Seanad debates

Thursday, 1 June 2023

Capital Investment in the Health Service: Statements


9:30 am

Photo of Paul DalyPaul Daly (Fianna Fail)
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Before we commence, I welcome the group in the Gallery from Cooneal National School in Mayo.

Photo of Stephen DonnellyStephen Donnelly (Wicklow, Fianna Fail)
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I welcome our esteemed guests from Mayo too. They are all very welcome. It is better than being in school, doing schoolwork and homework, is it not? It is way better.

I thank the Acting Chairperson and Senators for the opportunity to discuss with the Seanad today the very substantial capital investment in our health and social care services. This Government is absolutely committed to transforming how we deliver care to patients in our country. Our aim is universal healthcare so that everyone can access affordable, high-quality care when he or she needs it. I am delighted to confirm that the capital plan has been published. The plan makes funding of €1.027 billion available for this year for the construction and equipping of healthcare facilities. That is an increase of 11% on core 2022 funding. Funding of €140 million is also available for investment in our health ICT infrastructure.The scope of the capital plan is broad, and balanced across the sector and the country. I could happily spend hours detailing the hundreds of projects that are being progressed. However, I only have enough time to address some of the projects and programmes, including the new children's hospital, hospital projects, including extra capacity, critical care and maternity services, and investment in designated cancer centres. In the community the projects include the primary care centres, the HIQA programme for community nursing units, and the enhanced community care programme. Also included are mental health facilities, investment in trauma and rehabilitation projects, investment in ambulances, ambulance bases, equipment replacement and infrastructural risk projects, and climate action and sustainability projects.

In the area of hospital beds, over the past three years there have been more hospital beds delivered than at any other time since the foundation of the HSE. We have now delivered just short of 1,000 extra hospital beds since 2020. This year, we plan to construct an additional 261 hospital beds, 96 beds in the Mater hospital, which we opened in April, 12 beds in Naas, on which construction is complete and equipping is now under way, and 48 beds in Mallow, which are expected to complete construction this month. Similarly, we have expanded the number of critical care beds, with adult critical care capacity now at 323 beds. The capital plan for 2023 includes construction completion and commissioning of an additional 16 critical care beds in the Mater hospital.

I am in discussion with Government colleagues to expedite the rapid construction and delivery of 1,500 additional hospital beds across the country. Details of the proposal will be confirmed as discussions progress. In essence, this proposal is about driving time and cost efficiencies using standardised repeatable design solutions, with standard schedules of construction and accommodation, and using modern off-site manufacturing approaches.

A central objective of the programme for Government is to deliver increased levels of integrated care with service delivery orientated towards primary care, community-based care and home care. Projects being progressed this year include the construction and completion of nine primary care centres across the country: six under the operational lease model and three via the own-build model.

The capital plan also provides for the progress of the capital programme for older persons residential centres developed in response to the introduction of HIQA’s national residential care standards for older people. Construction is expected to complete at 11 centres around the country. I am delighted to say the 11 centres equate to 500 replacement community beds, which makes an enormous difference for all of the residents in these new facilities.

Progressing the new children’s hospital remains a core tenet of our capital plan for this year. It is the most significant investment in health infrastructure ever in the State. The hospital will play a vital role in strategic reform for children's services. The project is over 85% complete. The focus this year continues to be on the internal fit-out and commissioning, particularly around mechanical and electrical services.

I confirm that, this year, funding for the national children's hospital is specifically profiled. That means there will be no negative impact on other projects identified in the capital plan. The plan will continue to support the delivery of other Government priority projects, including the new national maternity hospital. I expect a recommendation to commence the tender for the main works can be brought to Government in the coming months, which will be a really important milestone. Following Government approval, we are also progressing the new elective hospitals in Cork, Dublin and Galway.

In the shorter term and to address waiting lists, surgical hubs are being developed in Cork, Galway, Limerick, Dublin and Waterford. Locations for four of the six hubs were announced last Friday. The first of the new hubs will be operational before the end of this year, with more following next year.

Looking at how we deliver capital projects, the approach to date has simply been far too slow. The approach has too many stages and projects have been susceptible to veto and delay. As such, I have had considerable and very constructive engagement with Government colleagues, my Department, with the Department of Public Expenditure, National Development Plan Delivery and Reform and the Minister, Deputy Donohoe, critically, and with the HSE to explore all opportunities to speed up the delivery of capital projects. I am very happy to confirm that important progress has been made. In March, changes to the public spending code aimed at enhancing delivery were introduced that streamline the appraisal and approval of projects. This means we have a faster project with fewer steps. I have also met with the HSE to ensure the internal processes of the HSE and the Department are streamlined to get infrastructural projects completed to deploy them for better patient care. I have been encouraged by the response by the HSE to this challenge.

I am working with my Department and the HSE to ensure policies and procedures to plan and deliver capital projects are improved. This includes the development by my Department of a strategic healthcare investment framework, implementation of HSE's capital and estates strategy, and updating the HSE's capital projects manual.

There is a strong track record of delivery of infrastructure in the health sector. Every allocated euro in the current national development plan provision is invested to ensure we deliver on our core goal of universal healthcare. This is underpinned by a strong pipeline of capital projects being progressed, including several new hospitals, significant new facilities for existing hospitals and our essential community-based services.

Photo of Lorraine Clifford-LeeLorraine Clifford-Lee (Fianna Fail)
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The Minister is always welcome to the Seanad. I do not know where to begin with his statement because it is so large. Having more than €1 billion in funding available is phenomenal. The Minister also mentioned primary care centres, surgical hubs and the national children's hospital. It is all fantastic work and we are very happy with progress and the amount of money that has been rightly designated for these major infrastructural projects.

