Colm Burke (Cork North Central, Fine Gael) | Oireachtas source

I very much welcome the work the Minister has done over the past two to three years. There are challenges in healthcare provision and a supplementary budget will be needed to deal with the expenditure of an additional €1.5 billion this year. There are issues we need to look at in dealing with healthcare. It was interesting to hear the Sinn Féin spokesperson on health acknowledging that the health service in this country had contributed to the increase of 11 years in life expectancy, from 71 to 82, in the past 50 years. In the past 20 years, in particular, the way in which healthcare has been provided has had a major influence on life expectancy.

Part of the challenge in providing healthcare arises from the increase in population. CSO figures show there were 3.85 million people in the country in 2000. There are now more than 5.2 million, which is an increase of 1.5 million, or 40%. In real terms, there should have been a 40% increase in healthcare provision. There has been such an increase in a large number of areas but there are challenges in some areas, which we must work to resolve. Over the past seven years, the number of staff in the HSE has increased from 103,000 whole-time equivalents in December 2014 to more than 142,000 now. There are approximately 162,000 staff in real terms but when the number is converted into whole-time equivalents, it amounts to 142,000, which is an increase of 40% in that period. Every one of those staff is required, no matter what area they are in.

The question is whether more efficiencies can be created. An area of concern is that a huge number of organisations deliver healthcare services. The health budget is €22.5 billion for this year but more than €6 billion of that will go to 2,500 organisations that receive their funding from the HSE or the Department but are not under the remit of either. They provide really good services but there is a question as to whether we could do better in achieving efficiencies in some areas. Are different organisations providing the same service? We might be able to do more in looking at that issue. At the meeting of the Committee of Public Accounts this morning, I asked whether there are enough checks and balances in this area. Some of the organisations I am talking about are voluntary hospitals and others are organisations such as COPE that provide a superb service, including rehabilitation services, right across the country. Those services were developed because there was a gap in provision by the healthcare sector. The organisations have filled that gap very well for a number of years but we need to examine how more efficiencies can be created.

To give an example of a lack of efficiency, I was talking recently to a consultant who has worked in the United States where there was access to an operating theatre two days a week. This person is now back in Ireland and has access to an operating theatre for only half a day a week. The problem is that the half-day slot is after lunch but the consultant has been advised that no patient can be admitted into theatre after 4 p.m. I am not blaming staff, who want to leave at 5 p.m. because they have children to collect and look after or there are other demands such as caring for elderly parents. Surely, however, it should be possible to have an arrangement whereby one lot of staff work from 6 a.m. until 2 p.m., say, and another lot cover 2 p.m. to 8 p.m. This would make better use of the facilities. In the private hospitals, many of the theatres are operational until 8 p.m. because that is the way the rota is done. The question is whether a more efficient service can be created with what we have. A lot of people are calling for more consultants to be appointed, which I fully support.

It is fine to appoint consultants, but we also have to make sure they have access to what they require, whether that be theatre space or treatment rooms. When we have built the new children's hospital, that will not be a problem there, but not having access to facilities is a problem in an awful lot of other hospitals in the country. While we must employ more consultants and get the best people in here, it is important that when we do so, we use them effectively and efficiently. That is something we need to look at.

This goes back to the issue of management. There was a big call last year to get in consultants on Saturdays and Sundays to discharge patients from hospital. That is all fine if we want to discharge someone, but if it is the case the person being discharged cannot go home because they are not well enough to do so, even though they are well enough to be discharged, and if they need to go to a step-down facility, will enough administrators be in place to arrange that step-down facility, or what forward planning has been put in place? That is where we can create efficiencies.

I acknowledge the HSE will say something like 500 people who are in hospital on any one day are ready to be discharged but, unfortunately, cannot be discharged either because there is not adequate support at home or because there is no step-down facility arranged for them. We need to prioritise step-down facilities and the issue of contracted beds. For example, I was recently dealing with a patient in Cork University Hospital, CUH, who had Huntington's disease. One nursing home already had 12 contracted beds with the HSE and one of the people it had been looking after was a person with Huntington's disease. It was quite prepared to take the second person because it now had expertise for dealing with a patient with Huntington's disease, but the HSE would not engage with it because all 12 contracted beds were in use. We need to start thinking outside the box in regard to such issues in order that we can create more efficiencies.

I was recently in an emergency department, not, thank God, as a patient but to help the family of someone with an intellectual disability who was a patient there. It was at a weekend. Staff in emergency departments face significant challenges. First, they need to assess the patient, and if he or she then needs to be admitted, it is about getting a bed. In a lot of cases, people there did not need to be in an emergency department. If proper structures were in place at weekends, they would not have to go to emergency departments. We need to look at how we can put in place a proper GP system for weekends. A very successful unit in Cork, for instance, is the minor injuries unit. Rather than having to go to the emergency department of CUH in Cork city, people can go to the minor injuries unit at St. Mary's Health Campus. It deals with a huge number of people because it is just for minor injuries, and it has a team of nurses and doctors who can deal with minor injuries every day of the week. We need to develop that to get it in place more widely.

I acknowledge the Minister has been working on the issue whereby a nursing home gets concerned about a person and needs to have them admitted to hospital. A system was set up during Covid, which I think St. Vincent's University Hospital in Dublin spearheaded, to get a team to come out from the hospital to the nursing home to assess the patient and then to give guidance to the nursing home as regards how they were to be managed. The Minister has encouraged this to be developed but it is important we develop it in every part of the country in order that we can keep people where the same level of care can be provided for them in the nursing home as can be provided in a hospital. In that way, we will not have to look for a vacant bed in a hospital and people from nursing homes will not have to wait in emergency departments for a number of days before a bed becomes free when, in fact, they could have been looked after just as well in a nursing home. We need to look at these issues with a view to creating efficiencies while, at the same time, giving a good quality of care.

It is important to acknowledge the commitment and dedication of the staff in all our hospitals and care facilities, whether they are people who are dealing with disabilities or others. We should recognise the work they have done, not least during the very challenging time of Covid. One area that now presents a challenge relates to home care, and the Minister has done a great deal of work to try to develop that area and improve access to home care. The big challenge he faces, however, concerns the lack of availability of people who are prepared to take on that role. We need to see how we can further entice people who were previously involved in those roles back into them while also getting new people into them. The Cork-Kerry region had 1,800 really dedicated people providing a very good service of home care but, unfortunately, 400 of them decided to opt out of the system, and the HSE in the south and south-west area has found it challenging to recruit additional people.

There are now more than 805,000 people in this country over the age of 66 and there has been a huge increase in the number of people who are over the age of 80 and even over 90, and that trend is going to continue. The more home care we can provide, therefore, and the more people we can keep out of nursing homes and out of hospital, the better. We need to look at how we can advance the recruitment and make it attractive. If we spend some more money on that, given the service home care providers give, we will get a much better return on the money spent. It is a challenge, however, and I fully accept that, with full employment, it is going to be a challenge to get people into areas where both people with disabilities and elderly people who require care and support in their home have to be catered for.

Overall, we need to be positive about the healthcare system. While we need more money, we also need to create efficiencies, and I have no doubt the Minister will deliver comprehensively in all areas of healthcare over the next 12 months.

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