I remind Ministers and Deputies that I will be strictly enforcing the timeframes for questions. There are 30 seconds for the Deputy to introduce a question and two minutes for a response from the Minister. The remainder of the response will be included in the Official Report. The Deputy will have an opportunity to ask a question, to which the Minister will reply. The Deputy can then ask a final question.
Priority Questions
The Minister has two minutes. How long do we have?
The Deputy can ask two one-minute supplementaries.
General Practitioner Contracts
Stephen Donnelly
Question:1. Deputy Stephen S. Donnelly asked the Minister for Health if he will report on the negotiation of a new general practitioner contract; and if he will make a statement on the matter. [17265/18]
I look forward to working with the Minister in the coming months and for however long this Dáil lasts. My intention and that of Fianna Fáil is to work with the Government on the issue of healthcare where we can, although, as I am sure the Minister will appreciate, we will robustly hold him to account where we believe there is not sufficient action being taken. I certainly extend the hand of co-operation to the Minister and the Government. There is obviously much important work to be done across the country in the area of healthcare, on much of which we agree in terms of what needs to change. One of the areas in which there is a need for change is general practice. The GP group has reached tipping point. We are all aware of the very serious challenges being faced by patients in the community and GPs who, financially and in terms of having a work-life balance, are under enormous stress. Many are leaving the profession. There are numerous challenges. A key component in fixing this problem is beginning negotiations on a new GP contract as soon as possible. Will the Minister report on progress in getting the negotiations under way?
I congratulate the Deputy on his appointment as his party's spokesperson on health. We obviously know each other well. It is a great day for Greystones and County Wicklow, with such great emphasis being placed by us on healthcare. I, too, look forward to us working together. As a much more accomplished politician than I once said, "I wish you luck but not too much." I also very much extend the hand of co-operation. There is much on which we all agree - Sláintecare being the most obvious and important blueprint. I look forward to working with the Deputy in the many months and years ahead and being held to account in this House on the important issues.
I thank the Deputy for his important question. I note that he attended the IMO conference recently, as I did, at which we both heard clearly that general practice in this country was in need of a significant investment. It is fair to say that, like many parts of the public service, it suffered significantly during the years of recession. Decisions that had to be made by the Deputy's party in government on the FEMPI legislation and decisions made by mine starved it of much needed resources.
I made it clear at the conference that I intended to commence negotiations with GP organisations at the end of this month. The purpose of the negotiations is twofold. The first purpose is to ascertain what we must do to ensure general practice in Ireland can be sustainable into the future and what is a fair fee to pay for the services general practices are currently providing. As the Deputy will be aware, I now have powers, given to me by this House under legislation passed by the Minister for Finance, Deputy Paschal Donohoe, last December, which allow me to set fees. The second purpose is to ascertain what can general practice do, if we are willing to resource it to do more. We have all heard about the exciting things GPs want to do in terms of access to diagnostics, working as part of the primary care service, interacting more with the hospital setting and taking some work out of it and into the community, but they can only do this if they are resourced to do so. The Government wants and expects to spend many millions of euro more in general practice in the next few years and wants to start doing so quickly. I hope, with intense negotiations that can commence by the end of this month, we can make progress to that end in the coming months.
I thank the Minister for his co-operation.
I thank the Minister for his response. I hope all sides can come to the table in the next few weeks because I am not entirely sure the GP population and the patients they serve will be able to take much more. As I see it, the relationship between GPs and the HSE and between GPs and the Government is at an all-time low. There is no trust, at least as expressed to me by GPs and their representative bodies. They are deeply suspicious. What would help and go a long way early on is a reversal of the FEMPI legislation. Obviously, it must be unwound in a fiscally responsible and affordable way. We are aware that it is being reversed for us, as politicians, civil servants, nurses, NCHDs, consultants and teachers, but GPs have been left out in the cold. Will the Minister put together in the coming days, as a gesture of genuine good faith towards GPs, a roadmap for how the FEMPI legislation will be unwound because many GPs are saying it is all well and good that the Government is stating it will consider the issue but that it cannot take any longer than three years? Is the Minister able to commit to putting a roadmap in place for the unwinding of the FEMPI legislation as a matter of urgency as a gesture of genuine goodwill as the new negotiations start?
