Pat Gallagher (Donegal, Fianna Fail)
Link to this: Individually | In context | Oireachtas source

Deputy Thomas P. Broughan was in possession.

Tommy Broughan (Dublin Bay North, Independent)
Link to this: Individually | In context | Oireachtas source

I am delighted to make some concluding remarks. As I was saying last night, we know that every major metropolitan region in Europe is pulled along economically by a dynamic city at its core. Dublin has begun to wear that mantle since the turn of this century but it would be invidious if we now came along with this kind of indicative plan, or legislative plan, which would restrict the development and growth of Dublin. After all, Dublin is still a relatively small city by comparison with, for example, the 5 million population of Athens, the 5 million-plus in Barcelona, the near 5 million in Manchester, the 3 million to 4 million in Vienna or the 2 million-plus in Budapest. When we compare it with what we would regard as premier division cities of the European Union, Dublin is still a relatively small city of some 1.5 million people, if we count the four Dublin counties.

Although there is no reference to it in the plan, one noticeable aspect of all of those dynamic cities is that they have an elected local city leadership. This is one thing we could have advanced and had ready for 2019, particularly for Dublin and Cork.

Dublin critically needs infrastructure across a range of areas, from health to transport to schools to housing. At Leaders' Questions last week, I raised the urgent need for social and affordable housing in the city and the four Dublin local authority areas. My constituency of Dublin Bay North has the longest housing list in Ireland. The plan remains lethargic in that regard. The delivery for 2015-17 in which the Minister was involved has not happened, or at least not in Fingal and Dublin city. I welcome the social housing target of 20,000 to 25,000 units for 2020 and subsequently the 30,000 to 35,000 target. We still seem to be running to stand still.

I do not disagree with the idea of there being a more compact city in appropriate areas although the people who make these planning decisions should be prepared to live in more compact high-rise buildings themselves. One finds that the people who make these plans live way out in the countryside in large haciendas and plan for others to live on the fourteenth floor or the fifth floor with no lift, which has happened to residents in my constituency. The plan does not recognise the full scale of the housing crisis in Dublin. While I welcome the national regeneration development agency, it is not the agency which I asked that the Taoiseach set up, which would have been available to look at all land. We need close cohesion with local plans, such as the Fingal plan and the Dublin city plan in my constituency. In the north fringe and south fringe we have had the awful situation where there was no strategic development for a new urban region, which was effectively another city the size of Waterford, and have suffered all the massive problems for the last decade as a consequence.

In transport, I warmly welcome what I hope is the final decision to proceed with metro north. I cannot understand why it would be delayed in any way in order to link up with the existing Luas green line. Naysayers such as Colm McCarthy have come out already to complain about the €3 billion cost of this public transport infrastructure but we will soon have one of the biggest airports in Europe and one of the few airports in a major city that does not have a fixed-line rail link to the city centre. I welcome it because originally we were to have a northside Luas.

Referring briefly to national infrastructure, I do not understand the lack of any plan for a motorway to the north west and why it is not a national task. Why is the M11 not extended all the way to Rosslare given Brexit? I support the Cork to Limerick and Western corridors as timely connective developments. If any of these huge infrastructure developments take place it will lead to significant jobs growth but we have to worry whether the 660,000 jobs mentioned can be delivered.

I do not have the time to raise the concerns I have on education and on the marine environment, which I know the Leas-Cheann Comhairle will raise himself, but on health I do not see the influence of Sláintecare and its delivery in the plan. The plan refers to a new elective hospital for our region. In the northside, Beaumont has always been at 120% to 130% capacity. I do not see why the proposed new hospital should not be somewhere such as Swords or the Swords-Donaghmede interface.

Strategic planning for the country's future is of the upmost importance but Project Ireland 2040 would have been better had there been cross-party agreement. There will be some legislative plans on planning regulations and so on but there should be general agreement on how we advance Ireland and make it a prosperous, peaceful and well-developed country by 2040.

