Ceisteanna Eile - Other Questions

HSE Staff

Bernard Durkan


85. Deputy Bernard J. Durkan asked the Minister for Health the extent to which he remains satisfied regarding the adequacy of staff at all levels throughout the health services; the degree to which he has identified staff shortages at consultancy, nursing, general practitioner or other levels; his plans to address these issues in the short and medium term; and if he will make a statement on the matter. [33482/20]

This question relates to the extent to which the Minister has examined the need for vacancies to be filled at various levels throughout the HSE, with particular reference to the need for adequate permanent staff to deal with all exigencies that arise in the future.

I thank the Deputy. Covid-19 has greatly increased pressures on the health service and staff have shown incredible strength and care in their duties. Several initiatives were undertaken to staff the necessary expansion of the workforce and these have facilitated an expansion of 4,292 whole-time equivalents from the end of February to the end of September of this year.

While this increase was necessary to deal with the pandemic immediately, a larger and more permanent expansion of the workforce is necessary and is under way. This expansion will support the resilience of the services but also ensure our healthcare system is resourced to meet the longer-term healthcare needs of the population.

Shortages exist across disciplines, including at consultant, nursing, midwifery and allied health professional levels.

Budget 2021 has provided funding for up to 15,738 additional posts in the HSE, above what was funded for 2020. That is inclusive of the posts identified in the winter plan. The funding will provide for a permanent increase in the size of the public health workforce, with a focus on front-line staff. The Government is committed to the ongoing roll-out of the framework on safe staffing and skill mix for nursing by the HSE in hospitals and has committed to further funding for the initiative in 2021. Specific increases in supports for general practitioners in rural practices and practices in urban areas of deprivation will help make general practice more sustainable and a more attractive career option for doctors.

This level of recruitment is ambitious, as Deputy Kelly pointed out to me previously in the Chamber, and there will be challenges faced by the HSE. Irish graduates are attractive in the global market. They are very well trained and highly sought after. The HSE is working to develop a recruitment plan that will ensure the Irish public health service is recognised as one of the places in which people wish to work. However, there are always challenges in recruitment. I am committed to supporting the HSE to find solutions to these challenges and to ensure our health service is adequately staffed to manage the pressures we will face in the coming months and years.

I thank the Minister for his comprehensive reply. Is he satisfied that progress to date is sufficient to reassure him that there will be adequate resources available to his Department to meet future challenges, including the normal challenges as well as the Covid challenges? Is he satisfied that the recruitments sought already have been taken up by the HSE to the extent necessary?

As to whether the resources are enough, the budget provided for the biggest increase in health spending we have ever had. That would hold true even if one stripped out the Covid funding. What we are funding next year is very ambitious. We are funding the biggest increase in acute beds, ICU beds, community beds and workforce in a single year. I think we are pushing the limits of implementation, to be honest. We have sufficient resources in terms of funding in the budget. The real challenge now is that I, the Government, the Department of Health and the HSE work together on implementation. What has been laid out in the budget is very ambitious but, given the waiting lists and the needs of patients, we must be ambitious and try to push the implementation as far as we can. Step 1 was the formulation of the plan, much of which was informed by Sláintecare. Step 2 was to get the budget in place and step 3 will be implementation.

Comment has been made regarding the availability of staff who answered the Be on Call for Ireland initiative and are available and ready to take up duties but have encountered delays. I understand there are logistical issues. Will the Minister assure the House that these offers will be taken up at the earliest possible date? In the event of there being an inability in the early stages to appoint people to full-time positions, will they be appointed to part-time positions while awaiting approval for the posts in question? Has the Minister examined the extent to which such a measure could and would augment the staffing levels in the first instance and, second, prepare for any challenges in the future?

In terms of the figures in respect of the Be on Call for Ireland initiative, when one narrows down the number who applied to the number deemed to have the relevant qualification, then to those who answered the follow-up, then to those who went through the interview process and finally to those who successfully interviewed, one moves very quickly from a very large number to a far smaller number. I have discussed the matter with the HSE and heard its chief executive explaining on the record that when it moved through all of those steps in the process, it ended up with a far smaller number than all Deputies had hoped for, given the very high number of people who applied.

On the recruitment process, I do not think the current recruitment process works. It is too centralised, bureaucratic and slow. It is probably too expensive as well. It means that people who are ready, willing and able to take up some of these 16,000 jobs are being asked to jump through too many hoops. Some of them walk away because they get better offers. One of the things I wish to do is to work with the HSE to improve and speed up that process while maintaining the quality controls because it is clear that we need a better and more responsive recruitment process.

