Stephen Donnelly (Wicklow, Fianna Fail) | Oireachtas source

I am really pleased to have this opportunity to address the House on investment in healthcare. Before I do, I would like to add my voice to those condemning the bombing of the al-Ahli Baptist Hospital in Gaza. While there are claims and counter-claims about which side the bombs came from, the killing of hundreds of innocent patients, healthcare workers and families is outrageous. Our thoughts are with the families of all those who died and were injured.

At the same time, we must never take our eyes off the Russian murderers who have deliberately targeted healthcare workers, patients and health facilities in Ukraine. According to the Ukrainian health minister, Russian forces have destroyed around 180 hospitals and damaged more than 1,200 hospitals. They have shot up more than 350 ambulances. These deliberate attacks are utterly repugnant. They violate international law and the clear protections that should be in place for patients, healthcare workers and health facilities.

To turn to the debate in hand, for years we have invested in our health services at a lower rate than many other countries. Of the 15 western European countries, Ireland comes 11th in terms of the amount we invest in healthcare per person. Germany, the Netherlands, Austria, Belgium, France, Sweden, Norway, Switzerland, Luxembourg and Denmark spend more than we do per person on healthcare, when we adjust for local prices. Of the best comparator countries we have, we are in the bottom third. We need to bear that in mind when we have any discussion on future investment in healthcare.

The result of this was that when Covid arrived, and before that, we were not in a good place. We had fewer hospital and ICU beds and hospital consultants then many of these countries. We have not opened a new hospital in 25 years. Our digital health or ehealth service is rated as one of the poorest in the entire EU. We all know that this has led to higher waiting lists and too many overcrowded emergency departments in too many hospitals.

There has been a response to this. The response has been an unprecedented increase in funding for healthcare. The previous Government, in its last three budgets, increased core funding for healthcare by 40%. In the first three budgets of this Government, that was increased by a further 18% increase. That is a huge increase in capacity, but capacity alone is not the only solution. Our health services were not designed to treat the greatest number of people for the money that is available. Until recently, too many people were being treated in hospitals rather than in the community, which is a better and less costly place to provide that care.

Our goal is high quality, affordable healthcare for everyone when they need it, that is, universal healthcare. We are all signed up to that via Sláintecare. To achieve this in the lifetime of this Government, we have been following a clear plan, namely, increase the capacity of our health service and fundamentally reform how and where patients are treated. I fully accept that there is still a long way to go. This will take years to do. However, thanks to the efforts of our healthcare workers, substantial and important progress is being made. Our focus, as colleagues will be aware, has been on reducing costs, improving services and speeding up access for patients. Inpatient hospital charges have been abolished, saving people up to €800 a year. Free contraception has been rolled out to women up to the age of 30. Half a million more men, women and children have access to State-funded GP care. We have just rolled out State-funded IVF for the first time. The most a household now has to pay for medicines in any month has been reduced to €80.

We have allocated unprecedented funding to our national clinical strategies. Our healthcare workers are in the middle of delivering a revolution in women’s healthcare. This includes opening new menopause clinics, fertility hubs, perinatal mental health teams, specialist endometriosis centres, same day see-and-treat gynaecology clinics and lots more across the country. That is having a huge impact. New services are becoming available for the first time in areas like diabetes, stroke, dementia and obesity. Existing services are being expanded in cancer care, maternity, trauma, home care, cardiology, ambulance services and lots more. Last year, waiting lists fell for the first time since 2015. We all know there is a long way to go, but progress is being made. The total number of patients removed from waiting lists in the first eight months of this year is 150,000 more than was achieved last year. The number of patients being treated who have been on waiting lists is going up, thanks the work of our healthcare professionals and the unprecedented level of investment the Government is providing to them. We are absolutely determined to continue with that progress.

Waiting lists in the Republic are now half of what they are in Northern Ireland. For the most urgent cases, that is, people waiting more than a year for a hospital procedure, believe it or not waiting lists in Ireland are now one tenth what they are in Northern Ireland. Our healthcare workers deserve huge credit for bringing this about. Over the past three years, we have added 22,000 healthcare workers, comprising 6,700 extra nurses and midwives, 3,100 additional health and social care professionals and 2,500 doctors and dentists. We have increased our hospital bed capacity by over 1,000. We have significantly increased ICU capacity. We are going to keep going.

Critically, we are also improving productivity in our health services. A growing number of people are now getting the care they need when they need it and where they should be getting it, which is in their own community rather than having to go to hospital.

This is better for patients and better for our health service because such care can be provided at a fraction of the cost of someone having to go to hospital. This is not happening by accident. It is happening because over the past two and a half years we have rolled out a completely new community care service, called enhanced community care. We have 180 new healthcare teams around the country doing this. There are 96 primary care teams, 30 chronic disease management teams, 30 older persons' teams and 30 community intervention teams.