I expect that we will, as part of the engagement on general practice, put together a roadmap to move to a post-FEMPI legislation era. I am glad that the Deputy mentioned other healthcare professionals because he is entirely correct. We have begun the process of unwinding the difficult FEMPI legislation pay cuts for all public servants, including other staff working in the health service, but, as the Deputy will also be aware, we did so as part of a process. I hear from GP organisations - I disagree with them - that one could reverse the FEMPI legislation with the stroke of a pen, but that would not be fair to nurses, speech and language therapists, physiotherapists, porters and everybody else who works in every other element of the health service. I want to move beyond the FEMPI legislation. I want to be able to pay GPs a fair fee for the services they are providing that reflects the better economic situation. I also want to spend a great deal more on general practice. We are training more GPs than we did in previous years. For example, in 2009 there were only 120 GP training places. This year it is expected that there will be 194, an increase of 60%. The challenge is to ensure that when those GPs come out of training they will want to stay here to work in general practice. We need a new contract to do this. We need to move to a post-FEMPI legislation era. I have the support of the Government, including the Minister for Finance and the Taoiseach, to put real resources behind this move to a much better place.
GPs are concerned the Government will unwind the FEMPI legislation as part of the contract negotiations. We all know that in a new world of integrated primary care the role of the GP will become more prominent, more important and better funded but much more will be asked of them. It is fair to say that while there was a quid pro quo in the unwinding of the FEMPI legislation for teachers, nurses and civil servants, there was not such a substantial rethinking of their roles, as teachers, educators or nurses. GPs will be entering a different conversation because their fundamental role in the community will change and become more prominent. The fear is that the new contract could take several years to negotiate - it may well do - and that the FEMPI legislation may not be unwound until it is in place.
This is why I asked that as a gesture of good faith, the beginning of an unwinding of FEMPI might be considered very quickly. For example, will the Minister consider putting a budgetary allocation in for 2019 as a partial unwinding of FEMPI for GPs?
I appreciate the question raised by Deputy Donnelly and I am sure he appreciates the position I am in where I cannot negotiate on the floor of the House. I expect that we will be investing many millions more in general practice from 2019 and that we will be beginning to move post FEMPI in 2019 subject to us being able to agree a myriad of things we need to discuss. In any negotiation, both sides will have things they want to discuss. GPs are very clearly saying to me, the Government and this country that they cannot do more unless the existing services are made sustainable and that requires additional investment. I hear that so we must get that right at the start of the process. However, they also want to have a conversation, which I also want to have, about how we make things like Sláintecare a reality. Quite frankly, we cannot do it, as the Deputy correctly says, without involving the GP, practice nurses and the entire primary care team and without resourcing it to do so. I see the conversations as interlinked. How do we make current services sustainable? This involves a discussion about moving to a post-FEMPI era. How do we also then resource, pay and fund general practice to do more? These talks will commence at the end of this month.
Health Services Staff
Louise O'Reilly
Question:2. Deputy Louise O'Reilly asked the Minister for Health if his attention has been drawn to the increased incidence of assaults on staff in the health service, if reports have been conducted into the issue of assaults, the measures taken to protect staff and if he will make a statement on the matter. [16981/18]
Unlike Deputy Donnelly, the Minister and I tend to disagree quite a lot but I think we can all agree that there is a recruitment and retention crisis in our health service. I have said this many times. I believe this Government, the previous Government and even the one before that have made our health service a very unattractive place in which to work. We now see that our health service is becoming an increasingly dangerous place for healthcare professionals. This is contributing to the recruitment and retention crisis. It is making it worse because not only do we have unattractive pay, conditions and places in which to work, we now have unsafe places in which to work. My question is very simple. Is the Minister aware of the increase in assaults and will he do anything about it?
I do not think Deputy O'Reilly and I disagree on quite as many things as we like to think. I know it is very important that we stress those differences but in respect of recruitment and retention, I certainly agree with her that this is a challenging area. As she is aware, the Public Service Pay Commission is doing a body of work. I know the unions and representative bodies have fed into that process and I hope it is helpful in coming up with new strategies regarding how we recruit and retain nurses and indeed other healthcare professionals, including doctors, in this country.
The Deputy's question is extremely important and timely. Whatever else we disagree on, I am sure this is something on which everybody in this House can agree because the safety of all those who work in our health service is of paramount importance. Obviously, it is a complex issue as those being cared for may not always have the capacity to be responsible for the actions they carry out. That is a reality. In terms of the number of assaults reported, I understand better data is now emerging from the national incident management system, which was introduced in 2015.
