Simon Harris (Wicklow, Fine Gael) | Oireachtas source

I move amendment No. 1:

To delete all words after “Dáil Éireann” and substitute the following: “notes that:

— the population aged 65 and over has increased by 35 per cent since 2009, with the result that there have been increasing levels of demand for health and social care services;

— there has been an increase of 29,000 attendances and 2,600 admissions to emergency departments in hospitals in 2019, as against the same period last year; and

— the Health Service Executive (HSE) has published its National Winter Plan 2019-20, which identifies mitigating actions to bring down the number of patients on trolleys, and reduce waiting times in emergency departments, notwithstanding the growing demand for its services;

acknowledges:

— the allocation of an additional €26 million to fund the implementation of the National Winter Plan 2019-20 to support egress from hospitals;

— the establishment of nine Winter Action Teams aligned to Community Healthcare Organisations and associated acute hospitals which have prepared integrated winter plans that will focus on demand management and reduction;

— that an additional investment of €52 million has been made to bring the total funding for home supports to €487 million in 2020;

— that over the last two years an additional €45 million has been provided to the Nursing Home Support Scheme (NHSS) budget, and in 2020 the NHSS will see a further investment into its budget of €45 million, bringing the total annual budget for the NHSS to €1.03 billion;

— the sustained focus in recent years on reducing delayed transfers of care and enabling patients to be discharged from hospital in a timely manner;

— the increased investment of €210 million per annum to be made by 2023 in general practitioner (GP) services set out in the Agreement on Contractual Reform and Service Development of May 2019;

— the establishment of a fully-funded chronic disease management programme to be delivered by GPs from January 2020;

— the commitment to comprehensive patient care on the part of GPs including the improvement of out-of-hours services;

— the steps being taken to introduce diagnostic facilities at community level;

— that the Minister for Health is engaging with the Rotunda Hospital, RCSI Hospital Group and the HSE in relation to the scope of interim works necessary to address the infrastructural challenges in the Rotunda Hospital, pending its relocation to Connolly Hospital Blanchardstown;

— the increased investment in the health services, including the increase of over 250 whole-time equivalents of medical and dental staff and over 370 in-patient and client personnel since the beginning of 2019, and 800 nurses and midwives since September 2018;

— the HSE has established a Medical Workforce and Patient Safety Oversight Group to agree and oversee implementation of actions in relation to recruitment of consultants and non-consultant hospital doctors;

— that engagement with the consultants’ representative bodies has commenced and further engagement is planned;

— that Project Ireland 2040 provides €10.9 billion for health capital projects including 2,600 acute hospital beds and 4,500 social care beds

— that the Government will provide record levels of funding of €18.3 billion in revenue and capital funding for the health services in 2020; and

— the publication of the Sláintecare Action Plan 2019 progress report this week which will show that the Government is on track with its implementation; and agrees:

— with the Sláintecare vision of a universal single-tier health and social care system where everyone has equal access to services based on need and not ability to pay;

— that as part of the Sláintecare Action Plan 2019 reducing waiting times for patients in hospitals and for community services is a key priority for the Government;

— that the Government, through its policies and funding for the health services, is addressing the issue of capacity in the healthcare system by enhancing community services, improving patient flows and providing additional capacity in line with the recommendations of the Health Service Capacity Review; and

— that the most effective way of achieving the Sláintecare vision is by backing the Government’s continued implementation of the Sláintecare Action Plan 2019, which has the support of all parties.”

I welcome the opportunity to address the range of issues raised in the debate. The pressures facing our health service are a deep concern for all of us. None of us wants to see patients, especially our older people, and staff enduring overcrowded conditions and none of us is immune to that. We are working very hard to try to improve the situation but in an honest debate it is important to acknowledge that there is no policy panacea, but rather a variety of reforms and measures are required. I believe this is why all parties in the Oireachtas agreed on the need for a long-term plan, which is Sláintecare. In that context, I hope we can have an honest and truthful debate this afternoon. There is no single solution that I am sitting on and refuse to deploy for some unknown reason. That is just lazy and partisan politics. I heard Deputy Donnelly outline a Twitter plan yesterday and I heard him outline some of it again this afternoon. With respect, I have to say it is very familiar. The Deputy calls for more resources for GPs and the Deputy is aware that we have just negotiated a new GP agreement, of which 95% of GPs voted in favour. The agreement reverses the FEMPI cuts, most of which were imposed by Deputy Donnelly's party. The Deputy also calls for bed capacity and he knows that we are delivering more bed capacity. While Deputy Donnelly was not in Fianna Fáil at the time, any honest look at the graph shows the number of beds his party took out of the health service. Fianna Fáil is calling for a taskforce on delayed discharges. I welcome that point but it does exist. The Minister of State, Deputy Daly set up that cross-divisional oversight group after he published the independent expert review on delayed discharges. I take the point, however, that Deputy Butler raised.

