Dáil debates

Thursday, 16 June 2016

Estimates for Public Services 2016 (Resumed)

 

Debate resumed on the following Estimate which was moved by the Minister for Health and Thursday, 16 June 2016: Vote 28 - Health (Revised).

2:55 pm

Photo of Michael HartyMichael Harty (Clare, Independent)
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I am not going to carry out a forensic examination of the health Estimates. I will focus more on solutions to our health service problems rather than on criticism. Many of these solutions will not cost any money to implement and indeed might save money in the long term. The first issue the Minister and his Ministers of State must address is the morale in our health service. Morale in our health service is at an all-time low because waiting lists, notwithstanding the best efforts of those working in the service, are getting longer. Accident and emergency over-crowding continues and there is not enough capacity in the system. This leads to low morale in our health service. When referring to the health service, the Minister must speak about his doctors, his nurses, his therapists and his support workers. That is not to patronise, but to be inclusive and to empathise with the problems. If we can increase morale, we will certainly improve outcomes and increase efficiency. In that regard, a well-constructed ten-year plan to lay out a pathway for the health service will be very important. This plan must be implemented year-on-year once it is devised. We are not going to wait ten years for it. There should be an immediate dividend from the plan.

My second point also relates to morale. The Minister and his Ministers of State must go to our educational facilities, including our nursing and medical schools to speak to our new nurses and new graduates, including those from post-graduate programmes. We must not allow our best educated nurses and doctors to leave the country. There is a huge problem with retention of staff, but also of recruitment of staff. We need to encourage our doctors and tell them the health service will improve and that we would like them to stay to be part of that. We must give our doctors and nurses hope. In many of our nursing schools, an entire class will go to one hospital in England be it St. Thomas’s or Great Ormonde Street, Liverpool Royal Infirmary or Edinburgh Royal Infirmary. They are taken entirely out of the system and we need to encourage them and give them hope to allow them to stay in it.

The next issue is the integration of primary and secondary care. This is not going to cost any money but it will produce tremendous efficiencies and savings. We need to develop our ambulatory care centres. There is a pilot centre in Kilkenny which is working very well and I encourage the Minister to visit it. If we can investigate patients with a view to avoiding admitting them rather than to admit patients with a view to investigation, we can save huge amounts of funding and bed space. When an elderly person goes into a bed and spends two or three weeks in it, he or she becomes immobilised and loses his or her independence. It is hard to reintegrate them back into primary care and community care. We must stop having patients go into hospital as much as we can. Obviously, acute illnesses occur and we cannot prevent everyone going into hospital but if we can keep our chronically ill patients out of casualty, it would free up casualty for true casualties, which is to say accidents and emergencies. So many of our accident and emergency departments are full of patients who would not be there if they were looked after in primary care. We need to develop our primary and community care services. We must look after our elderly patients within the community, but that needs support and resources. If that support and resourcing is provided, there will be a dividend from that infrastructure by preventing patients getting into secondary care. We need to change the focus of where we spend our money. This is not going to cost any money.

When we make decisions in relation to our health service, we must fully involve those supplying the service on the frontline. So many decisions are made by HSE management without consulting the frontline staff. Frontline staff are often bewildered by decisions made by HSE officials who have not properly consulted and integrated their decisions with those supplying the frontline service. The Department of Health must take ownership of the HSE and force it to be more transparent. Many decisions are made and it is quite difficult to know why or who made them.

We have spoken in relation to primary care about extending free GP care to children between the ages of six and 12. Most medical organisations and the majority of the medical profession want to see free care at the point of contact. There is no dispute about that. There is a problem in giving free care without increasing the capacity of general practice. The introduction of free care to under sixes and over-70s has overwhelmed general practice and taken up any spare capacity if there was any. It has meant that there are now waiting lists to see one's GP in Ireland which was not the case before. It is commonplace in the UK to wait six days, ten days or two weeks to see one's GP for a routine appointment. That never happened in Ireland before. Now, however, the capacity of general practice has been exceeded by giving free care without extending the number of GPs and developing general practice to cope with the increased workload. Waiting lists are developing within general practice and we do not want to see that. If we were to give free GP care to everybody in the community, we would need to double our GP numbers but there is a problem because the GPs are not there.

