Stephen Donnelly (Wicklow, Fianna Fail) | Oireachtas source

I move amendment No. 2:

To delete all words after "That Dáil Éireann:" and substitute the following:

"notes that: — as of end January 2022, there were 731,797 people on 'active' waiting lists for scheduled care services in hospitals, and 893,043 people on hospital waiting lists overall;

— the active waiting list figure of 731,797 includes people waiting for an appointment for their procedure or their first outpatient consultation, as follows:

— Inpatient Day Case: 77,818;

— Outpatient Day Case: 625,513; and

— gastrointestinal scopes: 28,466;

— the consolidated high-level figure of 893,043 includes the active list plus:

— patients under surveillance or receiving a course of treatments who have received their first treatment but will require further treatment;

— patients who have received an appointment for their procedure within the next six weeks;

— patients who are receiving treatment through an outsourcing or insourcing arrangement; and

— patients who temporarily cannot proceed with their care for clinical, personal or social reasons;

— the 2022 Waiting List Action Plan, which was launched on the 26th of February, allocates €350 million to the Health Service Executive (HSE) and the National Treatment Purchase Fund to reduce waiting lists by 18 per cent this year, which will bring the number of people waiting to their lowest point in five years;

— projections for 2022 show that over 1.5 million patients will be added to active waiting lists this year, that many people understandably stayed away from the health service during the Covid-19 pandemic and, as these people come forward for treatment, it will place huge additional demand on health services;

— under the 2022 Waiting List Action Plan, the health service will:

— deliver urgent additional capacity to treat 1.7 million people in 2022;

— introduce maximum wait time targets to ensure that the vast majority of patients do not have to wait more 12 months for any hospital procedure, or 18 months for an initial assessment, by the end of this year; and

— offer treatment to those waiting over six months for 15 high volume inpatient and day case procedures, including cataracts and hip and knee replacements;

— capacity continues to be built into the health service and this Government has allocated €21.7 billion to the health budget in 2022 (current and capital) – an extra €6.8 billion over the original allocation in the budget for 2018 – to enable the development of more capacity;

— permanent adult critical care capacity is now 301, up from a baseline of 255 beds in early 2020, an 18 per cent increase;

— new development funding enabled more than 800 permanent acute beds to open in 2021, and 347 additional acute beds are funded to open this year to bring capacity to 1,176;

— 51 of 96 new Community Health Networks have been established since 2021, with 1,700 staff either recruited or in advanced recruitment;

— there are 147 primary care centres open nationally (nine opened in 2021) with a further 24 to open in 2022;

— the general practitioners (GP) direct Access to Diagnostics scheme went live in January 2021 with over 138,000 radiology scans delivered and 17,000 radiology scans were completed in January 2022;

— despite the challenges of Covid-19, over 1 million patients/clients were seen across the main primary care therapies (speech and language therapy, occupational therapy, physiotherapy, psychology and dietetics) in 2021;

— specific measures have been developed to tackle waiting lists in primary care psychology, which has since enabled more than 1,600 additional young people to avail of the primary care psychology service and access necessary supports;

— the healthcare workforce has grown at the greatest rate ever in the history of the State in 2020 and 2021 with increases across all staff categories; the total number of HSE staff as at end 2021 was 132,323 whole-time equivalents (WTE); 2020 saw an increase of 6,357 WTE and 2021 an increase of 6,149 WTE – these are the largest and second largest annual increases in staffing since the foundation of the HSE; nursing and midwifery increased by 3,372 in 2020 and 2021;

— health and social care professionals increased by 2,225 in 2020 and 2021;

— medical and dental professionals increased by 1,256 in 2020 and 2021;

— patient and client care professionals, including healthcare assistants, home help professionals and paramedics, increased by 2,323;

— the Government has invested €195 million in 2022 alone to expand primary care capacity through the Enhanced Community Care programme, and some 3,500 new primary care staff will be recruited under the programme by year end, with 1,700 of these either recruited or in advanced recruitment as of early February;

— the number of Non-Consultant Hospital Doctors in formal training places has increased by 309 in the past year to 3,988, and by over 800 in the past four years;

— there are over 300 WTE consultants in post above December 2019 levels;

— the health service are recruiting the first ever Consultants in Public Health Medicine (CPHM) under the ambitious public health reform plan – 34 posts were advertised before end 2021 and it is intended that these will be recruited by mid-2022; by end 2023 all 84 intended CPHM positions should be filled;

— Budget 2022 secured funding for an additional 10,000 WTE;

— the Government has increased annual expenditure on general practice by 40 per cent since implementation of the 2019 GP Agreement, providing for increased fees to GPs and additional services, fully funded by the State, to patients;

