Dáil debates

Wednesday, 18 January 2023

Capacity in the Health Services: Motion [Private Members]

 

7:10 pm

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

I move amendment No. 1:

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

"recognises that: - this Government has delivered record funding to permanently increase capacity in our health service, with the Health Vote over €24 billion for 2023 up from €14.8 billion in 2018, and this is the largest allocation ever for the Department of Health;

- since 1st January, 2020, 970 new acute hospital beds and 365 community beds have opened;

- 65 additional critical care beds have opened since early 2020, bringing overall capacity to 323 beds, an increase of 25 per cent over the 2020 baseline;

- thanks to successive large increases in the health budget, there are 17,403 more people working in our health service than there were at the beginning of 2020, this is an expansion of 15 per cent, which includes 5,169 nurses and midwives, 2,870 health and social care professionals, and 1,801 doctors and dentists;

- funding has been secured in 2023 to continue this considerable expansion of the workforce with an additional 6,000 staff to be added this year; this growth will be seen across all service areas and in key staff categories, such as medical staff, nurses and health and social care professionals;

- limited access to diagnostics can result in patients being referred into hospital emergency departments (EDs) and outpatient departments for services; the nationwide general practitioner (GP) Access to Diagnostics programme, which began accepting referrals in January 2021, facilitates direct referral by GPs to diagnostic services for their patients; this structured pathway for GPs to directly access diagnostic tests enables a greater level of care to be delivered in the community, supporting patient-centred care, early diagnosis, and early intervention; and 251,601 scans of various modalities were completed by 25th December, 2022, which far exceeded the 2022 target of 195,000 scans;

- the Enhanced Community Care (ECC) programme is a suite of reforms enabling new ways of working, empowering local staff leadership to meet the needs of local communities and a shift in the focus away from acute hospitals; the Government is strongly committed to this goal, and have allocated very significant resources to ensure that this transformation will be delivered, with annual funding of €195 million provisioned to the ECC programme to enable recruitment of 3,500 additional staff, and with service delivery provided through Community Healthcare Networks (CHNs) and Community Intervention Teams (CITs), that commitment will continue into future years; and significant progress is being made, with 91 of the 96 CHNs and 42 of the 60 CITs now established, almost 2,500 staff recruited to the programme, with the balance of recruitment and establishment of the remaining teams targeted for 2023;

- the Government has strongly endorsed all 16 of the recommendations presented in the Report of the Strategic Workforce Advisory Group on Home Carers and Nursing Home Health Care Assistants (October 2022) and is committed to their full implementation as a priority; the Advisory Group's recommendations are targeted measures which, when implemented in conjunction with the wider sectoral reforms which are in train, will have a lasting impact on the workforce challenges associated with front-line care-workers; however, given the breadth and complexity of the issues that affect workforce-planning, it is not feasible to provide a precise timeframe for the implementation of each recommendation;

- on 16th December, 2022, the Government announced the authorisation of 1,000 employment permits for non-European Union (EU)/European Economic Area home-support workers, as recommended by the Advisory Group, this promises to significantly reduce the shortage of home-support workers in Ireland in the immediate future; and

- the Health Service Executive (HSE) procures home support services via a contractual arrangement with providers and it is envisaged a new contract will be finalised by 30th April, 2023, which presents an opportunity for sectoral reform, and the process of finalising the new tender is underway in the HSE and established procurement protocols apply; notes that: - our health service, in common with health systems across the northern hemisphere, is under significant pressure due to a combination of influenza, Covid-19 and respiratory syncytial virus (RSV); and in the United Kingdom (UK) the Health Secretary has said that England is suffering its worst flu season in a decade, and in France, President Emmanuel Macron has outlined his new plan to stop 'endless crisis' in the French healthcare system;

- our population is both growing and ageing, which is welcome but puts additional pressure on the health service, the population has increased by about a third between 2002 and 2022;

- there is a significant increase in presentations to EDs from older patients;

- 194,230 people over 75 years of age attended EDs up to the end of 2022, and that represented an increase of 25,505 (15 per cent) on 2019;