National Children's Hospital

David Cullinane


86. Deputy David Cullinane asked the Minister for Health the progress in respect of the development of the national children’s hospital; and if he will make a statement on the matter. [33615/20]

My question seeks an update on the national children's hospital. Is the Minister aware of any additional cost overruns associated with a delay in the completion of the project due to Covid? What is the anticipated total cost of the project? When it is anticipated that the hospital will open for patients?

I will give the Deputy the short answer first. As of now, I am not aware of additional cost overruns, but that is not to say that there will not be any such overruns. With Covid, it is inevitable there will be some overruns but none have been agreed, arbitrated on and reported to the Department by the National Paediatric Hospital Development Board, NPHDB. In fairness to the NPHDB, Members will remember there were quite significant additional asks by the contractor of which all Members became very aware. Mr. Fred Barry was asked to go in as chairman of the board. I apologise for not having the figures to hand. The board seems to have been very successful in fighting the claims that have been put in. I am happy to furnish the Deputy with the relevant numbers. To date, the board has been very successful in those challenges.

Like many other sectors of society, the construction sector was impacted by Covid. This resulted in construction-related work on the site of the new children’s hospital stopping on 31 March. Following the easing of restrictions in May, the NPHDB engaged with the main contractor to ensure the earliest possible reopening of the sites. The main contractor of the project returned to the site in Tallaght on 29 June and to the main site at St. James's Hospital on 13 July.

There will be delays associated with Covid, but it is too early to assess fully the impact on the children’s hospital project and the paediatric outpatient and urgent care centre at Tallaght. The board continues to engage with the contractor and is monitoring progress on site in the interests of completing the project as quickly and economically as possible. On that note, I wish to state that I am acutely aware of how urgently the new children’s hospital is needed and I wish to see it delivered as quickly as possible on behalf of children, young people and their families. I have no doubt the Deputy shares that view.

Under the contract, the children’s hospital is due to be completed by the end of 2022 and handed over to Children’s Health Ireland to open in 2023 after commissioning. I am advised that the NPHDB was of the view in March 2020, when the site closed due to Covid-19, that the main contractor was behind schedule on the construction works.

The problem is that the chief strategy and planning officer of the HSE told the Joint Committee on Health some weeks ago that delivering the project by 2023 would be challenging. He expressed a hope that it will be possible to open it in 2023 but stated there was no guarantee of that.

The Minister referred to additional claims. It is important for him to furnish such information to all Members. I am looking for his view on any additional claims that arose in 2019 or 2020. Members are aware that even before Covid struck, claims were being dealt with and there was a dispute between the main contractor and the board. Covid then came along and delayed the project even further. The current estimated cost is €2.5 billion. The cost has repeatedly escalated. People wish to know what the final price will be and whether the taxpayer will be on the hook for more expense. I ask the Minister to furnish me with a detailed note on the issue, which would be very beneficial.

I do not think there will be any issue in that regard so long as there are no commercial sensitivity issues. I will arrange for that information to be provided to the Deputy.

On the issue of timing, the board is continuing to engage with the main contractor to obtain an updated programme of works that is in line with its contractual commitments.

As any delivery outside of the timelines agreed under the contract could potentially be a matter for dispute resolution, I want to be careful in respect of what I say here. However, I reiterate that it is a priority for me and the Government that the hospital be completed as quickly as possible.

We all hope that is the case.

In the minute I have left I might again put the questions the Minister was not in a position to answer earlier. What is his understanding of the nature of the confidential GP contract, as we know it was, on 16 April 2019 when he spoke in the Dáil Chamber? Was it his view that that contract was widely available and known among GPs? As the current Minister for Health, does he think it was acceptable that the then Head of Government would have leaked that document to a rival organisation? Can he confirm to Members of this House that documents which are being sought by many parties, including mine, regarding any discussion involving the HSE, the Department of Health and the NAGP between April 2019 and May 2019, will be furnished to Opposition Members or any Member of the Dáil who seeks them?

I ask the Deputy to repeat that last bit.

I am asking about any information, documents or emails that might have been exchanged between the Department of Health, the HSE, the Minister for Health and the Taoiseach with the National Association of General Practitioners between April 2019 and May 2019.

We have time limits and other Deputies are waiting. I have no knowledge of this question, but the Deputy has indicated that he talked to the Minister about it.

