Stephen Donnelly (Wicklow, Fianna Fail) | Oireachtas source

I move amendment No. 1:

To delete all words after "Dáil Éireann" and substitute the following: "notes that:

— the Government has allocated €22.5 billion to the health budget for 2024;

— the health additional allocation for Budget 2024 is nearly €2 billion;

— this includes an increase of €808 million in core current funding, €1,032 million in non-core current funding and an additional €120 million in capital funding; and

— Budget 2024 includes funding for Covid-19 vaccinations, testing and tracing, waiting list initiatives, urgent and emergency care initiatives, Ukrainian supports, staffing for new acute beds, intensive care beds, community beds and surgical hubs, investment in our healthcare workforce including in advanced practice and new training posts, mental health and social inclusion measures, and cyber and digital capabilities;

further notes that the Government has focused on increasing capacity:

— in the last three years the Government has added 22,000 healthcare workers (net), including 6,700 extra nurses and midwives, 3,100 additional health and social care professionals, 2,500 extra doctors and dentists;

— hospital bed capacity has increased by over 1,000 beds during the same period;

— ICU/crucial care bed capacity has increased by 25 per cent;

— a national network of Enhanced Community Care Network teams is being rolled out, enabling patients to be treated outside of hospitals and closer to home; and

— six new surgical hubs are being progressed with the first due to open within months;

acknowledges that:

— funding has been allocated to clinical strategies and improving access;

— hospital waiting lists fell in 2022 for the first time since 2015;

— the total number of patients removed from waiting lists during the first eight months of the year is higher than target, with over 150,000 more patients removed from waiting lists compared to the same period last year;

— a record 22 million hours of home care are forecast to be delivered this year, up from 17.48 million in 2019;

— important progress for patients has been made in the rollout of national clinical strategies including in cancer care, maternity care, trauma care, palliative care, critical care, dementia care, mental health services, older persons services, health and wellbeing programmes, social inclusion, screening services, and in our National Ambulance Service;

— new services have been introduced in areas including diabetes, stroke, obesity, fertility and genetics; and

— unprecedented investment has gone into women's healthcare with the opening of new menopause clinics, fertility hubs, specialist endometriosis centres, and same day see-and-treat gynaecology clinics all over the country;

recognises that costs have been reduced to patients in line with universal healthcare:

— 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;

— 2023 will see half a million more adults and children have access to free General Practice care;

— state-funded In-vitro fertilisation has been introduced for the first time; and

— the maximum amount that people now pay on their monthly medicines bill has been cut from €124 to €80 per month since this Government entered office; and

further recognises that:

— significant reforms are underway and will continue to ensure strong productivity in provision of health services;

— there has been an unprecedented shift in patient care from the hospital to the community sector, including via 96 new primary care teams, national networks of Chronic Disease Management, older persons and community intervention teams, and a national network of new primary care centres;

— Ireland is now a leading country globally in advanced practice for nursing;

— the introduction of the new public-only consultant contract facilitates extended working hours, and this helps with patient flow and ensures more senior decision makers are available to patients after hours and at weekends;

— significant progress has been made in the roll-out of phase 1 and phase 2 of the safe staffing framework to all hospitals, with 56 million allocated for implementation since 2020;

— investment in Emergency Department (ED) avoidance measures including expansion of injury unit services and National Ambulance Service protocols are providing alternative pathways to EDs to patients; and

— roll-out of a new productivity platform provides, for the first time, detailed productivity information in the acute sector.".

Our goal is for everyone to have high-quality affordable healthcare when they need it through a public healthcare service. There is a long road to travel, and we know this, but we are well on the road to making our ambition a reality. Investment did need to grow. For years we had one of the lowest levels of hospital consultants and hospital beds in western Europe. We did not build new hospitals. We had too few GPs and out-of-date computer systems. There has been too much reliance on hospitals and too little investment in community care.

Too little was invested in keeping people healthy. Costs for too many patients have been too high. Too many people have waited too long for care. Too many patients are still waiting on trolleys. Too little has been known about which hospitals and which services are thriving and which are struggling to see enough patients. This is changing. While Ireland still spends less per person on healthcare than most other western European countries, funding has dramatically increased. We have cut costs for patients, abolished hospital charges, introduced free contraception, reduced monthly medicines bills, provided free GP care to another 500,000 people and rolled out free IVF.

We have built a lot more physical infrastructure with a record number of extra hospital beds, intensive care beds and primary care centres. Having not opened a new hospital in 25 years we are now progressing five new hospitals at the same time. We have hired a large number of extra healthcare workers, including thousands more doctors, nurses and health and social care professionals. We are increasing college and training places. We are becoming a world leader in advanced nursing and midwifery practice and in our approach to safe staffing in our hospitals. For every two GPs who retire, three to six new GPs enter practice.

We are fundamentally reforming how and where patients are cared for. An entire new community-based health service, with thousands of additional healthcare workers, has been put in place in just three years. More than 150 new clinical teams have been set up throughout the country in primary care, older persons services and chronic disease management. A large number of consultants have now taken up the public-only contract. This is a vital step in removing the distorting effect of private income from public hospitals. A new productivity platform is being introduced in every hospital. This means we can find those doing the best and learn from them. It also means we can identify those that are struggling and support them in treating more patients.

These reforms and this new capacity are beginning to work. Last year the waiting lists fell for the first time since 2015. So far this year our healthcare workers have removed 150,000 more patients from the waiting lists by providing them with treatment than was achieved last year. Not only are our healthcare workers removing more patients from waiting lists this year than last year, but so far this year they are 50,000 patients ahead of target. They deserve great credit for this. Our waiting lists are now one half of what they are in Northern Ireland. This has not always been the case.

More and more people are receiving the care they need in their own community. Our healthcare workers are delivering a revolution in women’s healthcare. This includes opening new menopause clinics, fertility hubs, specialist endometriosis centres and same-day gynaecology clinics. New services are becoming available in areas such as diabetes, stroke, dementia, neurorehabilitation, genetics and obesity. Existing services are being expanded in cancer care, maternity care, gynaecology, trauma, home care, mental health, palliative care, cardiology, ambulance services and more. They are making a difference every day throughout the country.

Some of our services are not delivering at the level that we all want and that patients must get. I fully accept the calls being made on the other side of the House in terms of individual patients not getting the care they need. It is what we spend every day in this House, on both sides, trying to fix and make better. These very serious and real concerns, issues and challenges take up most of the public debate. The good work going on, and there is a great deal of it, does not get a look in. The truth is our healthcare workers are making progress, and working damn hard in every part of this country to make this progress happen on behalf of patients. In every part of the country, healthcare workers are rolling out new services, taking patients off the waiting lists and providing fantastic care to millions of people all the time.

The national conversation about this year’s health spending is similar. Most of our health services are being delivered on budget. The main area that is not is the hospitals. This is mainly because many more patients are turning up than were forecast and medicines and other supplies are costing more than was forecast. This is happening in Ireland and across Europe. Let us take a doctor, a nurse and a radiographer working in one of our hospitals. The medicines and supplies needed to treat patients have become much more expensive. For every ten patients these healthcare workers have been funded to treat, 11 have turned up. What have these staff done? They have treated all 11 patients, as they should. How have they done this? They have done it by working longer hours, running more scans and using more medicines. To do all this, they are spending more money than they have been allocated. However, some of the terms being used to describe these staff and their spending of this additional money include a "runaway health service", in need of a "massive bailout", with spending like "a flesh-eating bug", that is "out of control" an "omnishambles", a "runaway train" and a "black hole".

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