Simon Harris (Wicklow, Fine Gael)
Link to this: Individually | In context | Oireachtas source

I am delighted to have the opportunity to speak on Project Ireland 2040, our plan for our country until 2040 but particularly, for the purpose of this statement, our capital spending plan for the next ten years. I am particularly pleased to speak about the very significant increase in capital funding for the health service as a result of this plan. Capital funding for our health service will be 165% higher for the next ten years than it was for the last ten years. This is a sea-change commitment to capital investment in our health services. It means we now have a solid, ambitious plan to build a better health service for the future through the combination of this significant capital investment programme alongside the implementation of the Sláintecare reforms.

We now have the opportunity to reform and modernise our health service, to deliver one that is fit for purpose, that our citizens can be proud of and that can meet the needs of our growing and aging population.

The €10.9 billion over the next ten years provides a real, long-term opportunity to improve our health services, drive down waiting lists, increase bed capacity, reform pathways of care and modernise how we deliver services through ehealth and the implementation of Sláintecare.

As our population changes and ages, the way in which health care is currently delivered in Ireland will become increasingly unsustainable. New models of care are needed, including a major shift from hospital centric to community-based care. Significant population growth and an increase in the population aged 65 years and over and in particular aged 85 years and over, in the next ten years will increase demand for health and social care services. The fact that people in Ireland are living longer and longer than the European average is a good thing, but we must plan accordingly to meet their needs.

The Government supports the vision for a high quality, safe, accessible and sustainable healthcare system set out in Sláintecare. Implementing that vision will require concrete and well-defined steps to be taken which are prioritised, sequenced, co-ordinated and funded. As part of this process, capital investment has a key role to play both in enhancing health service provision and as a driver of reform. Too often we speak about current health spending but do not spend enough time discussing the important difference which capital funding can make in reforming and increasing the capacity of our health service. Modernisation will require significant investment, including in ICT and ehealth, to underpin safer, more integrated, patient-centred care. At the same time, as with any health system, there is an ongoing need to maintain and update facilities and healthcare equipment. Government priorities in health capital investment supports the national planning framework outcomes in terms of plans to provide local, regional and national developments which empower rural communities and enhance urban amenities, which are outcomes Nos. 6 and 7 in the framework. Capital investments over the coming decade will support existing Government priority projects and commitments and will enable the roll-out of new additional capacity guided by the Sláintecare report and the recently published health service capacity review.

There are several drivers of the development and reform of the health services over the ten year period of the plan. The main ones include capacity since demographic changes, including an increasing and older population, and mean that the level and complexity of health care to be provided will increase. I will never understand why a policy decision was taken in 2007 to reduce the number of hospital beds in this country when the population was rising. We recognised that in education there would be more children who would need school places and we provided more school places, yet bizarrely the Government of the day decided to reduce the number of hospital beds in successive years between 2007 and 2010, and they remained reduced during the recession until 2014 when they began to increase. We need to increase capacity and the plan will deliver that.

A second driver is the need to deliver strategy. The strategy for the public health services is centred on integrated healthcare. This involves a decisive shift towards primary care to meet growing demands. I am pleased that this plan features €810 million for primary care including investment in diagnostics. There are many really good primary care facilities. On Monday, I will open two more, one in Kilcock and one in Coolock, but we need to put the diagnostic equipment into them. They must have the X-ray machines and ultrasounds so that people do not have to go to a hospital for every diagnostic test that could take place in the community.

Another area is ICT and innovation. The implementation of the ehealth strategy is required to develop the electronic records system, which enables the flow of information across various care settings. It will also enable patients, our citizens, to be more empowered in their own health information.

We also need to deliver on risk and compliance. There is an ongoing need to maintain and update both buildings and healthcare equipment and ambulances in particular in response to critical clinical risks. These are risks that exist in our health service which we need to fix. Now that the country’s economy is growing once again, we can invest in improving theatres, building ward blocks and replacing ambulances.

This leads me to the Report of the Oireachtas Committee on the Future of Healthcare, Sláintecare, and the recently published Health Service Capacity Review. The Sláintecare report has significant implications for capital investments, which I welcome.

The report strongly endorses investment in ICT and eHealth, and the Government's national development plan will provide the required capital investment in Health to fully delivery on eHealth in accordance with Sláintecare. The Sláintecare report and the Government's national development plan strongly support capital investments in primary care, including community diagnostics. When Deputy Broughan rightly asks me what will the capital plan do to deliver Sláintecare, I say it will deliver diagnostics in the community, which is a key element of Sláintecare. It will deliver in full a very significant investment in eHealth, which also is a key recommendation of Sláintecare, and will drive down waiting lists through elective-only hospitals, which is another key recommendation of Sláintecare. These are three key recommendations of Sláintecare. I note the presence of my colleague, Deputy Hildegarde Naughton, who is key on this committee to reform the health service. We are taking three solid steps to reform the health service in accordance with Sláintecare through this capital plan.