I hope the national children's hospital will be up and running in the very near future. Last Wednesday, Fianna Fáil tabled a motion on the naming of the national children's hospital and, on that day, the Minister of State, Deputy O'Donnell, confirmed that the naming decision rests with the Government. I want to use this opportunity to ask the Minister for Health to give good consideration to naming the national children's hospital after Dr. Kathleen Lynn. The motion received unanimous support and was agreed to. The motion has the support of parties throughout the country, trade unions and many other groups. The relatives of the 1916 Rising group also support the motion. I ask the Minister for Health to consider naming the hospital after Dr. Lynn in deliberations over the coming months.

Four projects in my constituency have been included, which made me very happy, and there is a total of €250,000 for this year. I know that some of the projects have received a substantial amount of funding. The construction of a 30-bed purpose-built psychiatry of later life facility on the main street in Lusk is very welcome. The national forensic mental health facility in Portrane, which the Minister visited with me a number of months ago, has received more funding. That facility is a major piece of health infrastructure in Ireland. Equally, St. Ita's in Portrane has been allocated another tranche of money. All of that funding builds on what the Minister has given the facility previously. A ten-bed high-support community residence will be developed in Swords to provide accommodation for the residents of Carlton House. That is development is welcome and I thank the Minister for putting that funding into the Dublin Fingal constituency.

I wish to discuss a report that has been produced by Marie O'Shea on the roll-out of abortion services in Ireland. I am sure the Minister and his officials have read her report in great detail. One of the recommendations might be something for future capital projects and reads:

The HSE should conduct a geospatial mapping exercise to measure the furthest distance a woman of reproductive age must travel to access a providing medical practitioner. In areas where there is low coverage and consequently women must travel longer distances to access care, the Department of Health and the HSE should consider supporting the establishment of local women’s health centres, providing comprehensive women’s healthcare services.

I think that is an excellent suggestion and I would like to hear the Minister's opinion on that. She continues:

These could be led by an obstetrician/gynaecologist or a GP with special interest in women’s health. Such a model would enable GPs who are interested in providing the service (but are unable to do so due to lack of peer support from practice colleagues) carry out sessions at a different location.

That is a really good and practical suggestion. When the Minister is considering future major capital projects, he might give good consideration to that. I say, "Well done", because that is a really good rundown of the money we are spending to improve the health infrastructure of this country.

Photo of Martin ConwayMartin Conway (Fine Gael)
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The Minister is very welcome to the House. Too often there are situations where the Minister comes before the House because the news is not good and he is challenged on various issues. However, today is a good news day. What is being rolled out in the investment in our health services across the length and breadth of the country is breath-taking. It is to the Minister’s eternal credit that he has ramped up the capital investment programme, because unfortunately there have been decades of underinvestment in this country. The children's hospital is the first hospital that has been built in a long time in this country. It has probably been a couple of decades. However, it will be built and it will be a phenomenal facility. It will ensure the health of children will be at the centre of our health priorities. That is very welcome.

In my area of Limerick, the 96-bed block is being built at the moment. The Minister turned the sod on it. That will be commissioned at the end of next year. While it will not be the panacea to solve the emergency department, ED, problems in Limerick, it is certainly an incremental step in the right direction. The Minister announced a proposal last week for the commissioning of and foundation works on the second 96-bed block, so that when the business case is submitted to and approved by him, it will happen without delay. That will have a serious impact on the situation in the emergency department. The first block will have an impact, but the second block will make a massive difference. The Minister might be able to give us an idea of timelines. The foundation works, etc., are being completed on the Minister’s instruction to the HSE by the current contractors. It is my understanding that enabling works and foundation works are major elements of the construction process. Building the walls, putting in the windows, etc., are not as big a job as the enabling and the foundation works. That is great news.

We try to explain to people sometimes that you cannot just build hospital blocks by clicking your fingers. There is a process involved. We are deeply committed, as is the Minister, to the process. We will be in a situation where there will be 190 beds. The Nightingale ward, which is the wing being closed down, has approximately 46. In real terms, therefore, we are still looking at the bones of 150 extra beds at UHL. There are changes happening at the moment under Bernard Gloster to processes and to the back door and the front door admissions and discharges. All of that will make a difference. It will seriously impact in a positive way on the situation in Limerick.

I am particularly struck by the huge investment that is happening in primary care and particularly primary care centres. Everyone in Clare can see the construction of what is going to be a phenomenal facility on Station Road in Ennis. The primary care centre in Kilrush is up and running and it is doing great work. There are plans for other primary care centres in south-east Clare and in Ennistymon. We would all love if they could happen immediately, but, as I said, there is a process is involved.

The Department does not have an easy job. The Minister probably has one of the hardest jobs in the Government in dealing with health, because of decades of lack of investment. That happened because there was an economic collapse in 2008, 2009 and 2010. It took us a while to recover from that. Then there was Brexit. There is now a war in Ukraine. There was Covid-19. In spite of all of that, we are still in a position in this country to invest €23 billion in health. We do not always get value money, but we are going in the right direction.

I concur with my colleague, Senator Clifford-Lee, about the report submitted by Ms O'Shea. We need to see action in implementing that. The operational areas in which she recommended change will happen and the Minister is committed to making them happen. Yet, we also need to see some legislative changes - for example, in regard to this three-day period of reflection. It is insulting to women. I can understand why it happened, because we were trying to get repeal over the line at the time. While I did not agree with it, I could see the logic behind it. When I asked Ms O’Shea at the health committee yesterday if one person had changed their mind after the three-day period, she was able to say that, to her the best of her knowledge, nobody had. This is something we can change very quickly.

