Dáil debates

Thursday, 1 June 2023

Ceisteanna ar Sonraíodh Uain Dóibh - Priority Questions

Health Services

9:00 am

Photo of David CullinaneDavid Cullinane (Waterford, Sinn Fein)
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1. To ask the Minister for Health his plans to enable seven-day rostering across the health service; his plans to address the workforce requirements to enable this while achieving safe staffing levels; and if he will make a statement on the matter. [26968/23]

Photo of David CullinaneDavid Cullinane (Waterford, Sinn Fein)
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There has been much discussion on the air waves over the last number of weeks about a seven-day rostering service across our health services and, obviously, that is ideally something we would all want to get to. I tabled this question to give the Minister an opportunity to set out his perspective on this. What plans are in place? What talks and negotiations with representative bodies have or will take place? Could the Minister set out his views on how this can be made happen?

Photo of Stephen DonnellyStephen Donnelly (Wicklow, Fianna Fail)
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I thank the Deputy for his supportive comments in terms of moving in this direction. I want to start by acknowledging the really extraordinary dedication our healthcare professionals have shown. To the Deputy's question, we have seen an unprecedented growth in that workforce. One of the things we must do, obviously, in moving from five to seven days is increase the workforce. As the Deputy will be aware, we have added nearly 21,000 additional healthcare professionals into our health and social care services since 2020. In spite of this, we are still seeing an unacceptable number of patients waiting on trolleys in too many hospitals. While there have been important reductions in the waiting list, much more needs to be done to achieve the targets to which we all signed up.

Government has been very clear in supporting an unprecedented expansion of capacity within our health service in parallel with fundamental reform of how that care is delivered through the regional health areas, chronic disease management, moving care into the community, e-health and so forth. I acknowledge that there are hospitals, such as in the Deputy's constituency in Waterford, that are already rostering staff right through the weekend. This is different to being on call. We need to acknowledge that many staff are on call over the weekends anyway. This is about rostered staff. The Deputy and I are both aware of the very positive effect that has had on the lack of patients on trolleys. Really, achieving that across the country and accelerating the reduction in the waiting lists is what we are seeking to do by moving from five to seven days.

The Deputy will be aware that nurses and junior doctors are already rostered. If any of us were to go into a hospital at 3 a.m. on any given night, we would find junior doctors and nursing staff already there. The new consultant contract is another piece of this, and there needs to be engagement with the health and social care professionals. The chief executive officer, Mr. Bernard Gloster, and I, for example, engaged with Fórsa recently at its annual conference in Galway on exactly this discussion.

Photo of David CullinaneDavid Cullinane (Waterford, Sinn Fein)
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As I said, it is a laudable objective and one I support. Obviously, there must be dialogue and buy-in from healthcare staff. We need to recruit as many healthcare professionals as we possibly can. Even though additional numbers have come into the health service, the State has not achieved the recruitment targets we set ourselves with regard to the big numbers we need. Obviously, therefore, there are recruitment and retention issues.

I see huge benefit in this with regard not just to acute hospitals but what is happening outside of hospitals and how that will help in terms of discharging patients and alternative care pathways at weekends for patients, particularly older people and those with chronic pain who really should not be going to emergency departments. Sometimes, if the alternative care pathways in the community are not there at the weekends, that adds pressures in our emergency departments, as we know. Diagnostics is another area where we need that seven-day rostering system as well. We need to speed up diagnostics in hospitals. For all those reasons, I want to see this happen. What dialogue there is with the representative bodies? That is the question I asked. Does the Minister have any timeframe as to how we can get to a point where this can be moved on?

Photo of Stephen DonnellyStephen Donnelly (Wicklow, Fianna Fail)
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The answer is "Yes". There are informal discussions going on. It is something I discussed with the Irish Nurses and Midwives Organisation, INMO, when I was at its conference, and the chief executive and I raised it when we spoke at the Fórsa conference. Most importantly around this, the people I hear supporting this are the healthcare professionals themselves. They are fully aware that this is where we need to go. I had a meeting with emergency department consultants from around the country in the last two weeks. The point several of them made was that in hospitals which are achieving this, such as Waterford, Tullamore, Portlaoise and others, with senior decision-makers onsite but, critically, with access to radiology, discharge teams in the hospitals and, to the Deputy's point, community teams working as well - it does not mean that every service has to be running through Saturday and Sunday but it is around patient flow - it really is making a big difference.

Photo of David CullinaneDavid Cullinane (Waterford, Sinn Fein)
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There are a number of options to get where we want to get to. I know that a call has been put out for people voluntarily to take up rosters at weekends. Obviously, that is something people may or may not do. The Minister pointed to Waterford and other hospitals that have done this. The former manager of the hospital in Waterford is now head of community services and is trying to bring the same level of energy into those community services that was brought into addressing problems at University Hospital Waterford. Therefore, I get the logic and it is one I buy into.

However, we are then looking at a fundamental shift because as the Minister said, nurses and junior doctors have what are called five over seven contracts. It is not that people work seven days; they work five days but over a seven-day period and the rosters will reflect that. What are called five-seven contracts will be a new departure for some professionals, however. Is it the Minister's view that in those specialties he talked about in community services and other areas of the health system in hospitals, we are looking at five-seven contracts in future as opposed to five-five contracts?

Photo of Stephen DonnellyStephen Donnelly (Wicklow, Fianna Fail)
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Yes, it is. One of the big groups we will rely on to work in this way, for example, who typically are not on the five-seven contracts yet, are the health and social care professionals. My view is that as part of the upcoming round of pay talks, certainly from a health perspective, that is something at which we would be looking.

To the Deputy's point, a lot of the workforce are already on these. Junior doctors and many nurses already have contracts like this. The new consultant contract moves from rostering 40 hours per week to 80 hours per week. Really, it is about pulling the service together to do all this.

We set up a working group led by the former chief the South-Southwest Hospital Group. That has been established within the HSE to put a national framework together for how we achieve this. The Deputy will be aware that the chief executive asked for this on a voluntary basis over the coming weekend, which is exactly the right thing to do.

Photo of David CullinaneDavid Cullinane (Waterford, Sinn Fein)
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Is that Mr. Gerry O'Dwyer?

Photo of Stephen DonnellyStephen Donnelly (Wicklow, Fianna Fail)
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Yes. We are now looking at putting a formalised framework around this so that we can transition to this and that it becomes the norm.