I shall begin with GP services. As Members are aware, in May we concluded an agreement on contractual reform and service development with GPs. This agreement will see an increase in expenditure on GP services of €210 million per annum on a phased basis. This will help to make general practice sustainable and an attractive option for medical graduates. Members do not have to take my word for it; 95% of GPs voted in favour of the deal. The measures included in the agreement are made up of an increase of 40% in the capitation payments to GPs for General Medical Services patients. In return GPs are committed to co-operating in a series of new measures. These include e-health developments, medicines reviews, the implementation of community healthcare networks and the management of hospital waiting lists. Crucially, there will also be an increase of 10% in the rural practice allowance - I know this is an issue of concern to Members - and for the first time ever there is the introduction of a €2 million per annum support for GPs working in areas of urban deprivation. Improvement in supports for maternity and paternity leave for GPs are also provided for to help attract new and younger GPs to the career.

From January next year we will be doing exactly what the motion calls for, which is the implementation of a chronic disease management programme that will help to move services from the hospitals into general practice and deliver structured care to patients through their local doctors, an approach which has been shown to improve health outcomes and reduce the need for hospital admissions.

The agreement signals the commitment of Government to general practice and the partnership that is required between GPs, patients, the wider health system and the HSE. The 2019 agreement also includes a commitment to a strategic review of GP services that is intended to examine how best to ensure the provision of GP services in Ireland for the future. This review on the broader new contract will commence in 2020.

We are also continuing to work on developing our diagnostics services in the community. This is crucial. It ensures that people do not have to go to a hospital to get an x-ray or an ultrasound. The HSE is making progress on a range of options across community healthcare organisations to increase access to radiology services, including publicly provided and outsourced models. Some 67,000 ultrasound and 79,500 X-rays are planned to be delivered by the end of this year through direct GP access to radiology services.

We all agree that more care needs to be provided in the community and in particular the need to support homecare. This was clearly recognised by all of us with the increased investment in this area for next year as provided in the budget. We have not just started next year, however, and have provided additional funding from September this year to improve access to home support and the fair deal scheme. As a result, we can see the number of delayed transfers of care falling - formerly known as delayed discharges. The average daily number of delayed discharges in October was 682, which is down from 757 in the previous month. This is still far too high but it is now beginning to reduce and I expect that to reduce significantly further.

The HSE published its winter plan last Thursday, which is earlier than before, and I secured an additional €26 million of taxpayers' money to support its implementation. The additional funding is being used for a range of services to help relieve demand for emergency department services and to support discharge and other initiatives to help hospitals deal with the challenges associated with winter.

Specific funding has been allocated to nine winter action teams to support initiatives at local level including additional staff to improve patient experience time, improve senior clinical decision making, reduce length of stay and facilitate weekend discharges; additional aids and appliances to help get elderly people in particular back home; additional home support hours; the implementation of frail intervention therapy teams to help avoid and reduce admissions of patients who are more frail; and additional flu-testing kits to improve patient experience times.

