Stephen Donnelly (Wicklow, Fianna Fail) | Oireachtas source

Healthcare for everyone is a cornerstone of a decent society. I am pleased to report to the Dáil today on the progress being made in making this a reality. If you need a doctor, nurse or therapist; if you need a simple procedure or a complex operation; if you need home care or a nursing home, it cannot matter how much money you have, where you live or what age you are.

Thanks to four strong years of investment from this Government, thanks to a plan to increase capacity while modernising and reform how care is delivered, and most importantly thanks to the efforts of healthcare workers right around the country, we are now well on our way to making healthcare for everyone a reality. Waiting lists and waiting times are falling. The number of people on trolleys is falling. The cost of healthcare for families is falling. Life expectancy has increased. Survivorship from cancer and other diseases has increased. The number of people getting great care every day from our healthcare workers is up.

I wish to thank our healthcare workers. Every day they hear about the challenges. They talk to me, and I am sure to the Cathaoirleach Gníomhach, about how demoralising they find it to hear so much focus on what is not working and so little focus on the good work they are doing. They know how hard it can be for families and patients. They know we have a long way to go. They also know that things are getting better for more people. We all know we have some of the best trained and most dedicated healthcare workers anywhere in the world. I will take this opportunity to say to all healthcare workers in Ireland: we see their hard work, we appreciate all they do and we thank them.

Given the focus right now on immigration, I would like to say something specifically to our international healthcare workers. One nurse and midwife in every two working in Ireland was trained abroad. More than two doctors in every five working in Ireland was trained abroad. I say to each and every one of them: without them, we could not run our hospitals and community services and we could not provide the care to patients that they need every day. I want to say to each and every one of our international healthcare workers that we are lucky to have them. We are proud to have them and we thank them for all that they do in our country every day.

We need to be absolutely clear on the challenges. Too many people are still waiting too long for care. Critically, however, progress is being made. This is the third year in a row that waiting lists will fall. For example, in Wicklow, Kildare and south Dublin, people were waiting about six years to have cataracts removed. They are now waiting less than 12 months and that time is falling. In Galway, Mayo and Roscommon, people sent by their GP to see a urologist were waiting two years for their first appointment. They are now not waiting two years; they are waiting five weeks. In Sligo, women sent by their GP to see a gynaecologist were having to wait for four years to see the gynaecologist. They are now waiting four weeks.

Nearly 180,000 more patients were removed from waiting lists last year than the previous year. We exceeded our target of a 10% reduction in the number of people waiting longer than the agreed Sláintecare ten to 12-week waiting times. The number of people waiting more than 12 months was reduced by a third, and that was achieved in just one year. The average time people were waiting for an outpatient appointment fell from nearly ten months to seven and a half months. Our goal is to bring that down to ten to 12 weeks but reducing it from ten months to seven and a half months just last year is really important progress.

In emergency departments this year, thousands more people are presenting to the EDs but thousands fewer have been waiting on a trolley. Some hospitals, like Kilkenny, Tullamore, Mullingar and Portiuncula, have more than halved their trolley numbers this year compared to last year. We have also cut the amount of money families need to spend on healthcare in Ireland. In 2021, we reduced prescription charges, increased medical card access for the over-70s and extended to two years medical cards for the terminally ill. In 2022, we abolished hospital inpatient charges for children, introduced free contraception for women aged 17 to 25 and reduced the maximum monthly amount families pay for medicines from €114 to €80 in any month. Last year, we abolished hospital inpatient charges for adults, saving families up to €800 per year. We expanded eligibility to GP cards to more than 500,000 people. That means that for the first time ever in our State, more than half the population is entitled to fully State-funded GP care, and that includes all children under the age of eight.

We introduced free national home STI testing services. We expanded the free contraception scheme up to the age of 30. I extended it to women aged 31 at the start of this year in order that no woman who accessed the scheme would age out of it. Last month, I launched the second women’s health action plan, where we extended the free contraception scheme up to the age of 35. The goal is for every woman in the country to have access to the scheme. We introduced State funding for IVF for the first time and I am delighted to be able to report to the House that more than 500 couples have been referred so far for fully State-funded IVF.

Taken together, these cuts to costs for patients amount to a radical shift in moving towards universal healthcare, which means healthcare must be affordable for everyone in our country.

While making sure people get faster access to care and ensuring that care is affordable, it is also vital that we roll out new services. Our healthcare workers are delivering a revolution in women’s healthcare. We have opened new menopause services, fertility hubs, endometriosis services and same-day gynaecology services. We have expanded services in breastfeeding, fertility, mental health and screening. We recently launched Ireland’s second women’s health action plan and this plan builds on the good work under way in the first plan. It means more same-day gynaecology clinics and post-natal hubs, an expanded free contraception scheme, expanded menopause and endometriosis clinics, more resources for eating disorder teams and screening services, and it adds new services in important areas like osteoporosis, bone health and cardiovascular health.

I would like to credit the Minister of State, Deputy Butler, for her leadership on mental health services and older persons' services. The Minister of State, Deputy Naughton, was until recently leading on addiction services and public health services, and now that has been taken on by the Minister of State, Deputy Colm Burke.

We have taken important action on vaping, making it illegal to sell vapes to anyone under 18. We are looking at new legislation, specifically around controls on colours, flavours and banning disposable vapes. Twenty years ago, the then health Minister, Deputy Micheál Martin, introduced the workplace smoking ban. We would all agree that it has saved many lives. Yesterday, I was delighted to secure a Government agreement to increase the age at which cigarettes can be bought from 18 to 21. This has the potential to save many lives into the future.

