Stephen Donnelly (Wicklow, Fianna Fail) | Oireachtas source

I move:

That a sum not exceeding €19,897,700,000 be granted to defray the charge which will come in course of payment during the year ending on the 31st day of December, 2020, for the salaries and expenses of the Office of the Minister for Health and certain other services administered by that Office, including grants to the Health Service Executive and miscellaneous grants and that a sum not exceeding €30,000,000 be granted by way of the application for capital supply services of unspent appropriations, the surrender of which may be deferred under Section 91 of the Finance Act 2004.

As I stand in the House for the first time as Minister for Health, I am deeply conscious of the impact of Covid-19 on the people living in our country. We have seen our safe, well-ordered worlds of routine turned upside down. We have lost beloved friends, family members and neighbours and have been unable to mourn them as we want to. We have asked more and more of the people working on the front lines and behind the scenes in our health service. We have asked them to work relentlessly in the face of what must have seemed like endless days and nights. I thank every one of them from the bottom of my heart for all they have done. I know that the people they have worked so hard to care for do too. I thank our radiographers, porters, healthcare assistants, midwives, doctors, ambulance personnel, receptionists, nurses, and those in the hundred other professions that have cared for patients and kept our hospitals and other health facilities running so well in the face of this awful disease.

We need to repay their hard work, and that of many others outside the health service, by continuing to listen to the public health advice. This disease has not gone away. It is highly infectious and many people in our society are especially vulnerable to it. As we heard last night from Siobhán Killeen of the Dublin GAA team, even people who are fit and healthy can become very ill. We know that, even after people have recovered from infection, they can face weeks or months of after-effects. We have to keep up the good work or we risk losing the ground so many have fought so hard to gain.

It is, of course, very important that we reopen society and our economy but we cannot do so at the risk of another wave of infection around the country. I ask people to follow the advice of the experts, who have guided us very well so far. We still need everyone to wash their hands well and often, to maintain their physical distance from others, to try to limit their contacts with others, to observe cough and sneeze hygiene, and to wear a face covering where physical distancing is not possible. We need everyone to remember the symptoms of Covid-19 and to contact a GP immediately if they feel sick.

Covid-19 has affected every part of society, including our finances and previously agreed budgets. This afternoon, I seek the House's approval for this Revised Estimate for the 2020 Vote for my Department, Vote 38, to ensure the health service continues to be funded in 2020 to meet the significant and unprecedented challenges of Covid-19 and to ensure the funding of much-needed health and social care services for our people.

The original Revised Estimates for Public Services for 2020 were published in December of last year and included a total of €17.9 billion in Exchequer expenditure for Vote 38. Following this, the national service plan for 2020 set out the totality of planned services for the year, based on the December allocation. This included additional provision to advance Sláintecare objectives in 2020 and other key development priorities.

The delivery of the plan for 2020 has been severely affected by Covid-19, as the health services responded in an unprecedented fashion to the pandemic and incurred substantial additional costs in so doing. As a result, the Revised Estimate presented today provides an additional €2 billion to health in 2020. This brings the new adjusted total for the health Vote to €19.9 billion.

Today's debate has a very specific purpose. Approval of these Estimates provides the legal basis for the increased expenditure being incurred by the health Vote and will ensure that the health service is funded in the months ahead. The scale of expenditure to date and measures taken in response to Covid-19 and the overall impact of Covid-19 on the finances of the health system means that the passing of this Revised Estimate is essential to ensure compliance with the four-fifths expenditure rule.

The figures presented to the House represent the expenditure approved by the previous Government for Covid-19 measures to date. It does not represent the totality of the costs of Covid-19 for this year, nor an estimate of same. Significant further investment will be required this year in areas such as personal protective equipment, PPE, acute bed capacity and planning for winter 2020. We will also have to continue to assess the impact of factors such as the potential increase in those qualifying for medical cards due to economic developments and a potential reduction in private charge income to hospitals.

Today's debate is also an opportunity to begin a new conversation about our health service and its funding. The pandemic response has highlighted many strengths and positives in the health service. However, we know that our health service is challenged in normal times and was not best positioned to deal with the pandemic. Poor access to primary and community services, capacity deficits in acute hospitals in areas such as critical care and weaknesses in the governance and integration of services were handicaps that the health service has moved rapidly to deal with as best as it could.

We need to build on this work and in doing so ensure the health system has the capacity and capability to meet future demand. We know for sure that future demand will be influenced by a growing and ageing population, but as recent months have proven, we must also be ready for unexpected public health threats. A stronger more resilient health service is a national priority. The pandemic response has required the implementation of many of the key principles in Sláintecare, a single-tier health system for Covid-19 patients, care provided at home or in the community instead of in hospital, and telemedicine, virtual consultations, e-prescribing and other e-health initiatives. The benefits of these principles have now been demonstrated and we must apply these lessons across the system.

