Health Service Reform: Motion (Resumed) [Private Members]

The following motion was moved by Deputy Michael Harty on Tuesday, 8 May 2018:
That Dáil Éireann:
— that it has been 12 months since the publication of the cross-party consensus report by the Committee on the Future of Healthcare entitled 'Sláintecare Report', regarding reform of the health service over a ten-year period into an effective and efficient health service;
— the failure of Government to deliver a response to the 'Sláintecare Report' in spite of committing to do so by December 2017;
— the failure of Government to develop a new funding model for the health service including multi-annual budgets to deliver universal healthcare;
— the failure to fulfil commitments in the Programme for a Partnership Government to:
— reduce waiting lists and overcrowding in our hospitals;
— provide new contracts for consultants and general practitioners;
— recruit additional nursing staff to support increased bed capacity;
— reduce delayed discharges; and
— introduce hospital avoidance measures;
— the failure of Government to develop the Emergency Aeromedical Service (air ambulance) and its extension to a night-time service;
— the failure of Government to develop a humane approach to the provision of discretionary medical cards to those who are undergoing treatment for cancer and end-of-life care;
— the failure of Government to fully implement the strategy document 'A Vision for Change', including building capacity into Child and Adolescent Mental Health Services (CAMHS), the provision of counselling and psychological services in primary care, and fully populating community psychiatric teams;
— the lack of equal opportunity and quality of life for people with disabilities by the failure to implement personalised budgets together with a comprehensive employment strategy to aid independent living and social integration;
— the failure of Government to legislate for a statutory scheme for home care, to enable our elderly population to live within their community;
— the important role that carers play in maintaining family members at home, supporting their needs by providing respite services, financial support and disability services;
— that acute hospital bed numbers, hospital consultant numbers and general practitioner numbers per head of population are below the Organisation for Economic Cooperation and Development (OECD) average and need to be increased to meet that average;
— that Emergency Department services are struggling to meet the increased demands for acute and complex care, particularly given our increasing population and ageing profile, and waiting times for out-patient assessments continue to grow and waiting times for elective and planned surgery are unacceptably prolonged; and
— the lack of coherent comprehensive planning to address these issues, lack of governance and accountability to underpin meaningful reform and lack of statutory requirements to meet acceptable targets, for waiting times and annual performance targets as committed to in the Programme for a Partnership Government; and
calls on the Government to:
— work towards the 'Sláintecare Report' proposal for a universal single-tier public health service based on need, not on the ability to pay;
— ensure a coherent implementation plan is immediately actioned to address the increasing lack of capacity and unmet need in our health service;
— immediately introduce legislation to ensure the delivery of entitlements to services on a phased, income-based criteria until universal public access is achieved;
— deliver expanded entitlements on income grounds only when capacity is available to deliver services;
— ensure immediate actions are taken to address recruitment and retention of front-line staff by improving working conditions, career progression and job satisfaction;
— work towards expanding diagnostic service availability to seven-day access, for both in-patients and out-patients, to speed patient diagnosis and treatment in a timely manner;
— immediately provide resources and recruit staff in order to open beds in hospitals which have been closed during austerity years;
— immediately commence a building programme to expand bed capacity to reach the OECD average per head of population in order to eliminate overcrowding and deal with unmet need;
— immediately complete negotiations on a new modern contract with general practitioners which recognises their central role in delivering prevention, health promotion and continuing care in the community;
— immediately enter negotiations on a new consultant contract, to recognise their value and role in delivering public care in our public hospitals;
— recognise the value of fostering and encouraging our nursing staff by improving working conditions, promoting career progression and further education;
— commit to meaningful and continuing health reform to take into account the continuing changes that are developing in modern medical practice;
— review the de-congregation model of care as it is clear that a one-size-fits-all model of care is not adequate; and
— establish that all service users who have been transferred from congregated settings to independent living are progressing positively.
Debate resumed on amendment No. 1:
To delete all words after “Dáil Éireann” and substitute the following:
— the historic cross-party consensus that has been achieved by the Committee on the Future of Healthcare and that the ‘Sláintecare Report’ now provides an agreed vision and framework for achieving healthcare reform over a ten-year period;
— that the demand for nearly all health and social care services is growing as a result of overall population growth and an ageing of our population (60 per cent growth projected in the 65 plus population over the period 2016 – 2031) as demonstrated by analysis from the Economic and Social Research Institute (ESRI) last year and the Department of Health’s, Health Service Capacity Review 2018;
— the challenges that many patients, service users and their families are experiencing in accessing timely care, and the difficulties being faced by healthcare professionals who are doing their utmost to provide safe, quality care to as many people as possible;
— that the Health Service Capacity Review 2018, recognised the need for both investment in additional capacity and healthcare staff, and a programme of whole-system reform over the next decade to modernise and improve our health services to meet current and future healthcare needs;
— that the Government has committed a record level of €10.9 billion in the National Development Plan 2018-2027 to the health sector over the coming decade;
— that the Government has increased funding for health services each year since 2013, totalling a 19 per cent increase over the period, and that the Programme for a Partnership Government commits to sustain these increases;
— that robust performance management and accountability arrangements are an essential component of any healthcare system; and
