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

I move amendment No. 1:

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

"recognises that:

— this Government has invested record funding in our health service and has allocated €23.6 billion net to the health budget in 2023 (Current and Capital), an extra €5.6 billion (32 per cent) over the original net budget allocation for 2020;

— more than 20,000 net additional staff have been hired into our health service since the beginning of 2020, which includes 6,281 nurses and midwives, 3,177 health and social care professionals, and 1,948 doctors and dentists;

— 2020, 2021 and 2022 have seen the biggest staff increases since the Health Service Executive (HSE) was established, and 2023 continues to show large increases;

— the Organisation for Economic Co-operation and Development figures clearly show that Ireland has more nurses per 1,000 population than most other European countries;

— as of mid-March 2023, 970 new acute hospital beds have opened nationally since 2020, and by the end of this year the HSE is due to have added 1,179 beds, against a target of 1,146;

— there are now 323 adult critical care beds, which is an increase of 65 beds, or 25 per cent, since 2020, and a further 29 beds will be added in 2023;

— the Framework for Safe Nurse Staffing and Skill Mix is an evidence-based approach to determining nurse staffing levels, and it is designed around the care hours required to meet patient needs across a variety of care areas and is focused on delivering positive patient outcomes and safer care environments;

— the framework has been national policy since 2018, and since then has continued to include more care areas, as following Phase 1 for acute medical and surgical care areas the framework was applied to emergency care in Phase 2, it is now in its third phase of development in long-term residential care settings;

— over €31 million has been allocated to date for implementation of the; and

— the Minister for Health recently announced that he is prioritising the full implementation of the framework for safe staffing in all acute hospitals, and this will result in hundreds more posts, both nursing and healthcare assistants, being hired and filled on a full-time basis in 2023;

acknowledges that:

— the Department of Health and the HSE are planning a refresh of the Health Service Capacity Review 2018, which will be informed by a series of scheduled Central Statistics Office statistical releases later in 2023, and this will be a key input to a strategic review of infrastructure capacity planning for the next phase of the National Development Plan (NDP) and beyond;

— as part of the overall NDP funding, the health sector capital allocation is €5.657 billion for the period 2021-2025, an 11 per cent increase in funding year-on-year, to invest in the delivery of strategic reform;

— over 500 health capital projects and programmes across the State and across the sector are underway at various stages of development;

— a Capital Programme for 2023 has been developed and the HSE Capital Plan 2023 has been approved by the Minister for Health as a related document of the National Service Plan, and publication of the capital plan is imminent; and

— the Minister for Health is in discussions with Government colleagues on a proposal to expedite the rapid construction and delivery of 1,500 additional acute beds across the country, using modern methods of construction, including modular construction;

further recognises that:

— the 2023 Waiting List Action Plan was published in March 2023, and many of our individual hospitals have delivered impressive reductions in both their waiting lists and waiting times, with for example, Louth County Hospital, University Hospital Waterford, and Portiuncula University Hospital having reduced the number of patients waiting over 18 months for an Outpatients Department appointment by 97 per cent, 55 per cent and 38 per cent respectively, in the last year;

— the HSE is currently working to replicate this positive performance across the entire hospital system;

— in Budget 2023, funding of €443 million was allocated to tackle waiting lists, and this includes €123 million funding for the HSE to progress longer-term reforms to sustainably enhance capacity, €240 million funding for the HSE and the National Treatment Purchase Fund for additional short-term measures to address acute scheduled care waiting list backlogs exacerbated by the Covid-19 pandemic, and the remaining €80 million will be focused on alleviating various waiting lists in community and primary care;

— 2022 was the first year that waiting list numbers fell since 2015;

— progress is being made, and in 2022 the numbers waiting over the maximum wait time targets of 10 to 12 weeks, fell by 11 per cent, which is 56,000 people, and since the pandemic peaks in 2020/21 to the end of April 2023, there has been a reduction of 135,000, or 21 per cent, in the numbers of people waiting above these targets;

— under the 2023 Waiting List Action Plan, our health service aims to treat and remove circa 1.66 million patients from the lists, resulting in a projected reduction of just over 10 per cent by year-end;

