Dáil debates

Tuesday, 23 May 2023

Hospital Waiting Lists: Motion [Private Members]

 

8:20 pm

Photo of David CullinaneDavid Cullinane (Waterford, Sinn Fein)
Link to this: Individually | In context | Oireachtas source

I move:

That Dáil Éireann:

notes that:
— the average waiting time for emergency department admission so far this year stands at 11.5 hours, which is an hour longer than for the same period in 2019;

— the trolley scandal which Fine Gael pledged to end is now worse than ever and has become a year-round threat to patient safety, with an average of more than 550 patients on trolleys every day so far this month, compared to 350 in May 2011;

— there were 24,000 hospital appointments and procedures cancelled in April 2023, which is an increase of 70 per cent on April 2022 and greater than the number of cancellations in January 2023;

— hospital waiting lists now stand at 888,000 patients, with more than 500,000 people waiting longer than the Sláintecare targets agreed by the Oireachtas, and with more than 225,000 people waiting for a diagnostic scan;

— full capacity protocols have been active across most major hospital sites for significant periods of the year to date, including 118 of the first 120 days in the year at University Hospital Limerick; and

— primary care services, in particular out-of-hours general practice services, are buckling under the strain of demand and historic neglect and underinvestment under successive Ministers for Health;
further notes that:
— the Economic and Social Research Institute (ESRI) has published estimates which reckon that the Health Service Executive is faced with a deficit of 1,000 acute inpatient hospital beds, and that there is a requirement for 330 additional beds every year in addition to this deficit;

— the Minister for Health, Stephen Donnelly TD, has pledged to deliver a multi-annual bed plan for 1,500 hospital beds, which will fall short of the requirements as set out by the ESRI;

— the Minister for Health, Stephen Donnelly TD, has failed to legislate for mandatory safe staffing levels in hospitals; and

— the Minister for Further and Higher Education, Research, Innovation and Science, Simon Harris TD, and the Minister for Health, Stephen Donnelly TD, have failed to outline a multi-annual health workforce plan to develop, train, and retain the requisite number of health and social care professionals to safely staff the health service and deliver universal healthcare; and
calls on the Government to:
— legislate for mandatory safe staffing levels in hospitals;

— publish and deliver on a multi-annual health service capacity plan, which matches the requirements as set out by the ESRI, and provides a 5 and 10-year health service capacity roadmap; and

— publish and deliver on a multi-annual health and social care strategic workforce plan, which develops, trains, and retains the doctors, nurses, and allied health and social care professionals we need to safely staff the health service and deliver universal healthcare.
A 78-year-old woman who suffers from cardiac issues had to wait more than 24 hours on a chair at University Hospital Waterford last week. The woman, who was subsequently diagnosed with heart failure, arrived at University Hospital Waterford at 3 p.m. but still had no bed or trolley at 3 p.m. the next day. She travelled from Dungarvan with her daughter who told Damien Tiernan on "Déise Today" on Waterford Local Radio, WLR FM, her mother's story: Mam went through triage very quickly, but then we sat and sat. Mam sent me home at 11 o'clock as I had to go home and do the jobs at home, so she told me that she would ring me when she was ready... At 2 o'clock in the morning, she rang me and she said "They told me I am staying in". [I asked her if she] had a bed as of yet, to which she responded no - though she was hopeful that it wouldn't be long before that came about. I said I would give her a ring in the morning, and I went to bed. I got up at 6am and I was working at 8am, so I said I would go down first with a bag for Mam. When I got in the door at 7am, I looked through and there she was, still sitting in the [same] chair. A 78-year-old woman, who was later diagnosed with heart failure, was left for 24 hours, not on a trolley but on a chair in a hospital. The Minister for Health, Deputy Donnelly, who has not come to the Chamber for whatever reason, tabled a very lengthy amendment to our motion but he left out a number of very important facts. Nowhere in the Minister's amendment does he agree or state that 85,000 patients had their procedures cancelled for the first quarter of this year. Nowhere does he talk about the thousands of patients who are languishing on hospital trolleys every day and the record numbers being broken every week and every month which are averaging at about 600 or 700 per day. Nowhere does he talk about the 50,000 bed days that were lost due to delayed discharges. Nowhere does he talk about the average wait time in emergency departments now exceeding 11 hours, and for children over 13 hours, and the same for patients over the age of 75. Nowhere does he talk about the 24,000 patients for the first quarter of this year who left emergency departments without being seen.

The facts are that the Minister for Health does not have a plan. He certainly does not have the confidence to come into the Chamber because I think this is the second Private Members' motion on health in recent times he has not been here. One would have to ask what his priorities are. I will tell the Minister for Health and will give him advice which I had done time and again on what I believe he needs to do.

There are a number of key issues on which we are asking the Minister to deliver. The first is to increase hospital capacity. This Minister loves to talk about stuff he is doing and talk up some of his successes. We see this in the very lengthy amendment tabled to this motion that does not acknowledge any of the hardships or any of the crises in emergency departments, hospital cancellations, what those of the front line are going through, or what patients are going through.

We need more beds, more surgical theatre capacity, and more diagnostic capacity. Yet, there is no pace or urgency on delivery from this Minister for Health. There are lots of promises. We are always waiting but there is no delivery. We also need more investment in community and primary care. One of the reasons we have a crisis in emergency departments is that we do not have proper care being given to people in the community. We know we need more out of hours GP care, greater use of community pharmacy, more step-down and recovery beds, and more care options including rehab in the community.

We need a comprehensive workforce plan for health. We need to ratchet up training places to ensure we have a greater pool of graduates coming through because we simply cannot deliver on what we need to deliver unless we have more qualified health graduates coming through. To underpin all of that, we need a multi-annual plan that gets serious about integrating all elements of healthcare. We have primary care and community care operating in silos from what is happening in our acute hospitals and that is one of the big failures. This Minister needs to have the courage of his convictions and come into the Chamber when there are debates on health. More importantly, he needs to come in with a plan and to deliver because patients and those on the front line are suffering.

8:30 pm

Photo of Seán CroweSeán Crowe (Dublin South West, Sinn Fein)
Link to this: Individually | In context | Oireachtas source

The Oireachtas health committee has consistently heard from health service workers and their unions that staff are at constant risk of burnout. Recruitment and retention remain at crisis levels as young graduates seek better pay and working conditions elsewhere, despite their express wish to remain in Ireland. This makes it impossible to legislate for mandatory staffing levels in hospitals as what staff we have we cannot keep and we are increasingly unable to replace those who leave. If we do not have key staff, hardly any other initiative will make a meaningful impact on healthcare reform.

There are nearly 900,000 people on waiting lists out of a population of around 5 million in the South. That is one in five people on a waiting list, some for months and others for years, often in pain, many on heavy medication and suffering further, waiting on procedures or elective surgeries that could have a transformative impact on their quality of life. The longer we leave them on waiting lists, the greater chance there is that complications will arise and their health conditions will get worse. One constituent, a double amputee, with whom I was dealing recently, was trying to gain access to an obesity clinic and will have to wait for years. The longer patients go without treatments, it could lead to things getting worse and to heart conditions or organ damage. By leaving people untreated, we create more for the services down the line. It is inhumane and makes no sense from a medical or financial perspective.

We need a real and actionable plan and the Government’s policies have us bouncing from crisis to crisis. Ordinary workers and families are suffering. We need a five- and ten-year health service capacity roadmap and we need to know what we need, when we are going to build and how much it will cost. We cannot repeat the mistakes of the past which have led to a still-to-be-finished children’s hospital already being the most expensive in the world. We need a strategic workforce plan which develops, trains and retains doctors, nurses and allied health and social care professionals. We need to safely staff the health service and deliver universal healthcare.

Photo of Thomas GouldThomas Gould (Cork North Central, Sinn Fein)
Link to this: Individually | In context | Oireachtas source

We face a perfect storm in our health service: a lack of community care and increasing pressure on already overburdened hospitals. In the first three months of the year, in Cork hospitals almost 6,500 beds have been lost because of delayed discharges. This has led to 1,900 cancellations in hospitals and that figure does not include CUH. Each one of these is a human being suffering because of the Government's and Minister’s inability to do their job.

I am supporting a constituent who for three and a half years has a colostomy bag that should have been removed and has had the surgery cancelled three times. He can barely walk, is in constant pain and is a carer for his sick wife. This is the reality people are living through. Another man contacted me yesterday to say his wife had a terrible fall a few weeks ago, breaking both her arm and wrist. She is 79 years old. He said she could not see because she is waiting four years for cataract surgery and no sign of it. He asked me to get him information as she will have to go to Belfast because the Government cannot supply the healthcare she needs. The tragedy is he suffered a stroke and she was his carer. He is 81 and she is 79. They are being abandoned because of Government inaction. I know of another lady. This is unbelievable. Her mother, being treated for life-threatening sepsis, spent four days on a trolley. She is 82 years old and has dementia. How terrified were that woman and her family?

Deputy Cullinane has a plan. For the love of God, will the Government ever listen to constructive proposals and take them on board? We want to work with the Government and the Minister. If they do not bring us on board, they are failing the people.

Photo of Pádraig Mac LochlainnPádraig Mac Lochlainn (Donegal, Sinn Fein)
Link to this: Individually | In context | Oireachtas source

The Minister of State's colleague, the Minister for Health, is not here. At the Business Committee last Thursday, I made it clear this Private Members' business would be on hospitals, relevant to that Minister. He has not given any apologies to our colleague and spokesperson on health, Deputy Cullinane. It is really disrespectful. What is happening in our health service is having a profound impact across the country on families and is incredibly cruel on the doctors and nurses carrying this impossible burden because they do not have the necessary supports.

We are extremely concerned about Letterkenny University Hospital in Donegal. We are extremely concerned about conditions in the emergency department and the lack of doctors, nurses and beds and have raised it year in, year out. What has happened in recent days is shocking. We had a situation where we had one consultant endocrinologist dealing with a massive burden of diabetes patients in Donegal. The clinical advice is the waiting time for an appointment should be six months for an adult with diabetes, and that is long enough. In Donegal, they are waiting 24 months, which is extremely dangerous. All the work on diabetes shows earlier intervention and more supports going in mean less impact down the line. We had one consultant endocrinologist working his socks off. Recently, we had a second one appointed who, within weeks, resigned. Now, the existing consultant endocrinologist is going too. We are without a support service of any substance in Letterkenny hospital. People were waiting 24 months and now they could be waiting even longer. This is a crisis.

The Donegal branch of Diabetes Ireland spoke out about this yesterday. Its representatives met with the Minister, Deputy Donnelly, when he was last in Donegal. I appeal to the Minister of State to speak to the Minister to make him aware of what the Donegal branch is appealing for: an urgent intervention from the Minister with the hospital to make sure there are necessary diabetes care supports. It is urgent at this stage.

Photo of Denise MitchellDenise Mitchell (Dublin Bay North, Sinn Fein)
Link to this: Individually | In context | Oireachtas source

The health service is in crisis and action taken by this Government has not made it any better. One just has to look at hospital waiting lists, people left on trolleys, people waiting in accident and emergency, mental health services, early interventions and assessments of need of children. The list could go on. The system is beyond breaking point and no amount of tweaks and small changes will cut it this time. The only thing holding our health service together is the dedication of our front-line staff.