Capacity and reform are essential to the improvements we are seeing. We have opened a record number of extra hospital beds and primary care centres. We have hired tens of thousands of additional healthcare workers. For every GP retiring, two new GPs are now entering practice. We are making it easier for people to get the care they need in their own communities, rather than having to go to hospital. To do this, we have built a new community health service with thousands of new healthcare workers who are working right across the country. This includes 96 new primary care teams, specialist teams for older people and specialist teams for those living with a chronic disease.

With regard to reforms, one of the most important reforms we have is that last year, we launched the public-only consultant contract. It is a fundamental reform in hospital care. It means more patients treated by consultants; patients being treated quicker and getting out of the hospital quicker; and public hospitals being used to treat public patients. I am delighted to be able to share with colleagues that just one year on since the launch of the contract, more than half of the consultants in the country have now signed up to the new contract, which really is very encouraging.

The investment and reform are working.

Take, for example, children who are referred to see an eye specialist. Before now, in many counties such as Galway, Wicklow, Dublin and many other counties around the country, children who were referred to see an eye specialist had to wait for two to three years for that appointment. They are now being seen in approximately six weeks. Much of the credit for that goes to our ophthalmology teams, as well as innovations in advanced nurse practitioner-led teams in the community, which see many of these children. We will continue with this project including through a clear focus on productivity across our health service. I have no doubt that we need to continue to invest and grow capacity, but it is also very clear to me that there are opportunities for us to achieve higher levels of patient care, given the level of resources we already have. It is a live conversation between me, my Department and the HSE.

Things are getting better but I will be the first to admit there is still a long way to go. There is still much to do. Waiting lists are still too high in too many specialities. When it comes to children waiting for spinal surgery, I know we all agree that we must reach the aim of seeing every child within four months. Quite frankly, that has not happened yet. I have set up a new task force with surgeons and patients right at the centre of what we are doing on it. I provided new funding again this year with the ultimate goal of every child being treated within four months.

Trolley numbers are still far too high in too many hospitals. We are adding more beds, more options for patients and better ways of working. We are targeting the hospitals that make up the majority of the patients on trolleys. I am very aware that colleagues here today will be keen to discuss the ongoing challenges at the emergency department in University Hospital Limerick. As I expect to receive the review by retired Chief Justice Frank Clarke shortly, I will be cognisant of that in my comments. However, I will say that I visited UHL and met its senior team when I was appointed. The team in UHL put up a very clear challenge to me and this Government. It stated very clearly that it needs more capacity. The capacity that should have been added in 2009 had not been added and that was core to the challenges it was facing. The team said they needed more bed, nurses and doctors and they were right. I fully agreed with them and the Government over the last four years has responded to that challenge.

University Hospital Limerick has received more investment than any hospital in Ireland. University Hospital Limerick has received a bigger increase in staff than any hospital in Ireland. In fact, compared with the start of 2020, there are now approximately 1,200 more healthcare professionals working in UHL than there were, and they are making a difference. As well as the 108 beds that have been added, the 1,200 staff and the record increase in funding, we also have more in the works. Two 96-bed blocks are being built on site. A new surgical hub is coming in as well and other capacity is being added.

As we have seen this year, more capacity on its own will not fix this problem. All around Ireland, hospitals are reducing the number of patients waiting on trolleys. They are doing this in spite of more and more people turning up at their emergency departments. By contrast, the number of patients on trolleys in UHL has gone up a lot this year. As the recent HIQA inspection noted, welcome reforms are now under way at UHL but there is a long way to go. Changes in governance and culture are required. UHL needs to implement solutions that we know work in other hospitals but are still not commonplace at UHL.

The new regional executive officer has my full support in working with the hospital team to drive these reforms. We need to see a partnership between the clinical leadership in the hospital and the administrative leadership at a regional level. We need to make sure that the entire hospital sees the patient on the trolley in the emergency department as the responsibility not just of the emergency department but of the entire hospital. We need to continue to drive down the average length of stay. We need to continue to see increases in weekend discharges. We need investment in more patient flow teams and capacity within the hospital.

As colleagues will be aware, I visited UHL recently and allocated an additional 86 beds. That includes 50 beds that we will take for just one year in Tipperary, 20 beds in Clare and 16 modular beds which will be permanent additions on site. This is in addition to other capacity, including longer opening hours of the medical assessment units, having a GP on the door and other capacity as well. Regardless of the extra capacity we have added and regardless of the significant extra capacity that is in train and will become available, the reality is that far too many people are languishing on trolleys in the emergency department while they are waiting for a bed in UHL. Given the big increase in the number of patients on trolleys in recent months, I have initiated a review by HIQA into emergency care capacity in the mid-west region. This will explicitly include consideration of the case for a second emergency department in the region. I will consider the findings and recommendations in the Frank Clarke report before finalising the terms of reference for this review.

I will conclude with just two points, the first of which is to once again acknowledge that we still have a long way to go. It will take several more years to get the health service that people in Ireland need and deserve - a health service where everyone can get the care they need when they need it. The second point is that while most of the debate in this House and the media focuses on the challenges that people face in healthcare - and we understand why that is so - in spite of this, a huge amount of progress is being made. I have no doubt that if we continue this project, continue to invest and continue to support our healthcare workers and patients, we will achieve one of the most important goals that is the cornerstone of our Republic: universal healthcare for everyone in our country when they need it.

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