Thursday, 29 September 2022
Financial Resolutions 2022 - Financial Resolution No. 6: General (Resumed)
I thank the Ministers for being here this evening for this debate on the budget. I welcome the fact that there is now over €23 billion being set aside in the health budget for 2023. It is extremely important that we continue to grow and develop our healthcare services and that we try to identify the areas where additional funding is required. We have done this in the budget, in the sense that €443 million has been set aside for dealing with waiting lists. It is extremely important that we use that money effectively and that we make every effort to reduce those waiting lists.
Some of that work will have to be done outside of the HSE hospitals, but we also need to make sure we get value for money in relation to the delivery of the healthcare that people require. We also need to look at how we can make the premises of the HSE hospitals and care facilities available to help to reduce those waiting lists. For instance, do we need to look at how we can use some of those facilities at weekends, particularly on Saturdays? How can we have the appropriate number of staff there to be able to provide the care and back-up support for delivering those services in respect of whether it is day care procedures or whatever medical consultation is required?
One of the big challenges we have over the next 12 months is in respect of having an adequate number of staff in all our healthcare facilities. We are competing in a worldwide market for medical care staff. All of the staff who are leaving Ireland are extremely well trained and have experience. No matter where they travel to in the world, they can get employment. We have got to make it attractive to retain the staff that we have here and make sure that they have adequate supports. It is extremely challenging for any person working in the medical area who has a young family and is to trying to do the balancing act of looking after a young family while giving their full commitment to providing healthcare. We need to be far more effective in giving those supports to our healthcare workers. I am not sure that we have done that in the past. We also need to be able to be flexible to take on board the challenges that people who are working in the healthcare sector have when they also have young families.
On healthcare infrastructure, we have much catching up to do. We have already put a huge amount of money into upgrading our facilities for elderly care. It is interesting, and I just got the figures today on the costs of running those facilities. These are community nursing homes across the country. It is now costing more than €550 million per annum. That money is spent wisely, but it is important that we make sure that every one of those facilities is up to modern-day standards and can deliver the care that is required. In the context of healthcare in general, it is important to note that private nursing homes do not have the same financial support that is available to public nursing homes. It has not been upgraded in the past number of years. We now need to make sure that they are adequately funded. We have had a number of private nursing homes close for different reasons. We cannot afford to lose any beds in either public or private nursing homes. It is important that the adequate amount of funding is available.
Likewise, on home care, we also need to bring more people into that area who can provide home care to keep the maximum number of people in their own homes but, at the same time, provide the care that they require. It is interesting that in the Cork-Kerry region, for instance, over 18 months ago we had more than 1,800 people working and providing home care. We lost 400 people in a very short period. We came from 1,800 down to 1,400 providing home care. That is just in the Cork-Kerry region. It is just a difficult challenge to reverse that drop-off in the number of people who are providing that service. Therefore, we need make sure – this applies to all people who are leaving our healthcare sector – that there is an exit survey to make sure we can identify what the issues are, why people are leaving and what we can do to reverse that.
It is important that we continue to provide healthcare support in the community. It is interesting that in this budget there is €138 million for healthcare and social care services, with €29 million out of that for new developments. That is very welcome. Likewise, there is €150 million for older persons and €18 million is in relation to new developments, which is, again, very welcome. The other area where we are putting in extra money in this budget is mental health, with more than €58 million being invested.
I was at the meeting of the Committee of Public Accounts this morning. We had the HSE in before us to discuss dealing with its 2021 budget. We went through the figures and challenges there. Again, like what we faced with the community hospitals, we now face in the mental health facilities as well, where we need to make sure that we invest heavily in infrastructure in this area. It is very difficult for staff to work in a place where up-to-date facilities are not available. Therefore, any place where it is identified that the facility is not up-to-date, we then must make sure that we can upgrade them and, if necessary, in some cases, we might have to build totally new facilities.
I just want to touch on the area of GPs. They form an important part of our healthcare provision. It is interesting that we have a huge commitment by them, but we do not have the same level of support that is in other jurisdictions in relation to back-up support, such as administration and nursing staff. Over the next few months we should engage with the Irish Medical Organisation to work towards having additional support staff put in place in GP surgeries so they can deal with the increased demand.
We are facing huge changes in healthcare over the next eight years. We currently have 760,000 people over 65. Within eight years, that will have risen to 1 million. This is going to be a major challenge. GPs are the first port of call for people who require healthcare. We need, therefore, to put in place an adequate level of supports for those GPs so that they can deliver healthcare and reduce the number of people that they are referring into hospitals where they do not have a choice because they cannot get access to the care that is required.
I touched on the issue of nursing homes. Again, we face challenges there where they are now facing the difficulty of trying to retain staff. We need to work with them to make sure that we can have the required number of staff in each and every healthcare facility across the country, whether it is in hospitals, community hospitals, nursing homes or day care facilities. We now need to look at how we grow the healthcare sector and make working in it attractive. I am not sure that we have done enough of that over the past ten years. As a result, people are leaving that sector and moving into other areas of employment. It is important that we meet the challenges. We have had an increase in population of more than 1.2 million in the past 20 years, which is 60,000 per annum. This year, the population may very well increase by 150,000 if you look at the people who are coming back from abroad, the natural growth in population and also the more than 50,000 people who have now come in from Ukraine. We could have a growth in population of 150,000. That will be more demands on our healthcare sector. We need to respond to that demand in every area, whether it is paediatrics, cancer care or elder care. Right across the board, we need to respond. The way we can respond is by making sure that we have an adequate number of staff in all areas.
Again, I thank the Minister for Health and the both Minister for Finance and Public Expenditure and Reform for their commitment to ensuring that we have an adequate budget for healthcare in the coming year.