Simon Harris (Wicklow, Fine Gael) | Oireachtas source

I welcome the opportunity to address the Dáil on the important issue of hospital overcrowding and thank Deputy Louise O'Reilly for facilitating the debate through the motion. I would like to approach this debate in a spirit of finding solutions and forging cross-party consensus. I appreciate that Deputy O'Reilly put forward a number of constructive suggestions. I am also conscious of the need for all of us to work together to reach a sustainable solution for the health service, placing patients and their needs at its heart.

The Government will not oppose the motion because we all want the same thing, namely, to do better by patients and front-line staff. However, there are a number of aspects of the motion that the Government contests and I will deal with these in the course of my address.

Nobody in the House considers it acceptable that we have high numbers of patients on trolleys waiting for long times in overcrowded emergency departments in conditions that are awful for them and the staff looking after them. I do not claim, nor does anyone in Government or the Health Service Executive, that the difficulties that arise immediately after new year are not predictable. We had detailed plans and extra resources in place for this reason. However, we still hit a surge that was extremely challenging for the health system. There is a difference between predictable and avoidable and the latter requires that we break the cycle of overcrowding. This will not be achieved in one year's winter plan.

I will first focus on this year's winter plan. I assure everyone that the Government is committed to investing in health and investment is having an impact. We do not often hear this but some things are going well in the health service. This year, as part of budget 2018, an extra €30 million was made available to respond to winter pressures, with a further €40 million being provided in 2018. Let me share something that Deputies may not have heard this winter. In the face of increased demand, staff across the country continue working to improve performance. The overall number of patients on trolleys over the whole winter so far, that is, from 1 November 2017 to 1 January 2018, has declined by more than 2,000 year on year. While far too many patients spend time on trolleys, staff are making an impact with the extra resources provided. The decline is the result of progress made in November, when the counts undertaken by the INMO and the HSE both acknowledged a significant decrease on the previous year. In December, the HSE's TrolleyGAR also showed a significant decrease on the previous year.

Measures such as expanded access to transitional care have meant 382 patients were approved for such care between 1 and 10 January. This has come about as a result of investment. Additional access to diagnostics out of hours has been provided as a result of investment. Investment in more home care has delivered a significant reduction in the number of delayed discharges. In addition, 80 patients are receiving care in private hospitals as a result of a decision to adopt a proposal made by Deputy Kelly last year to use all available capacity across the health service. While these measures have not been sufficient, they have had an impact.

The Government also provided €25 million for social care, including more home care supports and packages. It also provided €1.4 million for rehabilitation and step-down beds in Limerick and Cork and money to deal with complex case discharges to allow people to return to the community. We have opened additional beds at the national rehabilitation hospital and a day hospital is planned at Cashel. Moreover, the HSE's winter plan included a communication strategy, as called for in the motion. The strategy incorporated a public information campaign to increase awareness of the different approaches to accessing services, including emergency services, over the winter period. I must, therefore, counteract the narrative that there was a failure to predict or plan for what has occurred.

We need more beds to reduce the unacceptable number of patients who are still ending up on trolleys. This winter, we are opening an additional 227 beds and the capacity report will inform our plans for further increasing capacity. As of today, nearly 150 additional beds have been opened in Beaumont Hospital, St. James's Hospital, Naas General Hospital, St. Luke's Hospital, Kilkenny, Our Lady of Lourdes Hospital, Drogheda, and Limerick and Galway hospitals.

We have a growing and ageing population in this country and demand for our health and social care services is only going to go in one direction. In the region of 1.3 million people attended our emergency departments last year and more than 330,000 people were admitted to hospitals from emergency departments during the same period. This represents an increase on last year. In particular, there was an increase in the number of older people, those aged 75 years or over. The figure was up 11.3% last year on the year before.

Notwithstanding this rising demand, I wish to comment on something we do not often hear about, which is that some of our hospitals have done rather well. The figures show that Our Lady of Lourdes, Drogheda, Beaumont Hospital, Cavan General Hospital and St. Vincent's University Hospital, to name but a few, have seen a significant reduction in trolley numbers, ranging from 40% to 50%, compared to 2016. The Irish Nurses and Midwives Organisation figures acknowledge that point. We should acknowledge where good practice is in place and demand that it happens throughout the system.

I acknowledge that some hospitals experience specific challenges. The hospitals in Galway and Limerick have capacity issues but they have embraced the national patient flow project and both hospitals have seen improvements in this regard. I wish to thank staff and management in those hospitals.