We are operating under a contract which is now 44 years old and completely out of date. That contract is an impediment to the recruitment of GPs. Deputies Billy Kelleher and Alan Kelly referred to it. We cannot recruit GPs. Rural practice is the most sensitive part of general practice and we have experienced huge difficulties in recruiting GPs over the past few years. Of our GPs, 33% are over the age of 55 while 20% are over the age of 60. As they begin to retire, young GPs are not coming in to replace them because the contract is too onerous. Our GP contract is 24/7, 365 days a year. The GP has to provide the locum if he or she takes a holiday, gets ill or wants to attend an educational course. There is a huge problem in recruiting young GPs because when they come out of their training programmes they emigrate. The responsibility and administration involved in taking on a practice is too overwhelming. We have proposed that in areas where it is difficult to fill a GP post, GPs should be put in on a salaried basis. That should be an integral part of the new contract. That contract must come very quickly. It needs to come in the next year. It was promised before July this year and it has not happened. If it does not come before July 2017, general practice will be decimated.

Another serious problem with general practice is that we were decimated by the FEMPI legislation. We all had to take income cuts in relation to the emergency in our financial management, but general practice was disproportionately affected by FEMPI because not only was income taken out of the income for general practice, it was taken from the support structures that kept general practice working. General practice is now lacking huge infrastructural support. Rural GPs were also hit by their geographic locations. There was a recognition that GPs in rural areas served a widely dispersed population, but the supports that allowed that to happen were taken away as well.

The Minister has had to depart, but I will make a suggestion to the Ministers of State. In 1985 an educationist and psychologist by the name of Dr. Edward de Bono developed the six hats system for analysing problems and finding solutions. One put on a hat to teach in one way, a had of a different colour to teach in another and so on. I would love to give the Ministers of State the reference for this system which they could use in analysing and planning change in the health service.

3:05 pm

Photo of Michael CollinsMichael Collins (Cork South West, Independent)
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According to the study of the impact of reconfiguration on emergency and urgent care networks, SIREN, the farther one lives from a centre of excellence, the poorer the outcome in the event of a serious emergency. The SIREN report found that, while survival rates in Dublin were the best in the country, those in the south - counties Cork and Kerry - were the worst. This is in stark contrast with the aim of the reconfiguration programme, namely, to achieve the best possible health outcomes for the people it served. The people of west Cork have not been well served by the programme. Many find themselves having to travel up to 100 miles at night by ambulance to Cork University Hospital, CUH, a journey that could take three hours. They may then have to wait for several more hours before receiving medical attention. The appointment of a night-time casualty officer would mean the extension of the Bantry General Hospital emergency department's night-time service. More patients could be treated without needing to be transferred to CUH, resulting in more ambulances being freed for other emergencies and a reduction in the numbers presenting at and overcrowding in CUH's emergency department.

Recent figures released show that 50,000 patients per year are walking out of emergency departments because of long waiting times and overcrowding. Some leave without being seen by a nurse, which is further evidence of the failure of the reconfiguration of acute hospitals.

Home help and home care packages are a major issue throughout the country, particularly in west Cork. An underlying cause of overcrowding and bed blocking in hospitals is the fact that many elderly patients cannot return home owing to a shortage of home helps and a lack of investment in home care packages. I call on the Minister for Health to invest in this area immediately. In doing so, he would automatically reduce overcrowding and free hospital beds for those in need of more urgent medical care. When I spoke to the Taoiseach about this issue last week, he directed me to the Minister. I will take up that opportunity in the days ahead, but we need to consider the question of home help services as recipients are being treated poorly.

According to the Lightfoot report, CUH takes the longest time in Ireland to clear an ambulance from the time it arrives at the emergency department until it is available for its next deployment. The report recommends further investment in ambulances and related vehicles.