People deserve a state-of-the-art healthcare system but, I am afraid, the system we have falls way short. We do not have to look far to find concrete examples of a health service failing its people. My local hospital, Beaumont, had to cancel nearly 5,000 appointments in the first four months of this year. Roughly 50% of people attending the hospital’s emergency department were left waiting for more than nine hours just to be seen in January, February and March. Patients over the age of 75 waited to be admitted to the emergency department for an average of 17 hours in the same period. The Government and the Minister have failed our health service miserably.

The motion calls on the Government to immediately legislate to make sure there are mandatory safe staffing levels in our hospitals. This is in the interests of the safety of both workers and patients. It must also develop a multi-annual plan that sets out a roadmap for increasing capacity over the next decade and a strategic workforce plan to go with it. The solutions are there and we, in Sinn Féin, have handed the Minister solution after solution time and again but it is time for the Government to open its ears and act in the interests of workers and patients in the healthcare system.

8:40 pm

Photo of David CullinaneDavid Cullinane (Waterford, Sinn Fein)
Link to this: Individually | In context | Oireachtas source

Hear, hear.

Photo of Pádraig Mac LochlainnPádraig Mac Lochlainn (Donegal, Sinn Fein)
Link to this: Individually | In context | Oireachtas source

Hear, hear.

Photo of Mark WardMark Ward (Dublin Mid West, Sinn Fein)
Link to this: Individually | In context | Oireachtas source

In the limited time available to me, I will concentrate on mental health and the waiting lists for mental health. Currently, we are at a record high of 4,490 young people waiting for an appointment for child and adolescent mental health services, CAMHS. Some 752 of these children have been waiting for more than a year for a mental health appointment. These are the figures I received at the end of March. I also received figures in February, because I have been mapping this for the last while, and the figures are only going one way. Between February and March, there was a 1.2% increase, but what really concerns me is that there was an 8.6% increase in the number of young people who were waiting for more than a year. It would be unacceptable for one child to be waiting for a mental health appointment for a year, never mind 752 people in this country. If a young person hurt their head or cut their head, they would be seen almost immediately, but if they had an issue going on inside their head, they would not get the same level of care. We need to see parity of care between mental and physical health.

CAMHS is for young people with moderate to severe mental health problems. The Minister of State, Deputy Butler, who, I must point out, is also not here tonight, has pointed out numerous times that the number of referrals has gone up, which has contributed to the increase in the waiting lists. Yet, what seems to have happened is that the Government cannot seem to join the dots. If children do not get intervention at the earliest stage, they will need more specialist treatments, such as CAMHS. At the moment, there are 11,000 young people waiting for an appointment with a primary care psychologist and 4,000 of these children have been waiting for more than a year. This is in primary care.

In some areas, there is a 30-week waiting list for Jigsaw. Under this Government emergency departments are inundated with the number of young people who are going to them with mental health crises. This has never happened before. We can all get lost behind statistics. As was mentioned, behind each one of those statistics is a young person who has a family. This ripple effect will go right through the family. This young person will have hopes, dreams and ambitions but they are being denied the opportunity to reach their full potential under this Government.

Photo of Patricia RyanPatricia Ryan (Kildare South, Sinn Fein)
Link to this: Individually | In context | Oireachtas source

Sinn Féin's motion seeks to address the escalating crisis that has crippled the HSE, that is, the tragic scandal of hospital overcrowding and growing waiting times. Our people are suffering, in particular our elderly. I am my party's spokesperson for older people. Older people are being forced to endure waiting times that, in Naas General Hospital, can exceed 20 hours.

The Government's answer to this disarray is record cancellations. It mistakes activity for action and cancellations for solutions. Hospital waiting lists are going the wrong way. With each passing day under this Government, the situation is seriously worsening. Instead of treating symptoms, let us address the root cause. Patients are languishing on trolleys, procedures are being cancelled and there are growing waiting lists. They are not isolated issues, but interconnected symptoms of systemic failures.

Sinn Féin envisages a new trajectory, one that is defined by comprehensive reforms, increased accountability and patient-focused solutions. We propose the following: a sustainable, multi-year capacity plan. This will mean more hospital beds, more than 1,000 more than we have today. It will mean surpassing the Government's short-sighted goal of 1,500 beds and aiming for the 2,500 the ESRI believes are needed.

We are committed to building a health service that is both reliable and resilient. We seek to develop and retain professionals who will become the backbone of this service.

It is also time to accelerate Sláintecare reforms. Let us aim for a system where more care is delivered outside of hospitals and where outpatient appointments are managed in dedicated clinics untouched by the turbulence of emergency departments. Our health service deserves safe-guarded spaces for elective procedures and outpatient appointments. We must limit the impact of unscheduled care to prevent the chain reaction of cancellations that we are witnessing today.

Therefore, I am asking the Government to not oppose our motion but instead see this as a way to put people's health first, especially our older people, who need the most care in this delicate period of their lives.

Photo of Hildegarde NaughtonHildegarde Naughton (Galway West, Fine Gael)
Link to this: Individually | In context | Oireachtas source

I move amendment No. 1:

To delete all words after "Dáil Éireann" and substitute the following:
"recognises that:

— this Government has invested record funding in our health service and has allocated €23.6 billion net to the health budget in 2023 (Current and Capital), an extra €5.6 billion (32 per cent) over the original net budget allocation for 2020;

— more than 20,000 net additional staff have been hired into our health service since the beginning of 2020, which includes 6,281 nurses and midwives, 3,177 health and social care professionals, and 1,948 doctors and dentists;

— 2020, 2021 and 2022 have seen the biggest staff increases since the Health Service Executive (HSE) was established, and 2023 continues to show large increases;

— the Organisation for Economic Co-operation and Development figures clearly show that Ireland has more nurses per 1,000 population than most other European countries;

— as of mid-March 2023, 970 new acute hospital beds have opened nationally since 2020, and by the end of this year the HSE is due to have added 1,179 beds, against a target of 1,146;

— there are now 323 adult critical care beds, which is an increase of 65 beds, or 25 per cent, since 2020, and a further 29 beds will be added in 2023;

— the Framework for Safe Nurse Staffing and Skill Mix is an evidence-based approach to determining nurse staffing levels, and it is designed around the care hours required to meet patient needs across a variety of care areas and is focused on delivering positive patient outcomes and safer care environments;

— the framework has been national policy since 2018, and since then has continued to include more care areas, as following Phase 1 for acute medical and surgical care areas the framework was applied to emergency care in Phase 2, it is now in its third phase of development in long-term residential care settings;

— over €31 million has been allocated to date for implementation of the; and

— the Minister for Health recently announced that he is prioritising the full implementation of the framework for safe staffing in all acute hospitals, and this will result in hundreds more posts, both nursing and healthcare assistants, being hired and filled on a full-time basis in 2023;
acknowledges that:
— the Department of Health and the HSE are planning a refresh of the Health Service Capacity Review 2018, which will be informed by a series of scheduled Central Statistics Office statistical releases later in 2023, and this will be a key input to a strategic review of infrastructure capacity planning for the next phase of the National Development Plan (NDP) and beyond;

— as part of the overall NDP funding, the health sector capital allocation is €5.657 billion for the period 2021-2025, an 11 per cent increase in funding year-on-year, to invest in the delivery of strategic reform;

— over 500 health capital projects and programmes across the State and across the sector are underway at various stages of development;

— a Capital Programme for 2023 has been developed and the HSE Capital Plan 2023 has been approved by the Minister for Health as a related document of the National Service Plan, and publication of the capital plan is imminent; and

— the Minister for Health is in discussions with Government colleagues on a proposal to expedite the rapid construction and delivery of 1,500 additional acute beds across the country, using modern methods of construction, including modular construction;
further recognises that:
— the 2023 Waiting List Action Plan was published in March 2023, and many of our individual hospitals have delivered impressive reductions in both their waiting lists and waiting times, with for example, Louth County Hospital, University Hospital Waterford, and Portiuncula University Hospital having reduced the number of patients waiting over 18 months for an Outpatients Department appointment by 97 per cent, 55 per cent and 38 per cent respectively, in the last year;

— the HSE is currently working to replicate this positive performance across the entire hospital system;

— in Budget 2023, funding of €443 million was allocated to tackle waiting lists, and this includes €123 million funding for the HSE to progress longer-term reforms to sustainably enhance capacity, €240 million funding for the HSE and the National Treatment Purchase Fund for additional short-term measures to address acute scheduled care waiting list backlogs exacerbated by the Covid-19 pandemic, and the remaining €80 million will be focused on alleviating various waiting lists in community and primary care;

— 2022 was the first year that waiting list numbers fell since 2015;

— progress is being made, and in 2022 the numbers waiting over the maximum wait time targets of 10 to 12 weeks, fell by 11 per cent, which is 56,000 people, and since the pandemic peaks in 2020/21 to the end of April 2023, there has been a reduction of 135,000, or 21 per cent, in the numbers of people waiting above these targets;

— under the 2023 Waiting List Action Plan, our health service aims to treat and remove circa 1.66 million patients from the lists, resulting in a projected reduction of just over 10 per cent by year-end;

— productive engagement is ongoing with the Private Hospitals Association, to secure additional capacity both in the short- and medium-term to support scheduled and unscheduled care;

— plans are advancing on three new Elective Hospitals in Dublin, Cork and Galway, that will provide significant additional capacity, and combined they will cater for up to 977,700 patients/procedures annually; and

— the HSE is developing a multi-year urgent and emergency care improvement programme to deliver sustainable improvements to unscheduled care, most of which currently occurs in the Emergency Department; and
further acknowledges that:
— the Department of Health is working closely with the HSE on developing the plan for expansion of community care and other measures which will reduce unnecessary attendances and improve discharge supports, such as home support and residential care;

— this Government is committed to a 'home first' approach to health service provision, and the Enhanced Community Care (ECC) Programme delivers healthcare reoriented towards general practice, primary care, and community-based services that prevents admissions to acute hospitals;

— the Government has allocated significant resources with annual funding of €195 million provisioned to the ECC Programme to enable recruitment of 3,500 additional staff, and with service delivery provided through Community Healthcare Networks (CHNs) and Community Specialist Teams (CSTs), that commitment will continue into future years;

— significant progress is being made, with 91 of the 96 CHNs and 44 of the 60 CSTs now established, and 2,600 staff already recruited to the programme, with the balance of recruitment and establishment of the remaining teams targeted for 2023;

— the nationwide GP Access to Diagnostics programme, began accepting referrals in January 2021;

— 251,601 diagnostics were completed last year, which exceeded the 2022 target of 195,000 scans, and of this, 115,477 community radiology scans have been completed to date;

— Primary Care Centres (PCCs) are an essential part of the Government's significant investment and nationally there are 167 PCCs, two of which opened in 2023, with a further 13 currently in construction, and 10 due to open in 2023;

— there are approximately 3,500 general practitioners (GPs) working in Ireland currently, 2,500 of whom hold a General Medical Scheme contract with the HSE, and over 500 further GPs hold contracts for screening or vaccinations services;

— under the upcoming Strategic Review of General Practice, consideration will be given to the possible role of HSE-employed GPs, as part of a wider examination of the GP capacity issue;

— there has been an increase of almost 30 per cent in the number of first-year nursing places in Irish Higher Education Institutions over the period 2014-2021, from 1,570 to 2,032;

— in July 2022, Minister for Further and Higher Education, Research, Innovation and Science, Simon Harris TD, and Minister for Health, Stephen Donnelly TD, announced an agreement with Irish Medical Schools to phase in an increase of 200 additional Irish/European Union medicine student places over the next five years; and

— discussions are ongoing between the Department of Health and the Department of Further and Higher Education, Research, Innovation

and Science, regarding the expansion of student places across health-related disciplines."

