Mary Butler (Waterford, Fianna Fail) | Oireachtas source

I welcome the opportunity to address the House on the issues raised by the Deputies tabling the motion. I thank Deputes Harkin and McNamara and all colleagues present for putting forward the motion, and I acknowledge the spirit and the delivery of it. Obviously, I am going to address some of the unprecedented levels of investment in our health service in recent years, but I want to highlight, as I do at every opportunity I have, that Ireland has the highest life expectancy in Europe, as deemed by the WHO. That is something we should acknowledge. More than 140,000 people work in the HSE, day in and day out and they often come in for a lot of unfair criticism. I acknowledge all those people who work in private, public and voluntary health organisations the length and breadth of the country.

The Government has delivered unprecedented levels of investment in our health services in recent years. There should be no doubt that investment in health has been a substantial priority for the Government. In just three years, the net core allocation for our health services increased from €17.9 billion to €22.8 billion, almost €5 billion more, or a 27% increase in core funding between 2020 and 2023. That investment is clear, tangible evidence of the commitment the Government has made to healthcare and healthcare reform. Enabled by this significant investment, the Government has been driving important reform initiatives, working to deliver on the objectives of Sláintecare and building the capacity of our health service to address the changing needs of our growing and ageing population.

The Government has expanded our healthcare workforce. At present, almost 140,000 whole-time equivalents are working in our health service. We have hired thousands more staff since getting into government. Today, there are just over 20,000 more whole-time equivalents in our health services than at the beginning of 2020. The Government’s focus has been clear: to deliver more front-line staff. Of that 20,000, we have hired almost 2,000 more doctors and dentists, and more than 6,000 more nurses and midwives who are serving the needs of patients every day. In excess of 3,000 more health and social care professionals delivering physiotherapy, occupational therapy, psychology, dietetics and more. The years 2020, 2021 and 2022 have seen the largest staff increases since the HSE was established, and that pace of recruitment continues into 2023, despite the pressures and challenges we face in a globally competitive health services labour market. I also acknowledge that our population has grown, and there are still many challenges to meet the needs of the population.

Our health service has faced significant challenges over the past number of years. It has been called on to respond to a global pandemic, and emergency departments faced the most challenging winter in recent years as a perfect storm flu, Covid and other respiratory diseases surged. The Independent Group’s motion quite rightly points to the challenges facing our acute hospitals. It is clear much more needs to be done to tackle the delays in our EDs and numbers waiting on beds in hospitals.

What are we doing? The Government has expanded our healthcare capacity nationwide to address these challenges. As of 16 March 2023, 970 additional beds have been opened since 2020. Adult critical care capacity stands at 323 beds. This represents a very significant increase of 65 beds, or 25%, on the 2020 baseline of 258 beds. To put that in perspective, we had a total net increase of 18 beds in the three years 2017, 2018 and 2019, and more are planned. The HSE plans to add a further 29 beds this year, bringing our critical care capacity to 352 beds by year end. Furthermore, the Department of Health is continuing to engage with the HSE to ensure the timely delivery of the new elective hospitals in Cork, Dublin and Galway. These elective hospitals will specifically cater for low, complex and high-volume cases, and when established, will provide close to 1 million procedures annually. This will represent real change, helping us to utilise our resources more efficiently by separating scheduled and unscheduled care. It is expected that the three elective hospitals will commence providing care by the end of 2027. The Department has asked the HSE to develop an in-year urgent and emergency care plan informed by lessons learned arising from the after-action review of the escalation and broader winter period to which Deputy McNamara referred. The final draft of that in-year plan is due later this month. That in-year plan will also feed directly into a multi-annual urgent care plan being developed alongside it. We need a structured, co-ordinated, and collaborative framework to enable high-impact operational improvements.

The Independent Group’s motion calls on us to look beyond our EDs to address these challenges to LIUs and MAUs to provide care outside EDs. The Department and the HSE are doing just that. LIUs provide a high-quality and timely service for people with a wide range of non-emergency injuries. MAUs provide assessment, diagnosis and treatment for patients referred with medical conditions, including chest infections, chronic obstructive pulmonary disease, pneumonia, urinary tract infections and more. The MAU pathway for patients was introduced in Ennis Hospital on 9 January and Nenagh Hospital on 7 February. The pathway allows patients that meet clinical criteria to be transported to an MAU rather than an ED. Additional staff and targeted initiatives such as the NTPF have enabled the Ennis and Nenagh MAUs to significantly increase the number of assessment slots available over the past two years. In 2022, more than 12,700 patients were referred to the UL Hospitals Group MAUs, which have played an integral role in ED avoidance, patient flow to model 2 hospitals, and appropriate community referrals. As a result, patients in the mid-west are receiving treatment in a hospital closer to home, reducing patient presentations at UHL and releasing ambulances more quickly.

The urgent emergency care plan will include a review of the current operation of LIUs and MAU pathways to recommend how best their service delivery can be expanded to facilitate patients receiving medical treatment in a hospital closer to their home. The Government recognises that a strong healthcare system goes far beyond our hospital doors. Significant expansion of primary and community care is under way to provide people the care they need outside of the emergency department and to improve patient flow in acute hospitals by reducing unnecessary attendances and providing discharge supports such as home support and residential care.

I thank the Independent Deputies for the opportunity to talk about how we are working to improve the provision of healthcare for older people. A key focus of our Sláintecare reform programme is recognising the need to enable older people to age well at home and in their communities for as long as possible with the correct wraparound supports. For example, our community intervention teams facilitate patient care in the community, in the home or in nursing homes. There are now 21 community intervention teams in place across the country, with national coverage secured for the first time in 2021.

Supporting our ageing population is also a key part of our enhanced community care, ECC, programme. The ECC programme is delivering increased levels of healthcare with service delivery reoriented towards general practice, primary care and community-based services. Over 2,500 staff have been recruited as part of this programme of reform. As part of the ECC programme, the integrated care programme for older persons, ICPOP, model aims to shift the delivery of care for older people away from acute hospitals towards a community-based, planned and co-ordinated care model that is closely aligned to primary care and acute sector partners. As of May 2023, 23 ICPOP teams have been established across Ireland. It is envisaged that the full complement of 30 ICPOP teams will be established by the fourth quarter of 2023.

We recognise that we need to do more to support people in nursing homes too. Currently, the HSE is in the process of transitioning Covid-19 response teams into permanent structures to be known as community support teams, based on the recommendations of the nursing home expert panel. This is an important step in developing specific and targeted support to residents of nursing homes across the entire sector. We hear a lot of talk about nursing homes so I just want to say that the HSE will always step in. It is the provider of last resort and needs to be staffed accordingly to look after people with a very high dependency or high acuity when there is no other place that can do that. Initially, implementation of these teams will focus on supporting residential care facilities to build their capacity to effectively self-manage in terms of prevention, preparedness planning and effective outbreak management in the event of further Covid-19 surges, influenza and other respiratory infections.

The motion tabled by the Independent Deputies calls for targeted investment, including investment in electronic health records nationally. I agree with that wholeheartedly. The Deputies have also called for the expansion of MAUs and LIUs at tier 2 hospitals. In doing so, my Independent colleagues have acknowledged several areas where significant progress has been made, which is primarily as a result of an unprecedented expansion in our public healthcare capacity. This Government has invested in people and we will continue to do so. We accept the motion and look forward to implementing what is in it. One area in which we need to make progress in quickly is e-health, especially with regard to home care and CAMHS teams.

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