I wish to address the issue of waiting times for the assessment and delivery of services for children with special needs. I have been informed that some children are waiting a year and a half or more for initial assessments and a further six for the service to be delivered. Under the Disability Act, children have a statutory entitlement to an assessment of their needs within a six-month period if they were born after 2002. The Government is failing in its duty to these children under the Act.

I wish to address the cuts to disability services, specifically the €1 million cut in funding for CoAction in west Cork. With growing numbers availing of CoAction's disability services and supports, the organisation has been put under severe financial strain. Complying with the Health Information and Quality Authority, HIQA, standards has taken more than €350,000 out of its stretched budget. No additional funding has been made available for the residential, respite care or transport service in the past eight years. Many parents of adults with intellectual disabilities are ageing and finding it increasingly difficult to care for their adult children without the support of respite and residential care services. They are also under increasing stress to provide the future care of their children owing to the decrease in the number of places available in full-time residential services. I call on the Minister to reverse the savage cuts to a service that is vital for more than 600 children and 140 adults across west Cork.

Photo of Alan FarrellAlan Farrell (Dublin Fingal, Fine Gael)
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Deputies Stephen S. Donnelly and Eamon Ryan are sharing a 15-minute slot. Is that agreed? Agreed.

Photo of Stephen DonnellyStephen Donnelly (Wicklow, Social Democrats)
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We are debating whether to sign off on an additional €500 million for the health budget, an issue I will address alongside the lack of an analysis provided for the Dáil on same. While we are discussing health services that need more funding urgently, I wish to raise a particular matter, that of Cappagh National Orthopaedic Hospital, about which a constituent of mine contacted me in recent weeks. She needs a hip replacement, is in severe pain and her condition is deteriorating. She is on her way to being in a wheelchair, something I have had confirmed by her surgeon. She was told that she would have to wait 15 months.

When I looked further into what was happening at Cappagh hospital, what I discovered was disturbing. If a general practitioner, GP, believes someone in the greater Dublin area needs orthopaedic surgery, or if anyone in the country needs complex orthopaedic surgery, it will take 15 months to see a consultant. It will take a further 15 months to get into an operating theatre. As such, it takes two and a half years to get from a GP to the operating theatre. In the United Kingdom it takes four months and i New Zealand, three.

I have spoken to surgeons in this field. To say they are demoralised, frustrated and angry would be a gross understatement. Anyone who attends a GP and needs orthopaedic work, be it on a hip or a knee, is typically already in serious pain. In the two and a half years someone will wait for surgery, the pain will escalate, the person's condition will deteriorates and the complexity, cost and recovery time of the operation will move in the wrong direction, as will the clinical outcomes.

I will explain what is happening in Cappagh hospital and why people in Ireland are waiting two and a half years for a hip operation. By the way, if someone needs the other hip or knee to be operated on, he or she must go back to the start of the list. Compare this with the figure of 12 weeks in New Zealand and 16 across the water in the United Kingdom. In 2014 Cappagh hospital suffered a serious cut in Government funding, which meant that it needed to reduce the number of procedures it could carry out that year by 700. It let staff go and scaled down. In 2015 the situation was so bad that the Government increased its funding. Last year Cappagh hospital started to scale up again, but it incurred higher costs by hiring agency staff because it did not want to have to fire anyone again. At the start of this year the HSE could not tell the hospital how much money it would be given for the year. For the first three months it operated on the understanding that it would have the same budget as last year. After the first quarter, however, it discovered that it would suffer a further cut in funding. It must let staff go and scale back again.

There are six operating theatres in Cappagh hospital, only three of which are being used. Typically, an orthopaedic surgeon can perform five procedures in an operating theatre on a given day. The surgeons in Cappagh hospital have been instructed to stop after three. The State is paying all of the hospital's fixed costs - for the six operating theatres, the wards, the beds that are not being used, the theatre staff and the surgeons - but the hospital no longer has money for implants which typically cost between €1,500 and €3,000 each. For a complex operation, it might cost up to €6,000 and, obviously, the cost increases. I told the patients that, were my relative affected, I would borrow the money to buy an implant on eBay and bring it to the hospital, but when I asked them about doing this, they said they were not allowed to do so. When I asked the surgeons what they did after performing the three procedures, they told me that they went home or into private practice where they could actually treat patients.

