Stephen Donnelly (Wicklow, Fianna Fail)
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I thank committee members for their invitation to discuss the very real challenges faced by patients in public hospitals, progress in the past three years and, critically, plans for ongoing expansion of capacity in parallel with fundamental reform of patient care. Like many of my colleagues on the committee, I have visited emergency departments across the country to hear first hand the experiences of patients and healthcare workers. I have seen the distress overcrowding causes for patients, their families and front-line staff. I have visited hospitals in which conditions for patients and healthcare workers are simply unacceptable and listened carefully to solutions proposed for these hospitals. I have also visited hospitals in which patients are seen quickly and very few patients - in some cases, none - wait for admission to hospital beds. I have listened carefully in these hospitals to what healthcare professionals tell us about why things are better for patients and healthcare workers in these hospitals.

Our emergency departments are run by skilled and experienced staff, providing access to healthcare for those in urgent need and access to beds for patients requiring admission. Not all of the solutions to overcrowding are found in the emergency departments nor even in hospitals. As we continue to build capacity, we must ensure that new and expanding community services provide alternatives to hospital for all but the sickest of patients. Hospital waiting lists are too long in too many hospitals and in too many specialties. Waiting lists were far too long before Covid arrived and were made worse by Covid in Ireland and around the world. In Ireland, waiting lists for scheduled care increased by almost 60% between 2015 and 2021.

In late 2021, as the worst effects of Covid began to recede, we began to tackle the waiting lists in a meaningful way. We are now in the middle of a multi-annual approach to achieving the maximum wait list times of ten and 12 weeks, which were agreed by all parties in 2017. As a result of the efforts being made, last year saw an 11% reduction in patients waiting longer than these targets. That is about 56,000 men, women and children. In fact, from the Covid peak to the end of last year, 150,000 fewer people were waiting longer than the agreed Sláintecare maximum waiting times.

Without the intervention of the waiting list action plan last year, it is estimated that waiting lists would have increased significantly to over 1 million people. Instead, critically, last year was the first year since 2015 in which overall waiting list numbers decreased. A 4% reduction was achieved. This year will be the second year in a row that that happens. These reductions are contrary to what is being seen in many countries, with waiting lists increasing due to the after-effects of Covid.

In March we launched the 2023 waiting list action plan as the next stage of our multi-annual approach. The Government allocated €363 million to remove 1.66 million patients from the waiting lists. This is projected to result in a reduction of 10% in the number of people on waiting lists. It is important to say that in the last month alone, we have seen a 5% reduction in the number of people waiting for longer than the ten to 12 week targets, which equates to about 25,000 fewer patients now waiting for longer than those targets than there were just one month ago. I want to acknowledge that this has been achieved by huge efforts within my Department, within the HSE, and most importantly because of the work, effort and commitment of our front-line healthcare professionals to getting these waiting lists down and getting these patients seen quicker. I thank our healthcare professionals and acknowledge that this is not easily achieved. They have the full support of Government and deserve great credit for the achievements that are being seen.

The waiting list plan allocates €32 million to the three priority areas, which are paediatric orthopaedics, gynaecology and bariatrics, to address long-term capacity gaps and significant waiting lists. We are also rolling out important changes to how patients and waiting lists are managed. They include patient-initiated reviews and patient-centred booking arrangements, both of which will improve the patient experience.

As well as growing the workforce at record levels, improving how patients are cared for and implementing the urgent care and waiting lists plan, we are also expanding health infrastructure. We are fast-tracking development of new elective surgical hubs in Cork, Galway, Dublin, Limerick and Waterford to address shorter-term capacity demands, providing new elective day case capacity in the shorter term while the regional elective hospitals are built in the coming years. Over the last three years, we have added nearly 1,000 extra hospital beds, 410 community beds and 65 critical care beds. Some 261 acute beds and 16 critical care beds are expected to be constructed under the capital programme for this year. In addition, I am in discussions with Government colleagues on a proposal to create a rapid-build plan for an additional 1,500 hospital beds around the country.