I understand that 4,769 physical assault incidents by patients on staff were recorded in 2016. The number for 2017 was 3,610. These figures would seem to indicate that the number of assaults had reduced but it is still a very high level. In the longer term, the HSE anticipates that the number of recorded incidents will rise as the new system becomes further embedded and better data is available to us. The HSE continues to encourage reporting of all incidents, regardless of the level of harm, if any, so that we have very accurate data. Safety in the workplace has received considerable attention and focus from the HSE. A national strategy for the management of aggression and violence throughout the health service is in place.
The HSE also has a policy on the management of work-related aggression and violence and a policy on lone working. A detailed frequently asked questions document on work-related aggression and violence is also available to all staff. Management and staff receive training to equip them with the necessary skills and knowledge to recognise risks associated with aggressive or violent behaviours and the safety measures that can reduce or minimise these risks. Much is being done by the HSE to address this complex issue and ensure the safety of its staff in a balanced and cohesive way.
I also want to tell the House that a security review is being undertaken in our health service. Recommendations are being implemented and we are looking to grow the security presence and make sure there is appropriate security in or nearby our emergency departments, which I know is also a cause of concern. No staff member should ever have to work in an emergency department under threat of violence or assault, verbal or otherwise, and we need to do more in that regard.
That is a fine statement but they are working under the threat of violence currently. I am glad the Minister says it is not acceptable and that a national strategy exists. He says that security staff will be in accident and emergency departments or nearby. They need to be in accident and emergency departments. Nearby is not good enough. Staff are very well trained. They know how to recognise assaults. Notwithstanding the fact that our staff are trained to the very highest level, from January 2011 to July 2016 assaults increased from 673 to 3,462, with 65% of these recorded as nursing and midwifery staff, meaning 34 nurses and midwives per month were assaulted in this period. These are the people we are desperate to keep within our health service. They are the lifeblood of the health service and the people without whom we cannot deliver health services and we are putting them in a situation where it is dangerous for them to go to work. Will the Minister commit to increasing security in our hospitals for the benefit of the staff - not near our hospitals or where the assaults are happening but where the assaults are happening? The physical presence of a security guard is a great deterrent. Our staff are well trained and know how to recognise when an assault is imminent. They are working in intolerable conditions and are short staffed. The Minister cannot deny that. In that atmosphere, assaults are increasing day on day. Can the Minister commit to putting a security guard into every single accident and emergency department?
I can commit to increasing security in our emergency departments. Sorry, I thought that was what the Deputy asked.
Putting a security presence into accident and emergency departments.
I believe that has already been agreed through the emergency department agreement negotiated with my predecessor in 2014. I have discussed this with the INMO and have made it very clear to it and the HSE that this needs to be addressed. When the INMO pointed out to me areas where it did not believe this to be the case, I asked the HSE to take action. I want staff in all our hospitals to be safe - we all do - and we will increase security presences where that is appropriate and necessary. The figures I put on the record of the House are the first available figures through the State Claims Agency, which has only been measuring this since 2015. I want to break down some of those figures. In 2016, 965 of the recorded incidents of assaults by patients on staff were in mental health units. This rose to 1,478 in 2017. Overall, we have seen the number of assaults decrease in our health service but we have seen the number of assaults in mental health services increase. They now account for roughly 40% of reported assaults. The HSE does believe that a significant amount of this increase in mental health reporting is due to improved reporting so it involves having the data. Mental health services have a very proactive lead for quality and service user safety. We have put a number of schemes in place to support staff who find themselves in these unacceptable situations.
The rate of staff turnover for nurses and midwives is 7.9%. This should not be the case. It should be a career for life and somewhere people want to work and stay because we really need them to stay but the workplaces are unsafe. It is regrettable that there are accident and emergency departments where staff are exposed to a level of risk and do not have a security presence. The Minister uses the phrase "in or nearby". That is not good enough. Whether or not we say assaults may have decreased slightly or we include or exclude mental health, the fact is that there is an unacceptably high level of assaults against front-line staff. They are bearing the brunt of staff shortages and all that goes along with that. The physical presence of a security guard in an accident and emergency department is an active deterrent. I can tell the Minister this because I have also spoken to the INMO and health service unions. That is not happening and it needs to happen. We need a commitment to ensure that this will happen in every single emergency department.
