Catherine Byrne (Dublin South Central, Fine Gael) | Oireachtas source

I am sorry the Minister had to leave but he has asked me to make the closing contribution. I thank Members for their contributions, some of which I listened to before I arrived in the Chamber. The Minister and I have taken notes.

It is clear from the debate that the House shares our commitment and determination, and that of the Government, to do better for our patients. Despite the genuine efforts of politicians, health service managers and front-line staff, our emergency departments are under pressure this January. What we are seeing in our hospitals right across the country is a symptom of long-standing and fundamental deficits within our broader health system. I have listened carefully to the debate and I believe we need to move forward now and implement the three key priorities of Government: implement the findings of the health system capacity review; progress the reforms set out in Sláintecare; and make a decisive shift to primary care.

While improving hospital services is essential, we cannot underestimate the importance of moving away from a hospital-centric model of care. We need to recognise the interrelated, interdependent nature of the environment within which public hospitals operate. As the Minister pointed out, the Government is committed to delivering more non-acute care within the primary care sector. This means that better care which is close to home can be provided for communities around the country. To this end, we have invested significantly in our primary care infrastructure providing modern well-equipped primary care centres. This will allow our primary care teams and GPs to be located together and will enable the delivery of a wider a range of integrated primary care services. Currently, 110 centres operational with a further 18 expected to become operational throughout 2018. There will be a continued focus on advancing those 60 locations which are under construction or at various planning stages. Significant investment in additional staffing and service reorientation has also been made in the primary care therapy areas. Dedicated funding since 2016 is supporting the recruitment of additional posts in speech and language therapy provision and psychology services, both with a particular focus on children. Most recently, budget 2018 provided funding for additional occupational therapists. The new primary care centres are equipped to facilitate the new primary care staff that are being recruited. The centres will, into the future, be capable of facilitating additional new staff that may be required as the plans for further shifts of activity to primary care are implemented.

Another measure outlined by the Minister is the importance of greater access to diagnostics in the community. Access to diagnostics for GPs in the community will alleviate some pressures on the hospital system to provide such services. That is why we have put in place enhanced community diagnostic programmes for ultrasound and X-ray. Since 2015, the HSE developed a service whereby a GP can refer medical card and GP visit card adult patients for ultrasound scans currently in ten primary care sites across the west and south. By the end of November 2017, more than 19,000 scans had been undertaken, which exceeded the expected activity in 2017 by nearly 15%, and the onward referral rate to a hospital setting for further radiological-medical investigations increased by between 15% and 20%. This low onward referral rate demonstrates the success of the initiative arid highlights the effectiveness of having direct access to ultrasound available for GPs and is further relieving pressure on hospital services and decreasing waiting lists. Currently four primary care centres have on-site X-ray facilities available and the Minister has previously highlighted the success of the Castlebar centre, for example, where the services are run under the governance of the radiology department in Mayo University Hospital. There are now no waiting lists in Mayo for X-ray services which are a vast improvement on the waiting list figure of 517 for this service in the county in April 2017 before the start of the service.

I understand from the HSE that future primary care centres will have rooms that meet radiology specifications and may provide X-ray services to patients. Further phased expansion of the community diagnostic programmes in primary care sites will be undertaken in 2011. We must continue to build on these developments and we must further seek to expand our primary care provision. A key element of this will be negotiation of a new modern responsive contract for GP services. As the Minister for Health stated earlier, the provision of a €25 million primary care fund from budget 2018 reflects the commitment of the Government to ensuring that primary care sector now and in the future is equipped to deliver modern, responsive and effective health care provision for all in our society.

With the Sláintecare report, for the first time, we have political consensus on the vision and direction of travel for our health services and as such a solid platform for reform. The Government has affirmed its commitment to implementing a significant programme of reform, as outlined in the report, and this will set out our ambitions for the next decade and concrete plans for the immediate years ahead. As outlined by the Minister earlier, this detailed work will be overseen by a new Sláintecare programme office.