I cannot quote all the Standing Orders, but I imagine that the Deputy's question is miles out of order, nonetheless-----

I pointed that out. The Deputy stood up earlier and said he had indicated to the Minister that he was raising a second matter. The Minister did not object at that stage. I had no knowledge of that. Now he is raising again under a second question. It is entirely up to the Minister.

I will answer. I think it would be ruled out of order by the Chair, but I have no problem answering the question at all.

My understanding is that it was not available and hence I was looking for it. It was a critical contract because it was moving away from what is still the existing GP contract. It was essentially adding to the existing GP contract but in an important way - in ways that were identified by Sláintecare. One of the most critical was to have GPs lead the chronic disease management within the community. Essentially as it was explained to me, they were adding chunks the GPs could opt into. I do not believe the exact details were available and hence I raised it-----

Was it appropriate for the then Taoiseach to leak them?

-----at the time.

A question has been asked and we have run out of time.

I will revert on the other question.

The Minister can revert in writing. I am leaving it at that in fairness to other Deputies present.

Primary Care Centres

Cathal Crowe


87. Deputy Cathal Crowe asked the Minister for Health the status of the provision of new primary care centres in County Clare; and if he will make a statement on the matter. [33468/20]

I ask for an update on the status of planned primary care centres in County Clare.

I thank the Deputy for his brevity.

I acknowledge the Deputy's strong advocacy work for the local healthcare facilities in his constituency and for the people he represents. I am pleased to be able to inform the Deputy that the development of five new primary care centres in County Clare is being progressed and, when completed, will add to the existing centre at Westbury. I acknowledge the Deputy's work in continuing to advocate to ensure these critical projects happen as quickly as possible.

The development at Station Road, Ennis is expected to be completed late in 2021 and to be operational in early 2022, while a planning application has been submitted to An Bord Pleanála for another centre in Ennis on the Tulla Road.

Planning permission has now been granted following an appeal for the centre at Sixmilebridge, and the developer is currently working to conclude outstanding matters. It is hoped to commence construction works in the coming months.

Priced offers from potential developers are currently under review for Ennistymon, while several potential sites have been shortlisted in the Kilrush area and a review of accommodation requirements for that area is being undertaken.

Unfortunately, it is not possible at this stage to provide an estimated operational date for these centres, other than for Station Road. I am determined that these projects progress as quickly as possible as part of our efforts to enhance primary care capacity. I look forward to working with the Deputy on these issues.

A total of 135 primary care centres are now operational across the country, and these modern, well-equipped and accessible premises are key to the development of primary care services in line with the vision of Sláintecare.

I thank the Minister. I am glad to hear of the progress with the five new centres which are greatly needed in our county. When the primary care centre model was developed by the Department of Health it was to provide modern purpose-designed buildings for a wide catchment area with care by a multidisciplinary primary care team. I live quite close to the Westbury primary care centre. I have brought my children there for developmental check-ups. It is fantastic to have a state-of-the-art facility on my doorstep. The other parts of our county also need them, and I am glad to hear they are progressing. Without a 24-hour accident and emergency department, County Clare has a higher dependency on community-level healthcare and also the out-of-hours service provided by Shannondoc. This is good news. I would like to hear a bit more about Kilrush and Ennistymon which are further back in the county and have a more pressing need for primary care centres.

In Kilrush, the HSE is currently awaiting price offers from potential developers. There is not much more to say until those offers come in at which point, they will be evaluated.

In Ennistymon a site was advertised in May 2019 for a primary care centre development and priced offer applications from potential developers are currently under review. I am aware that an agreement for lease was issued for this site before being withdrawn. That the proposed centre has been re-advertised shows that the commitment remains to progress with this project. I am happy to reassure the Deputy of my commitment to work with him on behalf of the people he represents to ensure this critical project gets over the line and opens.

I thank the Minister for those words of encouragement. As with everything, rumours circulate on social media these days, including the rumour over the summer that these projects would not happen and that funding for them was questionable. I am glad to hear tonight in the Dáil that they are progressing. Ennis is the largest town in Munster that is not a city and it needs the two new primary care centres on the Tulla Road and the Station Road. Sixmilebridge was once a small village and is now a large town. As Kilrush and Ennistymon are more peripheral in the county, their need for primary care is more acute.

I ask the Minister to confirm that the money remains allocated to these and has not been pulled as was rumoured. I hope these new primary care centres will have the capacity to fully deal with developmental check-ups for the young, the elderly and also mental health. As I have often discussed with the Minister, there is considerable focus on physical health because of Covid, but mental health is also suffering. Primary care needs to have the capacity to cater for that also.

