Duncan Smith (Dublin Fingal, Labour) | Oireachtas source

This is a very good, simple, to-the-point motion that we wholeheartedly support because it goes to the heart of what is going on in the health service at the moment. The Minister's response was to begin talking about the aim to eliminate cervical cancer in Ireland. This is a very laudable aim, which we all support 100%. By God, what a legacy that would be for Vicky Phelan, just over a year on from her passing, if we were able to achieve it.

However, that is not what this motion is about. Even if it is, achieving that aim or any aim in our health service is going to be impossible while there is a recruitment freeze on front-line staff. I acknowledge non-training doctors and nurses are excluded from the freeze but doctors and nurses cannot operate effectively in a healthcare setting without healthcare assistants, porters and other front-line staff who are subject to this recruitment freeze. Our hospitals are at full capacity. The Minister will not solve or even make a dent in the trolley crisis if he cannot tackle delayed discharges. This means more home helps and home care workers are needed but they have also been targeted by this recruitment freeze.

In July this year, the Minister spoke at an event organised by the Irish Universities Association. He said that we will need to double the number of healthcare college places to meet the skills demand from the health sector over the coming years. This is a laudable long-term vision of what is needed. However, how can young people who want to enter the health service have any trust when the Minister says he wants to double the number of college places to meet the skills demand and four months later we have a recruitment freeze? How can people build a life and plan a career when, in the midst of huge budget surpluses and when the country has never been richer, recruitment freezes are announced and then extending them a couple of weeks later? It is crippling the trust of our young people who want to enter the health service. As it currently stands, almost 900,000 people are on waiting lists of some kind. That is just under one fifth of the ever-increasing, ever-ageing population. Our healthcare system is already understaffed with front-line worker numbers cut to the bone. Those waiting lists are not going to improve. They will disimprove and increase unless we get the staffing levels right.

Yesterday, the Irish Hospital Consultants Association, IHCA, raised concerns about the spike in the number of children on hospital waiting lists as flu season approaches. Waiting lists for child inpatient and day case treatment have increased significantly over the past year, with severe overcrowding expected in paediatric hospitals this winter. The figures are quite stark. Over the past year, child inpatient and day case waiting lists combined have increased by 26%, which is a much larger increase than that of adult inpatient and day case treatment. Children are being put into overcrowded and understaffed settings. It is outrageous and it is a complete failing of the health service, and the Government has to take responsibility, which it has failed to do. It is incredible that the legacy of budget 2024 will be of failing to fund the health service and two recruitment freezes in short order after the budget announcement.

The Minister mentioned budgeting and hiring the number of staff that is budgeted for. I have yet to see where all these staff have been hired that are doing nothing on the front line of our health service. I have yet to walk into a healthcare facility anywhere and see a load of healthcare assistants, nurses and porters doing nothing; they are not. These people are worked to the bone. The HSE managers are hiring the staff because they are needed to cope with an increasing and ageing population putting massive demands on our healthcare service.

It is so weak and insipid of the Minister to reply with this accounting comeback in the face of the healthcare crisis and especially on the back of our experience during Covid and how people embraced the health service. They were closer than they had ever been to front-line workers in supporting them and wanting to be there for them. This is being eroded by decisions the Minister and senior management in the HSE are making. The division between the Department of Health and the HSE and the public airing of positions and policies has to end. The ones who suffer are the sick and the vulnerable and those who require the health service, and those who are having cope are those on the front line.

A few days ago I was told of a CDNT where a new manager was about to be hired and onboarded has been subjected to the employment freeze. This has had massive knock-on consequences to the operation of that particular service. It will also have an impact on continuity, staff retention, recruitment, the establishment of family forums and everything else that needs to go into the running an effective CDNT.

I also spoke to speech and language therapists who voiced the fear that the recruitment freeze has compromised patient care and will have further negative impacts. It will lead to unsafe, poor quality health outcomes for patients. The clinicians who are committed to serve are being let down by this.

This again points to how the HSE is being run, staffed and managed in that there are not enough voices from the clinical side at the top of the organisation. More voices from the clinical side would be voices for the patients. Sadly, they have been absent from an awful lot of decision-making in the HSE. If there were more voices from the clinical side, I cannot see how we would end up with a recruitment freeze at this time. It is incredible that we are here debating for the sixth week in a row the issue of recruitment freezes in the health service. Whenever I or other members of the Opposition raise staffing levels we are told that they need to be put in context by the Minister. We are told that there are thousands more staff this year than last year. We are told that things are getting better instead of worse when we know that 7,000 essential posts have been scrapped since the implementation of the recruitment freeze. The number on waiting lists for home support has gone from 5,500 to 6,000 and there are 900,000 people on waiting lists. None of these key measurements are going in the right direction. No matter what the Minister says, every measure is going in the wrong direction. I am deeply concerned about the winter ahead. We need a greater uptake of the flu vaccine. Families who are not entitled to get it for free are making an economic decision and deciding that they cannot afford it. We need to get the RSV vaccine rolled out. We also need to see more uptake of the Covid vaccine to address the triple threat that will impact our winter trolley crisis. Will the Minister seriously examine a national adult immunisation programme that will take these three vaccines into account and consider shingles and other vaccines?

I know there is vaccine fatigue out there - I understand that on a human level - but nothing is better at keeping people out of hospital than having an effective vaccine. We need to look at the hurdles that exist, which are economic for many people, such as poor people who cannot afford to get a vaccine. It is something they will put on the long finger. It costs about €37 to get a flu vaccine. For a hard-pressed individual or family on a fixed income, that is something that will make them say they will just take their chances this winter, and they are the very people who will end up in our emergency departments.

We have a childhood immunisation programme and it is a good one. That is a good part of the health service. Some say the Opposition does not mention good things often enough but we do. We need a national adult immunisation scheme. Health technology assessments, HTAs, have been successful for a chickenpox vaccine for kids, so good work is being done but it needs to be brought together. My concern relates to the lack of funding in this budget for new medicines and that whole area. We are not seeing enough energy regarding vaccines and illness prevention. If that were brought in and people did not have barriers, and if we had enough staff and were lifting recruitment freezes in order that we could provide vaccines and keep people out of emergency departments, that would be a clever, smart way of impacting on the trolley crisis.

I brought forward a motion on home care two weeks ago and mentioned it earlier during this contribution. We need a proper plan for hiring, regulating and valuing our home care workers. They are so important to our health service and they do not get enough recognition. Unfortunately, what the Minister's Government has done on that is not enough. A living wage is good, but if they do not get travel expenses, mileage, regulation and value, we are at nothing.

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