— a comprehensive review of general practice, to ensure that it remains at the centre of the delivery of healthcare and can continue to provide services to all patients in their communities in a sustainable manner, will commence this year;

— the Government has supported increased funding for Information Communication Technology (ICT) by 50 per cent over the past two years; total investment in ICT and eHealth (capital plus revenue) is now €333 million, as compared to €222 million in 2019;

— capital funding is €130 million for 2022, an increase of €35 million since 2019, and revenue funding has increased significantly to facilitate the hiring of additional staff and expertise and to provide additional funding for cyber resilience;

— an additional 200 staff for the core ICT team at the HSE (Office of the Chief Information Officer) were hired in 2021 and funding has been provided to recruit a further 200 in 2022;

— work on the HSE's integrated financial management system, which is an extensive multiannual programme of work, is progressing;

— Individual Health Identifiers (IHIs) were deployed extensively during the Covid-19 vaccination programme, where they were used as the primary identifier for vaccination records, and there are plans to deploy IHIs more extensively in 2022;

— the Government is fully committed to the introduction of Regional Health Areas (RHAs) and had paused progression on the introduction of RHAs in mid-2021 for six months in light of the intense pressures experienced by the health service caused by the May 2021 cyberattack and the Covid-19 pandemic;

— the Government has since resumed work at pace on this health and social care system reform;

— the Government's introduction of RHAs will establish them as regional service delivery structures with appropriate devolution of corporate functions and responsibilities;

— RHAs will reduce management tiers in the health service by establishing them as single management structures across primary, community, and acute healthcare;

— this reduction in management tiers has already begun with the dissolution of hospital group boards at the end of 2021;

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

— the work programme to implement RHAs will be comprehensive and will include reforms to the health and social care system's governance, finance, workforce and human resources, data and capital infrastructure structures;

— the implementation of RHAs is being informed by health and social care professionals via the ministerially established RHA Advisory Group;

— work is progressing to develop elective hospitals for planned care and operations in Cork, Galway and Dublin; in December 2021 the Government agreed, subject to the necessary approvals and requirements under the Public Spending Code being met, a new National Elective Ambulatory Care Strategy;

— the development of additional capacity will be provided through dedicated, standalone elective hospitals in Cork, Galway and Dublin;

— subject to the necessary approval processes under the Department of Public Expenditure and Reform's Public Spending Code, it is hoped to bring a detailed plan to Government in the second quarter of this year; and

— the development of elective hospitals will allow for as many as 940,000 patients to be seen/procedures carried out annually, including 175,500 in Galway and 180,000 in Cork; acknowledges: — the Publication of the Sláintecare Implementation Strategy and Action Plan 2021-2023 Progress Report 2021 which noted 200 of the 228 deliverables in 2021 were on track, or progressed with minor challenges; and

— the full embedding of the drive for universal healthcare across both the Department of Health and the HSE through the establishment of a new Programme Board, co-chaired by the Secretary-General of the Department of Health and the Chief Executive Officer of the HSE, reporting directly to the Minister for Health, and comprising the senior management teams of the Department and HSE; and supports the continued reform of the health service; development of Regional Health Areas; and continued expansion of permanent capacity to meet the needs of patients."

Ba mhaith liom buíochas a ghabháil leis na Teachtaí Dála ar fad as a rún faoi liostaí feithimh. Tá an iomarca daoine ag feitheamh ró-fhada do chúram in Éirinn; fir, mná agus páistí timpeall na tíre san áireamh. Bhí siad ag feitheamh ró-fhada roimh Covid agus tá siad fós ag feitheamh ró-fhada. Tá sé mar thosaíocht agam agus ag an Rialtas go bhfuil fáil ag daoine ar chúram ceart in am.

I thank the Deputies for their motion on waiting lists. Too many people are waiting too long for care in Ireland. They were waiting too long before the Covid pandemic and they are waiting too long today. Providing people with timely access to care is a top priority for me and for the Government. The programme for Government commits to the introduction of universal healthcare, that is, a public health service that provides people with the care they need when they need it. Despite the challenges posed by Covid, we are delivering on that commitment and considerable progress has been made in modernising Ireland's health services and models of care.

The years 2020 and 2021 saw the two largest increases in the workforce since the HSE was established. We have also seen the biggest increases in hospital bed numbers, including acute ward and critical care beds. Last Friday, I launched our 2022 waiting list action plan, which builds on the success of the waiting list initiative in the final three months of last year. It is part of a new multi-year approach to making sure people can access care when they need it.