Since the Minister, Deputy Harris, had to leave the Chamber, I ask the Ministers of State who are present, Deputies Helen McEntee and Finian McGrath, to raise as a matter of urgency the fact that, owing to Government cuts, Cappagh National Orthopaedic Hospital has not got the money for the implants needed for patients who have been waiting for two and a half years for orthopaedic surgery. However, the problem is even worse because, as I found out, the target of being admitted to an operating theatre within 15 months of meeting a consultant is a HSE target. Cappagh National Orthopaedic Hospital will now miss the targets. The HSE will, therefore, fine it and it will have less money for implants. The waiting lists will get longer and the HSE will fine the hospital again. That is happening right now in our national orthopaedic hospital. If we are to have a conversation about a budget of €13.7 billion and additional expenditure this year of €500 million, the Minister should, as a matter of urgency, engage with Cappagh hospital. It needs approximately €5 million or €6 million for the rest of the year.

Cappagh National Orthopaedic Hospital also needs multi-annual funding. I cannot understand why this is not made available. Imagine a hospital not knowing in the first three months of the year how much funding it will have for the year. Other organisations just do not operate like that. The hospital needs funding for this year, and it needs multi-annual funding. It needs more ambitious targets. It is unacceptable that the HSE target for orthopaedics is 15 months. This period needs to be reduced.

There is no load balancing across the hospitals. Thus, the waiting lists in Limerick are much smaller than in Dublin. There is no national patient database. There is no co-ordinating function whereby one would be asked whether, on the basis that one must wait 15 months in Dublin, one would be willing to wait six months on a list in Limerick. There is no load balancing in this regard at all. I will send the Minister the notes on this. Will he please consider providing a low number of millions of euro to Cappagh National Orthopaedic Hospital? I will be more than happy to send him all the details.

What is happening in Cappagh, including the mismanagement by the health care system of the funding for the hospital and the results for patients and the medical staff, is symptomatic of a Health Service Executive that clearly does not know how to run budgets. The Government is asking the Dáil to sanction an additional €500 million. To put that in perspective, that is more than half the total fiscal space we will be debating in October for the entire budget for next year. An extra €0.5 billion — over half the entire budgetary space for next year — is being sought by the Government. I apologise if the analysis is unavailable. I have tried to obtain it. We have contacted the Minister’s office and looked at the website of the Department of Health but I cannot find any breakdown of the €500 million. I have read through the Minister’s speech and have found explanations for allocations of €40 million here, €50 million there and €15 million in other places.

I have to hand the revised book of Estimates. It gives the revised budget for this year, €13.69 billion, but nowhere is it explained where the extra €500 million has come from. There are references to some allocations in the Minister's speech but I cannot find a table indicating how the €500 million breaks down. There is €200 million for additional services and €300 million for overruns. It ought to be stated that the €200 million for additional services is going to listed places based on certain cost–benefit analyses.

The Dáil voting through an extra €0.5 billion is a massive undertaking but we are not being provided with the kind of analysis one would expect to see if asked to sign a cheque for €0.5 billion unexpectedly. I apologise if we were provided with it. This debate is about whether the Dáil is willing to sign a cheque for the HSE of an additional €500 million. Now that the committees are being formed, surely the Minister should offer an explanation of the allocation and the overruns to the health committee, finance committee or the new budgetary committee.

The Minister mentioned in his speech the new accountability framework that the HSE is putting together. It is very welcome to see an accountability framework coming together. If in my pre-politics world people said they had overspent by €0.5 billion, there would have been serious accountability. I am not talking about the Minister as he is new in the job; I am talking about the HSE. Has anyone been fired? Has anyone been demoted? Someone, somewhere, has overspent by hundreds of millions of euro. Will the accountability framework actually hold anyone to account for over-expenditure of hundreds of millions of euro?