- of these 194,230 some 101,561 people were admitted, an increase of 9,988 (11 per cent) on 2019; and

- significant additional funding was made available to support the HSE's Winter Plan 2022/23, which is supporting delivery of a range of actions to optimise available capacity across community and hospital services by expanding GP access, including within the GP out-of-hours service, facilitating patient flow through the hospital system, and supporting safe and timely discharge to the community upon completion of hospital care;

- building on recent investment across 2021 and 2022, the Department will continue to develop critical care, acute and community capacity, and progress a strong pipeline of capital projects with the HSE, including several new hospitals (including finishing construction of the National Children's Hospital, progress the elective programme/elective hospitals, and relocation of the National Maternity Hospital) and significant new facilities for existing hospitals;

- the Department is also developing a new Strategic Healthcare Capital Investment Framework, including a standardised/streamlined Capital Appraisal Framework for the healthcare sector, refreshing the Health Services Capacity Review, working out a medium-term capital plan to the end of the decade and building the required sectoral capacity, working with the HSE to deliver health infrastructure under the National Development Plan 2021-2030 process;

- the Department of Health is currently engaging closely with all stakeholders in working to mitigate the current immediate medicines shortage issues;

- of the products currently in short supply, there are none that do not have a therapeutic alternative that can be used to meet patient needs;

- the position, as outlined by the Health Products Regulatory Authority (HPRA) last week, remains that alternative strength, brands, and formulation are available for all medicines associated with the current winter surge; HPRA, through the medicines shortages framework, is managing the coordinated stakeholder response to these shortages to minimise patient impact;

- HPRA continues to engage with suppliers to obtain updates and remains open to expediting regulatory procedures to enable supply of additional stock, where possible;

- a subgroup responsible for Antimicrobial Resistance and Infection Control (AMRIC) is meeting with HPRA daily to provide live data to prescribers regarding currently available antibiotics;

- while other countries have introduced Serious Shortages Protocols (SSP) to allow for both generic and therapeutic substitution, Irish legislation already provides for generic substitution of therapeutically appropriate alternatives; the Minister for Health has asked his officials to explore options around developing a protocol to allow for therapeutic substitution in certain circumstances;

- key considerations may include the legislative amendments that would be required (as they were in the UK) to allow for the use of SSPs under Irish legislation, and the framework and governance of such a system; a SSP does not address over-the-counter medicinal products; and in the UK, as in other jurisdictions, SSPs are time-limited and have strict conditions associated with them; and

- there has been an increase of almost 30 per cent in the number of first-year nursing places in Irish Higher Education Institutions over the period 2014-2021 (from 1,570 to 2,032), with an additional increase planned for 2023; and further notes that: - the HSE directly engaged with the Private Hospitals Association (PHA) ahead of the Christmas period and asked that any additional capacity available be identified through HSE Acute Operations; and hospitals and hospital groups were also requested to continue to engage locally in this context;

- the HSE is continuing to engage with the PHA to maximise additional capacity, particularly for medical patients and time sensitive or urgent procedures; a series of local arrangements are in place and there are currently approximately 180 public patients in private hospital beds;

- additional GP supports have been made available to enable GPs to extend existing clinics or run additional clinics during weekday evenings and Saturday mornings; the funding grant arrangement for GP out-of-hours cooperatives has been increased by 7.5 per cent and additional funding is being provided to cooperatives to enable them to roster additional doctors, local GPs and locum doctors in treatment centres from 6pm to 10pm;

- these measures allow more patients to be seen by GPs and out-of-hours cooperatives, helping reduce need for ED attendance;

- this Government is committed to achieving one of the core goals of Sláintecare by continuing to invest in reforming and re-organising health and social care services, so that they are expanded and focused on delivering care in the community with a 'home first' approach;

- a number of teams currently operate in the community to provide care for patients at risk of hospitalisation or to facilitate discharge from hospital, for example, referrals to CITs have consistently performed above their annual targets and since October, referrals to the CITs have increased month on month; significant investment in recent years has facilitated an increase in the number of CITs from five in 2014 to the 21 CITs currently in place, ensuring national coverage for the first time and with at least one team in operation per Community Healthcare Organisation area; and we continue to augment and expand this invaluable service, with Winter Plan funding having been provided to target recruitment of additional staff to the CITs;

- the mandate of the European Medicines Agency (EMA) was formally expanded last year by way of Regulation 123 of 2022, which expanded the remit of the EMA to enhance its response to and coordination of shortages of medicines and medical devices at a European level, with a particular focus on driving consistency of approach with respect to mitigation actions; and

- the EMA is liaising with antibiotics manufacturers with a view to increasing supply to the EU market; and the HPRA is taking a lead role in this EMA work on behalf of Ireland.