If we are really to progress this debate, we need to move on to the solutions. What are we going to do to break the cycle? We are going to pursue three key priorities. We are going to increase bed capacity using the evidence and not the cries of those who want more beds for the hospitals in their constituencies. We will use the beds evidence of the capacity review to work out where we need the beds, what type of beds we need and how we are going to get them there. We are going to implement reform through Sláintecare. We are going to increase services provided through primary care by negotiating a new general practitioner contract and having engagements with GPs about how to unwind the financial emergency measures in the public interest legislation.

The first point relates to capacity. We simply do not have enough hospital beds in Ireland to serve our population. That might sound like stating the obvious, but it was not obvious during 2007 to 2011, when policy decisions were made to reduce the number of hospital beds. That was a policy of many people - it is not a partisan point. There was a view that we could do much in primary care, a view held by many eminent people in the health service. Clearly, there is a need to do more in primary care but we still need more beds in our acute hospital setting.

I became Minister for Health at a time when our country was back in economic growth. I want to build more hospitals, provide more beds and staff these beds. I am committed to doing this using an evidence-based approach. That is why we have undertaken a health system capacity review, aligning the needs of our health service now with our demographics out to 2031. The review is now complete and will be brought to Cabinet next week.

Additional capacity cannot be the only answer. Reform must take place as well. We need fundamental reform with significant development of primary and community care. Sláintecare provides a blueprint for this process. I am committed to driving a genuine all-party approach to agreeing a vision for our health service. That is what our country and people deserve. One of the first things this Government did was work with Opposition politicians on the establishment of the Committee on the Future of Healthcare and the production of the Sláintecare report. There is considerable consensus in this regard and I am keen for Deputies to know that I am absolutely committed to delivering on those reforms.

Detailed work will be overseen by a new Sláintecare programme office. The recruitment process for an executive director has commenced and is under way. The advertisement was placed on Friday. It is about getting the right person. That is why we did an executive search through the Public Appointments Service. This will be the largest level of reform ever undertaken in the health service, if not in the public service. It is essential that we get the right person with the right skills and experience. I expect that process to be complete by April.

We have already taken several actions with which Deputies will be familiar, including the preparation of legislation to introduce governing boards to bring back accountability and greater performance oversight. We are looking at the consultation process on how to align hospital groups and community health organisations, taking on board the views of front-line staff and patients. I have set up the Donal de Buitléir group, as the Sláintecare report asked of me, to look at how we can decouple public and private health care. Unlike the assertion of Deputy Adams, I want to see a universal health care system where private practice is decoupled from the public health service.

I wish to briefly focus on primary care. We will do Sláintecare. We are putting in more beds and we will continue to do this. We know we need to work with our general practitioners to do more in primary care. I know they are up for that and that they want to do that as well, but they need to be resourced. That is why, within a week, I will set a date for the FEMPI talks to begin. We can talk to our health contractors, staring with our GPs, about how to unwind some of the financial emergency measures brought in during times of economic recession to make their role more sustainable in future. This will serve to enable the delivery of a new GP contract. Much work has gone on. Talks have been held with GP organisations and there have been negotiations with the IMO in the past year. I believe the FEMPI talks will be an enabler to move those GP contract talks on further.

Earlier, I heard the leader of Fianna Fáil refer to the need to develop more community intervention teams. He is correct in this regard and that is why we are doing it. Budget 2018 provides further funding in this regard. We have seen a significant increase in the number of referrals. From January to the end of November, the figure was 34,452. That figure already exceeded the expected activity for past year by more than 5%. We need to do more in that regard as well.

Putting more diagnostics in our primary care centres is under way. This is not talk; we have done it. I went to Castlebar, where we have put X-ray and ultrasound machines in the primary care centre. This will ensure that we have more than fine buildings; we will have diagnostics as well. More than 500 people were waiting for X-ray services in Mayo in April. That figure is now down to zero. Expanding the roll-out of diagnostics and access to diagnostics in primary care is clearly an important point.

I agree with Deputy O'Reilly that there are recruitment and especially retention issues. We have a process that the unions are engaging in today under the Public Sector Pay Commission. We have a specific module whereby the INMO, the IMO and my Department have made detailed submissions. The commission will make a final report to the Minister for Public Expenditure and Reform this year. I will certainly make my views clear in that regard.

I wish to acknowledge the hard work done by our front-line staff and management during a very challenging period. This year can and must be the year of reform in the health service. I am committed to working with everyone in the House to make that reform a reality in order that we can build the health service that our citizens rightly demand and require, although we all know it will take several years.

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