The national development plan will support Sláintecare's recommendation that the outcome of the capacity review should be used as a framework for guiding future investments in health services. When I became Minister for Health, I commissioned a capacity review. We got it internationally benchmarked to answer the question, how many hospital beds do we need in Ireland now and how many hospital beds will we need in Ireland out to 2031, so that we could put an evidence base behind it. It stated clearly that even if we reform the health service and implement Sláintecare, which we will do, we still will need 2,600 more hospital beds by 2031. I am delighted that this capital plan will deliver all of those beds four years ahead of schedule. We will deliver, and fully fund, the capacity review by 2027. Obviously, now we need to look for opportunities to front-load that and I have already asked the HSE to examine what front-loading could be done in this regard.

We need continued investment in primary care facilities and the development of community diagnostic hubs and our ageing population will require the delivery of significant additional step-down and long-stay facilities. In this plan, we are not only delivering more hospital beds and more diagnostics in the community. I am pleased that we will also provide an additional 4,500 community step-down beds and long-stay facilities for our older citizens to get people back to the community and out of the acute hospital setting where they have no wish to be once they have received their medical care. Those additional 4,500 community beds are on top of the refurbishment and replacement of community nursing homes which is already under way.

We will deliver new elective-only facilities: one for Dublin, one for Galway and one for Cork. The idea here is that high-volume low-complexity procedures - many of the procedures for which people wait on the waiting lists - can be dealt with through elective-only facilities where we are decoupling scheduled and unscheduled care and the pressures of both. What we are doing here is learning from other jurisdictions. We are learning from Scotland where they put in place an elective-only facility and managed to dramatically reduce their waiting times. It took them ten years to get the waiting time down to 12 weeks but they did that, and they made incremental progress. I do not want Members to think we have to wait ten years for things to happen. We need to make incremental progress, each month and each year, until we can get to where we want to be. The Sláintecare report is a ten-year plan, elective-only facilities are the way to deliver it and the Scottish people and health service have shown us how we can do that. It is envisaged that these facilities will be sited adjacent to general hospitals and I will now ask that the HSE put in place a process to identify where best to locate these facilities. I would like these to be up and running as quickly as possible.

There are a number of major projects which will be delivered over the lifetime of Project Ireland, including the new national children's hospital at St. James's campus. People have been talking for decades about delivering a children's hospital. We are building it - it is under way in St. James's - and two children's outpatient and urgent care centres, one in Blanchardstown and one in Tallaght hospital in Dublin.

I note that, yesterday, there was much discussion in these Houses about the national maternity strategy. I am delighted that, as part of this capital plan, we will relocate all stand-alone maternity hospitals to acute hospital campus, providing women and their babies with world-class 21st-century facilities. Holles Street will move to St. Vincent's, University Maternity Hospital, Limerick will move to the site of the University Hospital Limerick, the Rotunda will move to the Connolly Hospital site and the Coombe to the St. James's campus.

In relation to the cancer strategy, we will also deliver the capital developments, including the national programme for radiation oncology at Cork, Galway and Dublin and the expansion of BreastCheck. We will build the new national forensic mental health service hospital at Portrane. We will continue with the redevelopment of the National Rehabilitation Hospital. We have commenced phase 1 and we will now fund phase 2. The primary care centre construction programme will continue at locations right across the country, as will the replacement and refurbishment of the community nursing homes for older people and long-term residential care units for those with disabilities and the implementation and delivery of the trauma system.

With the unprecedented capital investment in the health services, we must ensure that we carefully plan and select projects. This process will be guided by the national health strategy and policy, including the implementation of Sláintecare. We will have a robust method of project appraisal, assessment and selection in order to ensure that these are delivered appropriately.

In summary, the provision of this unprecedented capital investment of €10.9 billion over the next ten years will help us build that better health service that citizens yearn for, that staff deserve and that, quite frankly, we all need.