Minister send to staff regarding additional resources, in particular those suffering with long Covid but also those who have been assaulted? Will there be additional staff or security? Will there be additional supports for staff who are out sick in the long term? How is the issue of exhausted staff addressed, in particular at a time when trolley counts are rising once again?

Photo of Stephen DonnellyStephen Donnelly (Wicklow, Fianna Fail)
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It is difficult to overstate the level of exhaustion many of the staff have at the moment. Healthcare is a busy place at the best of times. There is a level of exhaustion now in the staff I am meeting that is beyond normal tiredness or normal busyness. It has been relentless for two years for the staff. Not only have they had to work under intense pressure, not only have they had to walk in every day to high-risk environments where many of them have got sick or got Covid-19, they have had to deal with huge trauma that has come with Covid-19. I was very taken by some intensive care nurses I met - hardened, seasoned professionals with decades of experience in intensive care. They had seen every human situation, hardship and suffering in terms of patients in intensive care, and they told me they were traumatised by Covid-19 like nothing they have ever had to deal with. They said it was a combination of how vicious Covid-19 is in attacking multiple organs at the same time but also that patients were lying in intensive care completely isolated from their families and friends, being cared for by people wearing a lot of PPE.

There is a level of trauma and exhaustion in healthcare that has to be dealt with. Obviously if such things as security are required locally, it goes without saying they will be funded. Long Covid is being taken very seriously and is being looked at. What nurses, doctors and health and social care professionals say to me when I ask them what the single most important thing is we can do for them to make their job sustainable and one they love coming to work to do, they say to me to increase the workforce. We have to hit safe staffing levels. That is fully backed and supported by the INMO and by the Oireachtas. The results from the pilot projects that were presented at the INMO conference in Cork a few years ago are beyond question in terms of the well-being of the nurses and midwives themselves. We have talked about the non-consultant hospital doctors, NCHDs. Much more is required than increasing the number of NCHDs. A root-and-branch piece of work is required. We need more consultants. We need more doctors, nurses, health and social care professionals, and we need to acknowledge what they have been through.

Photo of Mary ButlerMary Butler (Waterford, Fianna Fail)
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All HSE staff have free access through SilverCloud to self-directed online supports for mental health. Staff counselling is also available. During Covid-19 this was made available also to staff working in private facilities. This year I funded €1 million to MyMind, an organisation that provides online supports for people throughout Ireland in 15 different languages. We have to recognise that not everybody speaks only Irish and English. There are many supports, if that is the type of support they are looking for.

Photo of Seán CroweSeán Crowe (Dublin South West, Sinn Fein)
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I believe people are talking about practical support.

Photo of David CullinaneDavid Cullinane (Waterford, Sinn Fein)
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I have one quick question. I received a parliamentary question response last week in regard to the number of people over 75 waiting for various types of healthcare. In January, we had just under 1,100 people over 75 waiting more than 24 hours on a hospital trolley or waiting for access to an emergency department. That is a lot of people over 75 in one month across acute hospitals waiting over 24 hours. It is horrific. There are also 86,000 people over 75 waiting for an inpatient or an outpatient hospital appointment. Of those, 28,000 are waiting more than a year. These are patients over 75. When the Minister publishes his waiting list plan tomorrow, it must not give false hope, it needs to have realistic targets and it cannot have what some have described as fake targets. They certainly have to be targets that are ambitious but realistic. It must also be targeted. In regard to that waiting list plan, are those 86,000 people over 75 going to be a priority? I believe the vast majority of people would say no patient should be waiting more than a year to see a hospital consultant. No patient should be waiting on a hospital trolley more than 24 hours. To have such numbers of people over the age of 75 for whom that is the lived reality is unacceptable.

Photo of Stephen DonnellyStephen Donnelly (Wicklow, Fianna Fail)
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Completely unacceptable on both counts. It is unacceptable that anyone would be waiting more than 24 hours on a trolley for admission to a hospital. It is even more unacceptable that people over 75 would be waiting. It is being addressed but it is not acceptable that it is the case. A huge amount of extra resources were put in place, and what we have seen, in particular since about the second week in January, is a lot of delayed or deferred care and many people coming in. I met with the HSE several times on this issue and asked why this is happening given the huge extra resources we put in place in terms of prevention, emergency department, acute capacity and discharge. There are various Covid-related reasons the HSE points to, of which we are all aware, but one of the things it said is the number of people over 75 coming in has gone up a great deal. What is more, when they are admitted, the average length of stay for them is much longer.