I take what the Deputy said very seriously. This is a very important matter. The safety of staff in our emergency departments, which is an area on which she wishes me to focus with regard to this question, should be of paramount importance. I will get a report from the HSE about all our emergency departments. Where they have security staff within the emergency department, I will share that information with the Deputy and other health spokespeople in this House and will commit to engaging with the INMO and the HSE to make sure there is security staff in all emergency departments. I will revert to the Deputy when I have that information.
Respite Care Services Provision
Margaret Murphy O'Mahony
Question:3. Deputy Margaret Murphy O'Mahony asked the Minister for Health when the additional respite facilities for persons with disabilities and their families announced in the HSE service plan will be in place and if he will make a statement on the matter. [17266/18]
Whatever about the Wicklow presence, it is great to see a strong west Cork presence here this morning as well. When will the additional respite facilities for individuals with disabilities and their families announced in the HSE service plan be in place?
Deputy Murphy O'Mahony will have to accept me as a substitute for the Minister of State, Deputy Finian McGrath, who is in New York for the signing of a UN convention.
The Government is committed to providing services and supports for people with disabilities which will empower them to live independent lives, provide greater independence in accessing the services they choose, as well as enhance their ability to tailor the supports required to meet their needs and plan their lives. We are particularly committed to providing a range of accessible respite care supports for people with a disability and their families.
This year the HSE's disability budget is more than €1.7 billion, an increase of €92 million on last year. This year the HSE will provide in excess of 182,000 respite nights and 42,500 day respite sessions to families in need throughout the country. The Minister of State, Deputy Finian McGrath, and I acknowledge the absolute need for increased respite care throughout the country. That is why we secured an additional €10 million specifically to enhance respite care. This funding will provide extra facilities and we are also planning to provide a range of alternative respite options to families. The HSE needs to ensure a robust procurement process is followed and new facilities will need to be registered with HIQA. Recruitment is already under way to ensure services can come into operation as early as possible. These are badly needed and much anticipated.
A national task group has been put in place to implement these measures. This year we will deliver 12 new dedicated respite houses at a cost of €8 million. Houses will continue to come on stream over the coming months. This will ensure one new respite house in each HSE community health organisation, CHO, area plus three in the greater Dublin area. It will increase capacity by 19,000 respite nights in a full year.
I am informed by the HSE that work is progressing well with regard to tenders, completion of any capital works, recruitment and HIQA registration. In the past month, one house opened in Kerry, additional capacity has come on stream in Athlone, and in the past week a further house has opened in north County Dublin. There are commercial sensitivities with regard to the procurement of houses and respite services. Until contracts are signed, I am unable to provide more precise details at this time. However, I expect we will be able to announce where the remaining houses will be located and the target date for their opening in the coming weeks.
Additional information not given on the floor of the House
The Minister of State, Deputy Finian McGrath, and I receive monthly updates on progress and we are eager to ensure that targets are met.
The HSE is also looking at innovative respite solutions. We have committed €2 million for this purpose. These alternative solutions include home respite, Saturday and evening clubs, summer camps and many other flexible, family and child-centred respite options. An extra 250 people will benefit from this type of respite break in 2018. We all need a break, and I hope that this range of initiatives will help families and be a valuable social outlet to service users throughout the country.
Carers are unsung heroes. In my constituency in west Cork, I deal with them every day. When there is a lack of respite facilities, the fatigue they go through as a result is unreal. The Minister is aware that what is happening in west Cork is happening throughout the country. All carers feel the same fatigue, the same hurt and the same sense of helplessness. I am sure the Minister read in last weekend's Sunday Independent, the story of Noeleen Cullen. There is a Noeleen in every constituency. She said, "I badly need more respite services for the sake of my mental health and to get my energy back." In the same article, the general manager of community health care disability services in south Dublin, Kildare, and west Wicklow, said:
[R]espite services are running on reduced capacity due to budgetary restrictions. Currently, families receive respite mid-week and not weekends. The respite is usually of between two to four nights as the budget cannot meet full demand.
I know everything comes back to money but I hope the Minister can see the need for these respite houses to be up and running.
Not only do I see the need, I am determined we address it. We will provide 19,000 extra respite care nights this year. That is a large increase and has been welcomed by carers. However, they want to see the houses open and so do I. These houses will start to come on stream. We hope to be able to announce locations and target opening dates for all these houses in the coming weeks. Several of them have opened already which is important.