I want to see all the recommendations implemented. I know it might be not possible, but really and truly, we need to be liberal in how we approach this report. We need to be liberal in implementing the recommendations of the report. The main thrust of the referendum three or four years ago was to trust women. Let us trust women and let us implement the recommendations of the report.

Photo of Fintan WarfieldFintan Warfield (Sinn Fein)
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I welcome the Minister to the House. It is clear that since the launch of Project Ireland 2040, the socioeconomic environment that underpinned that plan has changed drastically. I want to speak about multi-annual plans. The proposed level of capital expenditure is inadequate to deal with the challenges we face in healthcare. The HSE capital plan for 2023 is inadequate. It lacks the urgency and ambition that are necessary to turn the health service around. Instead of bringing about much-needed reform, this plan guarantees a glacial pace of progress which has failed the staff of hospitals and patients to date.

We, therefore, call on the Minister to outline a multi-annual approach to capacity expansion. This would be vital to support the quicker delivery of projects and the development of the pipeline of capacity. The capital plan should at the very least set out how the HSE will address the deficit in beds and requirements in future years.

The massive cost overruns in key projects, such as the national children's hospital and others, have impacted the public’s confidence in our ability to turn the health service around. Even more worryingly, they have impacted the delivery and commencement of much-needed projects. The longer the HSE is without a proper multi-annual capacity plan, the worse the crisis in our hospitals will get. It is the ordinary people who are left to wait on trolleys and who will suffer. A change in approach is therefore desperately needed.

I want to speak briefly about sexual health. If the Minister ever has a chance if he is in London, he might visit 56 Dean Street. It is a purpose-built sexual health clinic in Soho in London, which has obviously been central to the LGBT community over the years. We have a situation where HIV and STI rates are rising. Sexual health services obviously closed during the pandemic. Multiple factors are responsible for the rising rates, including people transferring to Ireland and transferring their healthcare here. However, we need to have a new sexual health strategy as soon as possible. There are huge waiting lists for PrEP, which we campaigned for, and was long fought for.

In terms of capital infrastructure, 56 Dean Street is a state-of-the-art, purpose-built sexual health clinic. It is a great example. The staff and services in the GUIDE clinic in St. James’s Hospital, the Gay Men’s Health Service, GMHS, which is now on Heytesbury Street, and the Mater Misericordiae University Hospital do incredible work.However, I think that our capital infrastructure, when it comes to sexual health, needs investment. Regarding the prefabs for the GMHS, we can do better for our sexual health services. Home testing for sexually transmitted infections, STIs and HIV has obviously been a game-changer as well, and I commend the Government and Sláintecare on that work. If the Minister is ever in London, he would do very well and it would be a good experience for him to visit and meet the folks at 56 Dean Street.

Photo of Eugene MurphyEugene Murphy (Fianna Fail)
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Like other colleagues, I extend a welcome to the Minister. I acknowledge the number of times he, as a senior Minister, comes here to the Seanad to inform Senators and address us. He gives us a lot of time here. No matter what side of the House we are on, we appreciate and acknowledge that.

I welcome his recent statement on capital investments. Like other members, I pay tribute to the Minister and his staff because he is a Minister who has simply put his head down with his officials to get work done. He is getting the job done, and that is the consensus I am getting all over the country. I will be very open and strong about this, as we give credit where credit is due. As others have said, health is not an easy Ministry, not by any means. However, I always admire the way the Minister puts his head down, deals with and tries to sort out issues, meets groups, and tries to deliver to every part of the country.

It is good to see counties like Roscommon and Galway being acknowledged by the Minister and his officials, and I appreciate the amount of money which has been given for the new 50-bed unit at the Sacred Heart Hospital and Care Home in Roscommon, which has been granted planning permission. I know we are probably going to have a Commencement matter on that in the House in the coming weeks to update the people of the area. That is very significant, particularly for a county which has a high percentage of old people.

I also acknowledge the Minister's absolute support for the new rehabilitation unit, which will be the only one in this country outside of Dún Laoghaire, is a ten-bed unit, and will be attached to our hospital in Roscommon. I know that when the Minister attended that hospital with me in November 2021 and met the people there, he was highly impressed with what they are doing. This rehabilitation unit - the quicker it comes, the better - will be highly important to the people of the mid-west, west and north west. As the Minister knows, there is a big waiting list for the National Rehabilitation Hospital in Dún Laoghaire, and people from all parts of the country have to get there. It is a fabulous centre and the people there do fabulous work. However, something closer to the doorstep for people in other parts of the country is very important. One thing I want to see through is that national rehabilitation unit.

On other areas like cancer care, I know that with regard to Portiuncula hospital in Ballinasloe - which is in my own area - there is a commitment to that and the new developments going on there. There will be new moneys for that place as well and for what is going on at University Hospital Galway, because that is very important to the people of Roscommon as well. There is also the Minister's support for all that is going on in urology. I know he has met with the consultant urologist, Mr. Eamonn Rogers, and he hopes to meet with the Minister again. Mr. Rogers and his people tell me that they are very impressed with the way the Minister is moving on that issue, and the way in which he and his officials have funded it. It is way ahead of most of our European counterparts, they tell me. They are highly impressed with that programme in Roscommon, and because of the support the Minister and his officials have given in funding it totally, it means they can develop whole new projects in that particular area. There is going to be a growing issue there as the years go ahead, and it is really important to see those funds.

