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Cabinet Committees

Dáil Éireann Debate, Wednesday - 14 June 2023

Wednesday, 14 June 2023

Ceisteanna (10, 11, 12, 13, 14, 15, 16, 17, 18, 19, 20)

Neasa Hourigan

Ceist:

10. Deputy Neasa Hourigan asked the Taoiseach when the Cabinet committee on health is next due to meet. [25680/23]

Amharc ar fhreagra

Pádraig O'Sullivan

Ceist:

11. Deputy Pádraig O'Sullivan asked the Taoiseach when the Cabinet committee on health will next meet. [27246/23]

Amharc ar fhreagra

Aindrias Moynihan

Ceist:

12. Deputy Aindrias Moynihan asked the Taoiseach when the Cabinet committee on health is next due to meet. [28080/23]

Amharc ar fhreagra

Joe Flaherty

Ceist:

13. Deputy Joe Flaherty asked the Taoiseach when the Cabinet committee on health is next due to meet. [28111/23]

Amharc ar fhreagra

Pádraig O'Sullivan

Ceist:

14. Deputy Pádraig O'Sullivan asked the Taoiseach when the Cabinet committee on health is next due to meet. [28116/23]

Amharc ar fhreagra

Ruairí Ó Murchú

Ceist:

15. Deputy Ruairí Ó Murchú asked the Taoiseach when the Cabinet committee on health is next due to meet. [28290/23]

Amharc ar fhreagra

Alan Dillon

Ceist:

16. Deputy Alan Dillon asked the Taoiseach when the Cabinet committee on health will meet next. [28354/23]

Amharc ar fhreagra

Mary Lou McDonald

Ceist:

17. Deputy Mary Lou McDonald asked the Taoiseach when the Cabinet committee on health will next meet. [28322/23]

Amharc ar fhreagra

Richard Boyd Barrett

Ceist:

18. Deputy Richard Boyd Barrett asked the Taoiseach when the Cabinet committee on health is next due to meet. [28606/23]

Amharc ar fhreagra

Bríd Smith

Ceist:

19. Deputy Bríd Smith asked the Taoiseach when the Cabinet committee on health is next due to meet. [28609/23]

Amharc ar fhreagra

Paul Murphy

Ceist:

20. Deputy Paul Murphy asked the Taoiseach when the Cabinet committee on health is next due to meet. [28612/23]

Amharc ar fhreagra

Freagraí ó Béal (12 píosaí cainte)

Tógfaidh mé Ceisteanna Uimh. 10 go 20 le chéile.

The Cabinet Committee on Health met on 29 May and is due to meet again on 19 June.

In addition to the meetings of the full Cabinet and of Cabinet committees, I meet Ministers on an individual basis to focus on different issues. I meet regularly with the Minister for Health to discuss progress and challenges in the area of Health, including the Sláintecare reform programme.

Sláintecare is happening with the support and the oversight of the Department of the Taoiseach through the Cabinet committee on health. It is about four main things: making healthcare more affordable, making healthcare more accessible, ensuring better outcomes for patients and reforming and modernising our health service.

We are committed to expanding the core capacity of our acute hospitals, with more health professionals and more acute hospital beds. Over the past three years we have added nearly 1,000 acute hospital beds and 360 community beds, with further additional beds planned for this year and next year.

We have increased the total public health sector workforce by more than 20,000 since the Government came into office. That includes 6,500 extra nurses and midwives, 3,200 social care professionals and 2,000 doctors and dentists.

There is a strong pipeline of capital projects, including several new hospitals and significant new facilities for existing hospitals.

Approximately €443 million is being provided to reduce waiting times this year. Our multi-annual approach resulted in an overall reduction in the number of patients exceeding the maximum Sláintecare waiting time, that is, roughly three months, by 11% in 2022, with a target of a further 10% reduction this year. This includes €123 million on a recurrent basis for the HSE to introduce modernised care pathways and €80 million has been allocated to various primary care and community care initiatives.

The enhanced community care programme continues to improve healthcare at a more local level. This programme, which is investing €240 million in community health services, is easing pressure on hospitals and in more acute settings.

The majority of community healthcare networks, community intervention teams and community support teams are now in place and providing care closer to home.

In the first full year post implementation, it is projected that community healthcare networks and community specialist teams will enable between 16,000 and 21,000 patients to avoid having to attend an emergency department.

Work is ongoing on the reconfiguration of the HSE organisational structures into six new health regions and the establishment of elective care centres in Dublin, Cork and Galway, as well as surgical hubs in Dublin, Cork, Galway, Limerick and Waterford in the interim. We are also making healthcare more affordable at a time when a cost-of-living crisis is affecting everyone. Hospital charges for patients have been abolished, with the exception of emergency department fees. We are also widening the eligibility for the GP card, which will allow many thousands more people to attend their GP without fees. The drug payment scheme threshold has been reduced, so no individual or household has to pay more than €80 a month for their medicines. Additional eligibility initiatives include €10 million provided for access to IVF treatments, the expansion of free contraception to women aged 26 to 30, free home sexually transmitted infection testing kits and €5 million for oral healthcare for children up to seven years of age.