In regard to those waiting for inpatient or outpatient care, there are more than 700,000 on the National Treatment Purchase Fund, NTPF, lists. As the Deputy said, a good proportion of that number is over 75. We are not specifically targeting people based on age, to be clear. We are targeting people based on clinical need. Some of this will come down to individual consultants looking at their patient lists and, on the basis they now have extra outpatient facilities, the hospital has extra outpatient facilities or there are extra operating theatre lists, saying which people are the highest priority. One thing we must do is, regardless of a person's age, whether he or she is eight or 80, we must ensure those waiting the longest get some form of priority. People are waiting years in our country. In one of the richest and most developed countries in the world, to have people waiting years is not acceptable. That is what tomorrow's plan is all about. It is to start a full-scale assault on those waiting lists and bring them down.

Photo of Bernard DurkanBernard Durkan (Kildare North, Fine Gael)
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I support the points made by my colleague in regard to the drugs issue. It is a health issue and a justice issue. It has to be approached on two levels and to have all resources made available to deal with it. That needs to be done as a matter of urgency. What we are doing at present is perpetuating it. The drug issue is growing. We are a drug-ridden society, and people will tell you it affects all classes of people throughout the country who did not ordinarily resort to drugs. We must cut off the supply and we have to improve the rehabilitation system in a way that encourages people away from drugs - all drugs, whatever they are.

I have one question. Criticisms have been levelled at health institutions in the past in regard to the degree to which the HSE was remote from the people. From the point of view of practitioners, the regions were remote from the HSE by virtue of their geographic location. I want the Minister and the Minister of State to recognise that and try to deal with it.

We spent a great deal of time in the run-up to the report on the Sláintecare programme in ensuring that there was a return to a feeling among the people in the regions, whether they be GPs or specialists or whatever the case may be, that there would be a return to recognition of their particular position, as opposed to their position be determined by somebody at the HSE, at the central level, telling them what they do. We need to address that and we need to address the drug supply as well.

Photo of Stephen DonnellyStephen Donnelly (Wicklow, Fianna Fail)
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With regard to tackling the supply of drugs, it is a justice issue. From a health perspective, we need to treat addiction as a health issue rather than a criminal or justice issue. Those in addiction need to be helped.

Photo of Bernard DurkanBernard Durkan (Kildare North, Fine Gael)
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I do not take issue with the Minister. However, we are telling ourselves this to reassure ourselves. We can solve it without the two. We have to put the drug suppliers out of business. We can choose. We can continue, as it were, a programme of appeasement. I was on a drugs programme previously many years ago and we came to the conclusion that methadone treatment was excellent as long as it showed results. There has to be a result at the end of the day. Feeding the drug problem more and knowing that suppliers of the industry will supply more will not solve the issue. We put them out of business. They have the most growing business in the country at present. We cannot continue as we are. We cannot continue as a society.

The Minister already referenced society becoming more violent. It sure as hell is becoming more violent. The law of the jungle is prevailing now to an ever-greater extent every day. We need to be conscious of that.

I have to go over to the Chamber, unfortunately, so if I might be excused. The Minister can send me a reply to the question about the structures in the HSE and the regions. I will be waiting for that reply. My apologies for having to leave so early.

Photo of Seán CroweSeán Crowe (Dublin South West, Sinn Fein)
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To follow on the drugs issue, part of the challenge is that the funding model that has been used in the past in relation to allocation of funds to drugs task forces clearly needs to be looked at. When the Minister was in, he said they would look at that. We have a situation where some drugs task forces are on less money now than they were a number of years ago. That is unacceptable, particularly in view of the challenge that communities are facing on it. Again, as part of the Minister looking at the Estimates that - I asked the question about the decrease - even if there is a slight increase, it would help. The challenge is huge out there and it should not be a case of someone who is looking for supports and needs medical supports and rehabilitation should be waiting for a long time to get that support.

Many of the drugs task forces had front-line services that worked through the pandemic. They dealt with those who were coming to them and tried to do it as safely as possible. They all talk in terms of resources that are needed for them to continue to support people who are very ill and need that support. It is not just the addict - it is the family. It is the impact it has not only on the family, but society as well. I suppose people are so scared about crack cocaine because it has the potential not only to destroy the individual, but also destroy the family and the community itself. If we can do anything at all, it is one area of society that certainly needs support and attention.