I am delighted that the health system capacity review is complete and will be brought to Government next week. This will provide the evidence we need to make important decisions regarding hospital capacity at individual, regional and national level. The analysis carried out as part of the review indicates that given current capacity constraints and demographic projections for the next 15 years, we will have to invest in capacity across all aspects of the health service, including beds in acute hospitals and across the community. It is important that there is a full appreciation of our demographic profile. The rate of increase in the aged over 65 cohort is considerable. This increase is happening quickly and steeply and will become even more pronounced over the next 15 years. The following are key headline projections from the analysis of the period 2016-2031. There was a 12% growth in overall population, with a 59% growth in the age 65 and over population and 95% growth in the age 85 and over population. We will, therefore, need to put the supports in place for much greater numbers of older people in the future, both home care and residential care. We will need better supports in primary care to manage chronic disease and multi-morbidity.

Without significant reform of and investment in community-based services, acute care will continue to be the default option for the majority of care needs, and our hospital services will become even more unsustainable. The Minister asked me to point out that more than 750,000 additional home care package hours will be provided this year. The findings of the review will provide a basis for determining both the extent of capacity requirements over the next 15 years and the type of capacity that is needed. It is important that this be undertaken in a planned way and the new national development plan will give us the vehicle for doing this.

10 o’clock

Reform alone will not fix all the problems that exist. People are living longer and are healthier than ever before, as many Members have said, and this is something to be celebrated. In addressing the many challenges facing our hospitals, we must not lose sight of the fact the best way to address these challenges is to ensure that citizens have as healthy a lifestyle as possible. In 2013, the Government launched the Healthy Ireland framework. The vision of the framework is to address the threats to public health posed by issues such as obesity, smoking, alcohol abuse and physical inactivity. Significant progress has been made in implementing the framework since its launch, with the development of a suite of national policies and strategies, including A Healthy Weight For Ireland, the national obesity policy and action plan, and Get Ireland Active!, the national physical activity plan.

It is vital also to remember that health is not just the responsibility of the Department of Health and the HSE; it requires a whole-of-Government and whole-of-society approach. Since the launch of the Healthy Ireland framework, we have established a number of cross-sectoral partnerships with other Government Departments, agencies, NGOs, business and the private sector, and the voluntary sector in order to drive the Healthy Ireland agenda. We are seeing the results of this work on the ground in the success of national and local initiatives such as Operation Transformation, park runs, the Great Dublin Bike Ride and a host of other initiatives. I can assure the House this progress will continue in the months and years to come.

I know we all wish for a better health service and improved hospital services. I would like to reassure my colleagues this remains a priority for this Government and we will continue to work hard and stay focused on this issue. I have listened carefully to the concerns and issues that have been raised by Members this evening. As a public representative in my constituency and in my work as a politician, I have heard individual stories and listened to the individual problems on the ground. I think it is beholden on us all, no matter what party we are in, or for those in no party, to do our utmost to continue to work together to resolve many of the issues that have been highlighted in this debate. I thank Deputy O'Reilly for raising this very important issue. I am delighted the Government has decided to not object to the motion.

On a personal note, I ended up in accident and emergency on Christmas Day with my husband, who was taken very seriously ill. I have to say I was overwhelmed by the care given by the nurses and doctors, and even more so by the general staff who were there to give out the tea and the sandwiches, and so on. In general, we have a fantastic health service with fantastic people working in it. It is unfortunate that, in 2018, we still have people on trolleys filling our accident and emergency units and maybe not getting the service they deserve in a timely manner. It is time to put political views aside and to work together to resolve any issues we have into the future. I know Deputy Harty, who is a doctor, and the other Members present all feel the same.

I thank Members for their participation in the debate. I again thank Deputy O'Reilly. I want to express the Minister's sincere apologies that he could not remain until the end of the debate.

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