— productive engagement is ongoing with the Private Hospitals Association, to secure additional capacity both in the short- and medium-term to support scheduled and unscheduled care;

— plans are advancing on three new Elective Hospitals in Dublin, Cork and Galway, that will provide significant additional capacity, and combined they will cater for up to 977,700 patients/procedures annually; and

— the HSE is developing a multi-year urgent and emergency care improvement programme to deliver sustainable improvements to unscheduled care, most of which currently occurs in the Emergency Department; and

further acknowledges that:

— the Department of Health is working closely with the HSE on developing the plan for expansion of community care and other measures which will reduce unnecessary attendances and improve discharge supports, such as home support and residential care;

— this Government is committed to a 'home first' approach to health service provision, and the Enhanced Community Care (ECC) Programme delivers healthcare reoriented towards general practice, primary care, and community-based services that prevents admissions to acute hospitals;

— the Government has allocated significant resources 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 Specialist Teams (CSTs), that commitment will continue into future years;

— significant progress is being made, with 91 of the 96 CHNs and 44 of the 60 CSTs now established, and 2,600 staff already recruited to the programme, with the balance of recruitment and establishment of the remaining teams targeted for 2023;

— the nationwide GP Access to Diagnostics programme, began accepting referrals in January 2021;

— 251,601 diagnostics were completed last year, which exceeded the 2022 target of 195,000 scans, and of this, 115,477 community radiology scans have been completed to date;

— Primary Care Centres (PCCs) are an essential part of the Government's significant investment and nationally there are 167 PCCs, two of which opened in 2023, with a further 13 currently in construction, and 10 due to open in 2023;

— there are approximately 3,500 general practitioners (GPs) working in Ireland currently, 2,500 of whom hold a General Medical Scheme contract with the HSE, and over 500 further GPs hold contracts for screening or vaccinations services;

— under the upcoming Strategic Review of General Practice, consideration will be given to the possible role of HSE-employed GPs, as part of a wider examination of the GP capacity issue;

— 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;

— in July 2022, Minister for Further and Higher Education, Research, Innovation and Science, Simon Harris TD, and Minister for Health, Stephen Donnelly TD, announced an agreement with Irish Medical Schools to phase in an increase of 200 additional Irish/European Union medicine student places over the next five years; and

— discussions are ongoing between the Department of Health and the Department of Further and Higher Education, Research, Innovation

and Science, regarding the expansion of student places across health-related disciplines."

I welcome the opportunity to address the House on behalf of my colleague, the Minister for Health, Deputy Donnelly, on the issues raised by the Deputies tabling the motion. The Minister is unavoidably away because he is attending the World Health Assembly in Geneva.

One of the issues raised was how best to underpin framework for safe nurse staffing and skill mix. A question asked the world over is how to determine the number of nurses and healthcare assistants required to deliver care in various healthcare settings. The framework for safe nurse staffing and skill mix is an evidence-based approach to determine safe staffing and skill mix levels for nursing and healthcare assistants in the Irish healthcare service and it has been in development since 2014.

The framework is being developed in three phases. A policy on phase 1, medical and surgical care settings, was launched in 2018. A policy on phase 2, adult emergency care settings, was launched by the Minister, Deputy Donnelly in 2022. Phase 3 of the framework is in the process of being developed for general and non-acute care settings and includes long-term residential care settings for older persons, community care settings, and step-down and rehabilitation settings.

Phase 3 of the framework in long-term residential care settings for older persons is currently being tested in eight pilot sites. When the evidence and the recommendations from this pilot are available, phase 3 will be developed into a national policy for broader implementation. Responsibility for the implementation of the framework policies is given to the HSE and this is overseen by a safe staffing lead. To date, €25 million has been allocated to implement phase 1 in model 4 hospitals. This funding provided for almost 870 whole-time equivalents, WTEs, including both registered nurses and healthcare assistants. Some 92% of these positions have been filled with the remainder expected to be filled later this year.

The Minister, Deputy Donnelly, recently announced funding of €25 million to continue the implementation of phase 1 in model 3 and model 2 hospitals, which will provide for an additional 854 whole-time equivalents in these hospitals. Some €6.2 million has been allocated for phase 2 to provide for an extra 101 whole-time equivalent registered nurses in emergency departments throughout the country and 46% of these positions are now filled.

