Hildegarde Naughton (Galway West, Fine Gael) | Oireachtas source

I know that every Deputy in this House wants to ensure that our hospitals are staffed in a safe manner. Debates like this are important because they give us the opportunity to reflect on issues affecting the hospital sector. This debate has given us a very valuable opportunity to discuss what are, without doubt, extremely important matters when it comes to ensuring that our hospitals are safely staffed.

I take this opportunity to recognise the remarkable work of the staff in our health service, including those who have been there for many years and those more recently recruited under the initiatives mentioned. I commend these staff on their dedication, professionalism and commitment to delivering health services to patients. We will continue to invest in our workforce, we will continue to grow it and we will continue to provide to the members of our workforce additional opportunities for learning and advancement. Many of the issues discussed today are being prioritised in terms of the reviews, including those relating to safe staffing levels and ongoing recruitment and retention across our healthcare services. As the Minister indicated, the Government's objective is to ensure that patients get the best care possible through providing safe levels of staff in our hospitals. Implementation of the Framework for Safe Nurse Staffing and Skill Mix in General and Specialist Medical and Surgical Care Settings in Ireland is a priority in this regard. It is acknowledged that there have been some challenges with implementation of the framework in hospitals. In order to overcome these challenges, a revised governance structure was put in place in November 2022. The Department of Health is represented on the oversight group established under the latter.

The Minister spoke about the first two phases of the safe staff nursing and skill mix framework. Phase 1 deals with general and specialist medical and surgical care settings and phase 2 deals with adult emergency care settings. I want to update the House on progress in respect of phase 3, which comprises three distinct care settings. Implementation of the framework has commenced in long-term residential care settings for older persons and will commence later this year in community care settings. Implementation in step-down rehabilitation settings will then follow.

Legislation is sometimes cited as a solution to the problem of staffing shortages, but very few countries have implemented this as a solution. Of those that have passed legislation, some are struggling to implement it. Two of the main aims of introducing legislation for nurse staffing levels would be to promote patient safety and improve working conditions for nursing staff. The Framework for Safe Nurse Staffing and Skill Mix in General and Specialist Medical and Surgical Care Settings in Ireland incorporates these principles and goes beyond them to include improving quality of care. Internationally, there is limited evidence available which would justify the need to introduce legislation for safe staffing, whether as an effective solution to addressing recruitment and retention of nurses or otherwise. Recent evidence from the UK relating to tools and systems to determine nurse staffing requirements shows that there are no superior patient classification systems. Instead, the use of measurement tools that are endorsed by the UK's National Institute for Health and Care Excellence, NICE, was recommended. The patient acuity system, which has been used in Ireland for many years, is in line with this NICE recommendation. From the evidence we have, safe staffing policies, such as those used in Ireland, result in more registered nurses at the bedside and these policies have a clear and positive impact on patient and nursing staff outcomes.

Reforming our health and social care services is critical for the services we are delivering today and for the care needs of the next generation. Our ambition is universal healthcare. What this means for people is that when they need healthcare, they will be able to access it quickly, it will be of consistently high quality and it will be free or affordable. A significant programme of ongoing reform is under way and is making progress. This Government's aim is to make our health service one of the most attractive places around the world for healthcare professionals.

I will now speak about some of the improvements that have been delivered in the acute hospital sector and that have made a real difference to patients. This is despite the significant challenges faced in 2022 due to Covid-19 surges, pressure on emergency departments and other operational factors, including problems hiring staff. Some 1.56 million patients were removed from waiting lists, a further 1.53 million patients were added, there was a net reduction of 30,000 men, women and children in the numbers on the lists and the number of patients exceeding the maximum wait times in the 2017 Oireachtas Sláintecare report decreased by 11% and, since pandemic peaks, 24%.

The Government continues to invest in order to reduce the amount of time people are waiting for important hospital appointments and procedures. In 2022, some €350 million was allocated to the HSE and the National Treatment Purchase Fund to primarily provide additional public and private activity to further stabilise and reduce scheduled care waiting lists and waiting times in tandem with bringing forward much-needed longer-term reforms. For 2023, this investment has increased to €363 million. Some €123 million funding was allocated to the HSE in budget 2023. This will be made available on a recurring basis to ensure the reforms deliver sustained reductions in waiting lists and ensure we achieve the strategic Sláintecare maximum wait time targets. The Government has invested record sums in our health service. This has been used to boost permanent capacity, which is key to helping us tackle our waiting lists. Our workforce has grown by over 18,000 - doctors, nurses, midwives and therapists - since the beginning of 2020.

The Government takes the issues raised in respect of safe staffing levels in hospitals very seriously. I thank Members for their valuable contributions. We will reflect closely on Members' contributions. Many of the issues highlighted are already being addressed by means of our programme for Government commitments, our national policies and strategies and through the HSE's national service plan. We have achieved much in recent years through new developments and improvements to existing services.

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