Mr. Robert Watt:

I thank the Chair and members for the invitation to come here to discuss the implementation of Sláintecare. As the Chair mentioned, I am joined by colleagues from the Department, Ms Rachel Kenna, Mr. Muiris O’Connor, Ms Louise McGirr and Mr. Niall Redmond.

I am pleased to say we are continuing to make progress in implementing reforms designed to achieve the Sláintecare vision. Significant investment continues to be made by the Government this year. This is delivering additional staff numbers and health service capacity. We are also working to improve access to, and the affordability of, our health and social care services. There are some highlights that are worth mentioning. Significant progress continues to be made in establishing the necessary infrastructure to orientate care toward the provision of more services in the community. Critical care capacity has increased and is now at 323 beds. This represents a significant increase on the 2020 baseline. Acute bed capacity has also been increased significantly since January 2020.

At the end of April of this year, 140,503 whole-time equivalents were employed in our health and social care sector. This figure includes an increase of 2,758 whole-time equivalents since January 2023. These are the people who are employed within the HSE. The CSO census results released last week suggested that 270,000 people were working in health and social care across the entire economy, which is a much greater number and represents close to 12% of employment, which is up from 11% in the previous census. Again, the numbers employed in providing care across all of the different facets is increasing and the share of employment these workers represent is also increasing, which is interesting.

On training, the number of GP training places will increase from 258 last year to a projected 350 next year, which is a 35% increase. This is something the Chair raised in previous meetings with regard to the challenges the GP service faces, particularly in respect of recruitment. By 2026, the total number of GP trainees undertaking the four-year training programme will increase from the current 932 to 1,300, which is again a very significant increase. Capacity on the non-EU GP training scheme will also increase towards the end of next year.

We continue to expand eligibility with the abolition of public inpatient charges, which came into effect on 17 April this year. This means that people will no longer be charged when accessing public inpatient care in our public hospitals.

While we are focused on building capacity to address the immediate bottlenecks in our services, we are also focused on longer-term reforms. I will touch on a few of these, if I may. As we have discussed previously, the HSE health regions are a priority Sláintecare reform and essential for the improved integration of health services and for the development of population-based planning. The HSE health regions implementation plan is expected to be considered by the Government next week.

Elective hospitals will significantly add to our healthcare capacity and have a significant impact on future capacity. Progress is being made in delivering new elective hospitals in Cork and Galway. Again, we have discussed progress on those projects in recent committee meetings. The HSE has now secured a design team to take forward the design process and site investigations are progressing. A draft business case for the two elective hospitals in Dublin is now being reviewed by officials and is expected to be submitted to the external assurance process shortly. When fully operational, the elective hospitals will deliver almost 1 million elective or day-case procedures and consultations per year, significantly adding to our much-needed capacity. Complementary to their development, the Minister recently announced the locations of four of the six sites for the new surgical hubs in Cork, Dublin, Galway, Limerick and Waterford. The hubs are modelled on the successful Reeves Centre at Tallaght University Hospital, which, over 24 months of operation, has seen very significant reductions in waiting times. The first of the new hubs is intended to be operational before the end of this year and more will follow in 2024.

As outlined earlier, there has been unprecedented growth in our workforce, with almost 21,000 additional healthcare workers now employed within the public system, enabling the delivery of increased capacity across all service areas. We are seeking to continue to invest in our health and social care workforce and to plan for the future.

The Minister indicated previously that we need to double the number of training places for medicine and nursing and midwifery to achieve healthcare workforce sustainability for Ireland. For this year, the Minister is seeking to expand undergraduate student places across all nursing and midwifery and other health-related disciplines. My Department continues to work with the Department of Further and Higher Education, Research, Innovation and Science and the higher education sector to achieve this goal.

Ireland has an overreliance on international recruitment of doctors, nurses and midwives and this is unsustainable in the long run, given our health needs and the health needs of the populations of the locations we draw these staff from. In 2021, over 40% of our doctors in Ireland and 46% of the nursing and midwifery workforce were educated abroad. This is not a sustainable model. We need to address these challenges and significantly increase our domestically educated workforce.

Sláintecare makes clear that to build the health service we need in the future, we need to change the way we do things, as well as add capacity. The Government has been very clear in supporting fundamental reform in the delivery of care and with initiatives such as the provision of enhanced care within the community, improvements in chronic disease management, digital health and the implementation of HSE health regions. We have recently seen the significant impact that enhanced weekend working is having. It is essential that we also look to further support those nurses and doctors already rostered over seven days by activating the range of healthcare services necessary both in hospitals and in the community to ensure improved patient flow and care while addressing the capacity issues impacting our hospitals. A group has been established within the HSE to develop a national framework for extended working hours within the system, focusing initially on urgent and emergency care and delivering improvements for this winter. The new consultant contract is a further relevant development that doubles the hours available for rostering from 40 to 80, ensuring senior decision-makers are available in our hospitals in the evenings and at weekends.

As mentioned at previous meetings, the Sláintecare programme management office, SPMO, is currently developing the next Sláintecare implementation strategy and action plan 2024 to 2027. We will be building on the work undertaken to date, as well as the “refresh” of the 2018 health service capacity review. This will inform the approach we take to further building capacity and to ensure we are focused on getting the fundamentals right for the long term, as well as on delivering in the short term to meet the growing health and social care needs of our population. I look forward to engaging with the committee on the development of the next stage of the vision for Sláintecare.