3:15 pm

Photo of Eamon RyanEamon Ryan (Dublin Bay South, Green Party)
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This is a useful debate. Our most significant budgetary categories are social welfare, health and education. They reflect the three big Departments where the money goes. Our history over the past 15 or 20 years, including in the lead-up to the crash, shows that most of the money went into these categories. Expenditure on health increased dramatically in the period. Obviously, we have experienced a particularly harsh and difficult time in the past seven or eight years as the budgets came down again. They are starting to expand, which is welcome, because our economy is starting to grow but we should be careful to avoid the trap into which we fell in the early 2000s when we were just putting money into a system without getting value for it. We must be razor sharp and clinical in assessing the benefits of our health expenditure.

I am conscious that the Minister has a task ahead of him in conjunction with the rest of us in the Parliament as we are running our health system, or changing the entire system. I am very glad a joint Oireachtas committee is now examining how we can, in mid-flight, change some of the engines of our system to move towards a single-tier system. I do not see any of that set out in Estimates. This relates to one of the questions I was asking during Leaders' Questions earlier today. There is a need for detailed work in the committees whereby the Minister would outline, through his budgetary provisions for 2017 rather than through what we are discussing today, how he wants to make the desired shifts.

There are a number of other shifts I do not see in the spending priorities and on which I want to reflect and comment. Various Members have raised concerns about using specific examples to outline the problems at large. I am concerned that we are not allocating enough money for ICT. We are spending approximately 1%. When we invest in ICT systems — be it PPARS, electronic voting machines or Eircode — and the investment does not work out as originally planned, it becomes a big story. I fear that this freezes the public service such that it is afraid to take a risk or change the way it does business. Officials do not want to risk their career by suggesting some innovative ICT approach. We are not spending enough on ICT. The Green Party’s assessment of health policy is that we radically need to increase ICT expenditure because it may result in productivity in all the other areas where we are spending the money.

I agree with the comments of Deputy Stephen Donnelly on where the money is going. Parsing the figures as best I can, I believe the money is being spent on wages and staff primarily. Are staff being used to best effect? By investing in ICT, we can ensure our health and emergency systems and some of the processing in that regard are carried out in a more careful, creative and humane way. We could direct patients to where resources are under-used.

ICT investment would allow us to treat patients at home. It would allow us to change fundamentally the structure of the health system and the means of providing services, including through remote sensory systems, remote diagnostic tools and remote delivery of medicines. This is all available. We have most of the leading companies in this country that are interested in this space and which are good at what they do in this area. We should be using their expertise. We are not budgeting sufficiently in this space. I flag that for the Minister.

I wish to give a personal example. We have all used personal examples. One of my strongest memories concerning the health system is that I was once invited to an event by the great Risteárd Mulcahy, the professor of medicine in UCD and cardiologist in St. Vincent’s. I was once very proud to be involved with him on a cycling campaign. This is a very important example of preventive activity in the area of health in which we need to invest. Creating a healthy environment will actually cut the budget more than anything else. Professor Mulcahy brought me to the preventive centre in St. Vincent's. It may have changed since my visit was a number of years ago. I will always remember walking through long corridors with massive machines and considerable resources only to finally arrive at the centre of preventive health in the hospital. It was a broom cupboard. That is the only way to describe it. We now have the opportunity not only to put funding back into the health service but to reform it.

The Minister should push preventive medicine, the use of information and communications technology, residential care and community design systems. I do not see this being done and it is the Minister's job to change it.