In recent months there has been significant investment and enhancements in capacity and staffing across the health system. This too needs to be sustained, as major additional investment will continue to be required to increase the capacity of the public system to better meet the health needs of citizens. As the reopening of the economy and society progresses, the many challenges that the health system faced before the pandemic still exist, but now must be tackled in a new and at times more challenging context. One of the most pressing tasks is to resume the operation of health and social care services in the face of a, thankfully, much reduced rate of Covid-19 infection. This will involve on-the-ground assessment and changes in clinical practice to prevent and control infection. It will take some time to clarify what level of activity will be possible to achieve in each of these settings. While the HSE is working on a clinical roadmap for the delivery of non-Covid services in a Covid environment, it will be necessary to reassess the targets set out in the national service plan. Capacity in many services will remain reduced and demand is likely to be higher than normal, both because elective activity was postponed during the crisis and because demand for many services may be higher than pre-Covid levels. Meanwhile, we will need to be vigilant in implementing the public health surveillance controls to avoid further spikes of Covid infections, while being prepared to deal with any upsurge in healthcare requirements if, as a country, we are not successful.

The programme for Government sets out the Government's vision to address both the long-standing and new challenges. Building on the Sláintecare vision and reflecting on the Covid-19 pandemic response, this Government has set as its mission the introduction of universal healthcare. The key building blocks to achieve this include the delivery of more care in the community, increasing capacity in the community and in acute hospitals, with an immediate focus on critical-care capacity, supporting the healthcare workforce and implementing e-health.

The programme also makes specific provision for enhanced care for older people and provides for the establishment of a commission on care and supports for older people. The delivery of this programme will require major investment in the public health service through both current and capital expenditure. However, it will also require major reform. This reform will not just be about how we deliver health services but also how we fund and invest in them. The programme for Government identifies the need for generally improved budgeting for demographic-related costs, which is particularly relevant to health services. Ministers will be required to produce service improvement and reform plans. As set out in the programme, spending on health will be prioritised for improved budgeting.

Returning to the Revised Estimates and the measures contained within, in support of the national action plan on Covid-19, €2 billion in additional gross expenditure has been approved to date for specific measures. This funding is incorporated in the Revised Estimate. Approximately €1.2 billion in additional cash has been advanced to the HSE to the end of June to meet the ongoing costs of managing the pandemic. As a result, my Department estimates that, based on current trends, the health Vote will reach the ceiling under the four-fifths rule for expenditure by August. Hence, this request to the House to endorse the Revised Estimate so as to resource measures to tackle Covid-19 and continue to deliver a broad range of health and social care services.

I will now outline the key health measures delivered to date under the national action plan on Covid-19. Further detail has been provided to Deputies in the briefing pack prepared by my Department. The first measure relates to testing and tracing. At the core of Ireland's Covid-19 response is a commitment to robust and continuing public health actions, including testing levels, contact tracing, modelling and surveillance to estimate the potential impact, communicating evolving public health messages and maintaining public awareness so that we can adapt our public health response as flexibly as we need to.

The national public health emergency team, NPHET, has recommended that the health service needs to have a testing capacity of 100,000 tests per week for the remainder of 2020. The HSE has put this capacity in place with 90% of all tests complete from end-to-end in three days or fewer.

The plan includes support for nursing homes and home support. The Revised Estimate makes provision for the temporary assistance payments scheme, which provides support to private and voluntary nursing homes to ensure that they can continue their role in the overall public health response to Covid-19. The nursing home sector cares for one of the most precious and vulnerable groups in society, and our goal is to protect older people wherever they are living. Priority actions include heightened infection control measures, supporting staff working in nursing homes, and ensuring their safety and health as we continue to deal with this pandemic.

In addition to financial support, the HSE is also providing substantial non-financial support in the form of PPE supplies, temporary accommodation for nursing home staff and through the crisis response teams, including deployment of HSE staff. There is also considerable support in the form of telephone support, infection prevention and control, IPC, support and public health support provided to nursing homes.

Revised arrangements with GPs were established to ensure that the people had access to triage services for Covid-19. I compliment GPs and everyone who works in general practice on how they have responded. Dedicated Covid-related respiratory clinics were set up in GP practices, and telephone triage was set up to facilitate remote access to services in line with public health advice. The clinical management of patients with mild symptoms of Covid-19 was shifted from hospitals to home and community settings. These arrangements were for an initial period of three months. However, key measures have been extended until 10 August 2020.

