Mary Butler (Waterford, Fianna Fail) | Oireachtas source

I thank the Acting Chairman for his kind wishes. I welcome this opportunity to address the House on the winter plan, which was published by the Health Service Executive on 24 September. Every winter, our healthcare system faces increasing pressures on it, making it more difficult for people, particularly older people, to access treatment as quickly as we would wish.This is particularly noticeable in emergency departments, which see overcrowding, longer waiting times and patients receiving care on trolleys. This year the Covid-19 pandemic is likely to underscore and increase these existing pressures.

The €600 million investment in the winter plan represents a statement of the Government's intention to work towards moving care and the required resources towards home and community care, in line with the principles set out in Sláintecare. As Minister of State with responsibility for mental health and older people, I particularly welcome the plan's focus on supports for older people and those groups at greater risk. This is fundamental. Older people are more likely to be admitted to an acute hospital following a visit to an emergency department and they are more likely to experience a wait on a hospital trolley. Of course, other areas of our health system also need attention. I will advocate for increased funding for mental health services in our budget discussions.

I welcome the addition of further community healthcare networks, 36 community specialist teams and 11 acute hospital front-of-house teams. These will create the foundation and organisational structure which will allow older people to be treated in their own local community while still receiving the required standard of care. These networks and specialist teams will work closely with the National Ambulance Service to deliver end-to-end care with the aim of keeping people out of hospital, or where they are admitted, ensuring they are discharged without delay. The plan expects that this could lead to one in five of our older family members, neighbours and friends over the age of 75 not needing to be admitted to hospital at all.

I welcome the additional community beds, which will allow patients to leave hospital earlier and provide care closer to people's homes, as well as the 4.76 million additional home support hours, which will allow people to remain in their own homes. I also welcome the commitment to the provision of aids and appliances to an additional 5,500 people. Simple interventions like this can make a vast improvement to an older person's quality of life and independence.

I want to mention mental health, which is a very important part of my remit as Minister of State. As many Members of this House have noted throughout the pandemic, the outbreak of Covid-19 is giving rise to significant stress, anxiety, worry and fear for many people. This arises from fear of the disease itself, as well as from increased social isolation, disruption to daily life and uncertainty about employment and financial security.

During this period, acute inpatient and community residential facilities have remained open and patients have been provided with services throughout the pandemic, although numbers have been reduced in some settings and telehealth services also have been used to protect both staff and patients. Further improvements to mental health services are included in the overall HSE pandemic plan, Delivering Health Services in a Covid-19 Pandemic, to address HSE service delivery to the end of 2021 in the context of the pandemic. I would like to add my congratulations to various State bodies, including the HSE and the Department of Health. Some 90% of mental health supports have been maintained during the Covid-19 pandemic. Services have obviously had to move to a more blended approach, with many supports delivered online. For anyone already receiving services, 90% of supports were retained. That did not happen in all sectors, but I am delighted that the most vulnerable were able to receive those supports.

I wish to assure Members that I am working to secure additional direct funding for mental health services in the context of the main pandemic plan, a matter which is being considered as part of the Estimates. As part of this strategic plan, the additional resources I am seeking through the Estimates process are intended for the fulfilment of several short-term recommendations of the new national mental health policy, Sharing The Vision.

Full implementation of the Sláintecare reform programme continues to be our goal, but the impact of the Covid-19 pandemic has presented us with the more immediate task of resuming our services to the level they were at before the outbreak of the pandemic, in a prioritised manner. At the Government's request, the HSE developed a strategy for health service delivery to the end of 2021 in the context of the pandemic. The winter plan, which is a part of that strategy, focuses on the immediate problems we will be facing this winter. As I said at its launch, I welcome the publication of the plan by the HSE. I particularly welcome the HSE's recognition of the importance of reducing the number of patients receiving care on trolleys in emergency departments and improving patient experience and waiting times in the context of Covid-19. It is also important to point out that although this year has brought unprecedented challenges, the €600 million pledged under the winter plan is also unprecedented, amounting to 20 times the figure pledged in any previous year's plan.

Last winter more than 620,000 people visited emergency departments. While I encourage everyone who needs emergency medical treatment to seek it, experts generally agree that many patients could be cared for outside of the hospital. Where appropriate, the plan therefore provides alternative pathways to care with the aim of easing the pressures on the hospital system, including the emergency departments, and ensuring more timely egress from hospitals. This will free up hospital resources for the job they should be doing.