I confirm that these projects are going ahead. Rumours that they have been pulled or shelved are unsubstantiated. The services to go in is a matter that will be discussed with the HSE. Any input the Deputy may have would be very welcome. We try to have GPs in the primary care centres. Obviously, GPs are independent contractors and do not have to come in. There are generally ongoing negotiations to get local GPs to move in and then we put in primary healthcare teams as well. The exact configuration of what is needed in the community is different for urban versus rural, for younger versus older populations and so forth, as the Deputy said. I would welcome any feedback the Deputy has on what would be suitable for community-based services.

Health Promotion

Gino Kenny


88. Deputy Gino Kenny asked the Minister for Health the status of the women’s health task force that was established over a year ago; the actions taken or achieved in the intervening period; the plans in the area of women’s health over the next three years; and if he will make a statement on the matter. [33543/20]

The women's health task force was established in September last year. What actions has it taken and will it take over the next three years?

I was delighted to see this question come in. I share the Deputy's view that this is a priority. Progressing women’s health is a priority for me and for this Government. We made a strong commitment to promoting women’s health in the programme for Government. I am pleased that budget 2021 provides a very significant investment to deliver on this commitment, something I have been pushing very hard for.

I have allocated funding of €12 million to ensure a renewed impetus in the implementation of the national maternity strategy and the new model of maternity care and to improve gynaecology services as well. I have allocated funding of €10 million to strengthen screening services including BreastCheck and CervicalCheck. Building on the work of the women's health task force, I have allocated an additional €5 million to improve outcomes.

Women have specific physical, mental and social health needs and experience poorer health outcomes relating to certain conditions including some chronic diseases, cancers and mental health conditions. Women’s health outcomes and experiences are also affected by their roles in the family and society and their wider circumstances. For example, more than 60% of unpaid carers are women which means they often access services on behalf of others.

The women's health task force was established in September 2019 to improve both health outcomes and experiences of healthcare for women and girls. It builds on recent progress in women’s health, including the implementation of the national maternity strategy, the implementation of the sexual health strategy, the establishment of a national mesh specialist centre, improvements in screening services, improvements in sexual assault services, the introduction of termination of pregnancy services, the roll-out of the maternal and newborn clinical management system and the development of new models of care for ambulatory gynaecology and infertility.

The women's health task force is very welcome because in the past healthcare has been very patriarchal. It has let down women many times and women's healthcare in Ireland must be addressed. It is ironic that the task force was established because it was recommended in the scoping inquiry on the cervical screening programme after women had been completely let down. That should be remembered in the tribunal that will take place soon.

What areas will be developed around gynaecological health? Will it address endometriosis, something that one in ten women suffers from? It can take up to nine years for a diagnosis.

It is not lost on me that two men are discussing the future of women's healthcare. It must be pushed and funded. I might be wrong, but I do not believe that if men had babies that Holles Street, the Coombe or the Rotunda or other maternity services around the country would have the same level of investment as they have now. They would be state-of-the-art, brand new, custom-built, beautiful buildings. They are not and that is not good enough. It is not good enough that when we discuss crisis after crisis here on women's health and women's reproductive health - be it mother and baby homes, CervicalCheck or symphysiotomy - it is always the same.

There is a lot of new funding in place. The Deputy asked what exactly the task force has been doing and what it intends to do. I will provide the Deputy with the rest of the written answer as I am out of time but there is a lot of really good work going on. The task force has done a huge amount of work and hopefully some exciting things will come through in the next year.

One of the task force's mantras is that it will do radical listening on women's health. That is welcome. Women should be at the heart of women's health and they should be listened to, where not doing so was a problem in the past.

Covid-19 has had a huge effect on everyone, regardless of gender, but I raise its impact on women's mental health. Covid has done a huge amount of social, physical and mental damage. How will the task force address that?

The task force is focused on women's health and building capacity in the system for women's health, including mental health, but is not working specifically in response to Covid, for which the Minister of State, Deputy Butler, is leading a lot of initiatives. There was funding in parallel with the winter plan and a wellness initiative was launched last week. There has been a huge increase in calls and in texts to the support lines. We do not have very up-to-date data, but the figures we have for suicide and self-harm have not gone up. That may change in more recent data. The numbers asking for help have increased across the country. The task force is engaged with over 1,000 people and organisations representing women and girls across the country. It did the listening exercise and I might share some of its findings in writing with the Deputy.