I welcome the opportunity to address the House on behalf of my colleague, the Minister for Health, Deputy Donnelly, on the issues raised by the Deputies tabling the motion. The Minister is unavoidably away because he is attending the World Health Assembly in Geneva.

One of the issues raised was how best to underpin framework for safe nurse staffing and skill mix. A question asked the world over is how to determine the number of nurses and healthcare assistants required to deliver care in various healthcare settings. The framework for safe nurse staffing and skill mix is an evidence-based approach to determine safe staffing and skill mix levels for nursing and healthcare assistants in the Irish healthcare service and it has been in development since 2014.

The framework is being developed in three phases. A policy on phase 1, medical and surgical care settings, was launched in 2018. A policy on phase 2, adult emergency care settings, was launched by the Minister, Deputy Donnelly in 2022. Phase 3 of the framework is in the process of being developed for general and non-acute care settings and includes long-term residential care settings for older persons, community care settings, and step-down and rehabilitation settings.

Phase 3 of the framework in long-term residential care settings for older persons is currently being tested in eight pilot sites. When the evidence and the recommendations from this pilot are available, phase 3 will be developed into a national policy for broader implementation. Responsibility for the implementation of the framework policies is given to the HSE and this is overseen by a safe staffing lead. To date, €25 million has been allocated to implement phase 1 in model 4 hospitals. This funding provided for almost 870 whole-time equivalents, WTEs, including both registered nurses and healthcare assistants. Some 92% of these positions have been filled with the remainder expected to be filled later this year.

The Minister, Deputy Donnelly, recently announced funding of €25 million to continue the implementation of phase 1 in model 3 and model 2 hospitals, which will provide for an additional 854 whole-time equivalents in these hospitals. Some €6.2 million has been allocated for phase 2 to provide for an extra 101 whole-time equivalent registered nurses in emergency departments throughout the country and 46% of these positions are now filled.

The framework for safe nurse staffing and skill mix is recognised around the world as highly effective, with other countries now looking to Ireland. I understand the Minister, Deputy Donnelly, has recently spoken with several academic experts who believe the framework is one of the best, if not the best, model for determining staffing levels.

Since 2020, approximately half the required extra posts have been created, including both nursing and healthcare assistants. The Minister, Deputy Donnelly, has spoken with nurses about the challenges that arise when the framework is not fully implemented, including issues of cross cover. However, where the framework is in place, it is making a big difference.

There is limited evidence to show that legislation makes it safer for patients or impacts implementation in a positive way. The advice the Minister received from international experts in safe staffing is that now is not the right time for Ireland to underpin the framework with legislation. The priority should be on implementation and development of the framework in other areas, especially in community care. The Office of the Chief Nursing Officer, CNO, will, however, keep this under review.

As regards waiting lists, as Deputies will be aware, the Department of Health, HSE and National Treatment Purchase Fund, NTPF, published the 2023 waiting list action plan on 7 March this year. This forms the next stage of the multi-annual approach to sustainably reduce and reform hospital waiting lists and waiting times. The plan allocates €363 million in funding to the HSE and NTPF to reduce hospital waiting lists by 10% this year, to continue implementing reforms, and to continue momentum towards achieving Sláintecare maximum waiting times of ten weeks for new outpatient appointments and 12 weeks for procedures.

This is building on the reductions in the waiting lists achieved in the fourth quarter of 2021 and again in 2022. Although the initial target for 2022 was not achieved as a result of continuous Covid-19 waves and significant pressures on unscheduled care, it must be acknowledged that 2022 was the first annual decrease in hospital waiting lists since 2015.

The agreed cross-party objective is to have nobody waiting longer than the Sláintecare targets of ten weeks for outpatient departments and 12 weeks inpatient day care gastrointestinal scope. In 2022, the numbers waiting over the Sláintecare targets fell by 11%, or 56,000 people, and there was a 24% reduction since the pandemic peak.

The Government fully acknowledges the distress and inconvenience for patients and their families when elective procedures are cancelled particularly for clinically urgent procedures. While every effort is made to avoid cancellation or postponement of planned procedures the HSE has advised that this can occur for a variety of reasons, including capacity issues due to increased scheduled and unscheduled care demand. The HSE has confirmed to the Department of Health that patient safety remains at the centre of all hospital activity and elective care scheduling. To ensure services are provided in a safe, clinically aligned and prioritised way, hospitals are following HSE clinical guidelines and protocols.

The Department of Health is already developing a comprehensive health and social care workforce strategy and action plan and planning projection model. The health and social care planning projection model will provide demand and supply projections of numbers required in medicine, nursing and other areas spanning short-, medium- and long-term time horizons. Work on the planning projection model is due to be completed in quarter 3 of 2023. Building on the 2023 plan, this will enable detailed planning for 2024 onwards. The expected result and ultimate objective of this work is the development of scenario-based projections of health and social care workforce supply and demand. These projections will inform a strategy, action plan and set of recommendations for ongoing strategic health and social care workforce planning.

In recent years, significant investment has been made through the winter and national service capital plans. This investment, while responding to the immediate demands of the Covid-19 pandemic through initiatives and alternative pathways, also assisted in building bed capacity. Between 1 January 2020 and 16 March 2023, 970 new acute hospital beds have opened nationally. Of these, 541 were opened in 2020, 272 were opened in 2021, and 157 were opened in 2022. There are 209 beds now profiled for delivery in 2023 giving a total of 1,179 beds. Adult critical care capacity is now 323 beds. This represents a very significant increase of 65 beds, or 25%, over the 2020 baseline of 258 beds. To put that in perspective, we had a total net increase of 18 beds in the three years 2017, 2018 and 2019. The HSE plans to add a further 29 beds in 2023, bringing capacity to 352 beds by year end. This includes 20 beds already funded and nine beds included in the national service plan for 2023.

Currently, the HSE is examining potential capital projects to deliver remaining critical care beds under phase 2 of the strategic plan for critical care through the development of new-build capacity at five prioritised sites, subject to necessary approval processes. These sites include Beaumont Hospital, St James’s Hospital, the Mater hospital, St Vincent’s University Hospital and Cork University Hospital.

8:50 pm

Photo of Brian StanleyBrian Stanley (Laois-Offaly, Sinn Fein)
Link to this: Individually | In context | Oireachtas source

I welcome the opportunity to speak on this motion. The reality is we have 888,000 people on hospital waiting lists, record waiting times, record numbers of people leaving emergency departments without treatment. We got the figures this week on that. Figures released to Sinn Féin show that 497 people left Portlaoise emergency department between January and March 2023 without being treated. In Tullamore, 546 people left the emergency department without being treated between January and March this year. These are alarming figures. This is despite the best efforts of the front-line staff in the emergency departments of both Tullamore and Portlaoise. The trolley scandal the Government pledged to end is now worse than ever. It used to be January and into February but now it has become an all-year-round threat to patient safety. We need an immediate increase of 1,000 hospital beds with a total of 2,500 additional beds required over the next couple of years, according to the Economic and Social Research Institute, ESRI.

One solution I have persistently put forward is the need to improve discharge times. To do this, we need to increase step-down capacity to free up beds in the acute hospitals. In Portlaoise, between January and March this year, we lost 671 bed days due to the delayed discharges compared with 506 for the same period in 2021. It has become worse because we do not have the step-down and community care services. The situation in Portlaoise has deteriorated. When the bed days lost in the same period in Tullamore have shown a reduction over the two years, which we welcome, there are still 428 days lost in that three-month period. That is too many days lost.

These figures underline the ongoing scandal of the 12 step-down beds that were supposed to be delivered in the Abbeyleix nursing unit of the hospital and that are still not opened. I raised this last week with Mr. Bernard Gloster, the chief executive officer of the HSE, and impressed on him the importance of doing this. Anything the Minister of State can do to push that forward will be welcome. We need to free up these step-down beds.

Also delaying discharges is the lack of home care packages. People who are ready to be discharged cannot leave because they do not have a home care worker. We need to fix that situation. The health services can be fixed but it needs a Government and a Minister with the political will to do so. Sinn Féin believes that we need to drive on the reforms contained in Sláintecare, increase bed capacity and hold the health services to account. We need to bring a proper pipeline of workers and train and retain an increased number of those critical healthcare staff. We must increase capacity.

Photo of Dessie EllisDessie Ellis (Dublin North West, Sinn Fein)
Link to this: Individually | In context | Oireachtas source

The constituency of Dublin North-West that I represent is served by three hospitals. The Mater hospital is a teaching hospital that provides acute and tertiary specialist services for approximately 190,000 people. The Mater hospital is also the national centre for a number of specialties, for example, spinal injuries, cardiac surgery, and heart and lung transplants. It is the home of the national isolation unit. Beaumont Hospital provides emergency and acute care services for a catchment area of around 290,000. It is also a designated cancer centre and the regional treatment centre for a number of other medical conditions. The national orthopaedic hospital in Cappagh provides a national orthopaedic service for the treatment of lower and upper limb and spinal injuries and surgery.

Throughout the country, hospitals saw record levels of inpatient cancellations over the winter months. The health system was put under extraordinary pressure with an emergency department crisis. Almost 45,000 inpatient appointments were cancelled across December and January while hospitals experienced one of the worst overcrowding crises seen in Irish hospitals. The obvious consequence of such cancellations is that a massive backlog will result, and this backlog will continue to be a source of crisis in the health service for many months to come. This has proved to be the case. The number of appointments and procedures cancelled in quarter 1 of 2023 for the Mater hospital amounted to 4,524 appointments cancelled. A significant number of these cancellations were cancer-related appointments. Beaumont Hospital had 3,559 cancellations for the same period. These cancellations are causing hospital waiting lists to spiral. Almost 8,000 people are waiting more than 18 months for their outpatient appointments at the Mater hospital. This is unacceptable.

It will take a long time to reduce such waiting lists significantly. These cancellations disrupt the work of the medical staff and can endanger the health of the patient who has to wait longer for a much-needed medical procedure. This is stressful both for the patient and for the medical staff caring for the patient. What is required urgently is an increase in healthcare capacity. In particular, there needs to be a significant increase in the number of hospital beds. We need faster implementation of recommendations of Sláintecare, especially in delivering care in dedicated external clinics, which would relieve much of the burden on the public health service. While we have too few doctors, too few beds and too few healthcare professionals and a serious lack of real investment in the health service, we will continue to have a crisis in the health service and an inability to meet the needs of patients.

