Peadar Tóibín (Meath West, Aontú)

I welcome the fact that the Minister is looking to tie financial support for the HSE to its performance. It is something that I have made an argument for over the past number of years. I firmly believe that we need to reach a situation where the HSE is paid for the work it does for patients and the benefits it brings to patients. We would probably go further than this and tie funding for the HSE to the number of operations, treatments, consultations and engagements it has with patients. This will ensure that money would get to the front line and that taxpayers' money would not be lost in layers of administration, which happens in the HSE. The Government is fond of recruitment embargoes. A recruitment embargo in the administrative sector of the HSE for two years could be beneficial in reducing the level of administration in the HSE.

If we tied funding to services delivered, it would mean that theatres would not remain closed for months on end in some hospitals, as the hospital would get paid for the theatre being in use and having a throughput of patients. Therefore, it would be illogical to allow those theatres to remain closed.

There is a difficulty in terms of the HSE and funding. Billions of euro are being poured into the HSE but we are not getting the service to which we are entitled. All the talk in this Chamber is about more funding for health services but the Dáil needs to start focusing on how we get better results for the money we are investing in the HSE.

As the Minister will be aware, the IT system in the HSE is not fit for purpose. We see ourselves as a tech island, yet the technology levels in the HSE are not acceptable. Many people still have their documents in physical form and when those documents need to be shared, the physical documents need to be moved about for people. It means that we cannot deliver a proper system. Covid was an example of that because some people received their Covid shots on the basis of the nursing homes they were in while other people received them on the basis of their GPs. Some people were called for two Covid shots while others were not called for Covid shots. We all have bank account numbers at this stage and there are really important details of all our engagements with those banks kept on an IT system, and it works. The fact that we do not have this for the HSE is still a significant problem.

Accountability is very important. The Minister will not agree with me but sometimes the lack of accountability in the HSE comes from the top. I mentioned the issue of Simon Harris not admitting initially to signing the contracts for the national children's hospital. He has rowed back somewhat on that, which I welcome, but I am still not confident about what will happen with the National Maternity Hospital. I was given a bill of quantities that was being used for the National Maternity Hospital. It was given to me by an anonymous individual. I had a look at it and there were lots of gaps in it. There was very little detail in it. It looked like the bill of quantities that was used for the national children's hospital. It looked like it had the space necessary for a future contractor to wangle a heap more cash out of the State. I ask the Minister to look at that. I raised the matter with the Taoiseach, who did not deny the veracity of the document. He said he had no interest in reading it. He said it was not the Minister's job to look at this and that the finer details were down to staff in the Department, but that is not the case. We need ministerial accountability if we are going to sign off on such documents.

One of the most shocking replies to a parliamentary question I have received from the Department over the past number of years concerns the number of adverse incidents in hospitals. In the five-year period from 2018 up to and including 2022, there were 500,000 adverse incidents in hospitals. Many of these were of low significance and did not have a massive impact on the individuals, but there were 3,142 deaths as a result of adverse incidents. I will give an example of how this arises. I know a woman who lives a five-minute drive from Navan hospital. She worked all her life in Dunnes Stores and retired at the age of 66. A couple of months later, she had a stroke.

It took an hour and a half for the ambulance to get to her home. She was finally brought to the hospital. Two weeks later, she was being treated and was brought to the shower by two nurses. The hospital was so busy, one of the nurses was pulled away and the woman fell and hit her head on the floor of the shower unit and sustained a head injury. She was then brought up to Beaumont Hospital. Her name was very similar to somebody else's and she got the wrong blood transfusion as a result. She had significant internal organ failure. This woman worked all her life, did the best she could, paid her taxes and retired, and three separate adverse incidents shortly afterwards have left her debilitated to this day ten years later. That is what is happening and there is no accountability for it. The State paid €2.4 billion in compensation in a ten-year period, so it is not just costing us in lives and ill health, but in billions of euro in taxpayers' money. We need to really inject accountability into the system. I ask that accountability be one of the significant elements funding is determined by in future.

Last year, 115,000 people were so sick that they went to accident and emergency departments but had to turn around and leave without ever being seen by a doctor. That is an incredible statistic that shows the overcrowding that is happening in certain hospitals. The number of people who die before an ambulance reaches their homes is increasing significantly year on year. In 2019, 757 were dead before the ambulance came. That is going to happen and is just a natural part of the system, but this figure had increased to 1,000 people in 2021. This shows that a lot of ambulances are being tied up. We had 11 ambulances outside Drogheda hospital one night because of the overcrowding in the accident and emergency department. They were waiting to see if they could deliver their patients to the hospital. They could not and had to stay there. There was no ambulance available in Monaghan, Cavan, Louth or Meath for the whole night as a result.

I was the first person to raise insourcing in the Dáil. I spoke about how private companies were being created by consultants to funnel patients into the consultants’ businesses. A report showed that, in one year, €14 million had been paid out to some of these businesses. I was told by a consultant in the south of the country that there is no incentive to get rid of a waiting list, for the waiting list is the business model of these insourcing businesses. The Minister is going to have to get to grips with this issue. We cannot have that conflict of interest where a consultant operating on a public list is scheduling and creating rotas for people to work on those public lists but does it in a way that means there is a steady stream of business to the private business as well. That has to be challenged. I accept that it is on the Government’s agenda.

Another reply to a parliamentary question showed there were 300 private clinics operating on the grounds of public hospitals. That is quite significant. We have private patients being treated in private clinics operating in public hospitals with the use of public equipment. A different reply to a parliamentary question showed 300,000 public patients had gone through the NTPF since 2017. That is not what the fund was set up for. It was not set up for such a large quantity of patients to be dealt with in that fashion. Those numbers have ballooned in the last few years. If you take the NTPF, the private businesses operating in public hospitals and the insourcing that is happening, there is a significant level of privatisation of the public health system happening right before our eyes weekly and that has to be challenged as well.

Another reply to a parliamentary question we received showed 13,000 nurses had left Ireland in the last five years. That is an incredible figure. In 2022, over half the doctors who graduated left the country. Another reply indicated 51% of all undergraduates in medical schools in this State were from outside the EU. The reason for this is such students pay nearly €200,000 for their degrees over the five- or six-year period. The universities are dependent on those funds because they are short of funds, but the danger is that most of those individuals who are from outside the EU will want to work in their home countries by the time they graduate and will not be available to the GP system in this State. Thus, the Government talks about more spaces in the universities for GPs, but it is not translating necessarily into more GPs going through the university system to work in our health service. That has to change.

There is a major capacity issue with the psychiatric unit in Crosslanes in Drogheda at the moment. I am told people who are suicidal are being told to go home in taxis because there is not enough space to deal with them. I would love if the Minister’s Department would pay attention to that because, as she knows, that is a life and death situation affecting many families.

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