I outlined what we are doing with €8 million of the €10 million allocation. The other €2 million will be used for alternative solutions, including home respite, Saturday and evening clubs. Often a carer wants a break for a few hours to do the shopping or have a much-needed rest. We are also looking at family and child-centred respite options as well as summer camps. An extra 250 people will benefit from this type of respite break in 2018. We all need a break, and most importantly carers need a break from the incredible work they do.
We will be introducing legislation shortly, which I am sure will receive cross-party support, to provide free GP care for all carers in receipt of carer's allowance and carer's benefit.
It is important to point out that a one-size-fits-all approach does not work for carers. What one carer may need might be different from what another may need. It is important we do not make suggestions that would lead to such an approach. Each person and each family have to be taken for their own case.
In February, a reply to a parliamentary question I received indicated that 40 beds would be delivered in the first and second quarters of 2018. As we are now in the second quarter, will the Minister outline how many of these beds are in place and in which CHOs they are located? I do not expect the full 43 to have been rolled out but will the Minister give an update on the progress made? Given the geographical spread of the CHOs, is there a strong case for new facilities in each, especially outside of the capital, as everything should not be Dublin centred?
The Deputy is correct. Every CHO will receive one new respite house or facility this year. For some that will involve capital works to upgrade existing facilities, while for others it will involve the procurement, purchase or even construction of a new respite care centre. That is why there are tender processes in some CHOs. So far, two houses have opened in Kerry and north County Dublin as well as additional respite capacity in Athlone. There are commercial sensitivities regarding procurement for the remaining houses and the signing of contracts. The Minister of State, Deputy Finian McGrath, and I will be in a position to update the House in the coming weeks as to their location and their target date for opening.
I agree with the Deputy that one size does not fit all. For some families, it would be a night's break involving a respite care centre where the loved one can go for a night and get a break too. For others, it will be the Saturday club, the evening club, the summer camp or in-home respite. In addition to every CHO getting one new facility, plus three more for the greater Dublin region, we will have €2 million for these new flexible respite options. As we are getting monthly reports tracking this issue, I will ask the Minister of State, Deputy Finian McGrath, and the HSE to keep the Deputy informed. I believe this will make a substantial difference this year.
Hospital Admissions
Michael Harty
Question:4. Deputy Michael Harty asked the Minister for Health the actions he has taken to reduce the number of persons waiting on trolleys, chairs and temporary beds for hospital admission; and if he will make a statement on the matter. [17263/18]
What actions has the Minister taken to reduce the number of patients waiting on trolleys, chairs and temporary beds for admission to hospital? The trolley queue is a reflection of the problems in our health service. It brings up health and safety issues for patients and staff, such as with the transmission of infections and diseases when waiting for admission. This has a detrimental effect on patients. What actions is the Minister taking to alleviate this problem?
I agree with the Deputy's analysis of the problem. It still beggars belief that we reduced the number of hospital beds in this country long before the troika arrived in town. I believe we can do much more in community and in primary care. Even as we do that, there is a clear, compelling and indisputable case that we need to provide more acute hospital beds. There will be certain things we can never do in the community, even with all the investment we appropriately should make in general practice.
Against a background of growing demand for unscheduled care and high acute hospital occupancy rates, the Government provided €30 million in 2017 and a further €40 million in 2018 for measures to increase acute hospital capacity and alleviate overcrowding in emergency departments. Almost 50% of this funding was used to deliver home support packages and transitional care beds to reduce the incidence of delayed discharges. More than 200 beds have been opened this winter and more beds are due to come on stream later in the year. My colleague, the Minister of State, Deputy Jim Daly, will undertake some work in the Department to ensure all elements of the health service are working together on late discharges.
Notwithstanding the increased level of resources provided, this winter has been particularly difficult for our health services, with emergency department attendances up 3.7% and admissions up 3.3% during the first quarter of the year. Despite the fact people in the health service are working extraordinarily hard and additional investment has been made, capacity to meet attendances needs to be put in place.
The situation was further exacerbated by Storm Emma and the severe weather that followed. In response to this, I allocated a further €5 million in emergency funding to provide additional home support packages and transitional care beds to assist the safe discharge of patients who required support to return home following the adverse weather.