Photo of Ruairi Ó MurchúRuairi Ó Murchú (Louth, Sinn Fein)
Link to this: Individually | In context | Oireachtas source

We have crisis and chaos in some of our hospitals and across our health service. We have staff who are under severe pressure doing their utmost to keep the show on the road. Patients are on trolleys. There are record cancellations of appointments and the ensuing increasing waiting lists.

All these issues affect people with real lives and families who are watching their suffering. I will relate some of their real-life stories.

A 73-year-old woman who has been having problems with a suspected prolapsed womb for approximately five years had an appointment approximately three years ago with a specialist at Louth County Hospital but heard nothing back. Her next appointment at the hospital was on 20 January this year. She had blood taken and other tests and was advised that she is on the list for surgery at Our Lady of Lourdes Hospital. She told me the surgery was supposed to happen in the next 12 months. She is in terrible pain, however, particularly when she passes water, and cannot walk properly. Following a query from my office, she received notification that she would be advised of an appointment in quarter 4 or at the end of 2023.

A 66-year-old woman in north Louth has been waiting a number of months to see an orthopaedic surgeon at Our Lady of Lourdes Hospital following damage to her right shoulder, including bone damage and five tears. Her GP referred her to Louth County Hospital and she received an X-ray and an MRI scan. She was given painkillers and referred into the very good physiotherapy service at the hospital but the physiotherapist there is reluctant to continue to work on her because he is concerned about doing more harm than good. Her activities of daily living are severely affected. She is no longer able to shower, do her hair or dress herself and she is in significant pain. She is in urgent need of an appointment with an orthopaedic surgeon. Following a query from my office, she has been advised she will get an appointment date in August.

A gentleman from Dundalk who is at the end of life has dementia and has had a stoma bag fitted. His wish and that of his family is for him to return home. Although he has been offered a care package in the community, it does not include the provision of staff to change the stoma bag. His daughter has been told she might be able to learn how to do it in order to get him home. The family is under pressure from the step-down facility in which he currently resides, as well as from community care in CHO 8, to take him home without the stoma care. Rightly, the family is not willing to do that. They are being told there is no one available to provide that care but all present are aware there are healthcare assistants in the private sector who could do it. We are still awaiting an answer from CHO 8. I contacted the Minister of State, Deputy Butler, today on this issue. We need action on it.

We are dealing with people who just want the pain to stop. They want to be with their families. In some cases, they are at the end of their lives. The system is broken and the people are broken waiting for it to be fixed. This is not good enough. The people are owed better.

9:00 pm

Photo of Duncan SmithDuncan Smith (Dublin Fingal, Labour)
Link to this: Individually | In context | Oireachtas source

I thank Deputy Cullinane and Sinn Féin for tabling the motion. I echo the disappointment that was expressed. It is understandable that a Minister might be unavailable, perhaps unavoidably so, but there are also two junior Ministers at the Department of Health. It would be terrible to think there is a degree of lethargy from the Government in dealing with waiting lists across multiple areas of health but it is difficult to come to any other conclusion in light of the absence of any of the Ministers to respond to the motion.

As we can see the bright sky through the glass roof of the Chamber this evening, we know we are in the middle of summer. That is usually a time when pressure on emergency departments will have eased but we are now living through a perpetual trolley crisis. As the motion states, there have been, on average, 550 patients on trolleys every day this month. That is incredible. In previous winters, going over 500 was almost unthinkable. Now, it is the norm.

In her statement today on behalf of the Minister, the Chief Whip placed much emphasis on capital investment for extra beds and buildings. We need more capacity, including elective hospitals and in nursing homes and primary care, but we will also need staff to work in all those buildings that are yet to be developed and built. Staff are needed to work in the healthcare settings that are currently in use. We know from speaking with the healthcare unions that there is a recruitment and retention crisis. I attended the INMO conference a couple of weeks ago and heard Bernard Gloster, the relatively new CEO of the HSE, speak on the need to improve recruitment and retention. Those were good words but they need to be backed up with action. He also stated that the days of having a winter plan are over; it is now a year-round plan. Those were also welcome words but we need to see them backed up. That is from where the motivation behind the motion comes.

Having spoken to members of the INMO at the conference, as well as in my constituency and through my role as spokesperson, it is clear their conditions of work are very difficult, the pay is not meeting the cost of living and the domino effect of the housing crisis is having a real impact on the retention of current healthcare staff. We have spoken at length on the housing crisis and will continue to do so. I have been speaking to CEOs of hospitals that are looking at their land banks to develop accommodation facilities for their existing workers and to attract in workers from overseas. That is not a sustainable accommodation model for healthcare workers. It is not how front-line workers should be accommodated. They should be paid at a level that allows them to live in a society where they can afford their own home and secure accommodation, but that is not happening. According to the INMO, 59% of young nurses who are leaving to go abroad for better pay and conditions also cite living standards, as well as affordability and availability of housing This is having a direct impact on healthcare settings and the ability to deliver safe staffing. The motion calls on the Government to underpin mandatory safe staffing levels in hospitals through legislation.

I wish to speak to elements of safe staffing, particularly in the context of assaults and an inequity in that regard. We know that many front-line healthcare workers have to put up with physical, verbal and sexual assaults in the workplace. It is intolerable. The HSE serious physical assault scheme, however, has an inequity within it. Members of certain grades who are the victim of an assault are entitled to six months on full pay and can apply for two further extensions up to 12 months. Other front-line workers in the support grades, such as healthcare assistants, porters, receptionists and security guards, do not get that, however. At best, they might get three months and then go onto regular sick pay or no pay, even if they are unfit to return to work. This has to stop. It is a fundamental element of safe staffing. Two workers who are victims of the same assault may not be entitled to the same benefits through the serious physical assault scheme. The Labour Party has raised this issue on several occasions. My colleague, Senator Hoey, raised it in a motion she tabled in the Seanad at the start of April. It is a matter we will continue to raise at every opportunity.

Also in the context of support grades, among the unseen heroes of the healthcare service are medical scientists and laboratory workers. It is one year since medical scientists went out on strike for the first time in their 60-year history. To date, the Department of Health and the HSE have addressed none of the critical issues that drove them to withdraw their labour for the first time in their long history. A report confirmed calls from medical scientists and their union last year but we have seen nothing. In good faith, medical scientists agreed to suspend their industrial action upon completion of an independent report that reconfirmed the validity of their claim. The report was published in January but nothing has happened since. Kevin O'Boyle, chair of the Medical Laboratory Scientists Association, MLSA, stated:

...laboratory services are crumbling. Poor pay and conditions have left laboratories unable to recruit staff, with 13% of Medical Scientist positions currently vacant against a backdrop of spiralling demand and constant pressure.

Staff are more demoralised than ever.

We do not need to go too far back in our history to see the work done by our medical scientists during Covid with all the diagnoses they did. When we see these advertisements outside our hospitals attracting nurses and other medical workers to come and work in Australia, Canada or Dubai, it is also a call to medical scientists and lab workers who are finding work in those countries and who are also able to transfer quite easily to more lucrative roles in the private sector in the medical science sector of our economy. We want to keep these workers. They want to work in public health. They want to work in our hospitals and being in the engine room of diagnosis and care, but they are not getting the support they need. They have been ignored and it is one year on since they took that action.

We are still massively under resourced in the provision of primary care throughout the country. We need top-quality facilities and we need primary care centres. For a number of years now, and especially since I was elected to the Dáil, I have been banging on about the lack of a primary care centre in a town the size of Swords, which is 60,000 people. Swords is the largest town in Ireland that does not have a primary care centre. We need proper buildings for the community disability network teams, which we will discuss tomorrow in the Labour Party motion on disability supports. They cannot continue to operate in health centres that were designed and built for populations of around 20,000 people, not towns of 60,000 and which are projected to grow to more than 100,000. Our primary care centre can no longer be Beaumont Hospital. We can see the number of cancellations of treatments at Beaumont Hospital. We are aware of the pressure Beaumont Hospital is under in the northside of our city. Fingal is the fastest growing and youngest county in Ireland. We need the resources to ease the pressure on Beaumont Hospital and Our Lady of Lourdes Hospital in Drogheda.

I will make one last comment on front-line workers. They still have not received the pandemic bonus payment. We are sick of asking about this through parliamentary questions and getting the same response that the KOSI Corporation is looking after all of the workers. It is not. There are still front-line workers who are being left behind. We speak about the demoralising effect of working in healthcare services and having long waiting lists throughout our healthcare services. The pandemic bonus payment is not key to it but it is perhaps symbolic of those who are forgotten, left behind and feel totally under appreciated by the HSE, the Department of Health and this Government.

9:10 pm

Photo of Róisín ShortallRóisín Shortall (Dublin North West, Social Democrats)
Link to this: Individually | In context | Oireachtas source

I welcome the opportunity to speak about some of the underlying reasons for the stubbornly long hospital waiting lists and I thank Sinn Féin for bringing this motion forward. Reading through this motion should be a sobering experience, but the reality is we have become so accustomed to unacceptably long waiting lists with unambitious targets and missed deadlines that we are no longer shocked by those.

We have reached a point where our waiting lists may be shocking but they are no longer surprising. This is because a perpetual state of crisis has become the norm in the Irish health service, but it is not normal. In no other European country would people tolerate a situation where there are almost 900,000 people on hospital waiting lists, where it takes an average of 12 hours waiting in an accident and emergency department when a person is seriously ill before they are admitted to a hospital bed, where 600 people are stuck in hospital beds because there is no home care available or step-down beds available, and where so many feel they have no choice but to pay for expensive private health insurance. The number of people who feel, mainly through fear, that they must do that is a real indictment of this and previous Governments in the inability to provide a properly functioning public health service.

We know, however, that it does not have to be like this. Ireland is the outlier. This dysfunction in our health service should not be accepted. Behind every waiting list number is a patient and their family, a patient who requires care, and a patient to whom the State has a responsibility to ensure care is available but who is being failed.

Healthcare is a basic public service that the State, and especially a rich one like ours, should be able to provide in a timely manner. Yet this Government continues to fall short, even though we have the solutions in Sláintecare. It is increasingly the case that Sláintecare is seen as a convenient brand for the Minister to wrap himself in. This must be more than a rebranding exercise. We must see real and urgent progress being made in our health service. The way to do that is by implementing Sláintecare quickly.

It is about creating a universal, single-tier health and social care service where people can access timely care on the basis of need and not on their ability to pay. This has become a mantra quoted by all but, regrettably, it is far from the reality. While I accept that some steps are being taken to address cost, albeit late in the day, major obstacles to full implementation still persist. For a start, our health service is still heavily orientated towards acute settings. We know many people are presenting to accident and emergency departments simply because they have no alternative. To tackle this and realise the full potential of Sláintecare, we need to expand local community services, but we also need more data collection. I cannot understand why there is no analysis at all of the reasons so many people attend our accident and emergency departments. The most basic thing we could do is to get the statistics on why people end up having to go to a local accident and emergency department. Would you not think that these data would be available and would have been collected for a long time? In reality there are so statistics. We do not know, for example, what percentage of people going to accident and emergency departments have a sports injury, or what percentage go there because they have diabetes, or what percentage go there because they have heart trouble. Unless we have this basic information on the reasons people are going to accident and emergency departments, then how on earth can we plan for proper services? That this is not being done is just unbelievably inept. Such data would be extremely useful for the design and provision of services, and especially for illnesses and injuries that could be treated outside of an accident and emergency department, in settings such as medical assessment units or local injury units.