Our health service has its challenges, but our health system is responding and has expanded dramatically in recent years. We are treating more people, with better outcomes, than ever before. Life expectancy in Ireland is now among the highest in Europe. We also continue to see mortality rates for stroke and certain cancers improve, and we will advance these reforms further this year and next.

I am sure the Taoiseach is well aware, as a fellow Dublin Deputy, that community leadership on addiction and in the provision of services is core to how we deal with that issue in our communities. In my community, in 2022, the Government began a review on the north inner-city drugs and alcohol task force. We did not see its terms of reference, but it has been ongoing for nearly a year and a half. I ask that, as a matter of urgency, the Cabinet publish that report and facilitate the immediate return of the statutory representatives to the task force in order that it can resume its vital work in the community.

I raise with the Taoiseach, as I have done here in the past, the issue of reimbursement in the context of how our system is antiquated and insufficient to deal with the needs of patients. Rather than talk about the process at this point, I would like to talk about the previous drawdown from the primary care reimbursement scheme, PCRS. To be fair to the Minister for Health, he has provided €100 million over the past three years specifically for new drugs in this space but, unfortunately, €30 million of that was meant to be drawn down in 2022 and, according to the PCRS, only €9.4 million was drawn down. There might be an accounting explanation for that or there may have been some kind of clerical error but aside from that, if they are the facts, I would like to know why, of the €30 million allocated, only €9.4 million was drawn down. Is the National Centre for Pharmacoeconomics not approving enough drugs or is it not doing so quickly enough? If the Taoiseach could clarify the matter, I would appreciate that.

I thank the Taoiseach for his response and the overview he outlined. He mentioned the expansion of the GP card. Budget 2023 committed to expanding the GP card to people on median incomes, that is, some 400,000 people or thereabouts. It is a very welcome and positive measure, especially in a climate where people are finding costs so much more difficult right across their lives. That measure has not been implemented, but there was an expectation it would be earlier this year. I understand discussions are under way with the Irish Medical Organisation, IMO, the HSE and various other parties in regard to it. Where is the roadblock and why is this stuck? What is happening? How soon can people expect to get access to that expanded GP card? For a great many people, they are not, thankfully, going to be dealing with acute services and their interaction with the health services is in the community and with their GP. Being able to deal with issues there, before they become more acute, is the best approach, so having that access to the GP card for as many people as possible would be positive. Will the Taoiseach outline what the roadblock is and how soon the cards will be expanded to those people, as committed to in budget 2023?

I welcome the Taoiseach's comments regarding the additional allocation of €240 million for the community healthcare networks. The implementation of the Sláintecare vision for primary care facilities is crucial for creating a more accessible and effective healthcare system. There is certainly a focus on increasing the capacity and availability of primary care centres, but one issue I draw to the Taoiseach's attention relates to the delay in the provision of the Ballyhaunis primary care centre, which has been on hold since early 2022. This is deeply concerning for members of the local community who require urgent attention. I recently raised this with the Minister, Deputy Stephen Donnelly, who informed me the developer is facing difficulties reaching an agreement with the subcontractors due to escalated construction costs. This delay, which I am sure is reflected in other projects, is of real concern. The centre was originally scheduled to be operational in the final quarter of 2021. It is of the utmost importance for the people of east Mayo and the surrounding areas that the challenges are promptly resolved and the centre is completed and operational. I urge the Taoiseach to engage with his Cabinet colleague to find a solution to this issue. It is vital we get swift action to ensure progress on the construction of the Ballyhaunis primary care centre.

It has been reported HSE board members were told the health service needs to recruit nearly 12,000 full-time staff this year but expects to recruit only half that number. Government research tells us job-stay rates are greater in the public and Civil Service when compared with the private sector, yet one in ten staff left the HSE last year to retire or emigrate, and the job churn continues to increase. Despite this, it is only now that senior managers are considering the introduction of exit surveys to understand that phenomenon. As the Taoiseach knows, mental health disability service managers across the community healthcare organisation, CHO, areas openly tell us they do not have the staff needed, which leaves teams operating at partial capacity and people without services. Staff shortages in the health service extend to GP practice nurses, healthcare assistants, consultants, health and social care workers and all the professions. The evidence is that all Government parties have failed over the past 20 years to develop a workforce plan to train, recruit and retain enough healthcare workers to staff the health service safely. In the absence of this staff, the Government can make whatever announcements it wants or set out whatever plans it has, but it has no ability to deliver them. Where is the Government's comprehensive ten-year workforce planning strategy for the health system? Is the Taoiseach taking an active role in ensuring such a strategy is devised and delivered?

