Stephen Donnelly (Wicklow, Fianna Fail) | Oireachtas source

I welcome this opportunity to address the House on the winter plan which was published last week. Every winter, our healthcare system faces increasing pressures, resulting in difficulties for many people and many patients, particularly older people, in accessing services in a timely way. This becomes most evident, as we know, in the hospital emergency departments in the form of overcrowding, longer waiting times and patients receiving care on trolleys.

Before Covid arrived in Ireland, we already had the longest waiting lists in Europe. Last winter saw the highest trolley counts since records began. That was our starting point. Since March of this year, Covid has caused a substantial increase in waiting lists due to the necessary pausing of many aspects of healthcare. Covid has also caused a very serious fall in our healthcare capacity, due largely to the need for extra infection prevention and control measures. In short, it takes longer and it costs more to provide the same care to the same patient.

For all these reasons, this winter is likely to be the most challenging time our health services have faced in many years. The winter plan is one of the ways that we are responding to this challenge. None of us wants to see patients and staff enduring overcrowded conditions. The problems giving rise to these challenges are varied. Many are rooted in the way services have been historically delivered.

This is why a strategic approach was agreed on an all-party basis to bring about long-term structural reform to our healthcare system, namely, Sláintecare. I re-emphasise the Government’s and my commitment to the implementation of Sláintecare. I know colleagues recognise, and the Sláintecare report itself acknowledges, that these deep-seated reforms, which we need to make, take time to implement. There is no magic formula to immediately fix the various waiting list and trolley issues that we see. Nonetheless, Sláintecare is the strategy we are pursuing and the winter plan is designed according to Sláintecare principles and, I am very happy to share with the House, in a way that substantially accelerates the implementation of Sláintecare.

I welcome the publication of the plan. It is ambitious. Its aim is to deliver safe, efficient and effective services this winter and to do this by reorienting service delivery towards primary care and community-based services. I particularly welcome the HSE's undertaking to reduce the number of patients receiving care on trolleys in emergency departments and the improvement of patient experience times while they are in emergency departments. Both of these objectives are critically important to keeping patients and staff safe in response to Covid-19 this winter.

Last winter, more than 620,000 people visited emergency departments. While anybody who needs emergency medical treatment should, of course, receive it, it is generally accepted among experts that there are many patients who could be cared for in alternative settings other than hospital and who would indeed be better cared for in non-acute settings. Therefore, it is a central part of this plan to provide alternative pathways of care where they are appropriate. This is to ease pressures on the hospital system, including emergency departments, to speed up patient discharge and to provide patients with care as close to the home and their communities as possible and where possible. This will, of course, free up hospital resources for the patients who need to access acute care.

The Government's determination to meet the challenges of winter this year and support the healthcare system are demonstrated by the commitment of €600 million to underpinning this plan. That includes €200 million for the rest of this year and an additional €400 million for next year - that is, the 2021 part of this coming winter. The plan is designed to enable patients to be seen in the community wherever possible.

It does this by providing a better service in the community healthcare settings. The plan supports patients receiving timely care in hospitals when needed and supports patients returning home or to appropriate care settings when they are well enough to leave hospital. It does this by providing home care and step-down options.

I am particularly pleased to share with the House that there are additional supports in the plan for people at greater risk, including elderly people, homeless people, those in addiction, those with chronic illnesses and many more by allowing them to stay home while they are receiving the right level of care.

The plan provides for building capacity and resilience in the system. One of the big challenges facing us is building this extra capacity in the acute hospital system. In 2018, the health service capacity review was published. It sets out the necessity for increased acute and non-acute bed capacity right across the system in the context of major reforms being implemented in the way healthcare is delivered. These major reforms are a critical part of the plan. The plan that has been set and to which we are all working has approximately 2,590 acute beds but it is worth noting that the capacity review states that this is one end of a range and if the necessary reforms are not delivered, we would need in excess of 7,000 beds. These are essential reforms. The programme for Government commits to continuing investment in our health services in line with the recommendations of the capacity review and the commitments in Project Ireland 2040.

The winter plan provides additional health service capacity across a range of services and settings, including acute capacity, to reduce admissions and facilitate egress. Key initiatives include funding for nearly 900 acute hospital beds, nearly 500 sub-acute beds, 631 rehabilitation places and 530 repurposed community beds. Some of those are beds that have been put in place since the arrival of Covid-19 and were funded for several months through the initial Covid-19 response fund. The winter plan will continue the funding of those beds until the end of April and double the number of acute beds in the same timescale. The plan also provides for the utilisation of private hospitals for urgent complex care to reduce waiting lists and for their use in the event of a surge of Covid-19.