In light of the conclusions of the health service capacity review, raised at the Joint Committee on Health yesterday, that the system will need nearly 2,600 additional acute hospital beds by 2031 as a low-end figure even after we do all of the reforms that we need to do, I have asked my Department to work with the HSE to identify how we can front-load some of them. In other words, how we can put some of the reforms in place by the end of this year, and identify the location and the variety of build methods that could help to achieve that. The demographic pressures are very clear and we need to get on with delivering on the capacity review. I am pleased that it is now fully funded, but I now need to look at options to front-load it, because in the Deputy's part of the world, it is not good enough to tell University Hospital Limerick that it will be several years before a 96-bed ward block can be delivered. We need to see if there is an interim solution to put more beds into that facility.
I thank the Minister. Many of the actions he has outlined deal with the problems of lay discharges after they have happened. It is poor excuse to talk about the weather as being a problem where our hospital trolley count is concerned. It is not about the weather. The Taoiseach has said that we should not dwell on trolley numbers or waiting lists because they do not reflect the excellent work that is done in our hospital system. Of course excellent work is done in our hospital system, but that is despite the system rather than anything else.
Trolley numbers are a reflection of inadequate bed numbers, the failure to recruit and retain staff and a weak and under-resourced primary care service. They are a reflection of the growing population, as the Minister has identified, and the ageing population. It is a reflection of management structures that are 40 years out of date, and unless there is substantial reform in our health service, we are going nowhere. It is akin to a slow puncture. We are now running out of air in our tyres, and soon we will be running on the rim.
Between 2014 and 2017, average trolley numbers rose by 47%. If one takes the first month of the last five years, they have risen by 51%. We are not dealing with the problem. The average trolley number this month is 515, an all-time record. My question to the Minister is what is he going to do about this now. I do not refer to measures he is going to take in the distant future. When will the Minister realise that a fundamental reform of our health service is required, and not just the attempts to adjust a failing service we have at the moment?
I realise that fully, and the Deputy knows from our detailed discussions, both in one-on-one meetings that we have had in his capacity as Chairman of the Oireachtas Committee on Health and in my public actions and comments, that I fully recognise it. Mentioning Storm Emma is not about making an excuse, but about recognising what front-line staff and management tell me, which is that the already overcrowded situation was further exacerbated. Certainly the storm did not cause the trolley situation. I never said that or suggested that it did.
Capacity is a key issue here. I do not want to see primary care and community care pitted against acute hospital care. If one actually looks at the capacity review, it is very clear that even after all the reforms very clearly articulated in Sláintecare, which we need and want to make, there will still be a need for additional bed capacity in the health service. That is bed capacity that was not put in during the Celtic tiger years, or was taken out long before the troika arrived in town.
I have been very clear that I have the funding to deliver the 2,600 additional acute hospital beds through Project Ireland 2040. That is a ten year capital plan. Some projects, such as building a wing in a hospital, take time. We know that, but what can I do now, quickly, to get additional beds into the system? The HSE is carrying out an audit of where new beds could go into existing buildings, and where other methods like modular build could significantly increase capacity in the system for this winter. That is absolutely vital. Some hospitals are paving the way. If one looks at the trolley figures in Beaumont Hospital or Our Lady of Lourdes Hospital Drogheda, one sees how we can make progress where capacity is added to primary care and acute hospital care along with appropriate management.
I thank the Minister. He mentioned University Hospital Limerick. I note that University Hospital Limerick consistently has the highest number of people waiting on trolleys. The average number waiting on trolleys for this month alone is 56. It is double the number for the next worst hospital in the country on a daily basis. I get representations, I am sure like every other Deputy, including the Minister himself, on the trolley numbers and the experience that people have waiting for admission. I have had cases where people have had to bring food to their relatives while waiting on trolleys, because they were not being offered sustenance while they were there. What has happened in Limerick and elsewhere is a cart-before-the-horse reconfiguration.
Yes.
In Limerick, beds were taken out of our small peripheral hospitals, but they were not put into Limerick. It was a cart-before-the-horse reconfiguration, and it is a salutary lesson for any other areas where there may be reconfiguration. If services are not put in place in the central hospital before they are removed from the peripheral hospital, we will have what happened in Limerick. It is important that the Minister treats this matter urgently. There needs to be a commitment on the fundamental restructuring and reform of our health service. The Minister has had a report on his desk for the past 11 months and he still has not delivered a response to it. It is a shocking indictment of the Department that it has failed to address the solutions in the Sláintecare report.