There are other basic things that should be done. Why are the GP out-of-hours services so limited? They are limited because we expect GPs who provide a service during the day to cover at night-time. That is ridiculous. At a time when more and more workers in the health service especially are looking for better work-life balance, why are we not employing GPs to work out of hours? This is basic stuff but it is not being done. There are plenty of GPs who would welcome the opportunity to be employed potentially on a part-time basis. There are a very large number of female GPs who would be very pleased to work on that kind of part-time contract salaried basis. Why is this not done? Why are we running out-of-hours GP services on a skeleton staff? This makes no sense at all.

There is another aspect that should be obvious. Why is there no transparency about outpatient waiting lists? If I go to my GP with a particular condition, he or she may refer me to a consultant who has an 18-month waiting list. Why can I not find out if there is a consultant with a three-month waiting list and go to that person instead? There is no transparency in the system at all. People who are paid out of the public purse should have accountability. The waiting list should be transparent and show how long the waiting lists are for different consultants.

I also wish to address the NTPF.

People talk about outsourcing services to private hospitals. I heard that being suggested this morning on "Morning Ireland". The NTPF is used over and over again. When the NTPF was first introduced, it was as a temporary measure to deal with a crisis situation. We were told that once the backlog was cleared, there would be no need for it any longer. There does not seem to be a realisation that the more money is put into outsourcing services, the less there is for the core public service. Rather than this outsourcing, which is now so prevalent right across the health and social care system, we need to invest that money in building proper public services.

I acknowledge we are beginning to see some examples of the shift away from emergency departments. In the mid west, medical assessment units, MAUs, in Nenagh, Ennis and St. John's experienced their busiest year to date in 2022, with almost 13,000 patients receiving care. This represented a 19% increase on 2021. However, in order for these types of local services to be successful and attract more patients, which is what we should aim to do, expanded hours and additional resources are required. For example, the University of Limerick Hospitals Group needs €5.2 million in additional funding in order to increase staffing across its MAUs. This would allow it to operate seven days a week and increase the slots currently available to GPs, out-of-hours services and paramedics.

Providing these additional resources to MAUs and local injury units, particularly in underserved areas, would alleviate massive pressure on overburdened emergency departments. However, it would be remiss of me not to acknowledge that the situation in the mid west is more complex. Although the expansion of local services and the introduction of new pathways are welcome, there is still a compelling case for a level 3 hospital in the mid west. University of Limerick Hospitals Group is the only hospital group in the country without a level 3 hospital. It is very difficult to see how the current problems in University Hospital Limerick can be fully addressed without a level 3 to alleviate the pressure. The only explanation I have received for this hospital group not having a level 3 is that there are historical reasons. This is not good enough. It is certainly cold comfort to the many people in the mid west who are left without adequate services.

To return to Sláintecare reforms, another proposal that needs to be urgently progressed to reduce hospital waiting lists is the delivery of elective hospitals. I cannot understand why the Government will not move on these. The example was shown in Scotland, where the National Health Service took over a private hospital. It bought it out and very quickly built another elective hospital because it was so successful. It could operate like a clinic, for example, the Santry sports clinic, and could motor through the waiting lists, where there is that kind of speciality in addition to the avoidance of pressures that come from emergency departments, hospital-based infections and so on.

We have to move on these elective hospitals. There were supposed to be three hospitals. If the Government had acted on Sláintecare, those three hospitals would be in operation now. There is no other movement on the sites that have been identified for counties Cork and Galway, and we have yet to hear about a site in Dublin. This is basic stuff that the Government should be doing. It is failing the people due to its failure to address this in a way that stands up to vested interests in health and has the courage needed to implement a properly functioning public health service, just as citizens in every other country in Europe have.

9:20 pm

Photo of Gino KennyGino Kenny (Dublin Mid West, People Before Profit Alliance)
Link to this: Individually | In context | Oireachtas source

I will not use my entire ten minutes. I will probably take less than five. I welcome the motion tabled by Sinn Féin. We have had many debates on this issue. We probably cannot have enough debates about our health system. As it is, our health system is good, when people can get access to it. We have some of the best doctors, nurses, healthcare assistants and clerical staff in Europe. They are a very highly motivated and educated workforce, but there are mitigating circumstances whereby there is a schism between public and private. Over the course of the pandemic, we saw that no country could prepare for what was coming down the line, but front-line staff in each hospital stepped up to the plate in the most trying circumstances that could ever be imagined. I am sure people who were qualified doctors and nurses with years of experience could never have imagined that they would be up against something like Covid, but we pulled through. Many people died but the system saw itself through. However, many cracks were seen. The cracks in our health service are largely down to the divide of the inequalities. These are the historical inequalities between public and private.

The current situation in Ireland is unique in Europe in that 50% of our citizens rely on private health insurance. It is very weird that 50% of people have to rely on private health insurance because we have a divided system. I am sure people who have private health insurance want universal healthcare. Such healthcare, as seen across different parts of Europe and the world, is much better because whether somebody is on social welfare or is a millionaire, they get the same healthcare. That is a much better system for society and, most important, for the people who need that care.

One of the most crucial issues in our health service at present is the retention of staff. As I said, staff are very highly educated and very motivated but retaining that staff is a significant challenge, in the context of their working environment. Certain situations in our emergency departments are just not conducive to a safe working environment. There are situations where people have to go to work but are slightly frightened, to say the least. They are frightened as there is not a high enough ratio of staff to patients for people who are in that environment to actually look after certain medical situations. That is a fact. I have friends who work in the health service, as we all do. They are highly motivated and educated people who want to go to work but they are in situations that are completely unsafe. The Irish Nurses and Midwives Organisation has consistently said this. That has to be addressed. We do not want people who are newly qualified - some people want new experiences and to go to Australia and so forth, which is understandable - on a conveyor-belt system where they get fed up, burnt out and have to leave two or three years after qualifying. We just do not want that because we will have this conveyor-belt system as regards new staff. That is not a good situation to have.

As I said, universal healthcare, including Sláintecare, is a very good concept. For probably the first time in the history of this House, even those from the party of the Minister of State who have supported private healthcare now understand that a system of universal healthcare, or Sláintecare, would be much better. We largely agree on that. Sláintecare is a good concept but it is going very slowly. Its implementation is extremely slow. That needs to be fast-forwarded.

The creeping privatisation in our system is very worrying. I go back to the historical legacy of the 1980s and 1990s when hundreds if not thousands of beds were taken out of our public health system. We are playing catch-up. We are a very wealthy country. We are one of the wealthiest countries in the world. We should have a health system where people, regardless of their income, are treated properly. We all agree with that but it is not happening. There are pinch points, particularly around emergency departments and waiting lists. There are people who have been on waiting lists for years. That is just not acceptable at all. Once we fix all those pinch points, then we can have truly universal healthcare in Ireland.

9:30 pm

Photo of Peadar TóibínPeadar Tóibín (Meath West, Aontú)
Link to this: Individually | In context | Oireachtas source

I will try to encapsulate the state of the health service in a number of figures. Last year, 115,000 patients left emergency departments before they were seen. That is an incredible figure. Some 115,000 people were sick enough to warrant going to the emergency department but were forced to wait so long that after a while they felt they were safer and better off at home. The emergency department in Our Lady's Hospital in Navan was so busy last year that 1,230 patients left the emergency department before they were seen. That is an incredible figure for a hospital whose emergency department the Government is seeking to close.

Statistics that were given to Aontú also reveal that two people in the south-west region were left waiting for longer than 13 hours for ambulances last year. One person in the western region was left waiting 22 hours for an ambulance. That is according to the figures in a reply we received to a parliamentary question. The definition of an ambulance is a vehicle equipped to bring sick or injured people to hospital in an emergency. However, 22 hours is not a figure I would associate with an emergency response. The average response time for ambulances has been increasing year on year since 2019, as has the number of times patients have died by the time the ambulance reached them. In 2019, 757 people were dead by the time an ambulance arrived. In 2021, the figure was 927. That is both startling and devastating. It is a life-and-death indicator of the performance of the emergency services on the Government's watch. Last year, in the context of 103,000 ambulance journeys, or 34% of call-outs, the wait time increased to more than an hour for the handover of patients at hospitals. This means that they were tied up because of a lack of beds in emergency departments. As a result, their ability to get back on the road and help people who were in serious need was also messed up as a result. We had scenes of total chaos at Our Lady of Lourdes Hospital in Drogheda a few months ago as 11 ambulances were stuck waiting for five hours as a result of the lack of beds. Yet, the Government is seeking to close the emergency department in the closest hospital in Navan. The ambulances being tied up in Drogheda meant that no ambulances were available in Meath, Louth, Cavan or Monaghan that night. None. They were all stuck in a car park outside the emergency department in Drogheda.

Some 830,000 people are waiting to be seen at outpatient clinics or for hospital treatment at present. That is an incredible figure. Before Christmas, Aontú found out that 600 patients who had been clinically discharged were in hospitals. In other words, the doctor could do no more for the patient but they had nowhere to go. That is an incredible situation. Some 47 people who have been clinically discharged are currently stuck in hospital for more than six months. We found out that in 2021 there were 105,000 adverse incidents in the healthcare system, which was a significant jump on previous years. These are cases of people being damaged, made ill or disabled as a result of mistakes in the health system. This has led to €2 billion of medical negligence payments being made by the State in five years. That money should have gone into front-line resources, but it did not. These figures are shocking. Behind each of them is a human cost. There is suffering and pain, people cannot work due to ill health and people are dependent on carers because of ill health. These are heartbreaking situations for all of those involved. As part of the national hospital campaign, we have been fighting to ensure that the Government invests in hospitals and that it will continue to do so.

Photo of Matt ShanahanMatt Shanahan (Waterford, Independent)
Link to this: Individually | In context | Oireachtas source

RTÉ reported recently, on the basis of figures provided by my constituency colleague, Deputy Cullinane, that the average waiting time for admission through emergency departments in hospitals has increased and now stands at 11.7 hours. It also stated that children and over-75s are waiting up to 13.3 hours. Stephen McMahon of the Irish Patients Association correctly pointed out that these are average times. Therefore, we are also talking about people spending 24 hours and more waiting on trolleys to get into hospital beds. The trolley count is 550 each day on average. Some 24,000 hospital appointments and elective procedures were cancelled in April alone. More thank 880,000 people are on the national hospital waiting list and community GP and out-of-hours cover are impacted. All these metrics hardly point to a stellar record on the part of the Government.

