Stephen Donnelly (Wicklow, Fianna Fail) | Oireachtas source

I thank the Senators for their support. It is great to see. I assure Senator Hoey, who suggested that this might be the only time she and her good Labour Party colleagues would ever support a Government Bill, that we will be back in this House tomorrow morning with the Patient Safety (Notifiable Incidents and Open Disclosure) Bill 2019. If memory serves correct, we will be in a good place in terms of having that supported through the House too. I have no doubt there are many Bills which Senator Hoey and those Senators who are not in government can and do support as we make progress towards universal healthcare.

Several colleagues asked questions about the direction of travel, and whether we have the capacity in general practice. Senator Black and others asked whether we have the capacity in the system to realise our objective. Our objective is profoundly important and has never been realised. It is one of the guiding principles of our Republic and is enshrined in the declaration of independence when it speaks about cherishing "all the children of the nation equally". The reality is that has never happened in healthcare. Access to healthcare depends in part upon how much money people have, or how much money people's parents have, and whether they can afford to have themselves or their children treated privately. That is not in line with the values of our Republic. The declaration is very clear when it speaks of treating all the children equally. It is a profoundly important goal.

We have some way to go, but we are now within touching distance of achieving universal healthcare. Why do I say that? There are three tests for universal healthcare. First, is it affordable? Second, is it high quality? Finally, can one access it when one needs it? Today's Bill is about the first test, that of affordability. This is the third year in a row in which costs for patients have fallen. The cost of medicines has fallen, and the cap is now €80 per month, or significantly less for those with medical cards. GP care will this year be fully State funded for more than half of the population for the first time. We will continue on that journey in coming years, in line with increasing capacity. New schemes are in place which are now free. Contraception and IVF will be State funded. The exact details are still to be worked out. We are also abolishing hospital charges. Is healthcare rapidly becoming affordable for those patients who could not afford it? Clearly, it is.

The second test is on our outcomes and whether they are getting better.As we all know, Ireland has the highest life expectancy in Europe. There are many reasons for that but one of them is that we have extraordinarily gifted, well-trained and passionate healthcare professionals in the community setting, in general practice, in our pharmacies and in our hospitals. We are blessed with an extraordinary group of healthcare professionals. We have been rolling out clinical strategies like the national cancer strategy as well as strategies around stroke, chronic disease management and many others within the community. We have discussed the many new services we are rolling out in terms of women's healthcare. Colleagues will be aware that over the last two years we have been building from scratch an entire community health service with 96 primary care teams and 60 specialist teams in chronic disease management. They are bedding in now. It takes time but the feedback we are getting from patients and GPs is very encouraging. We are going to keep going. In this year's budget, I allocated funding for an additional five clinical strategies, including for stroke, obesity, genetics and genomics and others. As I said, the second test is around outcomes and experiences for patients and whether, broadly, they are good and getting better. Yes, they are. I think most people would say they are. They are not perfect but we are here today to discuss costs and tomorrow we will be discussing the patient safety Bill. We are rolling out new services at a significant pace. Ireland meets the second test for universal healthcare comfortably by international standards. We have to keep going and keep investing in clinical excellence and the patient experience.

The third test has been Ireland's big challenge, namely, access. Access in the community is now getting better and better but access to emergency departments and access to outpatient and inpatient hospital services is not at all where it needs to be. The top focus for this Government, for me, for the Department and for the HSE is improving patient access. We are putting in place an urgent care plan to deal with the unacceptably high levels of patients on trolleys. That will no longer be just for the winter but throughout the year. There is an awful lot of work being done on that and I am sure we will have a discussion on it in the coming months. The second measure being taken is the waiting list action plan, in which we are investing hundreds of millions of euro. We have a long way to go. The waiting lists were completely unacceptable before Covid arrived and Covid made them much worse. In many parts of the world Covid has made waiting lists much worse and the deterioration was worse than we saw here. If we compare the number of patients waiting over a year in the Twenty-six Counties versus the Six Counties in the North, there is a very significant difference. The situation is better in the Republic. It is a lot better and getting better quite quickly. Last year there were very significant reductions in the numbers of patients waiting more than a year to see an outpatient consultant for diagnostics, scopes or inpatient procedures.

We have a long way to go but we are moving in the right direction. We are achieving that because we have record investment and because we are doing two fundamental things. We are expanding capacity in the public health service at a record level, with new beds, doctors, nurses, health and social care professionals, community care, diagnostics, primary care centres and all the other capacity. We are building capacity at a huge level with 1,000 extra beds and about 18,000 extra people working in public health services, including thousands more doctors, nurses and health and social care professionals. At the same time, we are in the middle of a very significant programme of reform. We are bringing in regional health areas and investing in e-health, which Ireland is a serious laggard in. There is a lot more work required there.

