Leo Varadkar (Dublin West, Fine Gael) | Oireachtas source

If it was as simple as providing extra beds, extra staff and extra money, we would have solved the problem by now because we are spending €3 billion more per year this year than we did in 2011, have lots more staff and are adding beds. Let us take doctors, for example. Even though we are still below the European average, we are up to about 10,000 doctors working in the public health service, the highest ever. Even when it comes to GPs, there have never been more on the specialist register and never been more with HSE contracts. Often, when one sees these facts - they are facts - they jar with what one hears in the media and commentary, but they are facts over which I can stand.

To give a small example, on overcrowding in two hospitals - Beaumont Hospital and in Mayo - there was no one on a trolley this morning awaiting admission to a bed. In others there was none on a trolley for more than eight hours, including in Wexford, Mullingar, Portlaoise, Cavan and Kerry. Meanwhile, at the other end of the table, there were over 30 patients on trolleys in Tallaght, the Mater Hospital, Sligo and Galway. One can see the huge variations from hospital to hospital. A couple of years ago Beaumont Hospital used to top the league table when it came to overcrowding, but now it is regularly at the bottom, with the bottom being the good place to be, needless to say. It has some additional beds, but it was a lot more than that that helped to improve the position.

The difficulty we so often have in the health service is that, while there are pockets of best practice and good management, it has been a struggle to mainstream them and make best practice the norm across the health service. That would make a huge difference in patient care and might even save money, or at least achieve for us better value for money.

Nurse recruitment is going reasonably well. I do not know the exact figures, but I think there are about 900 more nurses employed by the health service than there would have been a year or so ago. As I explained, that has enabled us to open additional hospital beds, including more than 200 additional acute beds in the past six months. In part, it is probably down to pay restoration. It may also in part be down to Brexit, with fewer nurses migrating to the United Kingdom. The fall in the value of sterling has probably also had some effect. However, there are certainly issues with retention. There is a high turnover of staff for lots of reasons, including terms and conditions and the pressure and stress staff are under. That issue is being examined by the Public Service Pay Commission to see how we can improve retention.

We have 1,509 people waiting for knee operations, but the waiting list is starting to trend downwards largely because of the additional resources provided for the National Treatment Purchase Fund, NTPF. Of the 1,509, 1,200 are waiting less than nine months; therefore, the median waiting time for a knee operation is about nine months. I do not know the particular case to which the Deputy referred, but certainly most people are having the operation carried out in a shorter period. About 430 have been waiting less than three months; 416 have been waiting between three and six months, while 336 have been waiting between six and nine months. I hope that, as we continue to do the work we are doing with the NTPF, the lady in question will have her operation carried out, I hope sooner than she expects or has been advised of.

On Sláintecare, I discussed the draft implementation plan with the Minister and his team on Monday and also with the Minister for Finance, Deputy Paschal Donohoe, and his team. We had a good look at it and I expect it to come before the Cabinet in the next couple of weeks. I argue that, even though we do not yet have an implementation plan, implementation has started. There is a lead executive being recruited and they should be appointed within weeks. The implementation office for Sláintecare is being established in the Department of Health. Dr. Donal de Buitléir has been appointed to head up the group, as recommended by the Sláintecare committee, to examine taking private practice out of public hospitals, what it would cost, how it might be done and what the impact would be.

We are expanding access to GP care. Deputies will know that the legislation is pending to extend GP visit cards to all carers in receipt of carer's allowance and carer's benefit and change the income limits for people with disabilities in line with what was recommended in the Make Work Pay report. There are other measures to extend free GP care. The Sláintecare report recommends that we extend it to an extra 500,000 people per year. I think the Government has come to the conclusion that that would be too fast, that we would not have the capacity in general practice to add that many people every year, but we do intend to settle on a figure by which we will increase the number with access to free GP care every year.

We have also begun the process of reducing prescription charges, both for those who have medical cards and those who do not under the drugs payment scheme. Again, that was a recommendation made in the Sláintecare report. Also, the capacity review has been undertaken and we have begun its implementation. I have mentioned the beds that are being put in place.

On Respreeza, I share the Deputy's concerns. It is normal practice, when something is on trial or provided for patients on a trial basis - even if the HSE decides not to approve it as a reimbursable treatment - for those patients who have been on it and benefiting from it to stay on it. What happened with Respreeza was not what has happened with other medicines of this nature. I will certainly keep a very close watching brief on it.

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