I also wish to raise the issue Deputy Cullinane outlined earlier, namely, the 78-year-old Dungarvan woman who was referred by her GP to the emergency department in Waterford in the mistaken belief that some basic, routine diagnostics could be done there. Her GP was unaware of what is happening in Waterford at the moment because of the closure of the emergency department in Wexford General Hospital, as the Minister of State will be well aware. The lady presented for a chest X-ray and some blood tests and ended up sitting on a chair for more than 24 hours. She is 78 years of age. She was diagnosed with heart failure. She did not get a bed or a trolley because none was available. Will the Minister of State ask his colleague whether this is acceptable in a first world country? How does it play out in real life? It can be seen in that case.

Let me tell the Minister of State about my experience. My daughter was concussed recently playing Gaelic football. I had to bring her to the emergency department in the hospital late at night at the end of April. We sat in the new circus tent outside the University Hospital Waterford emergency department where she waited for four and a half hours to be seen. That was fair enough. I have no issue with that, but I have an issue with the fact that it was 0oC outside and the hospital staff were coming out after midnight passing out soup, sandwiches and blankets to the people waiting there. Where else in the country would you see that? Where else would it be supported by this Government? We have been highlighting the capacity problems in the south east for many years. This includes the hospital in the Minister of State's constituency - Wexford General Hospital.

The Waterford University Hospital emergency department has become the busiest in the country in the aftermath of what happened in Wexford. The rate of ambulance presentations every week has increased by 50%. The hospital is seeing 2,500 presentations in the emergency department every week. What support is the Government giving? It has sent some staff from Wexford to help with the rota of hours. What good is that when we do not have beds, trolleys or capacity?

Let me give the Minister of State an idea of capacity. I received four responses to parliamentary questions from the HSE about capacity in the past week. I asked about the long-standing commitment to build outpatient capacity and bed capacity at St. Otteran's Hospital. The project has been ongoing for ten years and in that time we have just managed to put a roof on the building. The HSE responded that it expects the final refurbishment to be completed by the end of next year. That is the earliest possibility for community beds to become available. In another question, I asked about the laboratory extension that has been spoken about since 2016. The response was that a capital submission was received and considered but is not in the HSE capital plan for 2023. It is hoped that it will be provided in the near future once it has gone through critical design stages, subject to the availability of funding and the prioritisation process. We know we are certainly not being prioritised.

I asked the Minister what was happening with the second cardiac cath laboratory and the provision of additional beds. At the end of a long preamble, the final statement tells us what is happening. Work on the development of a second cardiac laboratory project was completed in quarter 4 of 2022. A number of options are currently being appraised with the hospital management with a view to identifying the most suitable solution for the provision of a cardiac day ward at University Hospital Waterford. This is a project that has been planned since 2015. I asked the Minister about concerns about a block of 160 bed units that has been discussed for more than a year. The Minister stated it has been brought to the capital steering group but needs further validation. I am only talking about one hospital, but it is the regional hospital of the south-east region and it caters to a large number of Wexford patients who are the Minister of State's constituents. There is no urgency or good faith on the part of the Government to give us the bed capacity and personnel capacity we wish to have. I commend Sinn Féin on bringing forward a Private Member's motion about hospital waiting lists because, frankly, they are a disgrace and are getting worse.

It is within the gift of Government to solve a large part of the problem. It is about: recruitment; pay; sorting out section 39 agencies and workers; coming to terms on better working conditions; and providing resources to hospital doctors, nurses, specialists and consultants. We are faffing around and having discussion after discussion with the HSE, capital steering groups, appraisal groups and clinician representative groups, but we are not making any progress. I fear we are getting to a tipping point with people rightly calling out what this Government is doing about the situation.

9:40 pm

Photo of Mattie McGrathMattie McGrath (Tipperary, Independent)
Link to this: Individually | In context | Oireachtas source

I mean no disrespect to the Minister of State but cá bhfuil an tAire? He just does not care. The arrogance oozing from that man.

Photo of James BrowneJames Browne (Wexford, Fianna Fail)
Link to this: Individually | In context | Oireachtas source

He is in Geneva.

Photo of Mattie McGrathMattie McGrath (Tipperary, Independent)
Link to this: Individually | In context | Oireachtas source

The arrogance oozing from the former director general of the HSE, Paul Reid, and from its new director general. They do not give a toss about the people, and that is being honest. The sooner they are removed, the better. The sooner Secretaries General and other people who have responsibility are taken out of office and sacked, the better. They do not care about people either.

I compliment Sinn Féin on bringing this motion forward. I have figures here. Imagine the amateur psychology that goes on when an ambulance 999 call is made and the ambulance is dispatched from Donegal to Clonmel just to tick a box for the time it was dispatched, but no time is thought of for when it might arrive. The ambulance might be transferred three times on the way. The waiting lists at South Tipperary General Hospital and the cancellation of so many procedures are just shocking. The nurses and doctors on the front line work tirelessly and fabulously, but management is an abomination and a shame.

We give money to the HSE. When I came here first, the amount involved was about €11 billion per year. Now it is twice that. There is no accountability. Look at the mess at University Hospital Limerick. The manager there refuses to step aside, stand down or have transparency. We get promises that the emergency departments in St. John's Hospital, Nenagh General Hospital and Ennis General Hospital might be opened. That will not happen because the mandarins do not want it. The beds were removed under successive Governments. The current Government will not restore them. I hope to see Sinn Féin in power. I eagerly wait to see how many beds will be restored and what will happen, because consultants and others are dictating things. The patient comes last. and the patient is last. The Government's patient first strategy is a load of bunkum. There are consultant's reports and Mazars is looking into the better management of Cork University Hospital. The money it has got is obscene. It is corruption of the highest order and it is disgusting

Photo of Carol NolanCarol Nolan (Laois-Offaly, Independent)
Link to this: Individually | In context | Oireachtas source

It is shameful that, as the motion notes, "hospital waiting lists now stand at 888,000 patients, with more than 500,000 people waiting longer than the Sláintecare targets ... and with more than 225,000 people waiting for a diagnostic scan". From a reply to a parliamentary question that I received on this matter, I know that the Department of Health is working with the HSE and the NTPF to identify ways to improve access to care. Clearly, however, this is not happening at sufficient scale. We need to see: an urgent ramping up and increased use of private hospitals; the funding of weekend and evening work in public hospitals; funding for see-and-treat services; the provision of virtual clinics; and an increase in capacity in the public hospital system.

The 2022 waiting list action plan under which €350 million was allocated to the HSE and the NTPF to reduce waiting lists is just not working. Under this plan we were supposed to see the delivery of urgent additional capacity for the treatment of patients as well as investment in long-term reforms to bring sustained reductions in waiting lists. Again, the evidence would suggest that we are heading in completely the wrong direction. This is to say nothing of the crisis in our dental services, access to GPs in rural areas and the massive number of staff vacancies in our children's disability network teams, including its highest national level of 43% in CHO 8, my local CHO. This means that almost half of the children's disability staff positions are unfilled. I am informed by the HSE that while the largest discipline within the children's disability network teams is speech and language therapy, a staggering 162 whole-time positions out of a total of 447 are vacant. When all of these figures are combined, they show that, unfortunately, the health crisis shows no sign of improving.

Photo of Michael CollinsMichael Collins (Cork South West, Independent)
Link to this: Individually | In context | Oireachtas source

I thank Sinn Féin for bringing forward this motion. Waiting lists are scandalous. It is scandalous that people are suffering as a result of waiting lists. I have a double amputee in a hospital in west Cork who cannot go home because they cannot get home help, so it is in every area of health that the Government has failed the people. The previous Government collapsed on the basis of the health crisis.

Look at areas where patients are waiting to get community hospital beds. I heard the Minister last weekend on about something we have been on about for the past three or four years. He stated that people had better start working in hospitals over the weekend. In the name of God, what kind of planet has the Government been on? That should have been done ten years ago. Where is the Government going? It is making one plan on top of another. It is all only old talk and it is going nowhere. Of course the hospital staff should be working over the weekend and considering having hospitals working 24-7. If someone is seriously ill in bed, why in the name of God would you think that on a Friday evening the illness is going to go away? If a hospital bed is needed, how could you think the illness will not continue to obtain on Saturday and Sunday? Of course, it will.

I mention patients waiting three to five years for cataract operations. Deputy Danny Healy-Rae and I have taken 122 buses carrying such patients to Belfast. That is scandalous. Last weekend, we started what we call the first hip-hop bus to Belfast. It was full of people looking for hip and knee operations going to Kingsbridge Private Hospital on the reimbursement scheme. The Government will pay for those operations anyway. This whole place is a complete and utter shambles. People waiting on the ground for three and four hours cannot get ambulance staff while they are tied up in Cork University Hospital. I could go on forever. It is unreal that the Government has allowed this to happen and to get so bad. The Government cannot control what is happening, it cannot resolve matters and it is not capable of holding office as a result.

Photo of Danny Healy-RaeDanny Healy-Rae (Kerry, Independent)
Link to this: Individually | In context | Oireachtas source

I thank Sinn Féin for introducing this motion. I mean no slight on the Minister of State, but it is a shame and disgrace that the Minister for Health is not here. There is no excuse good enough for that. He has been playing to the gallery all the week. He launched some initiative to put ads on bottles, drinks or whatever and announced that Ireland is the first country in the world to do that. At the same time, this Government is suggesting that pubs in cities should remain open until 6 a.m. That is a complete contradiction.

The Government should insist that hospitals and medical staff work through the night and at the weekends in order to deal with the list that is there, because people get sick after 5 p.m. on Fridays and at weekends. People are dying because they cannot get attention if they go into the hospital during the off hours. There are no doctors there to see them and they remain on trolleys. That is unfair and very wrong.

I am proud of the following example. Six weeks ago a 98-year-old woman got on a bus in Killarney at 3.45 a.m. She told me she wanted to save her sight. I am proud that she came back home after a seven-hour journey up to Belfast and a seven-hour journey back. She had the sight in one eye and she is going again to get the second eye done. She is 98 years of age. It is hard on those people to do those things, but that is what we have to do to ensure that they do not go blind. It is a shame, a disgrace and indictment on the Government that this is what it is allowing to happen.

Photo of Michael Healy-RaeMichael Healy-Rae (Kerry, Independent)
Link to this: Individually | In context | Oireachtas source

I thank Sinn Féin. The only criticism I have of it is that Deputy Cullinane should have said at the start of this debate that he was pulling the motion. He should have collapsed the Dáil this evening over it and had the screens go blank. I will tell the House why. He should have done so because it is the height of disrespect to him, his party and the work its staff put into bringing this motion before the Dáil that the Minister for Health is not here.

Think about it. We are debating hospitals, waiting times and what ambulance delays are. We are debating all that and there is no sign of the Minister for Health. That is totally wrong and it is giving the two fingers to the people of Ireland and the electorate, who are the important people and our bosses. The letters "TD" stand for Teachta Dála, servant of the people. On the other side of the House, it has gone so much to their heads and bottoms that they do not know their heads from their backsides because their heads are firmly stuck into their backsides and it is horrible to think what they are doing to the people.

I want to highlight a number of matters, including the massive lack of investment, the regional disparities, matters relating to the mental health services and the impact on vulnerable populations.