The framework for safe nurse staffing and skill mix is recognised around the world as highly effective, with other countries now looking to Ireland. I understand the Minister, Deputy Donnelly, has recently spoken with several academic experts who believe the framework is one of the best, if not the best, model for determining staffing levels.

Since 2020, approximately half the required extra posts have been created, including both nursing and healthcare assistants. The Minister, Deputy Donnelly, has spoken with nurses about the challenges that arise when the framework is not fully implemented, including issues of cross cover. However, where the framework is in place, it is making a big difference.

There is limited evidence to show that legislation makes it safer for patients or impacts implementation in a positive way. The advice the Minister received from international experts in safe staffing is that now is not the right time for Ireland to underpin the framework with legislation. The priority should be on implementation and development of the framework in other areas, especially in community care. The Office of the Chief Nursing Officer, CNO, will, however, keep this under review.

As regards waiting lists, as Deputies will be aware, the Department of Health, HSE and National Treatment Purchase Fund, NTPF, published the 2023 waiting list action plan on 7 March this year. This forms the next stage of the multi-annual approach to sustainably reduce and reform hospital waiting lists and waiting times. The plan allocates €363 million in funding to the HSE and NTPF to reduce hospital waiting lists by 10% this year, to continue implementing reforms, and to continue momentum towards achieving Sláintecare maximum waiting times of ten weeks for new outpatient appointments and 12 weeks for procedures.

This is building on the reductions in the waiting lists achieved in the fourth quarter of 2021 and again in 2022. Although the initial target for 2022 was not achieved as a result of continuous Covid-19 waves and significant pressures on unscheduled care, it must be acknowledged that 2022 was the first annual decrease in hospital waiting lists since 2015.

The agreed cross-party objective is to have nobody waiting longer than the Sláintecare targets of ten weeks for outpatient departments and 12 weeks inpatient day care gastrointestinal scope. In 2022, the numbers waiting over the Sláintecare targets fell by 11%, or 56,000 people, and there was a 24% reduction since the pandemic peak.

The Government fully acknowledges the distress and inconvenience for patients and their families when elective procedures are cancelled particularly for clinically urgent procedures. While every effort is made to avoid cancellation or postponement of planned procedures the HSE has advised that this can occur for a variety of reasons, including capacity issues due to increased scheduled and unscheduled care demand. The HSE has confirmed to the Department of Health that patient safety remains at the centre of all hospital activity and elective care scheduling. To ensure services are provided in a safe, clinically aligned and prioritised way, hospitals are following HSE clinical guidelines and protocols.

The Department of Health is already developing a comprehensive health and social care workforce strategy and action plan and planning projection model. The health and social care planning projection model will provide demand and supply projections of numbers required in medicine, nursing and other areas spanning short-, medium- and long-term time horizons. Work on the planning projection model is due to be completed in quarter 3 of 2023. Building on the 2023 plan, this will enable detailed planning for 2024 onwards. The expected result and ultimate objective of this work is the development of scenario-based projections of health and social care workforce supply and demand. These projections will inform a strategy, action plan and set of recommendations for ongoing strategic health and social care workforce planning.

In recent years, significant investment has been made through the winter and national service capital plans. This investment, while responding to the immediate demands of the Covid-19 pandemic through initiatives and alternative pathways, also assisted in building bed capacity. Between 1 January 2020 and 16 March 2023, 970 new acute hospital beds have opened nationally. Of these, 541 were opened in 2020, 272 were opened in 2021, and 157 were opened in 2022. There are 209 beds now profiled for delivery in 2023 giving a total of 1,179 beds. Adult critical care capacity is now 323 beds. This represents a very significant increase of 65 beds, or 25%, over 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. The HSE plans to add a further 29 beds in 2023, bringing capacity to 352 beds by year end. This includes 20 beds already funded and nine beds included in the national service plan for 2023.

Currently, the HSE is examining potential capital projects to deliver remaining critical care beds under phase 2 of the strategic plan for critical care through the development of new-build capacity at five prioritised sites, subject to necessary approval processes. These sites include Beaumont Hospital, St James’s Hospital, the Mater hospital, St Vincent’s University Hospital and Cork University Hospital.

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