I welcome the Minister's absolute commitment to his Ministry and the way he engages with us all and takes on board the issues which we bring to him. I look forward to having him back in the Roscommon-Galway region in the not-too-distant future to visit some of those areas and projects.

Photo of Mary Seery KearneyMary Seery Kearney (Fine Gael)
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The Minister is very welcome. This is an exceptional plan. It is an extraordinary piece of work, and as the Minister can see, I have marked on it everything which is of relevance to my home constituency of Dublin South-Central. I confess I have not had the opportunity to get out and itemise all of the uplift it involves and the additional beds and services it will provide. However, it is considerable and I intend to itemise that over the next few days.

There are considerable investments going into Children's Health Ireland at Crumlin. There are also the main national children's hospital, the Coombe Hospital, St James's Hospital and Cherry Orchard Hospital, and while these benefit all the local community, they also benefit people from across the country. I am very grateful for that.

I want to focus on another investment, which is not even in this plan but which is coming through, and how it engages with a proposed investment which is mentioned in the plan, and that is the interaction between Davitt Road and Curlew Road. The Dublin Midlands Hospital Group is undertaking a rapid-build development on Davitt Road which it expects to begin in quarter 1 of 2025. The group is proposing to put in there a cancer care centre with diagnostic and research laboratories, accommodation for healthcare staff, which is a really welcome and instrumental change, and a primary care centre to include day care services for the elderly. It is not in the Minister's plan. It is the former Unilever site which is owned by the HSE and has been for the last number of years. I appreciate I might be taking the Minister unawares on that, but in it there are fantastic plans which are very concrete at this stage. There is what is in this plan and then there is so much more to come.

I do a lot of work with a group called Dynamic Drimnagh, which is extraordinary, cross-sector, and in businesses and the local community. It has a really fantastic plan for Drimnagh which it has worked through with Dublin City Council. It is very excited about the proposed Davitt Road development and the rapid build element of that. For years, the Minister has come in here and I have nagged him about the Curlew Road primary care centre which is planned, because that was supposed to be providing the Mother McAuley Centre and Alzheimer's centre. However, it looks like this Davitt Road plan will duplicate some of what was proposed there. I am making a representation to the Minister to say that an organisation like Dynamic Drimnagh would really welcome an uplift of the Davitt Road. It has access from Galtymore Road. It has access on Davitt Road. It would be so much more accessible to the Drimnagh community if it were actually the main plan and if that were in train.

On the one hand, I would welcome if the Minister could come out, visit and speak to the group. It would really value that and is very excited about where all of this is at. However, I note that we are the design team phase for Curlew Road and the Drimnagh primary care centre within this plan, and that is really welcome, although we have been at design team phase for a long time - I might just throw that in. However, maybe that slowed knowing that there are others coming in, and the campaign of Dynamic Drimnagh has actually been to locate the primary care centre where the Dublin Midlands Hospital Group is planning to do so.

There is a little bit of tying up there. I have been asked to represent it. There is a huge urgency for primary care in Drimnagh, and they have long waited for it. It was announced in November 2019 and it was advocated for years before that. Another question on that would be if there is a feasibility study regarding both sides of Curlew Road and Davitt Road It would be very valuable to see how they interact and where those discussions and plans are. I appreciate the Minister may not be aware of all that is going on in this as yet, but I would really value a discussion about it and to include Dynamic Drimnagh in that. That would be very welcome, and I thank the Minister.

Photo of Seán KyneSeán Kyne (Fine Gael)
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I welcome the Minister to the Chamber, as always, and I thank him for his visit to Moycullen, County Galway, last Friday, where he opened the Moycullen primary care centre. It is the first of its type in Connemara, and I hope it is the first of many to come. It is only when you see the team photograph outside the building that you appreciate the amount of people working there and in conjunction with other facilities in the area and the range of services they will be putting on for local people in the Moycullen community. I welcome that.

The Minister is very aware of the range of plans for Galway. In response to my questioning of the CEO of the HSE, Mr. Bernard Gloster at the Joint Committee on Health last week, Mr. Gloster accepted that Galway is further behind the curve than everywhere else when it comes to hospital infrastructure.That was due to the fact there was a debate as to whether a new hospital should be at Merlin Park or University Hospital Galway, UHG, which has gone on for too long. I believe the Minister said something similar in Galway in the past week on the "Galway Talks" show with Keith Finnegan on Galway Bay FM with respect to the debate and the fact we certainly need to move on from that and progress the plans the Saolta hospital group has.

As I said, for the first time since I became a Member of the Oireachtas in 2011, there is a plan and vision for Saolta, which the consultants, management and everyone are getting behind. That is the main project of the emergency department, ED, maternity and paediatrics, new laboratories, a new cancer centre and much-needed beds, all to be built on the UHG site, and of elective care, starting with the surgical hub in Merlin Park.

The plan and vision have been agreed. It has taken a great deal of time, with many years wasted on options appraisals and all of this debate. It did not progress, there were delays and nothing was happening. To be blunt about it, people in Galway are sick of plans. We want to see delivery of these projects. We want to see progress. The Minister and Mr. Gloster have said that we are further behind the curve than other parts of the country and that our facilities are not up to scratch. We need to prioritise these plans and to progress those which are first up and best-dressed and to get delivery.

