James Browne (Wexford, Fianna Fail) | Oireachtas source

I will begin by mentioning the significant investment in the health service since 2020. The Government allocated €23.6 billion net to the health budget in 2023, both current and capital, and an extra €3.2 billion or 15% over the original net budget allocation for 2020. This is the largest allocation ever for the Department of Health. The Government has allocated 27% more in core funding in 2023 compared with 2020, with an additional €4.9 billion being invested in our health service. The net core allocation increased from €17.9 billion to €22.2 billion in the last three years. This demonstrates our huge commitment to healthcare and healthcare reform.

We now have 139,838 whole-time equivalents working in our health services and we have hired thousands more staff since getting into government. Thanks to successive large increases in the health budget, there are 20,020 more people working in our health service than there were at the beginning of 2020, which is an increase of 17%. This includes 6,281 nurses and midwives, 3,177 health and social care professionals and 1,948 doctors and dentists. The patient and client care staff category currently stands at 28,505 whole-time equivalents. This is an increase of 2,786 whole-time equivalents or 11% on 2019. Those working in patient and client care include home helps and healthcare assistants.

The years 2020, 2021 and 2022 have seen the biggest staff increases since the HSE was established. So far, 2023 continues to show large increases due to funds secured this year to continue the considerable expansion of the workforce, with 6,000 staff to be added this year. This growth will be seen across all service areas and in key staff categories such as medical staff, nurses and health and social care professionals. Increased retention efforts by the HSE have contributed to this record-breaking growth with significant career development and progression and educational development opportunities being offered. Recruitment capacity is also expanding to ensure that ambitious workforce targets can be met and to maximise the numbers who are recruited. This has included the expansion of international recruitment markets, targeted recruitment campaigns and streamlined recruitment processes. There has also been an increase of almost 30% in the number of first-year nursing places in higher education institutions over the period 2014 to 2021, with an additional increase planned for 2023. Since 2019, all nursing and midwifery graduates were offered permanent contracts, and this will continue into 2023. All health and social care professional graduates who applied for the HSE national campaign were offered permanent positions. This will also continue into 2023.

In March, the total workforce stood at 139,838 whole-time equivalents. This is an increase of 651 on February figures and a growth of 2,092 this year to date at 1.5% ahead of the end of 2022. The growth year to date is stronger than the same period last year. If the current growth levels continue, we expect to achieve the recruitment target for the year of 6,400 whole-time equivalents.

The medical and dental staff category has shown strong growth in March with an increase of 144 whole-time equivalents. Increases are seen in all staffing grades in this category. There were also increases across the following stock categories in March: health and social care professionals, nursing and midwifery and patient and client care. In terms of year-to-date growth, nursing and midwifery has grown by the largest amount of 867 whole-time equivalents.

Deputies will be aware that the Minister for Health established a national task force on the non-consultant hospital doctor, NCHD, workforce in September 2022 to address doctor training capacity and retention issues. In its first six months, the task force developed interim recommendations strengthened by specific implementation requirements, including over oversight and monitoring structures. The Minister published the interim recommendations reported of the task force on 13 April 2023 with a focus on seven priority themes and 42 recommendations for immediate implementation by the HSE. The task force interim recommendations on the medical workforce targets recommend increasing the number of consultant posts, in line with workforce planning projections, to 6,000 by 2030 and a consultant to NCHD ratio of 1:1.3. As part of the steps to achieve this, there will be continued increases in the number of specialist training posts in national training programmes. Changing population demographics and workforce needs have placed increased pressure on the health service in recent years. To ensure the service can meet the needs of the population and provide high-quality effective patient care, it is essential that the medical workforce configuration evolves to meet these challenges. The Minister recognises that the healthcare workforce must be configured such that the most efficient, sustainable and cost-effective models are developed, and non-consultant hospital doctor reliance is reduced.

I will turn now to primary care services. The Government has taken a number of measures in recent years to increase the number of GPs working in the State and thereby improve access to GP services. Annual expenditure on general practice has been increased by €211.6 million under the 2019 agreement with an approximate 40% increase on the funding provided prior to the agreement. Funding under the agreement provides for significant increases in capitation fees for participating GPs, a 10% increase in rural practice support payments and a €2 million annual fund for GPs in areas of urban deprivation as well as improvements to maternity and paternity leave arrangements. More flexible shared general medical services, GMS, GP contracts were introduced and a GMS retirement requirement was extended to a GP's 72nd birthday. The measures make general practice in Ireland a more attractive career choice for doctors. The number of GPs entering training has more than doubled from 122 in 2019 to 258 in 2022, with 285 places available this year. Working with the Irish College of General Practitioners, 350 training places per year are planned to be available for new entrants by 2026. Until then, the annual increases in training places will be determined on an annual basis by the training capacity of the health system. The number of applications from doctors to undertake GP training has also increased year-on-year with 446 applications received in 2019 rising to a record 968 applications this year. The college stated that the number of GP training graduates emigrating has been decreasing since 2017 with less than 6% of GPs emigrating as per its latest graduate survey. The terms of reference for a strategic review of general practice were published on 3 April this year. The review will examine a broad range of issues affecting general practice, including issues relating to GP capacity and the reforms needed to improve GP out-of-hours service. Based on the findings of the reviews, a report is to be provided to the Minister this year setting out the actions required to provide a more sustainable general practice into the future.

To conclude, I thank Deputies for tabling the motion. I also thank Deputies for their contributions to what has been a stimulating debate on a very important issue.

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