With regard to caring for people in acute services, the initial focus for acute hospital preparedness was on building up surge capacity to ensure the maximum number of critical care and general acute beds were available to cope with the potential number of cases requiring hospitalisation.

Baseline permanent adult critical care capacity in Ireland was 255 beds. Funding for a further 40 adult critical care beds, and two paediatric critical care beds, was provided as part of the response. In addition to the funding for increased critical care capacity, the response to Covid ensured funding for an additional 324 general acute beds.

The acute hospital system and critical care service have coped during this crisis.

While bed occupancy reached 280 critical care beds at the peak, the additional demand for critical care was met by surge ICU capacity. Thank God we did not see the scenes that some of our neighbours in Europe did with people needing serious acute care in hospital car parks.

The HSE secured 100% of the capacity of the private hospitals for an initial period of three months. As of Monday 22 June, 11,531 public patients have been treated as inpatients, 46,298 as day cases, 44,865 as outpatients while 71,967 public patients have been provided with diagnostics in private hospitals under these arrangements. This agreement concludes today, 30 June, and work is ongoing about future arrangements with the private hospitals.

The national action plan provided for a significant expansion of the health workforce. The HSE pay budget has increased by €490 million in these Revised Estimates due to the projected increased salary, agency, overtime and absenteeism costs associated with the response to the Covid emergency. The number of whole-time equivalent staff in the HSE has grown by 3,271 this year to the end of May. My officials are engaging with the HSE on staffing requirements for the remainder of the year to meet Covid-19 and non-Covid-19 demand.

As part of the response to Covid, there has been investment in the expansion of community care places, including those for persons with a disability, across the country. This includes advancement of projects planned in line with the disability de-congregation programme, as well as upgrade and refurbishment work on suitable facilities. In addition, arrangements were made for healthcare staff needing to self-isolate. These have largely been managed locally by the community healthcare offices of the HSE. Centrally, the main isolation facility established was Citywest. The HSE has decided to step down this arrangement and has triggered the break clause. The agreement will conclude on 22 October.

A key focus throughout the pandemic has been in the area of infection, prevention and control. In a time of global shortages and intense competition for personal protective equipment, PPE, the HSE, with the support of my Department, IDA Ireland, the Department of Foreign Affairs and Defence and others, managed to rapidly develop global and domestic supply of PPE. PPE will represent one of the single biggest items of expenditure associated with the Covid-19 response. My Department advises that HSE modelling has identified that the overall cost of PPE in 2020 could be as high as €1 billion. My Department and the HSE are engaging on this matter.

The additional funding allocated to the health Vote has allowed for a rapid and targeted response to implement the measures outlined in the national action plan. We remain in a pandemic and the scale of the challenge for the health services is unprecedented. Further investment will be needed, such as additional PPE, an enhanced 'flu vaccination programme for next winter, increased capacity and alternative arrangements with private hospitals. Such measures are under review by my Department in collaboration with the Department of Public Expenditure and Reform. The Government will be asked to determine additional funding allocations where necessary. Also subject to further review and deliberation are the achievability of national service plan savings, the loss of hospital income as a result of Covid-19, additional costs associated with recommencing non-Covid healthcare in an environment of physical distancing and heightened infection control and additional initiatives for the winter.

The health system responded quickly and efficiently to the Covid-19 emergency. Additional spending has facilitated necessary and rapid introduction of testing, provision of essential PPE, enhanced support to critical health services and introduction of additional hospital capacity and community services.

Existing oversight structures between the Department of Health, the Department of Public Expenditure and Reform and the HSE, including the health budget oversight group, along with new structures and processes, have facilitated timely decision-making during the pandemic while also ensuring high standards of governance are maintained. These structures ensure this significant investment is approved, monitored and reported in line with agreed sanctioning processes and financial procedures.

I commend the Revised Estimates for the health Vote to the House. It represents a significant but essential investment in Ireland’s pandemic response. Ireland has been successful in flattening the curve of coronavirus transmission. This pandemic has been an unprecedented challenge, met with great solidarity and fortitude by the people. We are going to need that continuing sense of community and responsibility as we take our first steps into a reopened country, travel around Ireland and learn to live with Covid-19. We all need to use our own judgment and take personal responsibility for protecting, not just ourselves, but those around us. I am asking everyone to be aware of the risks, keep informed about the disease and where it is in our community. People should check our online Covid-19 data hub before they leave the house, like they do with the weather. One should keep a log of the people one meets so that public health officials can contact them if they need to. We are not out of the woods yet. If we stay the course together, however, there will be a day when we are.

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