— that delivering real and sustained improvement in our health services continues to be a priority for the Government; and
supports continued cross-party cooperation and consensus on the vision and direction of travel for health policy outlined in the ‘Sláintecare Report’, including the following commitments:
— put in place a programme of reform arising from the ‘Sláintecare Report’, this follows actions already taken to advance recommendations in the report:
— a Sláintecare Programme Office will be established and the recruitment of an Executive Director is almost complete;
— an independent expert group is undertaking an impact assessment of separating private practice from the public hospital system; and
— draft legislation will be brought forward this year to establish a governing board for the Health Service Executive (HSE);
— publish the Sláintecare implementation plan in the coming weeks which will set out a clear roadmap for delivering on the Sláintecare vision of a universal single-tier public health service based on need, not on the ability to pay;
— invest in additional capacity in line with the National Development Plan 2018-2027, which includes provision for 2,600 acute hospital beds including three new elective facilities, 4,500 community care beds, diagnostic hubs in the community and the rollout out of eHealth infrastructure across the health system, and work is underway to identify the number and location of additional beds that can be opened and staffed in 2018 and into 2019;
— continue to develop comprehensive primary and community care services with a number of investments and initiatives being pursued including:
— continued roll-out of primary care centres, with 114 now fully operational across the country, six of which opened in the first quarter of this year with a further fourteen scheduled to open this year;
— additional funding of €25 million for primary care services, including an expansion of Community Intervention Teams which will help to prevent unnecessary hospital admissions and facilitate early discharge of patients;
— the engagement process to develop a new, modernised contract for general practice has commenced which will have a population health focus, providing in particular for health promotion and disease prevention and for the structured care of chronic disease;
— the number of General Practitioner (GP) training places has been increased from 120 in 2009, to the current 194 places available in 2018; and
— the commitment of Government to develop a new statutory scheme for the financing and regulation of homecare services, to enable our elderly population to live within their community;
— provide improved care and services to our most vulnerable in society as a central component of overall health policy and delivery, and initiatives include:
— legislation will be brought forward this year to provide GP Visit cards to those in receipt of Carer’s Allowance or Carer’s Benefit, benefitting approximately 14,000 persons;
— increase in the number of discretionary medical cards in circulation, from 52,000 in mid-2014 to 135,728 on 1st April, 2018;
— over 182,000 respite nights and over 42,500 respite day sessions will be provided this year, with an additional €10 million provided by Government to establish twelve extra new respite houses;
— in line with national policy and international best practice, there are now less than 2,400 people living in a congregated setting, with 170 more people expected to move to community living in 2018;
— a taskforce has identified how personalised budgets can be introduced in disability services and its recommendations are under consideration; and
— in light of significant additional funding provided, the Government is committed to continuing to fully implement and refresh ‘A Vision for Change’, including building capacity into Child and Adolescent Mental Health Services, the provision of counselling and psychological services in primary care, including the recruitment of 114 assistant psychologists, and fully populating community psychiatric teams;
— prioritise a range of initiatives during 2018, aimed at reducing waiting times in emergency departments and elective waiting lists, including:
— as part of Budget 2018, an additional €70 million was provided to respond to winter pressures, this included €3.5 million for additional transitional care beds and €18 million for additional homecare packages;
— over 200 new beds have been opened this winter to help alleviate the pressure our hospitals faced this winter;
— €55 million has been allocated to the National Treatment Purchase Fund targeted at reducing waiting times for the longest waiting patients, the Inpatient/Day Case Action Plan 2018 published in April, provides for treatment of 20,000 patients, and an Outpatient Department Action Plan will be published later this year;
— an additional €9 million has been provided to paediatric orthopaedics, including scoliosis, to deliver on the commitment of a four-month waiting list target for surgery for clinically suitable patients, following an increase in the total number of surgeries delivered in 2017 to 321 from 220 in 2016; and
— continuing to manage an increasing volume of emergency department attendances, with an increase in overall attendances in the first three months of this year of 3.7 per cent as compared with the same period in 2017, including a 5.9 per cent rise in attendances of people over 75;
— continue a series of focused campaigns to attract frontline staff in order to meet patient care requirements, including:
— an additional 942 nurses and midwives were recruited in 2017, including student nurses, and all nurse graduates have been offered permanent contracts to work in the Irish Public Health Service in 2018;
— the Framework for Safe Nurse Staffing and Skill Mix in General and Specialist Medical and Surgical Care Settings in Ireland was launched in April 2018, which sets out for the first time a methodology for calculating the staffing requirement and skill mix needed in our specialist medical and surgical wards in adult hospitals;
— the number of Non-Consultant Hospital Doctors has increased by 289 in the twelve months to the end of March 2018, and the number of consultants has increased by 110 in the same period; and
— the Public Service Pay Commission is currently examining issues relating to the recruitment and retention of staff in the health sector, and their report is expected in June; and
— to continue to develop and expand our aeromedical services and implement the recently published trauma policy.”
- (Minister for Health)

I must now deal with a postponed division relating to the amendment to the motion regarding health service reform. On Tuesday, 8 May 2018, on the question that the amendment to the motion be agreed to, a division was claimed, and in accordance with Standing Order 70(2), that division must be taken now.

