David Cullinane (Waterford, Sinn Fein) | Oireachtas source

You do indeed.

I welcome the fact that we have statements on trends in mortality and estimates of excess mortality. It is important that we have clear, factual and evidence-based data put on the public record. Some of the information given by the Minister of State is very helpful. I have seen some misinformation and mischaracterisation in respect of this topic, especially online, which is unhelpful. It is very important that we have a chance to have a debate on this matter and to have factual information. It is also one of the reasons we need more investment in digital transformation in healthcare because it is sometimes difficult for the HSE and the healthcare systems to capture data. We know that data are rich as regards decision-making in healthcare and that many of our IT systems across acute primary community healthcare do not speak to each other. We do not have interoperability and we lag behind other European countries in our digital transformation of healthcare. I wanted to make that point at the start.

I acknowledge the important strides that have been made over the past few decades in improving life expectancy in this State. In 2021, life expectancy at birth stood at 82 years. This is obviously a positive feature of life in Ireland and demonstrates how far we have come since independence. It is also important to recognise this progress, part of which is to do with improvements in innovations in health, new medicines and therapies, a better healthcare system, and all the improvements we have seen over decades. All of that has to be recognised.

As the Minister of State said, however, we also have an ageing population. Since 2016, the total population has increased by 8%, but the number of people aged 65 years and over has increased by 22% and the number aged over 75 has increased by 25%. We have to acknowledge that in the context of this debate and what we are discussing. The average age now stands at 38, which is up from 36 in 2011. People are having children later in life, as we know, and fewer of them are having children. While some of that is due to lifestyle choices that people have made, and we know the difference between when people have children now compared with maybe 30 or 40 years ago, we also have to recognise that social changes are being driven by the lack of housing and childcare supports, which are preventing young families from forming and settling. The Government has to address the barriers young people face to avoid, or at least mitigate, the severe impact that unplanned demographic challenges can and do have on the sustainability of social services.

It is not enough to just recognise the progress that has been made. It is essential that we also react to it. The demographic changes will obviously heap additional pressures on our hospitals, which they cannot bear. If we do not plan for those demographic changes, then we will not be able to deliver the health services that people need. I will deal with some of those issues when I talk about the existing level of service funding in healthcare, which we know is, in part, to deal with those demographic changes, in the context of what happened in budget 2024.

Our older people are already funnelled into hospital-based care because of a lack of alternatives at home and in the community. I pointed that out to the Minister for Health time and again. He does not need it pointed out as everybody knows, from the Sláintecare report and the very extensive debates we have had on healthcare, that we need to reorientate the healthcare system to ensure that we have the right care in the right place at the right time for patients. While we need to put more capacity into our hospitals, we have to do much more in relation to GP capacity, out-of-hours GP care, making better use of community pharmacies, building on the enhanced community care model that we now have in healthcare, which I welcome, making sure that people with chronic pain and chronic conditions are treated and managed in the community where we can, and delivering the statutory home care scheme to ensure that people can be cared for in their homes. All these are areas where we need more investment. All of that is also necessary as we deal with the huge changes and transformation we are seeing in healthcare.

I also acknowledge the significant innovation we are seeing in healthcare. I am always blown away when I go to training colleges and see people who are being trained to work in our healthcare system, and the first-class research and development and training capacity. It is just incredible. We are at the cutting edge of it. We see it in nursing and across many areas. I have no doubt that all of that training and capacity is leading to better health outcomes, when we get those people to come to work in the public system. The problem is we do not get all of them. As I said, because of other societal problems, such as housing, we are unfortunately losing some of them out of the country. That is regrettable.

We need to change our approach to healthcare to focus on improving quality of life and focus on care in the community to reduce hospitalisation. Our focus should also be on prevention and early intervention, not just treating disease but, where we can, preventing it. Again, this is one of the areas in healthcare we do not talk enough about. We maybe do not invest enough in this area. The Irish Heart Foundation and others are doing some very good work and research in this area in respect of cardiac disease. If we can reduce instances of disease, it is obviously more cost-effective and more beneficial in the management of our health services, but it also means that people will live longer and will not be in hospital.

Long waiting times are also storing up problems and making matters worse. They make care much more complicated and reduce the ability of people to stay at home, manage conditions locally and live independently.

I take this opportunity to raise with the Minister of State the issue of the deficit in healthcare spending and this year's budget. I know there will be statements on this in the Dáil tomorrow but we cannot have a debate on the impact of demographic pressures on healthcare and avoid having a conversation about the money that was given to the health service last year and this year to deal with those pressures. One of the reasons we have what are called existing levels of service funding given to Departments is to deal with a number of areas. These include pay demands, inflation, which is running at a high level in healthcare, and the increase in population and demographic pressures. The heads of the HSE and Department of Health, speaking at the Joint Committee on Health some months ago, conceded that the health service did not get enough money to stand still last year. Whatever the level of service funding that was given, it simply was not enough. That has, in part, created what is a big deficit this year of potentially €1.5 billion.