I refer to the emergency department, maternity, and paediatrics. The temporary emergency department is now built. I acknowledge that it is somewhat of an improvement. The HSE received planning permission to demolish the old emergency department and we now need to progress the clearance of the site and getting planning permission for ED, maternity and paediatric units.

The strategic assessment report, SAR, took a long number of months - more than six, I believe - to be approved by the Department of Health. I find it shocking that with the processes we have, and after all of these years, we are talking about a preliminary business case. However, those are the stages we have to go through. Hopefully, that will be turned around by Saolta and the Department. We need to prioritise and say a project like this is one that can be delivered quickly. The other ones can progress as well, and if they catch up, so be it, but we need to progress this.

The Minister’s predecessor was in Galway in September 2018. At that stage, Saolta stated that the planning application for the ED would be lodged by Christmas. I saw a detailed design and I do not know how much more detail would be needed. I know there were some changes in the specification because there was a shell and core versus a full design fit-out, but here we are, nearly five years later, and we are still talking about the planning permission being lodged.

The Minister can understand why people do not believe reports and plans. I am not blaming the Minister as I know of the forms, in respect of the system, of the public spending code and of the number of steps that need approval at Government level, but we have waited too long for this.

In 2015, the Tánaiste, Deputy Micheál Martin, asked the former Taoiseach, Enda Kenny, in the Dáil about the emergency department. Enda Kenny said at the time that it was not fit for purpose. It was not fit for purpose then, it had not been fit for purpose for a long time before that and it is not fit for purpose now. We need more than plans; we need to see delivery of this. I am confident that based on the vision from Saolta, and the final agreement with the Saolta management and the consultants in Galway, we can progress this plan. I certainly hope the Minister will endeavour to prioritise the delivery of this and all of the other initiatives and projects which are needed in Galway because they are all very important, not just for Galway but for the region.

Photo of Aisling DolanAisling Dolan (Fine Gael)
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Gabhaim buíochas leis an gCathaoirleach Gníomhach. I thank the Minister, Deputy Donnelly, for being with us today to debate the HSE capital plan. Is the figure of more than €1 billion for infrastructure across the country incredible? The Minister is looking at it not only in the hospital environment but in the primary care network. I am delighted to see the investment across Roscommon and Galway, particularly in Ballinasloe for Portiuncula University Hospital to which €20 million has been allocated. I visited the hospital in the past week and one can see the 50-bed ward block, which is up to the third level. Such progress has been made in the past year to two years. The €15 million allocated for 2023 is for the 50-bed ward block with en suite rooms. The excitement and joy about 13 beds and 13 rooms in a hospital is fantastic. All I can say is that the staff cannot wait. There is great excitement and anticipation and there will be a great deal of demand around how it will be used. It means patients who are in multi-bed ward blocks will no longer be accommodated in that way. We will be able to deliver care, and show dignity and respect, to patients and their families at all stages of life, particularly when it is very difficult at the end stages of life.

In addition, €4 million has been allocated to the outpatients department. The outpatients department will move to a building on the grounds of the hospital. This is a great initiative. The hospital wanted to get more single rooms, particularly when dealing with the pandemic. There will, therefore, be eight single rooms en suite with two two-bed units. That is 12 beds. That is literally doubling the capacity.

HSE estates will be making some decisions shortly. As far as I know, these beds are ready. Portiuncula University Hospital is recruiting staff at the moment and many are considering this hospital because it is just off the motorway. We have increased the number to more than 1,000 people, with over 200 people recruited in the past two years. However, the challenge is in just equipping those rooms. My request is in regard to approval for equipping those rooms so they can come on stream this winter.

I thank the Minister, in particular in respect of the expansion of the emergency department, ED, and that consideration for that has been added as a new project in the HSE capital plan. We need the rooms I have spoken about to come on stream this winter because that new project will probably take slightly longer. I hope that will be modular build and that we will get design approval and to the tender stage in order to be ready for next year. It would be incredible if HSE estates was able to do some of that preparation work so that this time next year, we might be in a position to allocate funding to a project that is ready to move forward very quickly.

In paediatrics, in the emergency department, ED, Covid-19-streaming is still happening. The reason is that we do not have single rooms to manage infection-control. There is nowhere to bring a person who is infectious. The paediatrics section and team stepped up during the Covid-19 period and moved their ED for children and young people under 18 years of age upstairs to their own section. They then lost out in terms of what they needed, particularly perhaps around oncology. Currently, the hospital is working so hard and the equipping of those rooms will make it easier for it to open up that space again for paediatrics. More than a quarter of the presentations to the ED in Portiuncula University Hospital are under-18 years of age. We sometimes see challenging behaviours and difficult situations and staff manage them, but in paediatrics, which I visited in the past week, we are looking at wards where healthcare staff cannot get around the bed. They have to move the child to another space to try to deliver healthcare in a crisis situation.

I ask the Minister about approval for the equipping of these rooms by HSE estates, and approval to move to design stage, or to that point to enable the ED expansion so that we can expect this in 2024. This is a period of great excitement and I know there will be real joy when we see those 50-beds coming on stream. I hope the opening of the 12-beds might happen in September, please God. This would be wonderful. If I had a wish list, it would be on it.

I very much acknowledge the funding for the St. Brigid’s hospital unit at Oak Grove, under community healthcare organisation, CHO, 2. The increase in terms of getting the 20 beds in the rehabilitation unit in Roscommon University Hospital is of great significance. There is also the Sacred Heart hospital and care home residential unit.

On e-health, and I know this is a debate on the HSE capital plan and its infrastructure, I would like to ask about funding for it and the information technology, IT, infrastructure. Has the Minister any information on that and could he comment on it?