3:25 pm

Photo of Finian McGrathFinian McGrath (Dublin Bay North, Independent)
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I welcome the opportunity to speak on the Revised Estimate with reference to disability services in this important debate. I listened with great interest to the views and concerns expressed by Deputy Stephen S. Donnelly. Ministers had an important meeting on the health service this morning, at which we addressed the issues of accountability and proper management in the health service. We are listening to Deputies' views and pushing the accountability agenda. I am specifically demanding investment in disability services, reform and accountability. My aim is to empower people with disabilities to live independent lives, provide them with greater independence in accessing the services they choose and enhance their ability to tailor the supports they require to meet their needs and plan their lives. In this context, I am particularly pleased that the €30 million in additional funding secured last week will support the programme for Government commitment to ensure all 18 year old school leavers with disabilities will have access to supports and services which meet their needs at this crucial point in their lives. Service providers must also be able to respond effectively and sensitively when people experience crises in their lives and require immediate support. The additional funding secured will also cover costs incurred in meeting compliance with national residential standards, services provided to meet the changing needs of people with disabilities and emergency residential places already provided. It is important to get that message across.

Deputies should note that funding of €1.56 billion was allocated by the Health Service Executive for disability services in the national service plan 2016. Together with the additional €31 million I managed to secure last week, the total allocation for disability services now stands at €1.59 billion. We must ensure these services are managed efficiently and properly. Investment will be made; reform will be introduced and accountability achieved.

Photo of Helen McEnteeHelen McEntee (Meath East, Fine Gael)
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I thank my colleague, the Minister for Health, Deputy Simon Harris, for his commitment to the health budget, as is clear from this discussion. In particular, I welcome the additional funding provided for home care services. In recent weeks I have engaged with numerous advocacy groups, officials from the Department of Health and the Health Service Executive and, most importantly, individuals who use home care services. Older people have consistently stated they want to stay in their homes and communities for as long as possible. Home care services are key to achieving this objective. In 2016 the HSE has a core provision of €324 million for home care services. Notwithstanding the significant improvements in the overall economic position, pressures continue to apply and demand for home care services is rising with an ageing and growing population. People want to be supported at home rather than in hospitals or nursing homes.

Without a shadow of doubt, home care services need more resources than are available. For this reason, the programme for Government commits to increasing funding for home care packages and home helps year on year in the coming period. Of the additional funding of €40 million provided for this area, €20 million will be allocated to ensure the services provided in 2015 are maintained; €10 million will be used to ensure the rate of service allocation can be maintained during the summer months, while €10 million has been ring-fenced for home care services as part of the new winter initiative. While there is always scope to do more, Deputies will agree that this is a step in the right direction.

Long-term care is one of the most challenging issues facing older people. Many reports, reviews and other documents have been written in the past 20 years, all of which ask the same question, namely, "How can we make Ireland a great place for older people to live in?" For the most part, the answer is the same - older people will live longer, healthier and happier lives if they live in a family or home setting.

As Deputy Michael Harty correctly stated, we need to change the current approach and move away from secondary to primary care services. It is my intention to set out a clear plan for how we can progress that vision.

As the Minister of State with responsibility for mental health services, I welcome the reinstatement of €12 million to the development budget. Just this week, I conveyed sanction to the HSE for the spending of €18 million in 2016. In addition, sanction has been given to spend €4 million, on a once-off basis, on minor capital works. A further €6.55 million will be spent in significant service areas, including in providing additional bed capacity, peer support services, to meet the additional cost of private placement of complex cases and additional posts to provide for improved patient safety in certain areas. Some €11.37 million will be spent on new developments outlined in the HSE national service plan. These include the development of early intervention and counselling services in primary care, further expansion of Jigsaw services in three cities, opening new acute care units and high observation units and the provision of funding for the child and adolescent eating disorder service, the homeless and the mentally ill. A sum of €80,000 will be spent in meeting other commitments commenced in previous years. I am engaged in discussions with the Health Service Executive and other Departments on the figure of €12 million and will revert to Deputies on the matter as soon as possible.

Photo of Jackie CahillJackie Cahill (Tipperary, Fianna Fail)
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I wish the new Minister and Ministers of State the best of luck in their portfolios. I welcome the allocation of an extra €500 million for health services.

