Simon Harris (Wicklow, Fine Gael) | Oireachtas source

I thank the Members of the Seanad for the opportunity to make a statement in this House today.

Trolleys and waiting lists are critical measures of how our health service is functioning and in recent weeks I have referred regularly to the pressing need, once and for all, to break the vicious cycle that leaves patients waiting in unacceptable circumstances. There are four fundamental issues to be addressed to break this cycle. These fundamental issues are four priorities of mine for 2018: bed capacity; implementing reform through the Sláintecare report; recruitment and retention of health care staff; and making that decisive shift to primary care a reality, once and for all.

As well as dealing with emergency department performance, I will provide an update on some of the short-term, medium-term and longer-term measures I wish to see implemented in order to drive improvement in how we deliver our health services and promote better health outcomes for the people.

At the outset, I acknowledge the distress for patients and their families, and the impact on staff, caused by cramped and overcrowded conditions in some of our hospital emergency departments. There is no doubt that we are facing increased demand for health services. A total of 1.3 million people attended emergency departments last year and more than 330,000 were admitted to hospital from emergency departments during the same period. This represents an increase of 2.3% in emergency department attendances and a 2% increase in emergency department admissions, when compared to 2016.

Despite the intensive efforts of staff, management and the HSE through the course of the winter, since the beginning of January this year we have seen a rise of 8.4% in the number of patients waiting on trolleys. This reflects an increase of 5.6% in the numbers attending emergency departments - that is 1,247 more patients being seen - and an increase in delayed discharge figures as compared with the same period last year.

Each winter, the system must also deal with the increased demand for services due to the prevalence of the flu, which is currently at its height. Our system is also working hard to grapple with the challenge of infection prevention and control, specifically the emergence of virulent antibiotic-resistant bacterial strains or superbugs.

This has been a difficult January for our hospitals. Let me share something with Senators that they may not have heard. In the face of increased demand, staff across the State continue working to improve performance and the overall number of patients on trolleys over the whole of winter so far - from 1 November to 31 January - is actually down almost 1,500 year on year. This is a result of significant progress made by our front-line staff, especially in the November when 1,864 fewer patients were on hospital trolleys, and in December when there were 447 fewer patients on hospital trolleys. On a bad day in a bad month we will always see it well commented on in this House and we always see it well commented on in the media. We do, however, also have to comment on and acknowledge the progress that staff have made, particularly the progress made in November and December. Despite their incredible efforts and despite the extra resources we provided, when it reaches the tipping point in January it is very clear to me that we have a health system that is not an appropriate size or model. Despite the good work and progress made, despite the fact that fewer patients were on trolleys in November and December and despite the fact that more patients had been seen in hospitals, when we reach that tipping point we see that we do not have a health service that is the appropriate size or model for our demographic composition and our growing population. This is why I bring the Senators back to the four key areas of reform on which I want to see progress this year.

I assure the House that the Government is committed to further investing in health and to increasing the health budget. That investment is having an impact. I do not accept the logic that when funding is increased to the health service we do not see tangible benefits. Tell that to a man or woman who got an extra home care package as a result of the increase investment, or tell it to a man or woman who has seen the benefit of the more than 170 additional beds already opened this year in the health service, or tell it to the person who has seen the benefit of the extra transitional care. While there is a lot more to do, the benefit of the extra investment has seen 170 additional beds already opened this winter: 22 in St. Vincent's Hospital; 25 in Our Lady of Lourdes Hospital, Drogheda; 17 in University Hospital Limerick; 28 in University Hospital Galway; 20 in Beaumont Hospital Dublin; 23 in St. James's Hospital Dublin; 24 in the Mater Misericordiae University Hospital Dublin; and 11 in Naas General Hospital. Further beds will open throughout 2018, including at St. Luke’s in Kilkenny, University Hospital Waterford and Cork University Hospital. In addition, new critical care beds will come on stream this year in Cork University Hospital and the Mater in Dublin.

Other capacity developments funded this year will include the new emergency department in Our Lady of Lourdes Hospital, Drogheda, which will come on line in 2018, and the development of a modular build for South Tipperary General Hospital, which I hope could be a model for short-term modular interim measures at other locations around the State. We will also see the expansion of services at the Roscommon medical assessment unit this year.