Our ambulances are full because our EDs are full; our EDs are full because the hospitals are full; and the hospitals are full because they struggle to discharge patients or they do not have enough beds in the first place. Ireland simply does not have enough beds. Another thing that is happening in our EDs is that they are full of people who would go to a local GP if they had a local GP, but they do not have one because the whole system is breaking down. I do not see why the Government thinks that money is the answer when mismanagement is what is actually happening. It is a disgrace. I am very glad to be taking Kerry patients out of Killarney and Castleisland to the North for treatment. The bus leaves full of Kerry patients. I am very glad to have been organising that service for many years for those who need hip and knee operations and all the different surgeries that can be performed, but it is a shame to have to do it. It is great to be able to take Kerry patients to the North, but it is wrong to have to do so. On a personal note, it is great to see a man of Deputy Ring's experience and ability in the Chair.

9:50 pm

Photo of Michael RingMichael Ring (Mayo, Fine Gael)
Link to this: Individually | In context | Oireachtas source

I thank the Deputy. The next grouping is the Independent Group. I call Deputy Connolly.

Photo of Catherine ConnollyCatherine Connolly (Galway West, Independent)
Link to this: Individually | In context | Oireachtas source

I never get praise like that, a Chathaoirligh. May you enjoy it.

I think it is appropriate that the Minister of State at the Department of Justice is here, because there is a complete lack of justice, fairness and equality in our health system. It is ironic that is has been left to the junior Minister for Justice to be here for a health debate. I thank Sinn Féin once again for bringing the motion. I welcome the opportunity to speak on it, although I tire of hearing my own voice. One colleague outside said it is Groundhog Day. That is what it feels like all the time when we come to debating health services. I thought we had come to a reasonable situation when we had a committee that looked at the issue and came up with Sláintecare, so that we could stop this continuous raising of crises and waiting lists. That has not happened. Today, there are 561 patients on trolleys, 44 of whom are in Galway. Yesterday, there were 516 patients on trolleys, 46 of whom were in Galway. On 3 January this year, there were 77 patients on trolleys in Galway out of a total of 931. The figures relating to waiting lists have been set out. There are 888,000 patients on waiting lists, as referenced by Deputy Cullinane. I thank him for highlighting that.

We may ask what is going on. What is going on is that we are absolutely normalising a totally abnormal situation. It is not acceptable for people to be waiting two and three years for essential surgery. It is not acceptable for people to be on trolleys. We know from Dr. Hickey, who has repeatedly pointed it out, that at the most basic level we have 300 premature deaths per year because of time spent on trolleys. We have said all of this over and over again. The cross-party group produced Sláintecare, and yet we are still in this complete and utter mess, while all of the time the private hospitals are making profit. They are making profit on those going there with their VHI or whatever insurance they have, and fair play to them; they are entitled to do that. However, we are also helping the private hospitals to make a profit by channelling people through the National Treatment Purchase Fund, NTPF, and other schemes. The role of the Government is to help companies - mostly the companies that own the private hospitals - to make a profit.

We introduced the NTPF 21 years ago. You would imagine that we would have a little bit of sense 21 years later. At the time when we introduced the NTPF, I understood that like the housing assistance payment, HAP, it was to be a temporary measure because of the state that the health service was in then. It had funding of €5 million at the time. When I looked at the funding that it has in 2023, I learned that €240 million has been allocated to the NTPF, and there are Deputies appealing for that to be increased, as they are with the HAP. I see where they are coming from. We are in a most abnormal situation. We should not need a NTPF to channel people into private hospitals to be treated by the consultants who let them sit on a waiting list, and by a management that let that waiting list get bigger. We channel them into private hospitals all over the country, including in Kilkenny. A patient I know was waiting over two years for an injection for pain. In the end, that person drove themselves down to the private hospital in Kilkenny and back up to Galway. There is any number of such examples. I know an 81-year-old man who has been waiting for over two years to get on a list for surgery. He has been told that if it gets worse, he should tell the GP. He is hobbling around Galway. I also know of a 60-year-old female who has been waiting two years for urgent hip surgery. I am not just throwing these examples out. Just as I believe in public housing as a major part of the solution to the housing crisis, I believe in a public health system as a right. Yet, we are not delivering that. We are talking the talk, but all the time privatising in every way possible. Primary care is being provided by private for-profit companies that are not owned by the State. We lease the primary care centres for a certain period of time. All of the time, we are privatising by stealth. Recently, a person near to me had to avail of a primary care service. It was delivered by a private company with management and everything in Dublin. The company came to Galway and provided a service that was a very good service. It had all been privatised.

Taking Galway as a microcosm of the country, we are not taking the pressure off the hospital, which is creaking at the seams, and we will not have an ED for another few years. We have had a temporary ED in the meantime. An elective hospital has been promised, when really the answer was to build a brand new hospital in Merlin Park but it never happened. We have a district hospital in Clifden that could take the pressure off, that is limping from day to day. There is a day centre in An Cheathrú Rua, which I will be talking about later in the Topical Issue Debate, that has been closed since Covid. That is repeated all over the country, where pressure is placed on hospitals because of the failure of primary care and the failure to have step-down facilities. Of course, we have also allowed home care to degenerate, and the conditions are appalling in the mostly women-dominated home care service. It is simply appalling what we have allowed to happen in our name. We have normalised it and we have reduced our sense of outrage. The day that I lose my outrage in relation to people on trolleys for any length of time, I will be leaving this Dáil.

Photo of Thomas PringleThomas Pringle (Donegal, Independent)
Link to this: Individually | In context | Oireachtas source

I thank the Cathaoirleach Gníomhach for the opportunity to speak today. I fully support this motion and commend Sinn Féin on putting it forward. The motion calls on the Government to legislate for mandatory safe staffing levels in hospitals. The current waiting lists for Sligo and Letterkenny hospitals are completely unacceptable, and many of my constituents have reported long waiting times and understaffing in both hospitals. These hospitals are buckling under the strain following years of neglect and lack of investment into the north west. The Irish Hospital Consultants Association recently warned that the growing shortage of essential acute hospital beds and consultants across the west and north-west region is resulting in waiting lists for treatment that are impacting on patient outcomes. What a surprise. The Government’s inaction on this is an absolute disgrace. Unfortunately, that is not a surprise either.

I was disappointed to learn about the recent resignations of consultant endocrinologists for adult diabetes services in Letterkenny University Hospital. One of these resignations came from a new consultant endocrinologist who only began working in the hospital a few weeks ago. What does that say about what it is like to be a consultant in Letterkenny? There are obviously deeper underlying issues to be dealt with here, and I urge the Minister to seek these out and address them as soon as possible. Perhaps the Minister of State at the Department of Justice could do it rather than the Minister for Health, seeing as he is here. Another consultant who has recently resigned has worked at the hospital for many years, so his absence will create a significant hole in adult diabetes services provision. This is incredibly concerning and it raises questions about the level of care now available for adults with diabetes in Donegal. It also raises questions for the many people with appointments over the next few weeks, and how they will be facilitated.

We are now facing disruptions to the delivery of, and access to, care for people with diabetes in Donegal, and the negative consequences that will inevitably come as a result. The current waiting time for diabetes appointments in Letterkenny is at least two years, despite clinical guidelines that state that adults with diabetes should have an appointment every six months. I have been told that the Donegal branch of Diabetes Ireland has informed the Minister for Health, Deputy Stephen Donnelly, of its concerns on the provision of care in Letterkenny hospital, but he has never followed up on it. That is hardly surprising, because he does not respond to me either when I raise issues with him. Perhaps the Minister of State could take that up with him too, and see if we can get responses.

I have also been raising my concerns about diabetes services in the north west with the Minister for over a year. The lack of investment is completely unacceptable. Sligo University Hospital has been seeking funding to provide insulin pump services in the hospital for the last two years. However, due to a lack of funding, it is still unable to hire a specialist nurse to provide the service. This is yet another example of the north west being left behind. People with diabetes should not be at a disadvantage just because they live in the north west. Services here are scarce enough as it is, and we cannot afford to lose any more endocrinologists.

I urge the Minister of State to please engage with this issue to ensure a short-term and long-term solution for the people of Donegal. I also call on him to ensure further investment for diabetes services. It is not good enough to hire more endocrinologists and think that is the problem sorted. There is no point in hiring new endocrinologists for them to leave within a few weeks. The issues are obviously deeper than recruitment and they need to be sorted out.

We also need to address issues with our National Ambulance Service. There is a list of what we need to address, which has been outlined by other Member during this debate. The National Ambulance Service and primary care services all impact on hospital services because if patients cannot see a GP or get services outside the hospital, they end up going to the accident and emergency department in an attempt to be dealt with there. This all leads to the importance of the whole area needing to be dealt with.

Unfortunately, the Government is actually dealing with preparing the privatisation of the services. It is interesting that while Letterkenny University Hospital is losing consultants left, right and centre, more private hospitals are opening up in Letterkenny to facilitate CAT scans and everything else that is required there. What is the actual programme here? Is the programme privatisation by stealth? That certainly seems to be what is happening across the board.

10:00 pm

Photo of James BrowneJames Browne (Wexford, Fianna Fail)
Link to this: Individually | In context | Oireachtas source

I will begin by mentioning the significant investment in the health service since 2020. The Government allocated €23.6 billion net to the health budget in 2023, both current and capital, and an extra €3.2 billion or 15% over the original net budget allocation for 2020. This is the largest allocation ever for the Department of Health. The Government has allocated 27% more in core funding in 2023 compared with 2020, with an additional €4.9 billion being invested in our health service. The net core allocation increased from €17.9 billion to €22.2 billion in the last three years. This demonstrates our huge commitment to healthcare and healthcare reform.

We now have 139,838 whole-time equivalents working in our health services and we have hired thousands more staff since getting into government. Thanks to successive large increases in the health budget, there are 20,020 more people working in our health service than there were at the beginning of 2020, which is an increase of 17%. This includes 6,281 nurses and midwives, 3,177 health and social care professionals and 1,948 doctors and dentists. The patient and client care staff category currently stands at 28,505 whole-time equivalents. This is an increase of 2,786 whole-time equivalents or 11% on 2019. Those working in patient and client care include home helps and healthcare assistants.

The years 2020, 2021 and 2022 have seen the biggest staff increases since the HSE was established. So far, 2023 continues to show large increases due to funds secured this year to continue the considerable expansion of the workforce, with 6,000 staff to be added this year. This growth will be seen across all service areas and in key staff categories such as medical staff, nurses and health and social care professionals. Increased retention efforts by the HSE have contributed to this record-breaking growth with significant career development and progression and educational development opportunities being offered. Recruitment capacity is also expanding to ensure that ambitious workforce targets can be met and to maximise the numbers who are recruited. This has included the expansion of international recruitment markets, targeted recruitment campaigns and streamlined recruitment processes. There has also been an increase of almost 30% in the number of first-year nursing places in higher education institutions over the period 2014 to 2021, with an additional increase planned for 2023. Since 2019, all nursing and midwifery graduates were offered permanent contracts, and this will continue into 2023. All health and social care professional graduates who applied for the HSE national campaign were offered permanent positions. This will also continue into 2023.