Is there any way the Minister might be able to streamline HSE estates using e-health and IT to do that?

Photo of Paul DalyPaul Daly (Fianna Fail)
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Before we proceed, I welcome our guests in the Public Gallery from the active retirement group in Mohill, County Leitrim. Tá fáilte rompu.

Photo of Joe O'ReillyJoe O'Reilly (Fine Gael)
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I welcome our colleague, the Minister, Deputy Donnelly. I salute his proactivity and his bringing about change and results, which is what it is all about.We salute that. It is a wonderful and exciting programme with an 11% increase on 2022, €1.027 billion in expenditure, which is a phenomenal level of expenditure, and €140 million devoted to ICT. In that context, the Minister does not need reminding that we need every system in place to avoid cyberattacks.

I turn, as is natural, to another part of the good news story, namely, our wonderful Cavan General Hospital. We are very proud of the latter. The Minister visited it recently. It has excellent staff and leadership and offers great patient care. I meet people a few times a week at my office and that and I have yet to meet people complaining of their experience within it. Sometimes there is an issue around waiting, but never with the quality of care there. I am delighted that part of the capital programme is a new emergency department and endoscopy suite in a new build at Cavan General Hospital. It will involve 18 rooms with en suite facilities, two more isolation rooms, relocation of the existing emergency department, two resuscitation bays, ten major injury treatment bays, three paediatric beds and three isolation areas. It is a great potential building. It is wonderful news. The enabling works are going on involving mechanical and electrical work. As it stands, it is a three-storey build. Would the Minister consider supporting the concept of going up two more storeys? That would be more cost-effective and efficient. We could achieve 52 new beds, which would be a great news story for a wonderful hospital, a growing population and a developing area.

The tenders are going out this year and I understand it takes about 24 months to get these things delivered. The Minister said a wonderful thing at the end of his address. It was that he will see the projects delivered on time and, indeed, ahead of schedule. This has been quite bizarre. After great lobbying on my part, we secured a new Garda barracks for my village. We got approval in 2015. It is only one year in construction at the moment. That is bizarre. We have to, particularly in health, get this right. I am pleased the Minister identified that. Will he respond more on how he intends to achieve that?It would cost roughly €25 million to go up the two new storeys.

There are additional facilities in Monaghan Hospital, namely, eight new beds and a minor injuries unit. That is great news because it helps make Cavan hospital efficient. There is a wonderful Monaghan Hospital there, providing great rehabilitative care and great care for stroke patients and a range of people. We are proud of what has grown in Monaghan Hospital. There were initial difficulties and controversy when Monaghan Hospital was closed but, no more than Roscommon, it has turned out to be a positive development in terms of what is in Monaghan. I hear nothing but good about the rehabilitative facilities there.

The programme and plan are exciting and welcome. The fact the Minister wants it to happen fast and to supervise that is also exciting and welcome. The spend on my hospital in Cavan is good, and on Monaghan. Will the Minister consider my suggestion on going up the two floors? He might also give us a concept of how we sees that all finishing and when. I like the fact he is going to get these things to happen.We cannot have plans on paper, money committed and these things not happening. I know the Minister means it and will do it but would like to hear when he hopes to be down to open it.

Photo of Maria ByrneMaria Byrne (Fine Gael)
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I thank the Minister for coming to discuss the capital plan and for his announcement last Monday. I welcome all the investment he announced. I am passionate about University Hospital Limerick, the mid-west and improving things down there. I welcome the Minister’s recent announcement of a further 98 beds. That is most welcome. The hospital needs to look towards recruitment of staff. I understand how difficult it is to get staff in the current climate. They need to look outside and I would like to see that starting straight away. The jobs might be 12 months away but training and so on needs to happen by the time contracts are drawn up. I understand the Minister confirmed the other day there would be no drawback in terms of the project going ahead. There was some scaremongering that projects might be halted. Will he clarify that?

I have raised the better utilisation of St. John's Hospital with the Minister before. It is currently a Nightingale hospital. I spoke to somebody yesterday who got called for a procedure there during the week and is grateful for that. There is more we could do with that hospital. The small injuries unit there, since the hours were extended, has been busy and numbers are up. If that could be open 24-7, it would alleviate pressure on the accident and emergency in Limerick and the mid-west.

We have other hospitals in the area. The Minister announced investment in Croom and in the region but we need to look at the other hospitals. For example, cataracts are working extremely well in Nenagh. Are there other uses for Nenagh? Certain procedures are going to Ennis. There is quite a bit of scope.

A number of hubs for procedures were announced. I have raised this with the Minister already. Will work in Limerick start this year? University Hospital Limerick has to be at the top of the list for putting in those surgical hubs, particularly in light of the pressure it is under. The Minister has visited the hospital and knows exactly what I am talking about.

On children and mental health, since Covid there has been a huge acceleration in mental health issues in younger people and older people, especially the former. In the mid-west we do not have any beds for children with mental health issues. Will the Minister look at that matter? Will he also look at the services provided to the likes of the 5B unit? I know from a patient who is there and has been for quite a long time that they needed a hoist recently and there is no hoist in the 5B unit. There are other things. A speech and language therapist had to be brought in from another hospital. It is about utilising the services we have in a better way and spreading them around the system. I welcome the considerable investment announced in the capital plan. I look forward to working with the Minister.