Bizarrely, even in times of great prosperity - and long before I was in Government - Ireland had a policy of reducing the number of beds in the health service. Ireland now has fewer beds in its health service than in the early 2000s. We saw a situation where the number of beds decreased in 2007, decreased in 2008, decreased in 2009 and decreased in 2010. Since the Taoiseach was the Minister for Health, and in my time as the Minister for Health, we are increasing the number of beds in our hospitals, but quite frankly it is not at an adequate enough pace.

We have to do more in respect of additional capacity and we must do it more quickly. This is why last week I was delighted to bring to the Cabinet - and to publish for everybody to see - the health service capacity review, which outlines the projections of demand and capacity for our health services now and out to 2031. This kind of analysis is integral to future planning. We can all tell the important story of our own locality and if people believe they need more beds in a particular part of the country. It is very important, however, to have an evidence base. It is important that we look at international best practice and look at the impact on hospital bed capacity of moving more towards primary care.It is important that we do in health what we have done in the Department of Education and Skills and other Departments. In that context, we must link the number of beds and the size of our health service to our population and the need that exists. The Department of Education and Skills has done a very good job in recent years in that every year it knows that a certain number of children will require school places and it matches largely that demand with the provision of schools and teachers. We need to do that in the health sector. The heath service capacity review, which was internationally peer reviewed, provides us with a solid evidence base which will now inform future investment and policy decisions. It is clear from that report that we will need approximately 2,500 additional acute hospital beds over the period out to 2031 and that we need to front-load some now and deliver some in as quick a manner as possible. I am committed to doing that but it is also clear that if we just do that and do not reform the health service that it will not be adequate enough.

That brings me to the second key reform, Sláintecare, I would like to highlight. One of the first actions I took upon becoming Minister for Health was to work with the Opposition to establish the all-party Committee on the Future of Healthcare, chaired by Deputy Róisín Shortall. That committee worked for almost a year to come up with a plan for the future of the health service. What is unique and important about the report it produced is the fact that it enjoys support from across the political spectrum, and this should not be squandered. Political consensus is a great achievement. Perhaps it is a creature of a minority Government but it is one that I am committed to ensuring is not wasted. The Government has affirmed its commitment to implementing a significant programme of reform, as outlined in the Sláintecare report. We had a special Cabinet meeting on the issue in Cork a few months ago. I expect to present a response to the report along with a proposed detailed implementation plan to Government very shortly. This will set out our ambitions for the next decade and will put concrete plans in place for the immediate years ahead. Effectively, we will have an action plan where the Members will be able to see what we have committed to doing, when we have committed to doing it by, who is responsible for doing it and how that is progressing. Importantly, this work, in line with the recommendations of the report, will be overseen by a new Sláintecare programme office. The Members will have seen in the national newspapers that the recruitment process, under our Public Appointments Service, has commenced for an executive director for this office and that is expected to be completed by April of this year.

I want to touch on two issues, which I am sure will come up in this debate. We can have all the beds we want in the health service but we need to staff the beds. I am very pleased that the public sector pay agreement was accepted by all our health unions and that the benefits of the agreement will now be seen in the pay packets of our health care staff. I am also conscious that more needs to be done. I am conscious of the fact that we see particular recruitment and retention challenges in the health care sector. That is why I am particularly pleased that myself and the Minister, Deputy Donohoe went to Government and got approval to have our Public Sector Pay Commission do a specific piece of work on the health sector on recruitment and retention challenges. That will give all our representative bodies and everybody else a chance to feed into the process with respect to what we need to do to keep Ireland competitive and attractive in terms of recruiting and retaining our health care staff. That work is under way.

On general practitioners, GPs, which I know is an issue close to the hearts of many people here. Senator Swanick speaks about this issue with a great degree of expertise. We need to deliver a new GP contract. To do that, we need to look at how we can unwind the Financial Emergency Measures in the Public Interest, FEMPI, legislation. I now have Government approval to engage with GP organisations on the unwinding of FEMPI and I expect that process to commence very shortly. We need to have a conversation about how we resource general practice. There are matters that I need General Practice to do, matters that are currently done in the acute hospital setting that could be done in primary care. I know that GPs are up for that but they want to know that the model is sustainable and that it will be resourced. There is great deal more I could say, to some of which I will return in my closing statement. I want to hear the views of Senators on all sides of this House. We know the challenges in our health service. I believe we know what the solutions are, namely, bed capacity, Sláintecare, recruitment and retention, and moving more to primary care through community nursing and a new GP contract. They are my priorities for 2018 and I look forward to working with all of the Members to advance them.