Jennifer Carroll MacNeill (Dún Laoghaire, Fine Gael)

Deputy Healy-Rae has helpfully set out the difficulty with regard to hospital beds. Let us take Kerry hospital as an example. In the context of staff numbers, in the past five years, Kerry hospital has had an increase in staff of 43%. It has had a budgetary increase of 67% in the past five years also. To provide the breakdown of that staffing increase, Kerry hospital has had a 52% increase in medical staff; a 44% increase in nursing and midwifery staff; a 74% in patient and client care staff, who are the support staff; and a 43% increase in health and social care staff. Those are significant numbers.

Kerry hospital is perplexing me at the moment. In May, it was one of the best performers in hospital trolley management, which is a big issue in Kerry hospital because it has been historically poor in that regard. In May, there were 13 days on which there were zero patients on trolleys in Kerry hospital. There were three days on which one patient was on a trolley. May was, therefore, a good month. It shows there was bed capacity and management of the hospital in the round. The considerable extra staff meant there was good management of the emergency department. Something happened in June, however, and the figures were the complete opposite. This is the nuance of hospital-by-hospital level experience.

The Deputy set out exactly why this is so important. It is about the dignity and safety of patients who should not be waiting for 24 hours. They should not be waiting for more than six hours. Of those people who present, only 25% of them need to be admitted and managed in other pathways. This is only one particular example that happens to relate to Kerry because Deputy Healy-Rae was the last speaker. I could equally speak about Cork and the figures for that area. Although Deputy Healy-Rae was not in the Chamber when I was pulling the information together, with regard to Wexford, the constituency of the Ceann Comhairle, staffing numbers have increased by 21% over the past five years. There has been a 22% increase in medical staff and a 33% increase in nursing and midwifery staff. Wexford hospital is performing extraordinarily well with a much smaller increase in resources. It has low hospital trolley figures. Its culture is one of whole-of-hospital management. It is doing really well. It certainly needs more investment and support, but it is performing extremely well. I pulled the figures out for Waterford as Deputy Cullinane was present a minute ago. Waterford hospital has an average of zero people on hospital trolleys in 2024 and 2025. It has also had a 44% increase in staff, but with a different outcome compared to Kerry hospital.

If I take St. Vincent’s University Hospital, which is the closest model 4 hospital to me, it has had a 35% increase in staff and a 59% increase in budget. Yet, it has an inconsistent performance in its accident and emergency department and its management of delayed transfers of care. All of these particular local nuances matter. The Mater hospital, which I visited last week, has been good enough on its accident and emergency management. It is the rest of the hospital’s responsibility to support the accident and emergency department. A couple of weeks ago, however, it was one of the hospitals on a list of hospitals that were in considerable difficulties.

It had closed the Smithfield injury unit for the bank holiday weekend, which it has been paid to operate under the service level agreement. These are inconsistencies which are not acceptable and which we cannot stand over but they speak to the level of detail and nuance that is necessary to understand the complexity of health budgeting and how that is being translated to patient care on an individual basis.

While I appreciate this Bill does not transform the world, it does a couple of really important things that we need to happen. That includes in particular the corrective action plans, CAPs, that are necessary. The CEOs are now required to notify me or the Minister for Health of the overspend and to identify the detail of what caused the overspend and how it is proposed to avoid the overspend. The board can then review that, amend or approve proposals, agree on the cause, and agree on the actions that will eliminate or reduce overspend which it believes are practicable. None of that applies at present. There is a different level of detail in managing spend and overspend. It should not be the case that there are threats or assertions that a body cannot pay its pharmaceutical bill or its revenue bill and must close beds because all of those things are completely unacceptable, outrageous responses to a failure to manage a budget. In circumstances where bills for external consultants or legal advices outside of the State structure are still being paid or where, for example, there has not been evidence of non-pay savings over a three-year period, it is a bit like taking a dead cat and saying "Now, Minister, give me a big pile of money or else." We have to be serious about hospital management and about money being spent in a consistent and predictable way. We have to do that collectively and identify the instances where that is not happening.

There is unfortunately too much variance between hospitals and in how we think money should be spent. The budget has increased. In 2013, the health budget was €13.5 billion. It is now €25.8 billion. In a ten-year period, we have essentially doubled the health spend. We as a State cannot do that again. There was significant and necessary investment. We historically underinvested in health, particularly on the capital side. I thank every Deputy who has made the case for a large envelope to be given to the Department of Health and the HSE in the review framework, recognising the difficulty of managing that process overall, because of course all hospitals need water and energy security. Those things are also important but there needs to be significant capital investment. I appreciate the recognition of that. We cannot continue to grow the current budget the way it has been growing.

We have invested in people and hospitals. We must get the return for that investment. It is not acceptable for a hospital to make the case for an additional CT machine or any other diagnostic equipment in circumstances where that CT machine is not being used for all of the hours that Deputies and I expect it to be used. It is not acceptable to have CT machines or other diagnostic equipment which is not being used beyond 4.30 p.m., as is the case in some hospitals. I go in and ask what time the CT machine runs until and I am told it is maybe 8 p.m., maybe 5 p.m. or maybe 4.30 p.m. That is not okay and it is not okay for the State to be required, or have pressure placed on it, to put additional CT machines somewhere that one is not being used to the optimum capacity. Those are the savings and productivity necessary to deal with the sort of service we want to deliver to patients.

We have, together, a significant issue to manage, and which Deputies identified, with regard to insourcing. I believe it is not correct or moral for the State to continue a system which it knows is creating a barrier to achieving productivity in the public system. I am completely committed to a public health system funded by the State and delivered for public capacity, and to having that public work done in public hospitals. I recognise that there are historical contracts that enable consultants under certain contracts to do private activity in certain spheres. I recognise that that is so. On the other hand, I also see that 65% of consultants are now on the public-only consultant contract. We want public activity.

It was the correct set of decisions to take every step possible to reduce the waiting lists because that results in people getting pain relief, elective procedures and diagnostic tests that they need. Over the next 12 or 24 months, as we decide to do this, we have a real challenge in making sure that capacity is delivered in the hospital system. I would welcome the support and help of the health committee in particular in analysing the performance of hospitals in this way and making sure that we are winding down a structure we know is legitimate and lawful but is not what we want and not what we believe is the correct thing to do. I do not want to do it in a way that will cause waiting lists to spike, not because Deputies are going to correctly hold me to account for the waiting lists but because I do not want people to be in difficulties.

We will have to find the right way to bring down the activity that we do not believe serves the public interest in the medium to long term, that is, third-party insourcing and so on, and to increase productivity. Both are granular challenges which will be difficult and are complex. I need Deputies' insight, help and analysis and to use all of the tools of the Oireachtas to help to analyse the nuanced performance of hospitals that I have spoken of today. Deputy Conway-Walsh referred to Mayo in particular and I am interested in Mayo because it was one of the first hospitals I visited. It had very poor hospital trolley performance over the bank holiday weekend in early February, but it has been consistently difficult. It had a significant uplift both in resources and staff, but I am concerned about its weekend management. Not to be too unfair to Mayo, but the point is that there are different nuances in every hospital and we need to be honest about this.

This Bill is important because it helps to do one thing, that is, to be focused on corrective action. That is the sort of granular detail that we will need to improve financial performance in the health system.

See this speech in context