Stephen Donnelly (Wicklow, Fianna Fail) | Oireachtas source

I echo the sentiments of my colleague, the Minister of State, Deputy Butler, in her opening remarks to Deputies, particularly the Deputies who tabled what is a constructive motion and have made positive contributions to this important debate on targeted investment in our health service. As colleagues will be aware, our health service has been through extraordinary challenges. A global pandemic, a cyberattack and a recent winter season like no other, with the flu, Covid and respiratory syncytial virus, RSV, combined to put our health service, patients and health service professionals under extreme pressure. This pressure has been compounded by a population that is growing and ageing and, therefore, has more care needs that we have to meet.

It is crucial to acknowledge the outstanding efforts of our front-line workers across the country's health services. The Government has been working to match their commitment by investing more than ever before in expanding and reforming healthcare. The Minister of State outlined in detail the scale of that investment. We have put in place an additional nearly €5 billion in core funding since 2020. We have overseen the largest expansion of healthcare staff since the establishment of the HSE. Since 2020, we have hired more than 20,000 additional people into the health service, comprising more than 6,200 nurses and midwives, more than 3,000 health and social care professionals, and nearly 2,000 doctors and dentists. There has never been as much recruitment into our public health services.

However, the debate speaks to how this is not just a question of investment. We are expanding services and capacity at a level that has not been seen before, but meaningful reform is also vital for patients and the future of our health and social care services. Our goal is universal healthcare – a public health service that gives everyone the care he or she needs when he or she needs it. We are making progress. While I fully acknowledge the challenges in emergency departments, in accessing GPs and of too many patients on waiting lists, we must also acknowledge that important progress is being made. Last year, the number of people waiting over the agreed targets of ten and 12 weeks fell by 11%. This means that 56,000 fewer men, women and children were waiting longer than the agreed Sláintecare targets. Since the peak of the pandemic to the end of last month, there was a reduction in those figures of 21%, or 135,000. It is not enough, as there should be no one waiting, but let us acknowledge that our healthcare providers and professionals are doing the business. That reduction of 135,000 matters.

The motion rightly calls for measures to tackle overcrowding in our hospitals. We know it is a problem. We have seen the numbers. I have visited many emergency departments and spoken with patients and front-line staff. The situation in too many emergency departments on too many days of the week is simply not acceptable. We are rethinking, as we must, how our emergency departments work and are provisioned to tackle the issue of overcrowding and people waiting for too long, including on trolleys. We are considering discharge rates over the weekend, the availability of healthcare workers and the provision of community teams to support the transition of patients out of hospitals.

I have asked the HSE to develop an urgent care plan for this year, drawing on the lessons learned from winter and what is known to work. I am expecting a final draft of that plan later this month. I have also asked for a three-year plan because not only do we have to tackle these problems in the short term, but we have to put structural solutions in place. The Independent Deputies who tabled this motion quite rightly point to medical assessment units and local injuries units. The urgent care plan is looking at these and at expanding provision. Personally, I believe we need to standardise the LIUs. It does not work for people to have figure out what their local injury units do and to wonder whether they deal with paediatric cases or whether they are open at 7 p.m. or on Saturday. It should be standardised in the same way as emergency departments throughout the country. There is more we need to do with regard to LIUs and MAUs.

We also know that most of the solutions to overcrowding are found outside of the emergency departments, either through providing people with care so they do not need to go the emergency department or getting them out of hospitals and into appropriate community or home-based care as quickly as possible. To this exact point, I am focused on an unprecedented expansion of primary and community care. The ECC programme has seen the establishment of 94 community healthcare networks, so 94 of the 96 teams are now in place. Each of these serves a set population. In every one of our constituencies, there are now these new community healthcare teams that simply were not there three years ago. We are putting in new specialist teams for elderly people and chronic disease management. More than 2,500 staff have been recruited and I have provided funding for 3,500. They are bedding in and the feedback is very good but this is brand new. These services did not exist two years ago. They are bedding in, linking into the hospitals and linking into the GPs and the feedback we are getting is very positive. More needs to be done. Further integration is required and we still have to hire approximately 900 people into the teams but the feedback is very good.

We are developing services for our ageing population through the provision of integrated care teams for older people. We are looking at the impact of chronic conditions through community-based chronic disease management teams. The GPs are working with these teams and, again, the feedback I am getting from patients is very strong. Rather than being referred to a consultant in a hospital by their GP, people who have diabetes, heart issues or respiratory issues are now being managed by their GP or the specialist team in the community. They are not having to go near the hospitals and that is making a big difference.

The GP access to diagnostics programme, which we launched two years ago, is giving GPs and their patients direct access to diagnostics, something for which they have been asking for many years but have not had. Last year, there were more than 250,000 scans of various modalities through this programme. The programme is again well ahead of target this year. We are at approximately 115,000 scans so far. Preliminary research from the Irish College of General Practitioners, ICGP, suggests that, in the absence of this programme, the GP would have had no other choice but to refer nine out of every ten of these patients for an outpatient appointment or to an emergency department.

I am also strongly committed to pursuing the e-health agenda with regard to capital, revenue and resources. We all know that Ireland is a laggard on e-health. The situation is completely unacceptable in many of our hospitals and community services. My Department and the HSE are working together to put in place a new digital strategy and a plan to implement that strategy so that we can get to digital health and get the electronic health records that are needed. Deputies will be aware that we are working on a health information Bill to provide the legislative framework for all of that.

I thank them for their contributions and again acknowledge the Independent Deputies who tabled this motion. It is genuinely a very constructive and very positive motion that recognises the problems and calls for the right solutions. I am absolutely determined to continue to increase capacity right across our health system in many ways, including some broad ways and some of the very targeted ways the Deputies have called for. While expansion of capacity is absolutely essential, it is only half of the solution. The other half of the solution is fundamental reform of how our health services work. I agree with many of the points that have been raised, including those regarding productivity. Are we running our hospitals with the information we need? No, we are not. Do our healthcare managers, our hospital managers, the HSE centrally, I, as the Minister, or we, as the Oireachtas, have access to the kind of productivity data we need to hold the HSE to account and to make sure that everyone is doing the jobs they are meant to be doing? No, we do not have that information and so we are putting it in place.

We are fundamentally reshaping where patients are cared for. As Deputies will be aware, more and more care is being delivered in the community. We are supporting our healthcare workers to work to the greatest extent of their training and practice through new GP programmes such as the chronic disease management programme, through advanced practice for nurses, midwives and health and social care professionals and through enhanced roles for pharmacies, where we are also working. Critically, we are extending the normal working times for our health services into the evenings and weekends. We are reorganising the health service into RHAs to deliver properly integrated care. It is only through this combination of very significant investment and expansion of capacity coupled with fundamental and meaningful reform to how patients are cared for that we will achieve our goal of universal healthcare.

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