Nursing Education

Gino Kenny


89. Deputy Gino Kenny asked the Minister for Health if he will clarify the position of student nurses in the health service; if they have been offered healthcare assistants' contracts and work; if while on placement they will be offered similar payments as in March 2020; the supports that will be in place on an ongoing basis for student nurses serving in the public service given the risks of Covid-19 infection; if he will increase the current allowance of €50.79 a week; and if he will make a statement on the matter. [33542/20]

Richard Boyd Barrett


97. Deputy Richard Boyd Barrett asked the Minister for Health his plans to ensure student nurses are paid for the work they carried out in the fight against Covid-19; the details of the regime for the testing of these students when they are going on placements; and if he will make a statement on the matter. [33558/20]

Alan Kelly


117. Deputy Alan Kelly asked the Minister for Health when student nurses will be paid in full for the work they carry out; and if he will make a statement on the matter. [33476/20]

Peadar Tóibín


121. Deputy Peadar Tóibín asked the Minister for Health the reason student nurses have not been paid for the front-line placements in which they have taken part during the pandemic despite suggestions to the contrary. [31370/20]

The position of student nurses in our health service is very important. There is a lot of exploitation where student nurses work on the front line. They feel they are being exploited and are not being recognised for their work.

I propose to take Questions Nos. 89, 97, 117 and 121 together.

In my earlier response to Deputy Cullinane, I dealt with some of the issues raised by the Deputies, and I would now like to deal with the additional matters. Concerning fourth year nursing and midwifery students, the HSE continues to fund the internship employment of those students who are on rostered work placements. This includes those scheduled to commence in the coming weeks and those due to commence rostered work placements in 2021. These fourth year student nurses on rostered work placement are paid at the approved rate of €22,229 on an annualised basis for the psychiatric nursing specialism and €21,749 for all other nursing disciplines. I am open to examining what other measures can be put in place to protect and support student nurse and midwife education and welfare at the present time. My priority is to ensure that placements continue so long as it is safe to do so. In that regard, my Department is engaging with the HSE and the higher education bodies on an ongoing basis. Separately, and for the longer term, my Department is reviewing the accommodation and travel allowances for students on clinical placements that should apply from the academic year commencing in autumn 2021. This review is expected to conclude at the end of this month, and I look forward to examining the outcome of this review in due course. Regarding the testing of students when they are assigned to a placement, the testing regime follows the national system that the HSE has in place.

Two weeks ago, representatives from the Irish Nurses and Midwives Organisation, INMO, were before the Joint Committee on Health. The INMO's submission was extraordinary. It said that 3,400 students are on placements in Irish hospitals. Covid means they are in a vulnerable position. The failure by the HSE "to remunerate them amounts to exploitation". That is awful. The statement also notes that 50 nurses are infected by Covid each week. Student nurses feel very let down, unrecognised for their work but also financially. The Minister has to address that.

To follow up on that, the Minister said earlier on this that it was education not work so we should not pay them. We should be clear that this departs from what the Government was forced to do in March and April when it had to acknowledge they were actually working and pay them at the healthcare assistant level.

The idea that the student nurses who are on placement at this time are not working is a nonsense, when there are 500 to 600 healthcare workers out for more than 14 weeks with long-tail Covid, of whom the biggest cohort comprises nurses and midwives. Nurses and HCAs make up the largest cohort of workers being hit with Covid infection and they are working in a highly dangerous environment from an infection point of view. There is no question that the student nurses are working. In fact, they are being exploited and our hospitals would not be operating without them. The idea that they are exclusively on some sort of educational placement is not accurate. Their placements are part of their education but they are working. Indeed, they are being exploited because they are not being paid as they were earlier this year.

I endorse everything my colleagues have said on this matter. I have one additional point to make. Unless there is some capacity to distinguish between the risk of getting Covid for a nurse who is working full time and a nurse who is a fourth-year student, then this is an utterly disgraceful action and the Minister is putting students at risk as they strive to complete their education. The Minister cannot distinguish what he is doing now from what was done earlier this year. This is blatant exploitation and it is completely and utterly wrong. The Minister is underestimating this as an issue and he needs to do the right thing. These are front-line workers who are saving lives and putting themselves at risk the same as every other front-line worker. They deserve to be treated appropriately.

I thank the Deputies for their contributions. To pick up on the wider point, Deputy Boyd Barrett is absolutely right that nurses, midwives and HCAs throughout the system are doing extraordinary work. We often, rightly, talk about the amazing work teachers have done to make our schools safe places for children to be. There is not enough talk about the equivalent work nurses and midwives are doing to make hospitals safe places for patients. The Deputy is right that there have been a lot of Covid cases among healthcare professionals right across the board. I agree that nurses make up the biggest group of those who have been infected. That needs to be recognised.

