Brendan Howlin (Wexford, Labour) | Oireachtas source

The Labour Party will support this motion. I commend Sinn Féin on providing the House with the opportunity to address this very important issue. Any Deputy working in any constituency office is acutely aware of the pressure that is building up now. The figures set out are truly shocking. While the Covid pandemic, understandably, dominated the health focus for the past two years, the general level of our health service waiting lists is truly depressing. I am glad the Minister has acknowledged this and wants to set it right.

We should, as a collective, see how we can bring easement to our constituents and all those people who are waiting for basic diagnostic appointments and treatment.

As I said, I know that the Department of Health produces plans. It likes to produce papers, strategies and targets, and does so very frequently. An integrated plan, however, to systematically and comprehensively reduce the numbers of people waiting for fundamental and basic diagnoses and treatment requires three basic things, that is, beds, expert staff - above all - and equipment. I am under no illusion about their being a magic wand. I know how difficult it is to put all those particular things in place. Medical specialists are scarce. They are sought all over the world and bidders for their skills will offer them, certainly in the private sector, salaries well beyond the scope of our public sector. There are very well-functioning health systems across Europe, however, that actually do not pay even the level of payment we pay here. We are in competition largely with English-speaking countries, but that is a fact.

Although pay is, of course, a significant factor, working conditions and work pressures are even greater factors that inhibit us being able to recruit the staff we require and that we can actually now pay for. In many ways, that is a catch-22 situation. We need the staff to make tolerable working conditions and we cannot make the working conditions tolerable without the staff.

We made a commitment collectively that things would change post Covid. We learned that we needed an integrated acute and community system of healthcare. We have talked about it for long enough. The views on how to achieve it were set out by all-party committee of the Houses when everybody involved genuinely put their shoulders to the wheel to produce the Sláintecare document. That needs to be done quickly, however. The number of people of all ages awaiting appointments to be seen by specialists and of those waiting to be diagnosed is enormous. It is an enormous challenge to our well-being as a people and in maintaining public confidence in our country's capacity to look after the health needs of our people. That is not overstating the fact. If people lose confidence, they think that no change of Government, with all due respect to Sinn Féin, can make a difference because everybody promises they will do the Devil and all. That is why we had a concerted effort to have an integrated plan that worked. In fairness, Deputy Shortall led that and we all bought into it. It now needs to be resourced and put in place, however, and if there are obstacles to it, let us hear about them and have them removed.

There is no Deputy in this House who does not constantly deal with people on various waiting lists. I want to focus on a couple of points. The lack of child and adolescent mental health services, CAMHS, clinicians has meant that at any given time, more than 3,000 children and young people are on a waiting list to be seen by a specialist.

The Minister of State will be very aware of the difficulties in our region in the south east. We might look specifically at children's disability services. I could pick any one of a dozen or more different focused services. The model set out by the HSE is to establish children's disability network teams. Some 91 children's disability networks have been established, each with an assigned children network team. They were required to provide services for children who need specific services up to the age of 18 years.

I requested the numbers of children awaiting treatment up to last October from the HSE, which it provided. There were 9,554 children waiting for psychology services, 14,619 waiting for occupational therapy, 8,166 for physiotherapy, which we hear about repeatedly, and 12,867 waiting for an initial assessment for speech and language therapy. Having been assessed, 8,438 children were waiting for initial treatment. Some 16,838 children were waiting for access to ophthalmology services and 8,457 were waiting for audiology services. These are individual children with specific requirements that are not being met. What have we done for this huge number of children, all with legitimate expectations of the State to support them and give them those services? I am told that since 2019, 285 development posts have been allocated to children's disability services by the HSE. Under the national service plan, 100 posts were provided in respect of children's disability services in 2019. I am always careful about language when I ask the HSE something. I have no idea whether the phrase "have been allocated" means that they are actually there or not. Another 100 posts were allocated in the service plan for 2021. I do not know what happened to 2020; no figures are mentioned for that. I am told that 85 posts for services in special schools were approved to mid-2021. Again, one of the problems when dealing with the HSE and trying to get at the figures and data is transparency. Posts were allocated and places were approved but there is no guarantee at all that those positions have been filled. Even if all those 285 positions over three years were filled, the number is wholly inadequate to meet the pent-up demand for those critical services that need to be provided at the appropriate time in a child's life. If that is missed, it cannot be caught up on later.

I am not sure if the practice that used to exist still does whereby all monies allocated could be assigned to different functions. The HSE regarded it as a sort of blancmange of money and if there was a pressure point somewhere else, although the service plan said that X number of posts were going to particular functions, that is not necessarily how it transpired at the end of the of the year. Therefore, if you like, we vote it, the Department of Health negotiates it but actually the delivery of those might be a matter entirely for the HSE itself.

As I said at the outset, staff are but one of the essential requirements to address these issues. The Joint Committee on Health was told that operating theatres in our hospitals are functioning mostly on a nine-to-five basis. As expensive and valuable as it is, our diagnostic equipment is just not functioning as it should. In contrast to the private sector, it is often functioning a fraction all the time. I know this from when I went to have a scan on my knee with a private company. It was like a conveyor belt working virtually night and day, and certainly seven days a week. We do not utilise our equipment in the public hospitals in that fashion at all. Why is that the case? We need staff to do it but what is the point of providing very expensive equipment if it is not functioning on the same basis that the same type of equipment in the private sector would be expected to function? Have we no expectation of that in the private sector?

Many years ago, I started the very first waiting list initiative that provided what is now a laughably small amount of money - £20 million - to the public hospitals to bid for additional procedures such as hip replacements or whatever needed to be done, and it worked. That was hijacked into the National Treatment Purchase Fund, which basically privatised public medicine. We need to ensure that we resource the public service. In the interim, I suggest that the Minister looks at an old-fashioned waiting list initiative to provide money to get better value out of the infrastructure we paid for.

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