David Cullinane (Waterford, Sinn Fein) | Oireachtas source

I move:

That Dáil Éireann:

notes that:

— there are now 1.34 million people on some form of health waiting list;

— there are 893,043 people on hospital waiting lists as of February 2022;

— there are 226,966 people on diagnostic waiting lists for CT, MRI, and ultrasound scans as of December 2021;

— there are 224,631 people on primary and community healthcare waiting lists for mental health, disability, older person, and general community healthcare services as of September 2021; and

— there is a crisis in general practice and many private health and social services, such as in child psychology, which is causing unprecedented and undocumented waiting lists and difficulties for accessing primary and community services outside the public sector;

further notes that:

— the Government has produced a waiting list plan without a strategy for the health service workforce recruitment, retention, and wellbeing crisis;

— health and social care workers have been through an extremely difficult two years and are burned out;

— one in five consultant posts are vacant and the Government have not resolved even minor issues for doctors in training, such as paying them properly when they are deployed to a new training location, ensuring that breaches of the European Working Time Directive are resolved, or ensuring they receive rotas in a timely fashion;

— the Government has set out recruitment targets which are not realistic and were missed by 60 per cent in 2021;

— targets for new acute inpatient beds over 2020 and 2021 were missed by 40 per cent, and according to bed plans detailed in the Irish Times on 22nd February, 2022, they will not be reached by the end of 2022;

— 60 per cent of additional funding committed in Budget 2021 to home support hours was unspent due to workforce shortages and a failure to recruit home care workers; and

— the Government's new waiting list plan does not provide any additional funding above pre-committed levels to expedite capital projects for ward and theatre expansions or new diagnostic equipment;

condemns:

— the Government's slow pace on healthcare reform and moves to water down accountability structures; and

— the Government's plan for Regional Health Areas (RHAs) which may involve only minimal structural changes, no devolution of corporate functions in recruitment and capital planning; and

calls on the Government to:

— fully deliver the promised bed capacity, particularly acute inpatient beds and community recovery beds, and provide for extensions of surgical theatre and diagnostic capacity within the public system;

— produce a health and social care workforce plan, including realistic and transparent multi-annual training and staffing level targets and an assessment of service staffing need;

— train more doctors, nurses, and allied health and social care professionals in line with service need and give graduates a guaranteed job offer, including a provisional offer for those who intend to travel temporarily abroad for training or work experience;

— fully resource and implement safe staffing levels in all hospitals, including emergency departments and community settings;

— undo pay inequality for new entrant consultants while removing private practice from public hospitals to make the health service more competitive as an employer to fill the vacant consultant posts;

— honour public sector pay commitments and fully implement the 2019 Labour Court recommendations on the terms and conditions of nurses and midwives;

— establish RHAs as transparent and accountable delivery structures with the significant devolution of corporate functions and responsibilities in recruitment and capital planning, resourced and empowered to tackle waiting lists, and hold them to account for it;

— reduce management tiers in the health service by establishing RHAs with a single management structure across primary, community, and acute healthcare and prepare for the statutory establishment of RHAs;

— ensure the integration of healthcare services across primary, community, and acute services on the agreed geographic basis;

— expedite and additionally resource the development of essential eHealth and ICT upgrades and reforms, including an integrated financial management system, individual health identifiers, summary care records, a centralised referral system, and an integrated waiting list management system; and

— publish transparent monthly updates on the number of patients added to and removed from waiting lists, including the reason why they were removed, be it treatment, removal of duplication, removal following non-response to validation, or otherwise.

I am sharing time with a number of colleagues. Health waiting lists, as conceded by the Minister for Health, Deputy Donnelly, are dangerously high. The problem is not only the number of people on waiting lists, but the length of time people are on them. There are 893,040 people on an acute hospital waiting lists, 731,797 of whom are on active waiting lists. There are 226,966 people waiting for a diagnostic assessment and 224,631 more people are on primary and community health waiting lists across mental health, disabilities, older persons and many other areas. That is an astounding 1.34 million on some form of health waiting list. Ten thousand more people were added to our acute hospital waiting lists in January of this year.

This month, 10,000 people were left on hospital trolleys in corridors across acute hospitals in this State. In January of this year, 1,100 people over the age of 75 were on a hospital trolley for more than 24 hours in acute hospitals. In one month, 1,100 people over the age of 75 were left on a hospital trolley for more than 24 hours. That is astounding. People are now waiting for GP access sometimes for days, sometimes for weeks. Out-of-hours services are patchy in some areas and non-existent in others. All of this, as we know, is adding to the pressure in our acute hospitals. If people cannot get access to GP services, they are left with little choice but to go to our emergency departments in acute hospitals.

Dentists are leaving the dental treatment service scheme at a rate of knots. There are long waiting times for orthodontic treatment and for children waiting for dental treatment under general anaesthetic. Tens of thousands of children with disabilities are waiting for access to speech and language therapy, occupational therapy, physiotherapy and child psychology. There are long waiting times across the board. In audiology, children and adults are waiting a long time for hearing tests and hearing aids. Children are waiting for grommet insertions. All of these are examples of long waiting times across the system. We also know that the National Ambulance Service is chronically understaffed and needs to be resourced.

The Minister last week published his waiting list strategy. I pointed out at the time that there was no additional funding beyond that allocated through the budget. It was a repackaging of measures that were already provided. The only way to tackle waiting lists is to put capacity into our hospitals. I acknowledge that additional capacity was put in over the past two years. I welcome every single additional cent that is put into our health service. I welcome every additional staff member, consultant, nurse, healthcare assistant and home help worker who is employed in the public service. I support, welcome and celebrate such additions. However, the Minister knows as well as I do that we have had decades of underinvestment that mean many hospitals do not have the inpatient beds to admit patients to hospitals in the numbers who need it. We have a deficiency in community and step-down beds in some areas, which means patients cannot be discharged quickly enough. The Minister also knows there are problems with surgical theatre capacity and diagnostic capacity, not just in cases of children with scoliosis but right across the board.

The HSE service plan, which was announced today, refers to more reporting structures and more bureaucracy when what we really need is fewer tiers of management and more accountability. That is what we need. We must deliver regional health areas that actually devolve responsibility to those regional health areas and onto the floors of hospitals to make hospital managers more accountable. We need to take a zero tolerance approach to waits at emergency department. One of the things this motion calls for is a job guarantee for all health graduates who come through training institutions in this State. The Minister will accept that we need to train more people. We need a workforce planning strategy. We need to recruit more staff and we need to retain them.

I read the Minister's amendment to the motion, which is almost four pages long. What we need is less spin and less spoofing. We need more substance, efficiency and capacity. Without the changes that are necessary, the Minister will be left with more fake targets and missed targets, as previous Ministers have found out to their cost.

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