Photo of Colm BurkeColm Burke (Cork North Central, Fine Gael)
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I just wanted to raise with the Minister the concern I have on the people in the HSE, in particular the consultants who are due to retire. There does not seem to be a mechanism in place, because the complaints I am getting back from hospitals around the country are that nothing is done about recruitment of the replacement until the person has actually physically retired. That will be a huge problem over the next two to three years because there are quite a number of people due to retire.

A second issue that I know the Minister cannot come back to me today on is the step-down facilities from hospitals and a faster turnover of patients out of hospitals. The biggest problem that hospitals have and, in fairness, they work extremely hard trying to co-ordinate getting patients out who the hospital has done all that it can for, is access to step-down facilities. It is still a major issue across the country. Can we prioritise the issue of getting suitable facilities available so that staff can get people out of hospital in a timely manner and, at the same time, make space available for the people who need to be admitted?

Photo of Stephen DonnellyStephen Donnelly (Wicklow, Fianna Fail)
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I thank the Deputy for that. I will raise the issue around consultants directly with the HSE because, obviously, we need to forward plan. If we know someone is retiring, then we should be forward planning to make sure the replacement is in place, potentially before they-----

Photo of Colm BurkeColm Burke (Cork North Central, Fine Gael)
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It is not happening. It was happening 20 years ago and for some reason there was a different structure for recruitment 20 years ago. The structure was totally changed. I have come across consultants who, two years after they retired, are still inside the facility as a locum because no replacement has been identified or put in place.

Photo of Stephen DonnellyStephen Donnelly (Wicklow, Fianna Fail)
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I thank the Deputy for raising that. I will take that up directly with the HSE. With regard to step-down or a delayed transfer of care, those figures have gone up. It is now well in excess of 500 on a daily basis. One of the big things that is driving this, as the Minister of State, Deputy Butler, said previously, was about half of the nursing homes were in the 28-day period post-outbreak, where there could be no discharge. Just in the last week, the HSE has changed that 28-day period to between seven and ten days. That will help. However, the point the Deputy makes is broader than that, which is regardless of that, we need additional step-down facilities as well.

Photo of Colm BurkeColm Burke (Cork North Central, Fine Gael)
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In fairness, in my own constituency, for instance, there is a new extension being built to Heather House, which will provide accommodation for 60 extra beds. Likewise, we bought the golf links hotel at Blarney, and as I understand an extra 50 beds will go in there. The question is when will those facilities be ready to take the step-down patients and can those two projects be fast-tracked. In my constituency alone that is 110 beds. If they were available in the morning, it would be a huge benefit to all of the hospitals in Cork.

Photo of Stephen DonnellyStephen Donnelly (Wicklow, Fianna Fail)
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I will get the Deputy a detailed update on both of those specific projects, including timelines.

Photo of Mary ButlerMary Butler (Waterford, Fianna Fail)
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The figures I received yesterday showed that, between community nursing units and nursing homes at the moment, we have 320 in outbreak, which is a phenomenal number of outbreaks. The residents are all vaccinated and boosted and are not getting as sick. In the nursing home setting, the average outbreak is approximately eight patients. However, as the Minister alluded to, previously the homes had to be 28 days Covid-free before they could take in a referral from an acute hospital. Currently, about 230 people fall into that category in the acute system. However, the fact that the guidelines were changed last week, and how they can also take back in who actually have Covid but are not shedding the disease at that time, we hope will make a big difference, but we probably will not see the impact of that for two to three weeks. It will certainly help. It is really important to state as well, in relation to facilities such as nursing homes and community nursing units, the importance of people still adhering to mask-wearing, hand sanitisation and the infection prevention and control measures. Our nursing homes and our community nursing units are still very much challenged with Covid.

Photo of Seán CroweSeán Crowe (Dublin South West, Sinn Fein)
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We will end on that positive message. Again, apologies to the Minister, as we did stray off the Estimates to some extent. However, it was very useful, not only for the members, but also for people watching at home, because there were issues raised that I am sure many of them were asking questions on as well.

That concludes the consideration of Revised Estimates for Public Services 2022: Vote 38 - Department of Health. In accordance with Standing Order 101, a message to that effect will be sent to the Clerk of the Dáil. Again, I would like to thank the Minister and the Minister of State and their officials for attending the meeting. The select committee is now adjourned sine die.