As a representative of County Tipperary which no longer has a Government Deputy or Senator, I will focus on the lack of mental health facilities in the county. With a population of 160,000, County Tipperary does not have psychiatric beds, while the clinic in Thurles is under-resourced. For example, it does not have an occupational therapist; a psychiatric counselling service is not available and it is only open from 9 a.m. to 5 p.m. five days each week. This means taht people from the north of the county must travel to Ennis to avail of care, while people living in the south must travel to Kilkenny. This issue must be addressed and I look forward to the Government making proposals in that regard.

The Minister did not provide detail on how much funding is being provided for home care services and home care packages. Two completely different policies on managing home help hours are applied in north and south Tipperary, respectively. The service in south Tipperary uses its entire allocation of hours with HSE staff and thereafter employs agencies, whereas the service in north Tipperary uses a combination of HSE staff and agencies throughout the year. A consistent approach is required because the use of different approaches in the same county is preventing the system from operating efficiently. In any case, the service requires more funding if an adequate service is to be provided for those who need it most.

The HSE practice of offering home help hours in half-hour segments must be addressed as it is not an efficient use of resources. It is certainly not satisfactory for the service user and employees of the service.

I would like to know if any of the additional funding will be used to tackle the ever-increasing numbers on waiting lists. The numbers on the inpatient and day case lists have increased by almost 50% in the past two years.Figures for May this year show that 509,994 patients are either waiting for an operation or an outpatient appointment. The number waiting for an outpatient appointment has increased from 407,257 to 415,584 in the space of one month, while more than 62,000 of these individuals have been waiting for more than one year. In addition, the backlog of patients who need surgery increased from 74,274 to 74,986, having stood at 50,000 in 2014. This is an increase of approximately 50%. Last year’s targets are being missed, with more than 5,000 waiting for surgery for more than 15 months in May. This is a significant jump when one compares it with the figure of 4,603 who were enduring the same delay in April.

The figures also show that the number waiting in excess of 18 months for an outpatient appointment to see a specialist increased from 8,570 in April to 13,095 in May. Of those waiting for surgery, 4,704 are children, 58 of whom have been waiting for more than a year and a half. More than 60,000 people, including more than 4,500 children, have been waiting for more than one year for an outpatient appointment.

As a first-time Deputy, I find that the annual merry-go-round of health budget overruns followed by the introduction of a Revised Estimate smacks of poor planning. It appears that the HSE runs the service until its budget runs out before being bailed out by the Government. Surely a budget should be presented for a 12-month period. In every year since 2011 the HSE has required a substantial supplementary budget. Given the ad hocapproach to health planning and changing demographics, does the Minister agree that we are storing up major problems for the future? The population grew by 23% in the past 15 years and is set to grow by a further 30% in the next 25.

The 65 to 74 age group is set to grow by over 33% and the 75 years plus age group is set to grow by an incredible 82%.

We need careful planning to ensure the health service, which has come in for extensive criticism in recent years, does not run into even more trouble in the coming years. Deputy Healy referred specifically to South Tipperary General Hospital, Clonmel. Some things could be done in Tipperary which would not cost a great deal to the HSE budget. Our Lady's County and Surgical Hospital, Cashel, is fully furnished but its doors are closed. It must be re-opened as a set-down facility. The Dean Maxwell facility in Roscrea, a residential home for elderly people, urgently needs investment and more beds are required. Mount Sion in Tipperary must be kept open as a residential home for people with mental illness and the Community Hospital of the Assumption in Thurles also needs more investment and capacity.

3:35 pm

Photo of Simon HarrisSimon Harris (Wicklow, Fine Gael)
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I wish to begin by thanking everyone for their contributions. We have had a constructive debate. There is significant merit in much of what has been said on all sides of the House.

It is fair to say that today is a good day for the Irish health service. Any day when those of us in the Oireachtas decide to spend an additional €500 million on the Irish public health service can only be described as a good day. It is evidence that we are putting the fruits of our functioning economy to work for the public services that our citizens rightly demand.