The strategic plan for critical care is continuing to deliver additional beds this year, and we are leading strategic reform of pre-hospital emergency care through the development of a new National Ambulance Service, NAS, strategic plan. I am pleased to say that I was looking at the echo and delta targets just this morning for the year to date and there has been a significant improvement by the National Ambulance Service in meeting both the echo and delta targets. It is important that we recognise the work that has been done by our National Ambulance Service Teams to achieve that. The new NAS plan is focused on increasing permanent capacity in the services and developing alternative care pathways, including aeromedical services, which includes commencement of the new helicopter emergency medical service in the south west.

At the same time as these important changes and improvements to capacity, workforce and infrastructure, changes to working practices are also required in our public health service. Critically, we have to have senior decision-makers on-site and available to patients more often, both in hospital and community care. We have seen the positive impact this has. We need to ensure strong connections between hospital and community sectors, which is being addressed in part by the move to regional health areas, which is progressing this year. We need to see more discharge options available to the hospitals. We need a consistency in approach to patient flow, within the hospital and out of the hospital, with what is being seen in the best performing hospitals becoming the norm in every hospital.

I will touch on enhanced community care because it is an essential part of keeping people out of hospital in the first place and then accelerating their discharge from hospital. Annual funding of €195 million has been allocated to continuing the implementation of enhanced community care this year. I am delighted to be able to say that much progress has been made. Some 94 of the 96 primary care teams are now in place. Some 21 of 30 specialist teams for older people, or integrated care programme for older persons, ICPOP, teams are now in place. Some 21 of the 30 specialist teams for chronic disease management are now in place. All 21 of the community intervention teams are now operational with national coverage for the first time.

These community health networks, or primary care teams, for the first time in Ireland, mean that general practice is being properly integrated into community service. The feedback we are getting from our primary care teams and from general practitioners is positive. We have some way to go and the new ways of working are still bedding in, but the feedback has been good. This provides a foundation for truly integrated care, meaning more local decision-making and improved access to primary care services for individuals and their families.

Alongside all of this, the community specialist teams are now providing consultant-led multi-disciplinary care to older people with chronic diseases in the community. This embodies the shift away from a healthcare service centred on hospitals to a healthcare service centred on community-based and primary care-based care.

The community intervention teams are another really important innovation. These teams provide a rapid response to patients experiencing acute episodes of illness. The services facilitate the delivery of enhanced care in the community and at home. We are further expanding the community intervention teams, with a particular focus on the mid-west and the north west. Essentially, these community intervention teams provide some of the services in people's homes that they would typically have only been able to get in a hospital. It means people have options other than being admitted to hospital. Critically, it means people are being discharged from hospital earlier and getting some of that lower acuity but traditionally hospital-based care in their homes now. The patients I have spoken to said it makes such a difference to their care and recovery.

The committee will be aware that we are investing heavily in GP access to diagnostics. We are looking at heart failure virtual clinics, facilitating delivery of shared and integrated care between GPs and cardiologists, which again reduces the need for GPs to refer their patients to hospital. We have had a very strong response to the programme for access to diagnostics. We are targeting about 500,000 scans this year and about 500,000 last year. Again, the GPs are saying that this really makes a big difference to their ability to care for their patients.

We will continue the implementation of other important reforms. Just some of these include advanced practice, community-based care, and more decision-makers available to patients more often. This is how we achieve our goal, which is universal healthcare. We are driving down costs for patients. We are rolling out new services such as those in stroke, diabetes, bariatrics, women's healthcare and genetics. Critically, while we acknowledge that access is our biggest challenge, whether through emergency departments or waiting lists, we are now making real progress. As I said, it is encouraging that last year was the first year since 2015 in which the waiting lists fell. They are falling again this year. The HSE is ahead of the extra volume that was seen last year. We are working closely with the HSE to make sure it has the support to get these waiting lists down to what we have all agreed, which is that no patient waits for more than ten or 12 weeks.