As Deputies opposite have rightly said, hundreds of thousands of adults are waiting too long for care. About 100,000 children and adolescents are also waiting too long for care. As I am sure my Dáil colleagues have, I have met and spoken to a lot of patients and families, including a lot of Mums and Dads of children. We all know these long waits cause enormous distress, pain and discomfort. We all have a responsibility to do better and that is why I decided to allocate an access to care fund of €350 million and why I established a waiting list task force to ensure delivery. As I said, the waiting list plan is supported by a dedicated fund for this year of €350 million. It has been developed with expert input from clinical leaders. The plan shows how the money will be used. We are not trying to reset to where we were before the pandemic, because before the pandemic our waiting lists were too long. We want to improve and transform access to care. The pandemic resulted in many people, understandably, not coming forward for the care they needed due to concerns about contracting the virus. Others were unable to access non-urgent care due to the pressures on our hospital system. As these people come forward, we are seeing and we will see an understandable additional demand on our health service.

Projections for this year are that a record 1.5 million patients will be added to active waiting lists this year. This is well in excess of the underlying capacity of the HSE to meet demand from its core activity. Without this €350 million access to care fund and the associated plan, the projections I have are that those actively waiting would go up from about 720,000 at the start of this year to over 1 million by the end of the year. The waiting list plan details how we intend to ensure that 1.7 million people are treated and removed from the waiting lists. The plan would see about 470,000 people taken off the lists. This would ensure that the numbers waiting do not increase this from 720,000 to over 1 million this year. It ensures that the numbers will fall from 720,000 to about 590,000, a fall of about 18% that would represent the lowest waiting list levels in five years. By the end of this year we aim to have treated or offered treatment to nearly all of the 75,000 patients currently on active inpatient or day case waiting lists. In other words this includes those scheduled for procedures. Every patient waiting more than six months for 15 high volume procedures will receive an offer of treatment by the National Treatment Purchase Fund, NTPF, and as the year goes on we will expand that list of 15 procedures. These 15 procedures currently include: cataracts; cystoscopies; hip replacements; knee replacements; skin lesions; varicose veins; angiograms; tonsillectomies; and more. Colleagues will be aware that the list is in the waiting list plan.

At the same time as ensuring much quicker access for procedures, we have to tackle the long waits for outpatient appointments. We are all contacted about this by constituents and as we know, some people are waiting years just to see a consultant. This is not acceptable so what are we doing about it? The waiting list action plan for this year seeks to ensure that by the end of the year, no one is waiting more than 18 months for an outpatient appointment. We have to go much further than that and ultimately the Government target is that no one should wait more than 12 weeks for a procedure and that no one should wait more than ten weeks for an outpatient appointment. However, it will take time and as was rightly said by Deputy Cullinane, there have been decades of underinvestment and years of missed opportunities to get this right.

Our work on waiting lists will be complemented by ongoing commitment and investment in building permanent capacity in the public health service to eradicate this gap between ongoing demand and what the HSE is able to supply year on year. This year the health service will receive €21.7 billion in net funding. On top of large levels of investment, we are doing everything in our power to make sure that we have even more clinicians on the front line. We are investing in more beds, equipment and technology, while reforming clinical pathways and providing care closer to the home. Since the start of 2020, over 12,500 full-time staff have been added to the workforce, as well as thousands of staff who were hired to run the vaccine and testing and tracing programmes. This is a 10% increase on the 2019 staffing levels. Substantial investment in the ongoing expansion of the healthcare workforce is in the budget for this year. As outlined in the programme for Government, the Government fully intends to implement regional health areas, RHAs, which will include reforms to the governance structure, financial management systems and strategic workforce planning across the country. As Deputies will be aware, at the end of last year I stood down the hospital group boards, which was a clear acknowledgement that the current structures are changing. I expect to be bringing a memorandum to Government for decision on RHAs in the near future. A detailed implementation plan is being put together by the Department and the HSE with input from a new RHA advisory group, led by Leo Kearns, and that group has started to meet.

Many countries face huge challenges with waiting lists since the pandemic and I have looked at some of the figures in neighbouring jurisdictions. In Northern Ireland, for example, there are significantly more people per capita waiting for an outpatient appointment than there are in the Republic. When it comes to inpatient and day case procedures, again adjusting for population there are about two and a half times more people waiting in Northern Ireland than there are in the Republic. The point is that the pandemic and the pressures have hit jurisdictions across the world and we are all having to deal with significant pressure. The challenges we are facing here are not unique but that is of no comfort to those who are waiting for care. The waiting list problem has been building for years and I am committed to deploying every resource and idea we can to fix that. No one has a monopoly of wisdom on how to fix this. I am interested to hear from Deputies across the House on the kind of initiatives that should be deployed nationally and locally. I know Deputies will have excellent ideas on the reforms, investment and targeted changes that need to be made in their constituencies..

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