We are going to deliver the Sláintecare report. As the Deputy knows, I have three big asks and projects that I had to bring to the Government for approval, and on which I had to work with colleagues in other Departments to make sure they are backed up by significant resources. One concerns the capacity report on capital. Health has been starved of capital for years, even during the Celtic tiger era. Schools and motorways were built, but somebody forgot that it was actually important to invest in capital build for our health service. Beds were taken out, which was bizarre. Capital projects, the capital plan and the capacity plan have now been funded. Some €11 billion has been allocated to capital for health in the next ten years, compared to €4 billion for the past ten years.
The next piece was the GP contract, an issue Deputy Harty and I have discussed many times. Negotiations are to commence by the end of this month, backed up by resources to invest millions of euro. The next big piece of work is to bring the Sláintecare implementation plan to Government. I expect to do that by next month. I have been working very hard with colleagues across the Government to make that a reality. I also expect recruitment for the lead executive for the implementation office to conclude by the end of this month, and to be advised by the Public Appointments Service of an appointment shortly after that.
On University Hospital Limerick, the Deputy is entirely correct. It is absolutely an example of how not to do reconfiguration. Our promise is that change will happen now, and we promise that a better, brighter service will follow in the future. Limerick is owed beds, and needs beds. I am very determined to work with representatives from that area and hospital management to get that capacity quickly. Limerick sees more patients than Beaumont every year, and has fewer beds than Beaumont. We have to address that issue.
National Treatment Purchase Fund
Róisín Shortall
Question:5. Deputy Róisín Shortall asked the Minister for Health his views on whether the recently announced funding for the National Treatment Purchase Fund, NTPF, to procure medical procedures in private hospitals represents best value for money; if a cost-benefit analysis on this €50 million investment has been carried out; his further views on whether this policy could represent a perverse incentive in the public system and is delaying reform; and if he will make a statement on the matter. [17264/18]
The Minister's Government, along with Fianna Fáil, has resurrected the NTPF. We know that is only a stopgap measure, and we know it has been problematic in the past. Can he assure us that he has carried out a cost-benefit analysis before committing to the very substantial figure of €50 million? What kind of assurance can he give us that we are actually going to get value for money for that spend?
I thank Deputy Shortall for the question. As the Deputy knows, the programme for Government commits to reducing waiting times for procedures in hospitals and to increase funding for the National Treatment Purchase Fund to deliver on this commitment. In the budget and Estimates for 2018, funding for the NTPF to treat public patients was increased to €50 million.
The inpatient and day case action plan is a joint initiative between the HSE, the NTPF and my Department and sets the projected activity and impact that will be delivered in 2018 from within the allocated funding. As outlined in the action plan, a projected 1.16 million inpatient and day case procedures will take place in 2018, with NTPF activity accounting for 20,000 procedures and HSE activity accounting for 1.14 million procedures.
The NTPF procures capacity for each of the procedures identified in the action plan in both private hospitals or public hospitals. That is the difference between the NTPF now and in the past. We are spending resources also within the public health service. In 2018, the NTPF projects that 4,000 of its treatments will be delivered in the public health service.
No formal cost-benefit analysis was carried out on activity funded through the NTPF, nor indeed in respect of activity funded through the HSE. However, the action plan strikes the appropriate balance between maximising the number of patients treated in both public and private capacity, as appropriate, and ensuring the best return for the taxpayer.
The overall number of patients waiting for an inpatient or day case procedure is projected to fall to below 70,000 by the end of the year, from a peak of 86,100 in July 2017. My ambition is to build on this progress and to further reduce waiting times for patients.
Parallel to improving access for patients this year, I am committed to reforming and investing in our public health system. However, we know that with the trolley situation, elective procedures are regularly cancelled in our public health service. I cannot expect those patients to wait while the capacity is being built in the public health service. I am, therefore, implementing a commitment in the programme for Government and in the confidence and supply agreement to utilise the NTPF to find capacity wherever it may be, both in the public sector and in the private sector. I want to spend all of the investment that we spend in health on our public health service, but I think it is widely acknowledged in this House that it will take time to build that capacity.
Those figures are fine. They are very aspirational. However, the Minister has not answered the question. How do we know that we are going to get value for money for that €50 million? We know that the NTPF has been problematic in the past. There is a major structural problem within the health service in that we do not know relative costs for different procedures.
