Róisín Shortall (Dublin North West, Social Democrats) | Oireachtas source

I welcome the opportunity to speak about some of the underlying reasons for the stubbornly long hospital waiting lists and I thank Sinn Féin for bringing this motion forward. Reading through this motion should be a sobering experience, but the reality is we have become so accustomed to unacceptably long waiting lists with unambitious targets and missed deadlines that we are no longer shocked by those.

We have reached a point where our waiting lists may be shocking but they are no longer surprising. This is because a perpetual state of crisis has become the norm in the Irish health service, but it is not normal. In no other European country would people tolerate a situation where there are almost 900,000 people on hospital waiting lists, where it takes an average of 12 hours waiting in an accident and emergency department when a person is seriously ill before they are admitted to a hospital bed, where 600 people are stuck in hospital beds because there is no home care available or step-down beds available, and where so many feel they have no choice but to pay for expensive private health insurance. The number of people who feel, mainly through fear, that they must do that is a real indictment of this and previous Governments in the inability to provide a properly functioning public health service.

We know, however, that it does not have to be like this. Ireland is the outlier. This dysfunction in our health service should not be accepted. Behind every waiting list number is a patient and their family, a patient who requires care, and a patient to whom the State has a responsibility to ensure care is available but who is being failed.

Healthcare is a basic public service that the State, and especially a rich one like ours, should be able to provide in a timely manner. Yet this Government continues to fall short, even though we have the solutions in Sláintecare. It is increasingly the case that Sláintecare is seen as a convenient brand for the Minister to wrap himself in. This must be more than a rebranding exercise. We must see real and urgent progress being made in our health service. The way to do that is by implementing Sláintecare quickly.

It is about creating a universal, single-tier health and social care service where people can access timely care on the basis of need and not on their ability to pay. This has become a mantra quoted by all but, regrettably, it is far from the reality. While I accept that some steps are being taken to address cost, albeit late in the day, major obstacles to full implementation still persist. For a start, our health service is still heavily orientated towards acute settings. We know many people are presenting to accident and emergency departments simply because they have no alternative. To tackle this and realise the full potential of Sláintecare, we need to expand local community services, but we also need more data collection. I cannot understand why there is no analysis at all of the reasons so many people attend our accident and emergency departments. The most basic thing we could do is to get the statistics on why people end up having to go to a local accident and emergency department. Would you not think that these data would be available and would have been collected for a long time? In reality there are so statistics. We do not know, for example, what percentage of people going to accident and emergency departments have a sports injury, or what percentage go there because they have diabetes, or what percentage go there because they have heart trouble. Unless we have this basic information on the reasons people are going to accident and emergency departments, then how on earth can we plan for proper services? That this is not being done is just unbelievably inept. Such data would be extremely useful for the design and provision of services, and especially for illnesses and injuries that could be treated outside of an accident and emergency department, in settings such as medical assessment units or local injury units.

There are other basic things that should be done. Why are the GP out-of-hours services so limited? They are limited because we expect GPs who provide a service during the day to cover at night-time. That is ridiculous. At a time when more and more workers in the health service especially are looking for better work-life balance, why are we not employing GPs to work out of hours? This is basic stuff but it is not being done. There are plenty of GPs who would welcome the opportunity to be employed potentially on a part-time basis. There are a very large number of female GPs who would be very pleased to work on that kind of part-time contract salaried basis. Why is this not done? Why are we running out-of-hours GP services on a skeleton staff? This makes no sense at all.

There is another aspect that should be obvious. Why is there no transparency about outpatient waiting lists? If I go to my GP with a particular condition, he or she may refer me to a consultant who has an 18-month waiting list. Why can I not find out if there is a consultant with a three-month waiting list and go to that person instead? There is no transparency in the system at all. People who are paid out of the public purse should have accountability. The waiting list should be transparent and show how long the waiting lists are for different consultants.

I also wish to address the NTPF.

People talk about outsourcing services to private hospitals. I heard that being suggested this morning on "Morning Ireland". The NTPF is used over and over again. When the NTPF was first introduced, it was as a temporary measure to deal with a crisis situation. We were told that once the backlog was cleared, there would be no need for it any longer. There does not seem to be a realisation that the more money is put into outsourcing services, the less there is for the core public service. Rather than this outsourcing, which is now so prevalent right across the health and social care system, we need to invest that money in building proper public services.

I acknowledge we are beginning to see some examples of the shift away from emergency departments. In the mid west, medical assessment units, MAUs, in Nenagh, Ennis and St. John's experienced their busiest year to date in 2022, with almost 13,000 patients receiving care. This represented a 19% increase on 2021. However, in order for these types of local services to be successful and attract more patients, which is what we should aim to do, expanded hours and additional resources are required. For example, the University of Limerick Hospitals Group needs €5.2 million in additional funding in order to increase staffing across its MAUs. This would allow it to operate seven days a week and increase the slots currently available to GPs, out-of-hours services and paramedics.

Providing these additional resources to MAUs and local injury units, particularly in underserved areas, would alleviate massive pressure on overburdened emergency departments. However, it would be remiss of me not to acknowledge that the situation in the mid west is more complex. Although the expansion of local services and the introduction of new pathways are welcome, there is still a compelling case for a level 3 hospital in the mid west. University of Limerick Hospitals Group is the only hospital group in the country without a level 3 hospital. It is very difficult to see how the current problems in University Hospital Limerick can be fully addressed without a level 3 to alleviate the pressure. The only explanation I have received for this hospital group not having a level 3 is that there are historical reasons. This is not good enough. It is certainly cold comfort to the many people in the mid west who are left without adequate services.

To return to Sláintecare reforms, another proposal that needs to be urgently progressed to reduce hospital waiting lists is the delivery of elective hospitals. I cannot understand why the Government will not move on these. The example was shown in Scotland, where the National Health Service took over a private hospital. It bought it out and very quickly built another elective hospital because it was so successful. It could operate like a clinic, for example, the Santry sports clinic, and could motor through the waiting lists, where there is that kind of speciality in addition to the avoidance of pressures that come from emergency departments, hospital-based infections and so on.

We have to move on these elective hospitals. There were supposed to be three hospitals. If the Government had acted on Sláintecare, those three hospitals would be in operation now. There is no other movement on the sites that have been identified for counties Cork and Galway, and we have yet to hear about a site in Dublin. This is basic stuff that the Government should be doing. It is failing the people due to its failure to address this in a way that stands up to vested interests in health and has the courage needed to implement a properly functioning public health service, just as citizens in every other country in Europe have.

See this speech in context