I very much welcome the opportunity to talk about the issues raised concerning capacity in the healthcare system, and one element and knock-on effect of that, which is the unacceptable levels of overcrowding we are seeing in some hospitals in the public health service.

The context matters. The motion does not reference the context at all. Ireland and Europe are dealing with a perfect storm of Covid, RSV and flu. We are dealing with an unprecedented level of the combination of all three of those. The best resourced and run healthcare systems in Europe are dealing with various versions of what we are dealing with in Ireland. That context is important. This is happening throughout Europe. Deputies will be aware of the situation in the Six Counties, which is very serious indeed, as it is in Britain as well.

However, we must focus on our health system and do everything that we can. I have visited emergency departments around the country. I wanted to hear first-hand from patients and their families, and healthcare workers about their experience. I have seen the distress. I have spoken with patients and their families and with healthcare workers about the distress in many of our emergency departments. I acknowledge that what I have seen and what patients have experienced in many hospitals around this country in recent weeks is simply not acceptable in terms of the time waiting to be treated and the time waiting to be admitted to a bed in a hospital, if a decision is made to admit.

I have also visited hospitals where patients are being seen quickly. They are being treated quickly and they are being sent home quickly, or if they are admitted into the hospital, they get a bed quickly. In Waterford, Deputy Cullinane's constituency, the hospital has gone more than three years without having a patient on a trolley. We must be cognisant of those hospitals and those parts of the country where things are clearly working very well.

The motion tabled by Sinn Féin calls for an urgent expansion in the capacity of our public health service – more beds, clinicians and home care packages. What the motion fails to acknowledge in any way is that we are in the middle of an unprecedented expansion in capacity in the public health service. Over the past three years we have added nearly 1,000 hospital beds, more than 360 community beds and there has been a 25% increase in critical care beds. This is an unprecedented expansion in public beds across the country.

We have hired more than 17,000 additional healthcare professionals since 2020. This includes more than 5,000 nurses and midwives, nearly 3,000 additional health and social care professionals, and 1,800 doctors and dentists. In fact, 2020, 2021 and 2022 are three record years of net recruitment into the HSE since its foundation. This year is going to be the fourth in a row. The past four years, including this year, will have had the highest recruitment into the HSE ever. Do I want to go further and faster, and does everybody here want to do the same? Yes, but let us acknowledge that in the middle of Covid, the HSE has hired at a level that has never before been seen.

Our emergency departments depend on highly skilled and experienced staff to provide patients with care. We are rapidly expanding resources within emergency departments. I sanctioned 51 extra emergency medicine consultants last year. That is approximately a 40% increase in the total number. We have launched phase 2 of the safe staffing framework, which increases the number of nurses and healthcare assistants in emergency departments. However, as we all know, no additional resource we can put into emergency departments will solve the issue of overcrowding on its own. What we all know is that most of the solutions to the overcrowding in emergency departments lie outside them. That is why we are continuing to invest right across the board so that only those who really need hospital care come to the emergency department and when they do, they get seen quickly. We have added millions of extra hours of home care support. We fully acknowledge that more is needed.

The motion calls for a move to the living wage in the new tender. That is happening. We are also recognising travel. We have also added 1,000 work permits. The Minister of State, Deputy Butler, is leading the work on this for the Government. She and I would like to see that go much further. We acknowledge that too many people are waiting for home care packages. The funding is in place, and we are taking action to increase the workforce to be able to help those patients and their families.