Photo of Stephen DonnellyStephen Donnelly (Wicklow, Fianna Fail)
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I thank colleagues for their contributions. I have been trying to piece together responses to the various projects that have been raised. I acknowledge the Seanad's position on the naming of the children’s hospital. The advice I have is different. That is an ongoing consideration for Government.

On women’s health centres, the answer is "Yes", but not in the way laid out in the report. The report suggests that we put in those centres based on individual GP decisions to provide services, which is not how one would provide a national network. We are providing a national network and putting in place 21 see-and-treat gynaecology clinics.They are having a huge impact. We are now building some of them out into more holistic women's health centres. We are in the middle of putting an entirely new women's health infrastructure in place and we need to do it based on where patients are located rather than based on the decisions of individual GPs but GP services provided through those centres can certainly be looked at.

There were several contributions on Limerick. There is significant investment for Limerick in this plan. As colleagues will be aware, we have already started the first extra 96-bed block. A significant number of additional beds were provided during Covid as well. We now have agreement to proceed with the enabling works for the second 96-bed block. Between those two blocks and what was put in during Covid, we are getting close to an additional 300 beds. There is a suggestion that a number of these beds would be used as replacement beds but I want to minimise replacement beds. We are in the business of adding beds at the moment and in my view, too many of the extra beds we built were used for replacement beds. We are not there. We do not really have that luxury at the moment. We need extra beds to make sure patients get off the trolleys and the waiting lists get tackled. Obviously there are some cases where replacement beds are appropriate. Limerick got a lot of extra beds during Covid, and 96 more beds are being put in now. The enabling works for another 96-bed block have been agreed. There is a surgical hub going in, as well as an entire new suite of community-based services which did not exist two years ago. Limerick is also getting an extension to radiology and an additional MRI machine. There is a lot going on now. The request from the healthcare community to Government was for a massive investment in capacity and in staff. From memory, I think we have added about 1,000 staff in Limerick in recent years.

What we now need to see is a seven-days-a-week service. Improvements have been made in Limerick, but I am not satisfied that the hospital is where it needs to be yet. There is an ongoing process of engagement with the management, clinical workforce and the community workforce. The Government has more than stepped up in terms of the additional capacity required and it absolutely must be met with changes to working practices, seven-days-a-week services for patients and a zero-tolerance approach to patients on trolleys, as has been implemented in some other hospitals. It must be capacity plus reform. We can keep the situation with regard to St. John's under ongoing review. Croom Hospital has been doing incredible work in terms of the extra number of orthopaedic procedures that it has managed to do. We invested in a state-of-the-art facility in Croom to improve orthopaedic services there.

I am aware of the sexual health clinic in Soho to which Senator Warfield referred. There is a case to be made for 24-7 sexual health clinics in Ireland in the main urban areas for sexual health reasons, including for urinary tract infections, UTIs, and so on. If people are dealing with a UTI at 2 a.m. and need urgent action to prescription medicine, they cannot get it in many cases in Ireland at the moment. I am very much in favour of putting in hubs, particularly in urban areas, in order that we would have the kind of service provided in London to which Senator Warfield referenced.

We are investing strongly in Roscommon University Hospital. I was blown away by the dedication of and services being provided by our healthcare professionals in Roscommon. Obviously, we now have the hospice across the road as well. The hospital is very interested in expanding, using advanced nurse practitioners to provide same-day renal services, for example. I have been really impressed and am delighted to be able to continue to invest in and grow Roscommon hospital. For those who have very understandable concerns about Our Lady's Hospital Navan and who are wondering if it is going to be downgraded, the answer is that not only is it not going to be downgraded, we are investing in it. I would tell them to go and look at Roscommon University Hospital in that context. I am told the biggest problem in Roscommon now is that people cannot get parking because the hospital is so busy. There is a need to add more parking spaces. The hospital has been a great success and huge credit goes to the healthcare professionals there. They have done incredible work.

Do we need more rehabilitation beds, particularly in the West? The answer is "Yes". We have a significant deficit of rehabilitation beds and rehabilitation services in the country and are overly reliant on the National Rehabilitation Hospital in Dublin. There are more phases of development which we need to put in place. We had a bigger plan but it got scaled back. We need to get those extra beds open in Dublin but we absolutely need a better national provision of rehabilitation beds and services, including neurorehabilitation services which we are expanding at the moment.

On Galway, we had a really positive day there last Friday. I reiterate that while there has been some investment in beds, it has been small. Galway has not had many additional beds. There is a €60 million investment in radiation oncology, with four linear accelerators in an absolutely world-class facility. That is coming on line now for patients and it will make a big difference. What are we looking at for Galway and what is contained in this plan? In this plan there is a 76-bed block, new laboratory facilities which are essential, an eight storey emergency medicine, paediatric and maternity block, and a regional cancer centre. That is just in Galway University Hospital. In Merlin Park we will have a regional elective hospital and a surgical hub will be in place long before that. There is a new outpatient department going in, a new cystic fibrosis facility and more. There has never been an investment like this in healthcare in Galway. As Senators have said, we are going to progress each project as quickly as we can. We are not going to let any one project get held up because some other project might not be ready to go. We have four big projects for University Hospital Galway and while they will be done in sympathy with each other and cognisant of each other, we will move each of them on as quickly as we can. That is the way to do it.