Matters were made worse in the budget just gone. The current head of the HSE has stated clearly on the record that we do not have enough money to run the health service next year. I understand that at a press conference today, the Minister for Public Expenditure, National Development Plan Delivery and Reform, Deputy Donohoe, stated it was likely we would have a deficit in healthcare spending next year. Not only is it likely but it needs to be pointed out to the Minister that he has guaranteed there will be a deficit next year. He has also guaranteed that we now have a recruitment embargo in place on the front line, in hospitals and elsewhere, that will have an impact on patient care. We know, from all the studies that have been done in Britain, the European Union and internationally, that if people are waiting for longer in emergency departments, their outcomes will disimprove. The quicker people can be treated in emergency departments, the better their health outcomes will be. When there is a recruitment embargo in areas such as non-training non-consultant hospital doctors, NCHDs, and junior doctors, healthcare assistants, home helps and lots of other areas, that will bite and have an impact on services. I visited St. Luke's General Hospital in Kilkenny on Monday where I met hospital management. They told me they were already finding it very difficult to hang on to non-training junior doctors who were being poached by the NHS in Britain and health services elsewhere. They are really concerned about the impact of this recruitment embargo and what it will mean. St. Luke's hospital has improved in terms of the number of patients on hospital trolleys.

Another example I will give, because it has been talked about so often by Ministers and is in my constituency, is University Hospital Waterford.There have been no patients on hospital trolleys in the hospital for more than two years. That was partly due to a lot of work that was done. Of the many ingredients that enabled that to happen, one was that the hospital opened up a sixth medical ward with 35 beds. This ward is allowed to stay open through unfunded posts and agency staff. A decision has been taken to scrap 7,000 unfunded posts and cut back on the agency spend by a third. I do not have a difficulty with cutting back on agency spend as long as it does not bite on services. I have been told by hospital managers in Waterford that they cannot keep the sixth ward open unless they take staff from elsewhere. One of the areas they will take staff from will be cardiac care, which means the second cath lab that was opened to deliver additional cardiac capacity will not deliver the full benefits it should deliver. This is one local example. I am sure that in the coming days, weeks and months as we face into a very difficult winter, this will become more apparent.

On excess deaths and what contributed or caused them in recent years, I have been very clear about putting factual information on the Dáil record and being responsible when we talk about this issue. We know, however, and it is accepted in the health services internationally, that if there are pressures in emergency departments and people are waiting for days on end on trolleys - I have spoken to many families for whom that has been a very bad experience - it will have an impact on the health outcomes of patients.

In addition to investment in primary and community care to ensure that alternative clinical pathways are available and people who should not be in hospital have other options, hospital managers talk about the need for more hospital beds. It is not the only solution but it is one of them in some hospitals. As the Minister of State will know, the Minister for Health, on three occasions last year, including very loudly at a meeting of the health committee, promised and announced 1,500 rapid-build beds. They seem to have dropped off the face of the earth. Certainly no additional funding was made available in the budget and we do not know if these beds will be funded at all. Without those beds in hospitals, we will to be able to give hospitals the additional capacity to enable them to deal with the issues in emergency departments. That will be on the Government and the Minister with responsibility for public expenditure and reform who, thinking out loud and speaking as if he was not a direct contributor to this, said we will have a deficit in healthcare next year. He made a deliberate decision to underfund the health service. That will have consequences.

Having spoken to some clinical leads in healthcare, I am also concerned about cancer, cardiovascular treatment and diabetes in maternity. All these areas need year-on-year additional funding to advance and to deliver their strategies. The health service has been starved of additional funding in these areas. If anybody believes this will not impact on the future of healthcare services, patient outcomes and patient safety, they are living in cloud cuckoo land. It will have a real impact. I have given an example of what this will mean in an acute hospital in my county but we will see it right across all of the clinical programmes and the national strategies. Every strand of healthcare has been starved of additional funding. Worse still, we have not even provided the health service with enough money to stand still. Given what we have already seen with the recruitment embargo, the scrapping of 7,000 jobs and the disappearance, it seems, of 1,500 rapid-build beds in a puff of smoke, all of that will bite, and I think we will see more.

That big black hole the Government has created in healthcare will now be bigger next year because of the deliberate strategy of the Government. Maybe it thinks it is good to leave this to the next Government. Sinn Féin has said the Government has thrown in the towel on healthcare. Maybe it is the case that it has given up because it will not be in government next time around and has decided instead to leave it to the next Government. That is irresponsible because anybody who understands how healthcare is funded will say there has to be certainty on funding. In the absence of such certainty, there is chaos and confusion. We need multi-annual funding and accountability in healthcare, not cuts.

I listened very carefully to what Government representatives said in response to all of this as they have tried to pivot and shift this onto the HSE, arguing that the HSE is wasteful and needs reform. Nobody has been shouting that more loudly than I have. We do need to reform the HSE and there is waste. I have been pointing out a lot of these areas, including management consultancy, outsourcing, agency spend and so on. It is only now that the Government is waking up and saying it will do something about it. Even if all of that was delivered, at the best estimates it still would not come within an ass's roar of dealing with the deficit. I am very concerned about all of that. While I am pleased we are having this debate on excess mortality and related issues, I could not let the issue of the budget go without putting those points on the public record.

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