We are working with our clinicians to have them provide care to patients to the fullest extent of their qualifications, which they want to do. Our GPs are playing a more central role. The new public-only consultant contract is phasing out the deeply distorting effect of private income on public hospitals. The safe staffing framework for nursing is being rolled out in every hospital, making Ireland one of the leading countries globally in making sure we have the right level of nursing care for a given level of patient need on any given day, on any given ward.

We are training and hiring more advanced practitioners in nursing and midwifery and rolling this out for health and social care professionals. We are working with pharmacies to support them in providing a higher level of care in things like oral contraception, minor ailment clinics and more, which we are in discussions with them about.

The National Ambulance Service is going from strength to strength. It is providing more advanced care in the home or on scene, avoiding the need for patients to go to the emergency departments. We are investing in injury units and other initiatives to provide people with alternatives to emergency departments.

We are also rolling out a new productivity system in every public and voluntary hospital so that for the first time we will be able to see the extent of patient care being delivered by every hospital, every clinical speciality and every consultant. We have never had the ability to do this before. It is central to being able to ensure that patients are getting the best care possible, given the resources being provided to our healthcare professionals.

The budget for 2024 will continue a lot of this progress. The total budget allocation is €2 billion. Approximately half of that is recurring funding and the other half non-recurring funding. The waiting list action plan and urgent care plans are fully funded. Staffing is fully funded for 162 new acute beds, 22 new ICU beds, which is a very welcome increase, six new surgical hubs, which we are deploying around the country, and 70 new community beds. There is a lot more investment through HIQA in expanding the appropriateness and the quality of the existing community beds.

Full year costs for new measures such as 500,000 more GP cards and IVF are included. We are increasing the age for free contraception to age 31. I admit this is a modest increase. Colleagues will be aware that I wanted to go further but I was determined that we would not just stop at age 30. We have to keep the progress going. I am determined that we will see free contraception provided to all women. That is the policy objective we are committed to and that is why I made sure that we are make some progress. It is not the increase I would have liked but we will keep going with it.

Funding is also in place to continue with our Covid vaccine and testing and tracing programmes as well as supports for Ukrainians fleeing war who need access to our health services.

Between the budget and conversion of agency costs, we intend to hire 2,000 more healthcare workers. This includes the full completion of the roll-out of the safe staffing framework, phases 1 and 2, in all public and voluntary hospitals. It includes more advanced practitioners, more training posts and more expertise for ehealth, which we are laggards on. I am determined to make big strides in this regard.

Some areas are not getting the same investment next year as they have over the past three years. This is due primarily to an increase in inflation and patient demand being well in excess of what was forecast last year. This requires approximately €1.1 billion of the €2 billion allocated for this year. More than €700 million in recurring funding is allocated for current service levels next year and an additional €400 million in one-off funding for the non-pay pressures being seen in the hospitals is allocated for next year. This includes the necessary increased spending on medicine, catering, cleaning and all the things required in our hospitals to deal with the increase patient demand.

There has been much discussion on whether the budget is sufficient. I note the position of the chief executive officer of the HSE. Echoing the Tánaiste, the CEO is completely within his rights to give his view publicly on what he sees as the challenges faced in running our health services next year. He has my full support in having made the comments that he made.

Like many other countries in Europe, we are experiencing unprecedented demand for services. I want to give colleagues a flavour of what we are dealing with. Over the past 12 months, there have been 3.5 million outpatient appointments and 1.8 million inpatient and day case attendances. Our hospitals also treated 1.7 million patients in emergency care. The number of people, so far this year, referred to a hospital consultant is up 16% on last year. That was not forecast. It is not normal. I, along with others, believe that it is part of a post-Covid surge in patients, possibly due to deferred care during Covid.

The number of people aged 75 and older presenting at emergency departments is up by more than 20% versus pre-Covid levels. These are enormous increases in demand. I give huge credit to the HSE because these increases are being met. Not only are the increases being met, targets are being exceeded in the number of outpatient appointments being provided to get people off the waiting lists.

After the budget last week, I indicated that a supplementary budget for next year is entirely possible. We simply do not know at this point what demand will be seen, and what rate of healthcare inflation we will have to cope with. These two factors will be the main drivers of any potential supplementary budget. For example, this year's supplementary budget is estimated at approximately €1.5 billion. I believe that two thirds of that is due to higher than forecast inflation and the huge post-Covid demand, which was not expected.

While we address these challenges, we are going to continue our work on increasing productivity and treating more patients with the resources available. I am also commissioning an in-depth report into the future costs of healthcare. We are all united in our ambition for healthcare for everyone in Ireland. We are agreed on where we need to go on this. We need to understand better exactly how much that will cost in a much more volatile world than when the report was written in 2016 and 2017 in terms of medical inflation, post-pandemic patient demand and wars in Europe. This report needs to include some of the more modern innovations such as personalised medicine, artificial intelligence, remote sensors, breakthrough medicines for conditions such as dementia, genetics advances and much more. This can provide us with a baseline that everyone can work to in order to get to the place we all want to get to.

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