Many of these measures are aimed at reducing the number of those over 75 years of age who need to be treated in, or admitted to, acute hospitals. They also aim to reduce the number of patients whose discharge from hospital is delayed because of a lack of alternative care available to them. We saw that happen last winter although it was tackled with some success at the time. It must be comprehensively tackled this year.

The plan also provides additional community healthcare networks, more community specialist teams and additional acute hospital front-of-house teams. This will create the foundation and organisational structure through which integrated care can be provided locally within the community at the appropriate level of complexity. These networks and specialist teams will work closely with the National Ambulance Service to deliver end-to-end care with the aim of keeping people out of hospital or, where they are admitted, to ensure they are discharged without delay. It is anticipated in the plan that these measures could lead to a decrease of 20% in the number of emergency department admissions for people who are over 75.

Having mentioned the National Ambulance Service, I would like to put on the record my acknowledgement of the extraordinary work the men and women in that service have provided. They always do extraordinary work, but their response to Covid-19 has been nothing short of exemplary.

The plan also commits to delivering more diagnostics in the community, allowing patients to be seen closer to home and avoid going to hospital. The plan puts in place supports for GPs, including those in rural practices, to support service continuity. GP access to diagnostics has been coming up for many years. GPs all over the country are firmly of the view that they can reduce admissions to hospital and referrals to consultants and emergency departments by accessing diagnostics and bringing their own patients back to their practices to continuing their care. This winter, we are putting a substantial investment into making that happen and I hope we will see exactly the sorts of results that the GPs intend to deliver.

The plan also aims to double the existing level of home support hours to support the Home First initiative. This is designed to enable those with high and moderate levels of frailty to be cared for in their own homes. With this objective in mind, 4.7 million additional home support hours are being provided for in the plan.

A key action will be a comprehensive flu vaccination programme. The HSE has placed orders for approximately 1.35 million doses of the quadrivalent influenza vaccine as well as 600,000 doses of the live attenuated influenza vaccine, which is essentially a nasal spray rather than an injection for children aged two to 12. I remind people that the flu vaccination for these vulnerable groups is being administered for free, which is an important message and I would appreciate the help of my colleagues to get that message out to people that if they are in one of the vulnerable groups, they should approach their GP or pharmacist for a free vaccination.

Funding is also provided for waiting lists. I would like to acknowledge and support the necessary decision taken earlier this year to defer elective care. I know that this has had an impact on scheduled care waiting lists. Hospital waiting list figures are higher than at the start of the year with the inpatient day case and outpatient waiting lists 17% and 10%, respectively, higher than at the start of January. However, there are some indications of improvement which I think are worth noting. As a result of concerted efforts by front-line workers, the HSE and the National Treatment Purchase Fund, the trajectory of growth in waiting lists has been slowed since services resumed in June. There has been an almost 11% reduction in the numbers waiting for inpatient procedures since May, with early evidence that the rate of growth on the outpatient list has slowed. The HSE has actively sought to improve productivity through the increasing use of alternative work practices. This includes telemedicine, virtual clinics and other alternative settings. Private hospitals, community facilities, atypical outpatient settings, the HSE and particularly community health organisations have been innovative and deserve great credit for their response to Covid-19. They have responded with great creativity and professionalism. The HSE is also currently working to secure access to private hospital facilities for urgent and time-critical procedures for public patients.

The National Treatment Purchase Fund has resumed its activities on behalf of public patients and is currently reviewing strategies to maximise activity and benefit for patients. These include the increased use of private hospitals, funding weekend and evening work in public hospitals, and funding see-and-treat services where minor procedures are provided for at the same time as outpatient consultations. The funding of hybrid services where public and private hospitals contribute to the treatment of patients and the funding of virtual clinics and clinical validation are also included. We need, of course, to acknowledge that waiting lists are at record levels but the combined impact of this work should help to offset to some extent the awful impact of Covid-19 on waiting lists. The HSE and the National Treatment Purchase Fund will continue to work together to address this issue.

I very much welcome today's debate and look forward to hearing from my colleagues their views on the plan. The objective of the Government is to fully implement Sláintecare and I want to work collaboratively with all stakeholders and right across this House to do so. Sláintecare is not owned by this Government, it is owned by the Oireachtas and I hope to see it implemented to a great extent in the coming months and years. In the immediate term, we need to get services back up and running to at least the level they were at prior to the outbreak of the pandemic.

The winter plan is part of that process and is designed to meet the immediate challenges we anticipate this winter. With the ambitious targets in it and the funding provided by the Government, I am confident that we can make inroads into the problems in the system. I hope this is something all Deputies in the House want and will support.

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