I would say the same thing about Galway and reform. I had a very useful meeting with the hospital management after we announced the various capital plans. However, in Galway access to radiology and to MRI is typically scheduled from Monday to Friday between 9 a.m. and 6 p.m., with two nights where the service is provided a bit later than that. The operating theatres are generally closed on Saturdays and Sundays. We must move to a seven-days-a-week service. We must have scheduled operations in theatres on Saturdays and Sundays. We must have access to regular diagnostics and radiology on Saturdays and Sundays. The community teams, the health and social care professional teams, and the consultant teams must be working together to support the emergency department teams to free up the beds in the hospital, get people the scans they need and get them home, get them the treatment they need and get them into community care settings or get them home with a home care package. That is how we will free up beds and get patients off the trolleys in the emergency departments. What I saw while walking around the emergency department in Galway on Friday, which is typically one of the better days, was not acceptable. We had a temporary emergency department, with patients on both sides of a long corridor and the new surge beds were also full. It is not acceptable. In Galway and in Cork it is the same thing. This Government is investing in healthcare infrastructure at a level that has never before been seen, as it must because the system has not had the level of investment required. However, that investment must be matched with a fundamental modernisation of how patients are cared for in Cork, Galway, Limerick and right across the country. We know it works in some parts of the country and we must see that response in Galway and everywhere else.

In Cavan, memory tells me that there are two three-storey projects, one of which is more progressed than the other. One is now moving to tender while the other one is at the appraisal stage. We can always look at increasing the number of floors but all I would say as a cautionary tale is "Look at Galway". The Galway emergency department came up with the idea many years ago to just add a floor, then another floor, and then something else and it is only now making progress. Following my first trip to Galway I rang Mr. Paul Reid on my way back to Dublin and told him that we would prioritise the emergency, paediatric and maternity block and it is now happening. All I would say is "Just be careful". I understand the point but what can happen is that we can end up adding years on to a project. That said, if Senator Joe O'Reilly has a proposal, by all means let us take a look at it.

Photo of Joe O'ReillyJoe O'Reilly (Fine Gael)
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The intention would not be to stop progress.

Photo of Stephen DonnellyStephen Donnelly (Wicklow, Fianna Fail)
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Yes but we just need to be careful that it does not slow things down.Those involved locally have a very understandable instinct to ask why, if we are building it, we cannot just add the other thing that we need. In Galway, that meant nothing happened for years. We can of course look at this with an open mind.

Colleagues raised the issue of timing. The public spending code was not fit for purpose. The Minister, Deputy O'Donoghue, deserves great credit. I told him we need to fundamentally reform this in healthcare and he really delivered. He moved the envelope in terms of the public spending code from €100 million to €200 million. That means a lot of the bed projects we are all looking for around the country now do not need to go through the public spending code because they are between the €100 million and €200 million figure. That is really important. Previously, there was a 17-stage process involving four Government decisions required. That is all being streamlined. Credit is due to the Ministers, Deputies McGrath and O'Donoghue, on delivering on that.

I looked through some of the notes. There are approximately 500 capital projects in train across the country. There are 112 beds in the Mater, including 94 isolation rooms, 16 intensive care beds and highly infectious diseases suites. In the Coombe, there will be 37 new beds and some of the facilities are being upgraded. The existing medical ward in Mallow General Hospital, which is not fit for purpose, is being replaced, and there are 48 beds there. There are 12 beds in Naas, 96 beds in Limerick, 42 beds in Sligo, which are much needed, and 30 beds in Tipperary, in terms of refurbishment projects.

There are primary care centres throughout the country. One of these was opened in Galway last Friday, which is fantastic. There are 500 new state-of-the-art community beds. We do not talk about these things very often, but there is a quiet transformation going on in terms of community care where older people, and some vulnerable people, have been in eight or four-bed wards for years which is not appropriate accommodation. Right across the country, we are opening hundreds of new beds that are single-room occupancy. They are the kind of places where people can live and have dignity, privacy and respect. We do not talk about that much, but it is making a huge difference.

In terms of primary care centres, 167 are now fully operational. I opened the 167th a week ago. However, we are not stopping there. There are 13 more under construction, with nine expected to complete construction this year. I thank colleagues for their feedback. It is an ambitious and important plan. Critically, it is aimed at making sure that patients can get the care they need when they need it.

Photo of Mary Seery KearneyMary Seery Kearney (Fine Gael)
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The Minister has addressed all of the other Senators, but I expected a comment on Drimnagh, Curlew Road and Davitt Road.

Photo of Stephen DonnellyStephen Donnelly (Wicklow, Fianna Fail)
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I do not know about that. I will need to get back to the Senator on it.

Photo of Mary Seery KearneyMary Seery Kearney (Fine Gael)
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Can I have a commitment that the Minister's office will come back to me?

Photo of Stephen DonnellyStephen Donnelly (Wicklow, Fianna Fail)
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We will revert to the Senator.

Photo of Mary Seery KearneyMary Seery Kearney (Fine Gael)
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That would be great. We need to know what is the position.

Photo of Paul DalyPaul Daly (Fianna Fail)
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I welcome a group of German politics students in the Gallery from the Konrad Adenauer Foundation. They are all very welcome to view proceedings here today. Unfortunately, they have come at the end and I must now to ask the Acting Leader when it is proposed to sit again.

Photo of Lorraine Clifford-LeeLorraine Clifford-Lee (Fianna Fail)
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On Tuesday, 13 June at 1 p.m.

Photo of Paul DalyPaul Daly (Fianna Fail)
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Is that agreed? Agreed.

Cuireadh an Seanad ar athló ar 12.54 p.m. go dtí 1.30 p.m., Dé Máirt, an 13 Meitheamh 2023.

The Seanad adjourned at 12.54 p.m. until 1.30 p.m. on Tuesday, 13 June 2023.