I agree with Deputy Donnelly that we need extra bed capacity. We have published the capacity review and provided funding for the addition of 2,600 acute beds and 4,500 community beds, in line with the plan. Progress has been made on increasing capacity. An additional 267 acute hospital beds were opened under the winter initiative 2017-18. The provision of an additional 75 acute beds and 75 community beds was a component of the winter plan 2018-19. The modular facility to expand Clonmel Hospital by 40 beds is nearing completion and will open shortly. The much talked about 60-bed extension to Limerick hospital, promised for years but not delivered by anybody, is now well under way. While it will not be open this winter I have viewed it, it is under construction and is under way. As part of an agreed capacity programme, the number of available inpatient beds is expected to increase to above 11,000 for the first time since 2009. In 2009, 2010 and 2011 Deputy Donnelly's party reduced the number of hospital beds. From 2007, under Fianna Fáil, more than 1,500 inpatient beds were lost until Fine Gael began to reverse this trend in government with the Labour Party in 2012. Since then more than 600 beds have been added and we are continuing to work to reverse the damage done by Fianna Fáil. The truth is that Fianna Fáil left this country with fewer acute inpatient beds when it left office in 2011 than when it started in 1997. I have a graph here, published by my Department and available for all to see, called the open beds report August 2019. I encourage everybody to view this report. One graph shows a decline during Fianna Fáil's tenure in the Celtic tiger era when it closed beds and built motorways instead of hospitals. I agree with the Deputy's comments about not properly using beds and I hope in his reply to this debate he will stand up, as have Deputies O' Reilly, Kelly and I, to say that he believes it is inappropriate that private practice is taking place with public hospital beds. We want to see an end to that, but we have yet to hear Deputy Donnelly's party commit to that.

One issue was raised in Fianna Fail's motion that I specifically want to address on the Rotunda Hospital. I am fully aware of the concerns that have been raised in relation to the hospital by the Master of the hospital, Professor Fergal Malone. I have met with Professor Malone and other representatives from the Rotunda as well as the HSE to discuss potential interim works at the hospital.

It is important to recognise that we want to relocate this hospital to the Connolly Hospital campus and funding for this relocation project is in place in our capital plan. This is a longer-term plan and we need to look at current infrastructural difficulties. There has been engagement with the HSE to try to agree a proposal with the Rotunda and I look forward to meeting the Rotunda and the HSE to see how we can proceed.

I am happy the motion gives me an opportunity to talk about workforce planning. I want to make it clear there is no national recruitment embargo in the HSE. If there was it would be the only organisation in the world that could see 2,630 more staff working this year than last year despite an embargo. Fianna Fáil would know all about embargoes because it cut the number of health service staff. There are more doctors, nurses and therapists in the health service this year than last year. However, what we do have to do is what every public service has to do. Managers can only recruit funded posts. I am sure there are school principals who would love to hire more teachers. I am sure there are lots of people in the public service who want to do so but it has to be done in line with the budget. That is a fair and equitable way to do it.

There has been a constant increase in the number of staff in the HSE. There has been an increase of more than 250 doctors since the beginning of this year. The number of whole-time equivalent nurses and midwives has increased by almost 800 since September 2018. The recent nursing agreement, despite Deputy Donnelly telling the health committee he believed our nurses are well paid, includes additional measures to help with the recruitment and retention of nurses and puts more money back in their pockets. With regard to consultants, I am pleased that engagement has started with their representative bodies. With this engagement and with taxpayers' money must come reform. We cannot have a situation where patients are waiting in an overcrowded emergency department and just because they cannot afford private health insurance they cannot access our hospital beds while a patient in a private bed is upstairs in our public bed with a private health insurance company making money. That is not on. That is not equitable. I heard Sinn Féin talk at the weekend about an Irish NHS and I am up for that. That is what Sláintecare is all about. However, I am not sure Sinn Féin is up for it if it refuses to rule out private practice in our public hospital beds. I ask Sinn Féin to tell us its position. If, God forbid, it ends up with the health Ministry will it take on the vested interests and say no more private practice in public hospitals? Will it deliver on the Sláintecare commitments? I will and I will work with any party in the House that wants to do it.

The emergency department task force meeting this afternoon and obviously I cannot be there because I am here in the House accounting and talking about these important issues. I look forward to it monitoring the work of the winter plan. I welcome the debate. I want to work collaboratively to find solutions but be wary of anyone who stands up in the House and says there are three simple things we could do to fix it. If there were three simple things we could do to fix it we would have done it. It is a complex issue that requires massive reform and the delivery of Sláintecare. In the interim, it requires investment that we are putting in place this winter to try to alleviate some of the pressures.

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