Dáil debates

Tuesday, 28 September 2021

Hospital Waiting Lists: Motion [Private Members]


7:35 pm

Photo of Stephen DonnellyStephen Donnelly (Wicklow, Fianna Fail) | Oireachtas source

I thank the Deputies for tabling the motion and for their contributions. It is a debate we need to have and one we need to come back to repeatedly.

Some time ago, a constituent of mine in County Wicklow, Sarah, needed a hip operation. She was suffering. Much like the scenario recounted by another Deputy, she was waiting in intense, debilitating pain. She did not have private health insurance and she was told that on the public system, it was going to take two and a half years before she could be operated on.

I went to the National Orthopaedic Hospital in Cappagh to find out what was going on. The problem was not that we did not have enough doctors, nurses or operating theatres. It was that the budget allocated for buying the titanium hips was gone. We were still paying all the overheads, but because of this broken system, Sarah and many other people were not being seen. Three of the seven operating theatres in Cappagh were closed and surgeons were having their lists cancelled again and again.

When I took office, one of the first places I visited was one of our children's hospitals. I was told that right now, many children in our country who have been referred for an MRI by their GP or consultant must wait in some cases for years for that MRI. That is not acceptable. I will not stand over it. No government and no Member of the House would stand over it.

Before Covid-19 arrived here, our waiting lists were too long. They were described regularly as some of the longest and worst waiting lists in Europe. The number of patients waiting for a procedure in one of our hospitals peaked in mid-2017 at approximately 87,000 people. It has come down by approximately 12%. Today's figure is approximately 12% lower than that peak but it is still completely unacceptable. The figures were coming down. The inpatient and outpatient waiting lists were beginning to fall, but as we all know, because of the pandemic and the cyberattack, they have gone up. We have seen that a lot of planned and scheduled care unfortunately had to be delayed.

I want to be absolutely clear about this. As the threat from Covid-19 continues to recede, and, please God, it is going to keep receding, tackling the waiting lists is the greatest challenge we face in healthcare in our country. Addressing the waiting lists is my number one priority as Minister for Health. They will receive the same intense focus, attention and determination that I, my officials, the HSE and many of our partners have put up against Covid-19 and used to roll out the vaccine programme.

What are we doing? We are tackling the waiting lists in several ways and doing those all at the same time. The first thing we are doing is adding permanent capacity to the public healthcare system. We are adding that capacity in spite of the pandemic and doing so at record speed.

This year, we have added approximately 800 beds to the public hospital system so far and it is still September. We intend on adding beds right to the end of the year. That is the biggest number of beds that have been added to our public system going back several decades, as far as we can tell. At the start of last year, the number of critical care beds stood at 255. We have been adding beds all though the pandemic. By the end of this year, we intend to move from 255 critical care beds to 321.

That will be an increase of about 25% in our critical care capacity during the pandemic, which is welcome but not enough. I have secured agreement from the Cabinet that we will continue after this year and I have agreement to extend critical care capacity to 446 beds, which is very necessary and will help greatly with these waiting lists and stop the continuous cancellation of planned care that so many people have to deal with.

We are also adding to the workforce, again at a record speed, with more doctors, nurses, midwives, therapists, scientists, clinicians and specialists throughout the system. Last year, during the pandemic, saw the largest increase in the public health workforce since the establishment of the HSE, while this year will be another record year. Deputy Cullinane rightly stated we have funded just above 14,000 posts. We are on target to hit more than 7,000. While we would all like the original target to have been met, nobody last October anticipated the full year the world has seen in the context of the pandemic. In spite of the pandemic, however, and even though people have not been able to travel and all sorts of restrictions have been in place, we will see another record year in terms of increasing the workforce and we intend to continue in this vein. At the same time that we increased the permanent capacity in the HSE, we recruited, with external partners, 3,200 women and men to work in areas such as contact tracing, testing and tracing and the vaccination programme.

Consultant numbers continue to grow. In the past five years, more than 700 additional consultant posts have been filled, with more than half of them in the past two years. The number of consultants has increased over the past two years from 3,153 to 3,506. There are clear recruitment challenges, in certain specialties in particular and in particular locations. We all know that and it has to be addressed. Issues in Letterkenny University Hospital and University Hospital Kerry have, understandably, been raised during the debate and other hospitals are also finding it very difficult to recruit people. The majority of posts, however, that have been identified as vacant are currently filled under fixed-term or specified-purpose contracts. We want people full time in those roles and the new Sláintecare public-only contract will be essential to that end. In disability, mental health, home care and addiction services, there has been much progress over the past year or two. The Ministers of State, Deputies Butler and Rabbitte, will outline some of the successes and plans in these areas.

Elsewhere, we are innovating to improve how and where patients are treated. As the story of Sarah from Cappagh shows, it is not just about money and capacity; it is about using what we have as well as we can. It is about our clinicians working to the full extent of their licences. It is about ensuring that our operating theatres and diagnostic suites will not just run from 9 a.m. to 5 p.m., Monday to Friday. We have to staff them, run them longer and build and use the capacity within our public health system as well as we can. Right now, we are not doing that. There are some notable good examples but there is much opportunity to do better.

Change, as we all know, can be difficult. On my visits to the hospitals, including Our Lady of Lourdes Hospital in Drogheda in recent days, Tallaght University Hospital and many other places throughout the country, I have been meeting a galvanised, determined workforce who have been living change and innovation throughout the pandemic and who are passionate about universal healthcare, our public health system and their patients. They talk to me about a desire to continue innovating, continue changing and continue finding ways to treat patients more quickly and in their communities where possible when they need the care.

This year, we have provided funding to ensure GPs have access to diagnostics, MRIs, X-rays, ultrasound scans and CT scans. At a cost of €25 million, it has not been done before. We estimate that by the end of year, we will have funded about 140,000 additional scans, and we are getting strong feedback from the GP community on this. We are scaling up the provision of advanced nursing practitioners, one of the most exciting opportunities we have.

Advanced nursing practitioner-led teams in the community are treating and discharging a majority of patients waiting to see a consultant. In Tallaght University Hospital, for example, the urology waiting list has fallen from five years to 12 weeks, and we are going to be doing an awful lot more of this.

Third, I am launching a plan to tackle the waiting lists. In the immediate term, through the waiting list action plan, we will examine the impact of Covid-19 and the cyberattack. This is all the more necessary given that we expect hundreds of thousands of patients to come into the system between now and the end of the year. The second component of this is the development of a longer term, multi-annual waiting list plan. It will be overseen by a ministerial task force I am establishing, which will be led by my Secretary General. Targets and detailed hospital-by-hospital lists and plans are being established and it is our full intention to keep driving and investing on this until we meet the prescribed Sláintecare waiting list times for inpatient, outpatient and diagnostic care.

I welcome views on this issue from throughout the House. Sinn Féin will have been examining it in Northern Ireland, where the inpatient waiting list per capitais more than twice that in the Republic, while the outpatient list is about 70% higher than it is in the Republic. I expect, therefore, that there will be many ideas. We need to work on this together. I welcome the debate and look forward to sitting down with Deputies and figuring out how we can do everything possible to ensure men, women and children will get the care they need when they need it.


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