We are joining up community care and hospital care. We are also asking our healthcare professionals to work in new ways. For example, senior decision-makers are now in the hospital more in the evening and at weekends. We saw the difference that made to the number of patients on trolleys. Due to all of that and the extraordinary dedication from our healthcare professionals, as well as a huge amount of work from the Department of Health and a lot of legislative work from the Oireachtas, we are rapidly moving in the right direction on this third test. We have a long way to go but we are now moving in the right direction. Last year was the first year since 2015 that waiting lists fell in this country. This is going to be the second year in a row and next year will be the third. Our goal, which is agreed across parties, is that no one should wait longer than the ten or 12 weeks set out in the 2017 report.

Questions were asked about scoliosis in particular. There is a lot more to do. The waiting lists are not where I want them to be at all. Our commitment is that no child should wait more than four months unless there is a clinical reason. That has not yet been achieved but I want to see that achieved this year. However, last year there was a 34% increase in the number of children being seen in comparison with 2019. The number obviously went down during Covid. That is 129 more boys and girls being seen last year than in 2019 because the doctors, quite frankly, are working harder. The nurses are working harder and we have invested more money. This year I hope to see that number go up again. The fifth theatre in Temple Street is coming online. More people are being hired. More beds are being opened.

On CHI Blanchardstown, I have to say I have been in the children's service in Tallaght as much as a father as I have as a Minister. That service is second to none. I just inquired while we were here as to the current situation. CHI is saying that the feedback it is getting from patients has been very positive with regard to the booking system, where people can book at reasonably short notice to go in. It is saying that those who go in are finding it better and that a lot of the sicker patients who probably should not be there but need to be seen in one of the bigger hospitals, in a fully equipped emergency department, are being diverted to the appropriate place. It is something we will keep under review. What I want to see, not just in these centres but in other minor injury units right across the country, is expanded hours and enhanced services.

Senator Black raised the various other fees, such as car parking fees and the emergency department fee. The reason the emergency department and injury unit fees are staying in place is that if it becomes cheaper to go to hospital than to go to a GP for that group who still have to pay, inevitably more people will go to the hospital. That is why that fee was brought in years ago. The purpose is not to be hitting people with costs. The purpose is to make it a place where people go in an emergency rather than the GP out-of-hours service. However, I take the Senator's point. As we reduce GP costs for patients, we should be able to reduce these costs as well, maintaining a differential but bringing the cost down. I have paid that fee more than once in the last 12 months for my own children. That €100, or even €75, is a lot of money for people and it is something we need to look at.

The Senator also asked if there is an enhanced role for pharmacists here. Yes, there is. We are working very closely with the Department and we are talking with the Irish Pharmacy Union, IPU. Pharmacists should be able to dispense oral contraception, although there are some situations where they probably should not. We should have minor ailment schemes in place. Medical card holders should not have to go to their GP to get a prescription for over-the-counter medicines, taking up GP time. Pharmacists should be able to prescribe. There is a very significant amount of additional work pharmacists can do. As the Senator quite rightly said, they are absolutely up for that challenge.

We can also deploy more practice nurses in general practice. In fact, I think that is probably the single biggest opportunity in this regard. We need more GPs and are doubling the number in training. That will be tripled. It will go from what it was to double and then to triple in the coming years. We are expanding medical school places and training places. We are looking to support international GPs coming into Ireland. However, we have a low number of practice nurses relative to some countries in Europe. There is a big opportunity there. I speak to people who say they have gone to a GP numerous times when in fact they never needed to see a GP; they just needed to see a nurse or whatever it may be. More and more use of practice nurses is what some of this money can and will be used for.

GP access to diagnostics is expanding. We spent €25 million on this two years ago, €35 million last year and €45 million this year. I would expect close to 300,000 scans of all the various modalities that were referenced this year. That is going down very well with the GPs. They are very happy with it and we are going to keep pushing on that.

I will get Senator Seery Kearney a detailed update on the assisted human reproduction Bill. It is not what today's debate is about so I do not have an update but I can certainly get one. The Senator can rest assured that it remains an absolute priority. As we prepare the legislation, which is incredibly technical and detailed, we should note that Ireland will be the first country in the world to bring in legislation like this. We have to get it right because it will be open to challenge. It is incredibly complex legislation. We will be putting into this robust legislation all the recommendations from the report.It is happening and, at the same time, the regional fertility hubs are ramping up and hiring, services are being provided, a sixth hub will be in place this year and we are engaged with both the HSE and the private providers on IVF. To begin, we will use private providers. It will take years for the HSE to build up IVF capability. The ultimate goal is for the service to be fully publicly delivered. We are years away from that, so the options were to wait for years while we build up capability and then fund the service, or to fund it using private providers now and then transition. The latter is the option we have taken, for all the obvious reasons. We wanted this to be available as quickly as possible.

I am sure I have missed some of the contributions in my response. I apologise if I have. We have done a run-through of many parts of the healthcare service. I again thank my Seanad colleagues for their support for the Bill. I very much look forward to the discussion on the Patient Safety (Notifiable Incidents and Open Disclosure) Bill tomorrow.