Holly Cairns (Cork South West, Social Democrats) | Oireachtas source

I have quite a few questions for the Minister but I will try to be quick so that there is time to come back in after he responds. This pandemic has illustrated the importance of healthcare delivery at the point of need. Before, during and after the Covid-19 crisis, an issue of extreme concern for people in west Cork is the potential downgrading of Bantry General Hospital to a model 2 facility. The hospital provides vital healthcare services for the population of west Cork, some parts of which are more than a two-hour drive to Cork city. Downgrading the only acute hospital in this large geographical area will result in people's chances of survival being lower simply by virtue of living in west Cork. It is hard to believe we are even talking about this. Not only is this facility crucial to the local population but, without it, there will be a catastrophic knock-on effect on bed capacity in Cork University Hospital, which is already overstretched at the best of times. As things begin to return to normal, it is essential that this issue of fundamental importance to the people of Cork South-West is not forgotten about. What reassurance can the Minister provide that Bantry General Hospital will not be downgraded to a model 2 facility?

At the start of June, representatives of the Irish Medical Organisation, IMO, told the Special Committee on Covid-19 Response that between outpatient, inpatient and day case appointments, there are now approximately 800,000 people on waiting lists in Ireland. Cancer screenings are yet to restart and GP access to diagnostics and referral pathways is closed. There is now a very serious delay in accessing non-Covid care. The IMO predicts an inherent reduction in capacity in our public services of up to 50% following the implementation of new safety measures. This is in the context of a health service that normally operates at close to 100% capacity. The hospital capacity review in 2018 advised that the public health service needed an additional 2,590 hospital beds. That recommendation was made in the context of reform measures under Sláintecare, which is being pushed back under the new programme for Government. Funding for Sláintecare will only begin to be looked at ahead of budget 2022, meaning that the predicted bed capacity requirement will be too low. In fact, the IMO now believes we need some additional 5,000 beds to meet future demand. In light of new restrictions for health settings, what are the implications for bed capacity and the capacity review published in 2018?

Critical care staff have raised concerns about intensive care unit, ICU, bed capacity, which was already short of the review recommendations and below the European average before Covid-19. This crisis has underlined just how important ICU capacity is. The critical care community has made an enormous contribution to staff reallocation to ensure a temporary increase in ICU capacity at this time. However, this is a short-term surge and is not sustainable. Can the Minister outline his plans for additional recruitment of critical care staff and the provision of long-term, sustainable ICU bed capacity?

Despite the premium paid by the State for the use of private hospitals, they have remained at a very low bed capacity of approximately one third on average over recent months. These private beds were opened on a temporary basis during the crisis but they need to be retained for public use to ease the recovery of our health services as routine care resumes. Will the Minister comment on what the new agreement with private hospitals will look like after the current agreement ends next week?

Hospital capacity is not reliant on beds alone, as other Deputies have noted. It depends on a range of factors across the health system, including primary care services, social care provision and staffing. There are calls to open up more positions for non-consultant hospital doctors, NCHDs. Many junior doctors answered Ireland's call to return home during the crisis. As the Minister said, this is a once-in-a-generation opportunity to effect real change. We now have more junior doctors in this country than there are vacancies but getting people to come home is only half the battle. Many who did return are facing the prospect of unemployment because there are not enough positions and they cannot emigrate because of the travel restrictions. We need to ensure that junior doctors are encouraged to stay by opening up more positions in NCHD training programmes so that every person who returned to work in our hospitals during this crisis can be hired. Will positions be offered to those junior doctors and will more places on training programmes be offered to ensure longer-term job security and progression?

Social care provision is equally vital to improving our overall hospital bed capacity. Before this crisis, on any given day there were around 700 people across Ireland in delayed discharge from hospital while awaiting home care packages. Will we be reverting to this same mismatch? Will the Minister commit to bringing forward the long-promised work of introducing a statutory right to home care provision? Will he provide an update on the timeline for that process having regard to any changes caused by the Covid-19 crisis?

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