Amendment put:
The Dáil divided: Tá, 48; Níl, 77; Staon, 0.

  • Bailey, Maria.
  • Barrett, Seán.
  • Breen, Pat.
  • Brophy, Colm.
  • Bruton, Richard.
  • Burke, Peter.
  • Byrne, Catherine.
  • Canney, Seán.
  • Carey, Joe.
  • Creed, Michael.
  • D'Arcy, Michael.
  • Daly, Jim.
  • Deasy, John.
  • Deering, Pat.
  • Doherty, Regina.
  • Donohoe, Paschal.
  • Doyle, Andrew.
  • Durkan, Bernard J.
  • English, Damien.
  • Farrell, Alan.
  • Fitzgerald, Frances.
  • Fitzpatrick, Peter.
  • Flanagan, Charles.
  • Griffin, Brendan.
  • Harris, Simon.
  • Humphreys, Heather.
  • Kehoe, Paul.
  • Kyne, Seán.
  • Madigan, Josepha.
  • McGrath, Finian.
  • McHugh, Joe.
  • McLoughlin, Tony.
  • Mitchell O'Connor, Mary.
  • Moran, Kevin Boxer.
  • Murphy, Dara.
  • Murphy, Eoghan.
  • Naughten, Denis.
  • Naughton, Hildegarde.
  • Neville, Tom.
  • O'Connell, Kate.
  • O'Donovan, Patrick.
  • O'Dowd, Fergus.
  • Phelan, John Paul.
  • Ring, Michael.
  • Rock, Noel.
  • Ross, Shane.
  • Stanton, David.
  • Zappone, Katherine.


  • Aylward, Bobby.
  • Boyd Barrett, Richard.
  • Brady, John.
  • Broughan, Thomas P.
  • Browne, James.
  • Butler, Mary.
  • Byrne, Thomas.
  • Cahill, Jackie.
  • Calleary, Dara.
  • Casey, Pat.
  • Cassells, Shane.
  • Chambers, Jack.
  • Chambers, Lisa.
  • Collins, Joan.
  • Collins, Michael.
  • Collins, Niall.
  • Connolly, Catherine.
  • Cowen, Barry.
  • Curran, John.
  • Daly, Clare.
  • Donnelly, Stephen S.
  • Dooley, Timmy.
  • Ellis, Dessie.
  • Ferris, Martin.
  • Funchion, Kathleen.
  • Gallagher, Pat The Cope.
  • Grealish, Noel.
  • Harty, Michael.
  • Haughey, Seán.
  • Healy-Rae, Danny.
  • Healy, Seamus.
  • Howlin, Brendan.
  • Kelleher, Billy.
  • Kenny, Gino.
  • Kenny, Martin.
  • Lahart, John.
  • Lawless, James.
  • MacSharry, Marc.
  • Martin, Catherine.
  • McConalogue, Charlie.
  • McGrath, Mattie.
  • McGrath, Michael.
  • McGuinness, John.
  • Mitchell, Denise.
  • Moynihan, Aindrias.
  • Munster, Imelda.
  • Murphy O'Mahony, Margaret.
  • Murphy, Catherine.
  • Murphy, Eugene.
  • Nolan, Carol.
  • O'Brien, Darragh.
  • O'Brien, Jonathan.
  • O'Callaghan, Jim.
  • O'Keeffe, Kevin.
  • O'Reilly, Louise.
  • O'Rourke, Frank.
  • O'Sullivan, Jan.
  • Ó Broin, Eoin.
  • Ó Caoláin, Caoimhghín.
  • Ó Cuív, Éamon.
  • Ó Laoghaire, Donnchadh.
  • Ó Snodaigh, Aengus.
  • Penrose, Willie.
  • Pringle, Thomas.
  • Quinlivan, Maurice.
  • Ryan, Brendan.
  • Ryan, Eamon.
  • Scanlon, Eamon.
  • Sherlock, Sean.
  • Shortall, Róisín.
  • Smith, Brendan.
  • Smith, Bríd.
  • Smyth, Niamh.
  • Stanley, Brian.
  • Tóibín, Peadar.
  • Troy, Robert.
  • Wallace, Mick.


Tellers: Tá, Deputies Joe McHugh and Tony McLoughlin; Níl, Deputies Mattie McGrath and Michael Harty.
Amendment declared lost.

I move amendment No. 2:

To insert the following after "establish that all service users who have been transferred from congregated setting to independent living are progressing positively.":

"in pursuing these healthcare goals, stay within the fiscal parameters required to maintain a prudent budgetary approach over the entire lifetime of implementation."

Amendment put and declared carried.
Motion, as amended, put and declared carried.
Sitting suspended at 1.14 p.m. and resumed at 2.14 p.m.