The plan is designed to enable patients to be seen in the community wherever possible by providing a better service in community healthcare settings. It is intended to allow patients to receive timely care in hospital when this is necessary, and return home or to appropriate care settings when well enough to leave hospital through the provision of more home care and step-down options.

The plan provides for building capacity and resilience in the system. One of our core tasks is building extra capacity in the acute hospital system. In 2018 the health service capacity review was published. This outlined the requirement for increased acute and non-acute bed capacity in the system alongside major reform in the way healthcare is delivered. The programme for Government, Our Shared Future, commits to continuing investment in our healthcare services in line with the recommendations of the review and the commitments in project Ireland 2040. This winter plan provides additional health service capacity across a range of services and settings, including in our acute hospitals, to help reduce admissions and allow earlier discharges. Key initiatives include an the addition of 483 acute hospital beds, 89 sub-acute beds, 631 rehabilitation places and 530 repurposed community beds to support the pathway to home care. These community beds are absolutely essential. In a pilot scheme in Waterford last year, 20 beds in a nursing home facility were bought at a cost of €1,000 each. Persons deemed by their consultants to be fit enough to be discharged but not well enough to go home were transferred to community beds for three or four weeks. This provided a respite for patients waiting to receive home care or to go into a nursing home. This is a great model and should be rolled out everywhere. I really welcome the 530 repurposed community beds, which will support the pathway to home care.

The plan also provides for the utilisation of private hospitals for urgent complex care in order to reduce waiting lists. This capacity can also be used in the case of a surge in Covid-19 cases. The plan commits to delivering more diagnostics in the community, allowing patients to be seen closer to home and avoid going to hospital. It puts supports in place for GPs, particularly those in rural practices, to support service continuity. The plan also aims to deliver twice the current level of home support hours to support the home first initiative, designed to allow even those with high and moderate levels of frailty to be cared for in their own homes. To facilitate this, 4.76 million additional home support hours are being provided for in the plan, at a cost of €139 million.

A comprehensive flu vaccination programme is essential this winter. The HSE ordered approximately 1.35 million doses of the quadrivalent influenza vaccine as well as 600,000 doses of the live attenuated influenza vaccine, which will be made available to children between the ages of two and 12.

Finally, I would like to address the question of waiting lists, for which funding is provided. I recognise the necessity of the decision taken by the National Public Health Emergency Team, NPHET, to defer elective care procedures earlier this year. I know this has had an impact on scheduled care waiting lists and on the lives of the people waiting for these operations. Hospital waiting list figures are higher than at the start of the year, with the inpatient day case and outpatient waiting lists 17% and 10% higher, respectively, than at the start of January. However, there are some indications of improvements. Due to the joint efforts of the HSE and the National Treatment Purchase Fund, NTPF, the growth in waiting lists has slowed since services resumed in June. Since May there has been a reduction of almost 11% in the numbers waiting for inpatient day case procedures, with early evidence that the rate of growth of the outpatient waiting list has slowed.

The HSE has actively sought innovative new ways to increase productivity through the increasing use of alternative work practices such as telemedicine, virtual clinics and alternative settings including private hospitals, community facilities and atypical outpatient settings.The HSE is also currently working to secure access to private hospital facilities for urgent and time-critical procedures.

The National Treatment Purchase Fund, NTPF, is currently reviewing strategies to maximise activity and benefit for patients, including increased use of private hospitals; funding weekend and evening work in public hospitals; funding "see and treat" services, where minor procedures are provided at the same time as outpatient consultations; funding hybrid services where public and private hospitals contribute to the treatment of patients; virtual clinics; and clinical validation. While acknowledging that waiting lists are at record levels, the combined impact of this work should help mitigate the impact of Covid-19 on waiting lists and the HSE and the NTPF will continue to work together to address this issue.

I welcome the Seanad's consideration of the winter plan today. The Government is fully committed to its implementation and the Minister, Deputy Donnelly, and I want to work collaboratively with all stakeholders and across the Houses to do so. Right now, we need to get the services back up and running to at least the level they were at prior to the outbreak of this pandemic. This winter plan is part of that process and is designed to meet the immediate challenges we anticipate this winter. The ambition of the plan, and the significant funding provided by the Government, gives me confidence that we can start to address the problems in the system. I hope that is something all Senators in this House want and that they will support the plan.