This Revised Estimate does five things. First, it puts the health service on a stable footing. These are not my words; they are the words of the director general of the HSE. It is now up to him and his managers throughout the service to manage and live within their budgets. That is what they are paid to do and that is the job they must do.

It also does four other things. It allows us to have money for a winter initiative larger than the winter initiative last year. A total of €40 million is included to ensure we can put additional supports into our emergency departments for the winter period, a time when they come under particular pressure. It allows us to restore the mental health budget to €35 million, as outlined by my colleague, the Minister of State, Deputy Helen McEntee. The Minister of State will be getting on with drawing up plans to spend that money. It allows us to increase home help hours and home care packages rather than simply keep the levels we had in 2015. It allows us to have more home care packages and home help hours this year than last year, a welcome development. As outlined by my colleague, the Minister State, Deputy McGrath, it has allowed him to increase the disability budget by €31 million, including €3 million specifically for the important issue of school leavers.

This debate has been constructive in the sense that there has been recognition on all sides from all speakers that we cannot do things the way we used to do them in budgeting for the health service or in debating the health service. We need to try to find consensus, where possible, on the general direction of travel for the Irish public health service. That is why I have undertaken to co-operate and work with the establishment of the special committee to develop a single vision for our health service for the next decade. I am a supporter of the committee. Ministers of Health come and go. It is not fair that every time a new Minister arrives the health service gets tinkered with but there is no continuity in direction. I do not underestimate the challenge being put up to this committee, but I am certainly looking forward to working with Members in this regard. Reference was made to a short timeframe of six months and I agree, although that was the timeframe put forward in the motion. It is now a matter for that committee to do its work and see how it gets on in that timeframe.

Today, we published the national health care quality report. I wish to make a point for our front-line staff. There are major challenges in our health service. We have discussed the challenges and problems as we always discuss problems - that is our job. I urge our front-line staff to read the report. It is available on my Department's website. It shows the progress we have made. When I say "we" I am not referring to the Government, but "we" as in the Irish public health service. It will show the progress through successive Governments and improvements in outcomes in our health service. It is important that front-line people working in our health service today have that acknowledged by Members and by the media as well. Good things are happening in the health service every day.

There are still significant challenges, some of which have been referenced today. I take the point Deputy Kelleher makes about people talking about primary care since the time Dr. Rory O'Hanlon was Minister for Health in the 1980s. He is right. We must show significant progress. I agree that we cannot simply measure progress in terms of the number of primary care centres built. We must consider what happens in primary care centres and how many services and facilities can be provided in the community which, previously, had to be provided in acute hospitals. I have strong views about this. A crucial element of this is the new general practitioner contract. We have not had a new GP contract in 44 years. The patient values the relationship with the GP and the State must value that relationship as well. We will get the negotiation for a new GP contract under way. We also need to look at the provision of diagnostic equipment in the community. The programme for Government refers to incentivising health care professionals who purchase and place diagnostic equipment in the community in order that patients can get a scan or X-ray in primary care centres or GP centres rather than having to go to the emergency department.

I am keen to debunk some myths. I am all in favour of constructive politics, but I get frustrated when people try to say that I represent something that I absolutely do not represent. Deputy Louise O'Reilly is very constructive and I enjoy my engagements with her, but she referred to a charter of privatisation. That is nonsense. She referred to cuts to the overall health budget. There are none. We are giving an extra €500 million today. She referred to this representing bad news. If we are going to have an honest debate, then let us have an honest debate. This Government and I are committed to the development of the Irish public health service and to a singular vision for the development of that public health service in which access to services is based on need and not ability to pay. That is what I want to work towards with this Oireachtas. This Oireachtas is diverse but we need not necessarily be divided on all these issues.

We have significant challenges but I believe that putting the additional funding into our health service today - provided the Oireachtas chooses to pass this Estimate - will enable the HSE to get on with the job of providing the services that people need and will enable us to make the necessary service improvements.

Debate adjourned.