Anne Rabbitte (Galway East, Fianna Fail) | Oireachtas source

I will split my time. I will spend eight minutes delivering the Minister's speech and I will then take two minutes to address some of the issues that have arisen.

I thank all of those who have contributed to this evening's debate. As the Minister said in his opening remarks, access to high-quality healthcare when it is needed must be available to every girl, boy, woman and man if we are to be true to the vision of universal healthcare. It is pleasing to hear voices from all sides expressing their strong support.

A number of issues and themes have been raised in the course of the session. I will try to get to them all but if I fail to do so, the Minister will ensure there is a response on the issue concerned. Reducing dependency on the hospital model of care and supporting capacity in the community is pivotal to the Sláintecare vision. These measures will help people to stay in or near their homes for longer, either preventing hospital admissions or allowing for discharge earlier than would have been possible without these supports. The record level of investment of €21 billion in the health and social care system is absolute testament to this and will support us in creating an integrated health and social care system where patients can have access to the right care in the right place at the right time. It is worth reiterating where the funding has been allocated. I do not need to go through all of it because I think Senators are well briefed, particularly in respect of the €250 million, the €50 million for the NTPF model and the €10.5 million that has been provided for an additional 19 critical care beds in 2022, bringing the total number of critical care beds to 340, representing a significant increase of 85 critical care beds. Some €45 million has been committed for a range of family-friendly measures to progressively move health services to being provided free at the point of delivery, based entirely on clinical needs, which is a critical tenet of Sláintecare. This funding will advance this objective specifically to ensure that care is accessible and affordable for the most vulnerable in our society.

Some €32.2 million will be available to expand GP care. Some €30 million of new funding has been committed to care of the elderly and €16 million has been provided in measures for Healthy Ireland and the national drug strategy.

Senator Kyne mentioned elective hospitals. On the question of whether new elective care centres should include inpatient facilities, I would like to say a little more about the elective facility programmes and why their establishment will be so important. Greater elective care capacity created by elective centres will release capacity in existing hospitals for non-elective and inpatient activity. In addition, being able to dedicate more resources towards non-elective and inpatient care could enable patient pathway improvements, as well as operational performance. All of these impacts could result in faster treatment of patients and enable them to receive better health outcomes and experiences. The additional delivery capability provided by the proposed elective care centres would create significant value for the wider public hospital network. This initiative will, in particular, free up significant theatre space and bed capacity and further enable the separation of elective and non-elective care. Surgical stay has not been included in the scope of these new elective care centres because it is assumed that these procedures, which are by definition more complex, will be carried out within the public hospital network. It is also likely that this approach will better suit patients, for example, making it easier for families to visit. At the same time, we are cognisant of the infrastructural needs in Cork, Galway and elsewhere. Those needs have informed the development of the business case, and the development of inpatient facilities in later phases is not excluded.

Significant progress has been made in several aspects of the e-health programme but there is still much to do. I would go further, in fact, and say there is a lot more to do for e-health. The e-health programme requires continued commitment and ongoing investment for people and infrastructural systems to sustain existing assets and facilitate reform through the introduction of new systems and processes. As Senator Burke mentioned, we also need to engage with the unions on e-health. It is a change in performance and working relations. That is a big piece within e-health about which we sometimes forget.

Capital investment in e-health has increased threefold since 2012. The 2021 service plan approved funding for an additional 300 ICT, e-health, health informatics and clinical staff to support the e-health programme. The pandemic demonstrated the value of e-health and ICT solutions. They were used to support contact tracing and the timely collection of data required to inform daily reporting and modelling of the trajectory of the disease. As vaccinations became available, the national COVAX system and self-service registration portal was crucial in enabling logistics, scheduling and the speed at which vaccines could be deployed, and for the smooth operation of the mass vaccination centres themselves.

I will try to address some of the concerns that have been raised about the regional health access areas. In the second quarter of 2021, given the immense pressure the health system experienced as a result of Covid-19 pandemic and the cyberattack, the HSE asked the Minister to pause the implementation of the regional health areas for a period of time in recognition that structural and functional change is time-consuming. The Minister agreed to the request in order that HSE senior officials could devote time to managing the vaccination roll-out and the cyberattack recovery. Nonetheless, the Department of Health is actively progressing the delivery of a business case for the implementation of regional health areas.Sustainable work has been undertaken over the past several months in progressing regional health areas within the Department. As noted earlier, research into international best practice has been completed and policy options have been drafted. Consultation with stakeholders including patients, clinicians, policymakers, hospital groups and community healthcare organisation officials has taken place. An advisory group of clinicians and patient representatives is being established to inform the implementation process.

A number of speakers referred to the accountability and the governance of Sláintecare and the new structures that are being put in place, including the establishment of a new Sláintecare programme board comprising the Secretary General of the Department of Health and the CEO of the HSE, along with senior members of their respective management teams. The assignment of responsibility and accountability for delivery of Sláintecare to the senior leadership across the Department and the HSE will ensure that Sláintecare is embedded across the healthcare system and is fully owned by the healthcare system.

Budget 2019 provided €20 million for the establishment of a ring-fenced Sláintecare integration fund to support service delivery focusing on prevention, community care and integration of care across all health and social care settings.

I will finish with items which were raised by Senators. One of the biggest issues from my short experience of working in the Department is in regard to recruitment. There is no shortage of money. Some of the Senators spoke about that. There is absolutely 150% political support on this. The funding has been provided. Unfortunately when engaging in a 50-week process to recruit an individual, therein lies one of our problems. That is one piece. The other issue is the lack of agility within the HSE. If one were in a business and had to manage one's funding and meet the needs, one would be flexible and willing to move. The lack of agility within the HSE is very apparent to me. It is always a race to spend the money, as opposed to, start spending it and start bringing people on board, cranking it up to get it started. We sometimes talk about talk about talk as opposed to actually putting in the foundations and building the blocks upon them, and keep building around that. It is not quick enough either to say when something is not working, to actually call it to a halt. There is that lack of movement within it.

Reform and sustainability of the disability sector is badly needed and that reform and sustainability will ensure the longevity within the providers. They need to know if they are investing that it is a partnership. It is no longer them and us. It has to be the Department, the HSE and the various providers. That is how we must ensure business is done and ensure that there is sustainability within the sector.

As regards the National Ambulance Service, and this is not unique to Mayo, I have heard it from a number of Deputies and Senators who bring it up at parliamentary meetings and various meetings where they have the opportunity to speak to a Minister. This needs political intervention. It needs that willingness across the Department, the HSE and unions to come together. Everybody has a role to play, nobody has a monopoly on preventing a person from getting quick access to healthcare. A three-second turnaround time is deemed to be on-call, the ambulance has moved. That is not what I deem successful. Rather, success is when one gets to the person.