Would the Minister not be much better off concentrating on why it is that progress is so slow on working through the waiting lists? We do not know anything about the activity in hospitals in terms of waiting lists. Theoretically at least, we could have a situation where consultants are being paid on the double, when they are already being paid to do public elective work but we do not know about that activity. We know there are certainly the problems that were highlighted in the "RTÉ Investigates" programme, so it is slow progress. Is this not a perverse incentive if the State pays separately and on the double for that work to be done in either other public hospitals or the private sector? What guarantee is there that we are getting value for money for this substantial spend?
I have outlined to the Deputy how we are using the capacity that is available in the private hospital sector while building up the capacity in the public health sector. I would much rather be able to have adequate capacity in the public health service but it is not possible to bring all of that capacity onstream overnight.
I agree with the Deputy in regard to wanting to remove private practice from our public hospitals. As she knows, in line with the Sláintecare report I have set up the de Buitléir group chaired by Dr. Donal de Buitléir and it is to bring its report back by the end of the year. It is a significant statement for a Minister for Health to say they wish to see private practice removed from public hospitals and how we do that is something the de Buitléir group needs to make a reality. I want to make it clear that is the purpose of the de Buitléir group - to show me the roadmap as to how to do that, rather than to decide whether it is a good or bad idea. I accept it is a good idea.
The programme for Government committed me to utilising the NTPF to provide additional capacity. The approach will support HSE activity and performance management, with additionality being provided by the NTPF. The NTPF has a statutory responsibility in terms of how it procures and uses tendering. It will undertake a number of insourcing arrangements, for example, cataract surgery in the Royal Victoria Eye and Ear Hospital. It will use Nenagh General Hospital and will treat lesions in Roscommon General Hospital, and orthopaedic surgeries will take place at Cappagh hospital. Further insourcing arrangements will be put in place and a significant further insourcing arrangement will be the funding of a brand new cataract theatre in Nenagh General Hospital. This is not the old NTPF of the past, where it was all about money for the private health sector. We are looking at using all capacity, including available capacity in the public hospital system.
I am sure the Minister is aware that, in regard to the NTPF, in the past funding went into public hospitals but it was found by the Comptroller and Auditor General that this just went into the general budget of each of those hospitals and there was no ring-fencing. Again, the reality is that we do not know how much a cataract operation or hip replacement operation costs. Unless we have that kind of detailed analysis of costing within the health service, there is no way of knowing whether we are getting value for money or not. That is my concern, namely, this will go into the general pot and we will not see actual improvements. For example, did the NTPF engage in open tendering for this money? How can the Minister assure us we are getting value for money? Would he not be better off concentrating on introducing the kind of fundamental reforms that are required in terms of activity-based funding and establishing elective-only hospitals? Would that not make a much more substantial difference to the waiting lists?
I believe elective-only hospitals are the way to go and could have a real impact, as I know the Deputy does. We have seen this used in Scotland with very significant success. Scotland had very long waiting times and managed to reduce that substantially by purchasing what, ironically, was a former private hospital and turning it into an elective-only hospital. I have funding to deliver elective-only hospitals and that is a priority. I will keep the House updated in that regard.
The funding that is used by the NTPF to insource is ring-fenced. The NTPF has to satisfy itself that the HSE and the individual hospitals are going to spend that on providing the additionality in terms of procedures that they have agreed to, and the waiting list plan I published last week has outlined that.
The Deputy has rightly highlighted on a number of occasions the question of how we monitor and oversee hospital consultants' contracts, an issue on which we engaged here and at the Oireachtas health committee. My Department is working closely with the HSE to find a solution to ensure compliance is monitored more effectively. The engagement commenced last July. On 11 January of this year the Secretary General reinforced the point to the HSE that a key requirement is for a governance framework and a reporting and monitoring arrangement. The HSE responded on 12 February, outlining the arrangements it proposed to meet the Secretary General's requirements. These include monthly monitoring at hospital level of performance at individual consultant level, with appropriate actions to be taken where required. At a meeting with my Department on 23 March the HSE confirmed it would incorporate within the framework a map allocating additional responsibilities at each local hospital group hospital and at national level. I believe the Comptroller and Auditor General has also announced his intention to do some work in this regard, which I welcome.