In March, the total workforce stood at 139,838 whole-time equivalents. This is an increase of 651 on February figures and a growth of 2,092 this year to date at 1.5% ahead of the end of 2022. The growth year to date is stronger than the same period last year. If the current growth levels continue, we expect to achieve the recruitment target for the year of 6,400 whole-time equivalents.

The medical and dental staff category has shown strong growth in March with an increase of 144 whole-time equivalents. Increases are seen in all staffing grades in this category. There were also increases across the following stock categories in March: health and social care professionals, nursing and midwifery and patient and client care. In terms of year-to-date growth, nursing and midwifery has grown by the largest amount of 867 whole-time equivalents.

Deputies will be aware that the Minister for Health established a national task force on the non-consultant hospital doctor, NCHD, workforce in September 2022 to address doctor training capacity and retention issues. In its first six months, the task force developed interim recommendations strengthened by specific implementation requirements, including over oversight and monitoring structures. The Minister published the interim recommendations reported of the task force on 13 April 2023 with a focus on seven priority themes and 42 recommendations for immediate implementation by the HSE. The task force interim recommendations on the medical workforce targets recommend increasing the number of consultant posts, in line with workforce planning projections, to 6,000 by 2030 and a consultant to NCHD ratio of 1:1.3. As part of the steps to achieve this, there will be continued increases in the number of specialist training posts in national training programmes. Changing population demographics and workforce needs have placed increased pressure on the health service in recent years. To ensure the service can meet the needs of the population and provide high-quality effective patient care, it is essential that the medical workforce configuration evolves to meet these challenges. The Minister recognises that the healthcare workforce must be configured such that the most efficient, sustainable and cost-effective models are developed, and non-consultant hospital doctor reliance is reduced.

I will turn now to primary care services. The Government has taken a number of measures in recent years to increase the number of GPs working in the State and thereby improve access to GP services. Annual expenditure on general practice has been increased by €211.6 million under the 2019 agreement with an approximate 40% increase on the funding provided prior to the agreement. Funding under the agreement provides for significant increases in capitation fees for participating GPs, a 10% increase in rural practice support payments and a €2 million annual fund for GPs in areas of urban deprivation as well as improvements to maternity and paternity leave arrangements. More flexible shared general medical services, GMS, GP contracts were introduced and a GMS retirement requirement was extended to a GP's 72nd birthday. The measures make general practice in Ireland a more attractive career choice for doctors. The number of GPs entering training has more than doubled from 122 in 2019 to 258 in 2022, with 285 places available this year. Working with the Irish College of General Practitioners, 350 training places per year are planned to be available for new entrants by 2026. Until then, the annual increases in training places will be determined on an annual basis by the training capacity of the health system. The number of applications from doctors to undertake GP training has also increased year-on-year with 446 applications received in 2019 rising to a record 968 applications this year. The college stated that the number of GP training graduates emigrating has been decreasing since 2017 with less than 6% of GPs emigrating as per its latest graduate survey. The terms of reference for a strategic review of general practice were published on 3 April this year. The review will examine a broad range of issues affecting general practice, including issues relating to GP capacity and the reforms needed to improve GP out-of-hours service. Based on the findings of the reviews, a report is to be provided to the Minister this year setting out the actions required to provide a more sustainable general practice into the future.

To conclude, I thank Deputies for tabling the motion. I also thank Deputies for their contributions to what has been a stimulating debate on a very important issue.

Photo of Maurice QuinlivanMaurice Quinlivan (Limerick City, Sinn Fein)
Link to this: Individually | In context | Oireachtas source

This is a timely and necessary motion when we consider the state of our health service and the failure of the current Minister for Health who, unfortunately, is not in the Chamber to make any meaningful steps to address this crisis.

University Hospital Limerick, UHL, has been operating in a crisis, and has been for the entirety of Deputy Donnelly's time as Minister.

Indeed, it has been in crisis since Fine Gael closed down the emergency departments in Ennis, Nenagh and St. John's Hospital without delivering additional and needed capacity in UHL.

In Limerick, we have what is called the full capacity protocol, which was designed as an emergency measure to deal with overcrowding. It results in patients being placed in inappropriate areas of hospitals, overcrowding on wards, the cancellation of elective procedures and aggressive discharging practices. The protocol was never intended to be used every single day or to become the norm. While the protocol was used 30 times in 2011, the year Fine Gael took office, it was, unfortunately, used almost every single day in 2023. As of 30 April, the full capacity protocol has been in operation for 118 of the 120 calendar days of 2023. I accept there is a need to use the protocol sometimes but for it to be used so frequently shows there are major issues in our hospital. The Minister should be aware of those issues, which include capacity and staffing challenges. The frequent use of the protocol impacts patients across the hospital. In the first quarter of this year, 2,520 appointments were cancelled at University Hospital Limerick because available resources have been diverted elsewhere. Many of these people have been waiting for hospital appointments for many years with no date for when they will be rescheduled. People who were ready to go to the hospital, and in some cases people who were prepared to go to the hospital, had appointments cancelled.

This is not a new issue. The challenges facing staff and patients at UHL have been well highlighted by me since my inaugural speech in the Dáil in 2016. Of particular concern to me has been the number of people who are treated on trolleys in hallways in UHL and the challenges that poses to the staff and the patients themselves. In UHL today, 81 people are being treated on trolleys. For the year to date, the figure is 7,747. These are incredible figures and if not tackled, 2023 will pass out the disgraceful number of 18,012 patients who were treated on trolleys in 2022. Fine Gael pledged to end the scandal of patients on trolleys but the crisis is worse than ever before. There is a capacity and staffing challenge in UHL. While a 96-bed unit is currently under construction, it will only provide an additional 48 beds. Plans are afoot for a unit with additional beds but are still at the pre-construction stage. This needs to be expedited.

The health professionals in the hospital work very hard but in many cases, wards are understaffed. This is a risk to both patients and staff. In recent weeks, nurses in the ICU embarked on industrial action to highlight that their section is almost 25% short of the necessary staff. With the challenges facing the hospitals, is it any wonder that people are leaving our hospitals prior to being admitted? In the first three months of this year, 1,527 people presented at the hospital and were registered but never got into the emergency department. That is an absolute disgrace. Those 1,527 people were sick and went to hospital but left because they felt they would be better off at home.

The crisis facing our health service is not intractable. It requires work and planning but things can change. What is needed is a multi-annual plan that is backed by a strategic workforce planning to tackle the trolley crisis across the State. The Minister plans to deliver 1,500 beds over the next few years, yet the ESRI tells us we need 2,500. The Minister is already planning to fail. We need the availability of transitional care and recovery beds outside hospital settings. The numbers of these need to be increased, as does access to home care. We need change and I do not believe that a Fine Gael-led Government has the will or inclination to deliver. A mental health de-escalation unit was supposed to be up and running at the end of 2022 but still has not been delivered.

10:10 pm

Photo of David CullinaneDavid Cullinane (Waterford, Sinn Fein)
Link to this: Individually | In context | Oireachtas source

Behind all of the facts and numbers that were presented in both the Sinn Féin motion and the countermotion from the Government are real people and their experiences. We heard many of those stories shared by Deputies from right across the political divide. The stories of older people left waiting on hospital trolleys, sometimes for days on end, were shared. Many people do not even make it to a hospital trolley. They are left on chairs in emergency departments for 24 hours and in some cases, for days on end. Some children are waiting for more than 13 hours in emergency departments. People over 75 are waiting longer than people under 75, which is extraordinary. Some people have had procedures cancelled. That is true of outpatient appointments and hospital procedures, some of them cancer procedures. All of this is happening in 21st-century Ireland. Despite all of the boasting put forward by the Government in its countermotion, that is the harsh reality for far too many patients.

Our motion sets out alternatives which the Government should take on board. As another Deputy said earlier, it is like Groundhog Day when we have debates on housing and health because since I was elected to the Dáil in 2016, and long before that, there has been any amount of debate in this House and outside on the need to reform our health service and ensure it is fit for purpose. Here we are with all of those statistics going in the wrong direction and waiting lists for acute hospitals growing. The waiting lists are extraordinary. Approximately 220,000 people are waiting for a diagnostic scan. Over 200,000 more people are on community health waiting lists. Approximately 800,000 people are on acute hospital waiting lists. The mind boggles when you consider the numbers, behind all of which are real people.

We must start by putting the capacity into hospitals. The Minister, Deputy Stephen Donnelly, talks about more beds but there is no urgency around when they will be provided. Promise after promise is made but many hospitals, including the hospitals in the mid-west and Limerick, that have been screaming for more beds for years have not received them. We know we need more beds but we also need more surgical theatre capacity. We have consultants in hospitals who are fighting between themselves for access to precious surgical theatre capacity. That is holding up many medical procedures. There are far too many people waiting for a diagnostic scan because we do not have public capacity.

Of course we need capacity in our acute public hospitals but we also need investment in primary and community care. Anyone who has any understanding of what is happening in emergency departments knows that part of the problem is hospital capacity but another part of it is that we are not providing the right care in the right place at the right time. People who should be cared for in the home are not being cared for because home support packages and intensive home care packages are not available. There are people with chronic pain and chronic conditions who should be managed in the community but that does not happen. Many community intervention teams are not fully staffed. There are people who cannot access out-of-hours GPs. We are not making best use of community pharmacists, particularly out of hours. We do not have enough step-down and recovery beds and we do not have enough rehabilitation options to treat people at home. All of those failures in primary and community care drive more people into emergency departments.

We need to underpin all of that additional investment with a comprehensive strategic workforce plan that once and for all deals with the recruitment and retention crisis in healthcare. The Minister had to acknowledge that he could not deliver the beds and many of the promises he made because staff could not be recruited. Last year, we funded 10,000 additional places for healthcare workers but only 5,500 could be recruited. After years of talking about a recruitment and retention challenge, the Minister stated in his countermotion that "discussions are ongoing between the Department of Health and the Department of Further and Higher Education, Research, Innovation and Science, regarding the expansion of student places across health-related disciplines". God Almighty. For years we have talked about the need to ratchet up training places to ensure a greater pool of graduates coming through and to make sure we have the people to fill children's disability network teams, one third of which still have vacancies. The Minister of State will hear tomorrow about the horrendous waiting times, and the numbers of children involved, for access to those teams right across community care but also in hospitals where we cannot recruit staff. According to the countermotion, there are going to be discussions between the two Ministers. No sense is given of what that means. There is no urgency and no plan. The Ministers are going to have a chat, it seems, rather than coming into this House, which the Minister has not done. I know he is abroad. However, it is standard practice that if a Minister cannot take a motion, he or she would have the manners to contact the proposer of the motion to explain why. Neither the Minister nor any of the Ministers of State were able to make it to the Chamber, which should be noted. That is wrong.

The Minister for Health has not delivered. He has no multi-annual plan and in my view, he is failing patients and those who work on the front line in healthcare.

Amendment put.

10:20 pm

Photo of Catherine ConnollyCatherine Connolly (Galway West, Independent)
Link to this: Individually | In context | Oireachtas source

In accordance with Standing Order 80(2), the division is deferred until the next weekly division time tomorrow evening.