We are also investing at an unprecedented level in the expansion of primary care, as called for in Sláintecare. Over approximately an 18-month period, we have put more than 90 new primary care teams in place. There are many new specialist teams throughout the country in elderly care chronic disease management. Approximately 2,500 healthcare professionals have been hired into this new enhanced community care programme around the country in every one of our constituencies over the past 18 months. This year we will continue with that. These teams, which are quite new, will further integrate into the healthcare services. They will integrate with GPs and into the nursing home sector, as well as the hospital sector. More and more patients can be treated at home and supported at home; treated in their primary care centres and community so they do not need to come into hospital, or if they do, they can be discharged as quickly as possible.

We all know that limited access to diagnostics is one of the reasons people end up in emergency departments. The GP access to diagnostics programme, which was launched in 2021, has been a great success. This year, we have allocated tens of millions of euro. It means that GPs around the country can directly refer their patients for diagnostics. Last year, more than 250,000 scans were funded and took place under that programme, which is new. Sinn Féin is calling for more diagnostics. I accept that more is needed, but what Sinn Féin is not acknowledging is that it is happening.

The motion calls for an increase in training places for clinicians; I agree. However, the motion fails to recognise that an increase in training places is happening. More training places are being funded for students and for clinicians pursing advanced practice, such as non-consultant hospital doctors, NCHDs, who are seeking to become consultants. I have stated previously that we need to double the number of college places in healthcare in this country. They are increasing in several areas, but we need to go further. The Minister for Further and Higher Education, Research, Innovation and Science, Deputy Harris, and myself are working together to that end. I have met several of the medical, healthcare and nursing colleges to see if there is an appetite for a radical expansion in courses for nursing, midwifery, dentistry, pharmacy and health and social care professions. The answer from every university team to which I have spoken is that there is. They want to work together to expand these places. We do not train enough healthcare professionals in this country.

In spite of what is an unprecedented expansion of capacity – beds, diagnostics, workforce community care – we are all aware that a perfect storm of Covid, flu and RSV, coupled with a growing and ageing population, means that too many men, women and children are not getting seen quickly enough in emergency departments or getting a bed in a hospital quickly enough when they have been admitted. They are also not getting access quickly enough to other healthcare services they need. What are we doing? We are continuing with the expansion. This year, we are funding an additional 6,000 healthcare professionals across the service. Hundreds more beds are planned for this year. Building on recent developments, my Department is working with the HSE on the roll-out of new elective hospitals, the rebuilding of the national maternity hospital and finishing the national children's hospital.

However, as I said previously, the current capital processes in this country, be they in the HSE, the Government, or are tendering and planning processes, when they are considered together, are not working. It takes years and years to put in place capital infrastructure and critical healthcare infrastructure that we need to put in place much quicker. I am working with the Department, the Government and the HSE to see what actions we can take to significantly reduce the amount of time required from when a decision is taken to add beds to those beds being open, staffed and used to treat patients. The current combination of processes, between European laws, tendering laws, planning processes, internal evaluations, re-evaluations, strategic reviews, business case modelling, and external validation of strategic reviews, when put altogether, are taking years and years to put critical infrastructure in place that patients need now. That is something we are looking to change.

At the same time, more capacity is not the only answer. There are significant changes to working practices and more community-based care is not the answer in and of itself. We also know there are significantly different outcomes from different hospitals and community groups throughout the country. We must see consistency of good practice. We have to see more hours in hospitals and the community sector whereby senior decision makers are present to treat, admit and discharge patients and help to bring them home. It is what the new consultant contract is all about. Over the past few weekends, we have seen the enormous beneficial impact of having senior decision makers in hospitals and the community at weekends.

We need more capacity. We are in the middle of the biggest expansion in capacity in a very long time right across the system. At the same time, we need to implement the Sláintecare vision of community-based and integrated healthcare. That is happening. In addition, we must modernise working practices, patient flow, treatment and discharge, and rostering, right across our service. If we do and continue doing all those things - we are in the middle of doing all those things although a lot more is needed - we will see a well-resourced, well-staffed and well-funded modern healthcare service that gets people throughout this country the care they need when they need it.

Comments

No comments

Log in or join to post a public comment.