The Taoiseach painted a rather rosy picture of the Government's progress in addressing the problems of the health service. A very different picture was presented by the Irish Hospital Consultants Association on Friday in a press statement it put out, detailing that 893,000 people are now on some form of National Treatment Purchase Fund waiting list, that a further 250,000 people are waiting for diagnostic scans and that hospital cancellations could exceed 250,000 a year if the rate continues, with 85,000 operations and appointments already cancelled to the end of April. Emergency department attendances increased by 38%, or 461,000, over the past decade, with average wait times now approaching 12 hours, or double the target in 2013. The association stated this is the first time in six months that the number of people on the outpatient waiting list has totalled over 600,000. It asked about the announced rapid-build programme to deliver 1,500 additional beds, whether the €1 billion capital budget increase necessary to deliver this has been secured and whether the Government is committing to that.

I raise the special leave with pay scheme for workers who are out sick with long Covid. Healthcare workers in particular have had long periods of illness from Covid, and a scheme was put in place in June 2022 to ensure they would get paid if they were out sick with long Covid.

That is due to end on 30 June. Therefore, from 1 July, potentially hundreds of health workers who stepped up to the plate, made sacrifices and put themselves out there for all of us in the middle of the Covid-19 pandemic will be told their supports are being cut. Can the Taoiseach please explain why that is going to happen when we are still giving financial supports to businesses and companies with Covid payments that possibly should have been cut long ago? We are now going to cut the supports we give to workers with long Covid, remembering how much we valued and should continue to value the front-line workers who did what they did during the worst pandemic. How are we going to proceed with this? It is a matter of urgency, according to the unions, but we can see we are running out of time. This scheme is due to end on 30 June.

I thank the Deputies again for their questions. Deputy Hourigan raised the issue of the north inner city drugs and alcohol task force. I am afraid I do not have my file on the north east inner city with me but there is a report and an update on it. I do not have it to hand but I will certainly make sure the Deputy gets a reply later in the week on it. I will send it to other Deputies from the constituency as well.

Deputy O'Sullivan raised the issue of funding for new medicines. If I picked him up right, he said that there is €30 million for this year of which only €9.4 million-----

There is €30 million for 2022, so the full amount allocated in that year was not spent. I was not aware of that. I am not sure it is correct but I will double-check because my impression had been the opposite in that any time any additional funding was provided for new medicines it was not enough. If that is the case, there is a problem so I will definitely check up on that this week and get back to the Deputy as soon as I can.

Deputy Moynihan mentioned that budget 2023, including funding to extend free GP care to children aged six and seven and also to those on median incomes or below. If that can be achieved, it will be the biggest expansion of free GP care probably in decades. It will mean for the first time in Ireland that most people will not have to pay to see their GP. That would be a considerable achievement if we can get it done this year. The Minister for Health, Deputy Donnelly, is in negotiations with the Irish Nurses and Midwives Organisation, INMO, about this. We accept that more people having free GP care will result in increased attendances. We have to bear that in mind. It will result in their private incomes falling and I know GPs have a concern about what the next steps after that might be. There is only so much capacity in the system and, as many people will know, it can be hard to register with a GP at all at the moment. Implementation will require additional financial resources and also additional staff resources for GPs such as staff nurses and administrative assistants, for example. Therefore, we are hoping to get agreement on that and it is still intended to be implemented this year.

Deputy Dillon raised the issue of the primary healthcare centre in Ballyhaunis and, as he mentioned, there is an issue with the contractor. The cost of construction has gone up but we have a protocol as to how we deal with that. It involves a degree of burden sharing and negotiation but I will follow up on it with the Minister, Deputy Donnelly, and with Mr. Bernard Gloster. We are very keen to have that important facility up and running.

Deputy McDonald raised the issue of HSE recruitment. Again, I put on the record of the House that there are 20,000 more people working in our health service now than at the start of 2020. This includes 2,000 extra doctors and 6,000 extra nurses. One would be forgiven for thinking that our entire health service workforce had emigrated to Australia. This, of course, is not the case. People are going in both directions and overall we have been able to increase the number of people working in our health service, including the number of doctors, nurses, midwives, dentists and therapists over the past three years. This year, the target is to increase the size of the health service workforce by a further 6,000 and we believe that will be achieved.

I think everyone acknowledges we have a huge challenge in staffing our health service, given the rising demand and the availability of new treatments and therapies. It is not a challenge unique to Ireland. It is the same problem in Northern Ireland, Britain, Germany, Australia, and Canada. Everyone is competing internationally for staff because everyone is short of staff. However, the kind of things we are doing, as well as improving pay, are increasing the number of training places for nurses, doctors, GPs, midwives and therapists and engaging in increased international recruitment. We now have a very attractive consultant contract which grants €250,000 if a person commits to public practice. That is a pretty good offer and we believe there are doctors and consultants in other jurisdictions who may be willing to take that up.

We have 12 minutes left for the next grouping.

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