Where I have a different view is in emphasising that for student nurses in the first, second and third year of their training who go out on placements, those placements are educational and make up part of their degree. This aspect of training was one of the components of moving the nursing qualification to a professional degree and it is a critical part of their education. I have a concern I wish to articulate in this regard but my time is up. I will return to it in my final reply.

The world we used to live in prior to Covid-19 seems like a very different world from the one we are living in now. In former times, many student nurses could take up other jobs in nursing homes and so on, but they can no longer do so for all sorts of reasons. Financially, this has left them out of pocket. Living on an allowance of €50 a week, with the responsibility that is entailed in their roles, is having a hugely detrimental effect on their well-being. Nursing is a very hard job and the people working in the profession are extremely dedicated. However, some are fearful of the nature of the business they are in. It is very important that the Minister for Health should recognise the contribution of student nurses, whether in first, second of third year. Of course their placements are part of their education. I know that because I used to work alongside them. However, it is really important that they are recognised, financially as well as educationally, particularly in the context of the Covid-19 crisis.

I raised this issue with the Taoiseach on 20 October. It might be of interest to the Minister to know that the video of that engagement has been watched 250,000 times, which is very rare for any video of proceedings in this House in which I am involved. That was the scale of the response from student nurses. In that engagement, the Taoiseach said the following:

...I will engage with the HSE and the Minister for Health on student nurses working on the wards in the current context. As they were earlier, they should be paid in accordance with the agreement arrived at earlier in the year. I will follow up on that.

When we put the points to him regarding the situation of the student nurses, he agreed that they should be paid at the previous rate. For the reasons Deputy Gino Kenny outlined, they cannot get other jobs. There is no question that they are working, in a context where they are replacing the hundreds of nurses who are down with Covid. That is why they are working. The Minister can call what they are doing an educational placement - it is, in a certain sense, education - but he cannot deny that they are also working. They cannot engage in any other work and they must be paid, not exploited, for the work they are doing.

There is a real issue for the Minister to deal with in this regard. Many of us have had student nurses and their parents contact us to tell their stories. Their health is at risk when colleagues go out sick with Covid and they have been thrown in at the deep end, being told to go into situations they did not expect to go into, sometimes with only a day's notice and certainly no more than a week's notice. The Minister needs to put them back on the HCA rate. It is completely and utterly unfair not to do so. I have spoken to two student nurses who are finishing their training and who told me, quite bluntly, that they intend to leave this jurisdiction because of the way they are being treated. They do not have any other means of getting an income and they have loans and other borrowings. Like many others did in the past, they are making the decision to leave. This is happening because the Minister is not making the right decisions. We know that the competition for staff nurses is extreme throughout the world. The last thing we should be doing is creating circumstances that lead to our student nurses deciding to leave the country when they graduate.

I assure the Deputies that I hear what they are saying. We all recognise the work of our qualified nursing and midwifery professionals throughout the country, in community healthcare and in the hospital system. Do students nurses make a valuable contribution while they are on their educational placements? Damn right they do and they work extremely hard. Those students are part of a clinical group whose members are funded for their educational placements. Are we looking at increasing that funding in a time of Covid? We absolutely are and we are engaged in doing that. However, I have a genuine concern that if we were to replicate what happened in the first wave, it could come at a risk to the educational element of those placements for nursing students in their first, second and third years of training. The placements are, first and foremost, part of their degree. Can we and must we do more for them? Absolutely. At the same time, we must protect their education. We are engaged in ensuring that we do both those things at the same time.

HSE Staff

Alan Kelly


90. Deputy Alan Kelly asked the Minister for Health the number of professionals who have been hired by the HSE since he launched the winter plan; the total increase in HSE employment that this represents in net terms; and if he will make a statement on the matter. [33477/20]

The Minister will be delighted to hear that this is a question I probably will ask him every month for the duration of his Ministry. It relates to the number of health professionals the HSE has hired since the launch of the winter plan, the total increase this intake represents in net terms and the total HSE employment numbers. The Minister has made some deep and serious commitments on which I 100% want him to deliver. I would like to get a report month by month on their delivery.

I have not forgotten the offer the Deputy made previously and which he undertook to make good if we get the numbers to 10,000 by the end of the winter plan.

I will honour that offer.

I thank the Deputy. The winter plan was launched by the HSE on 24 September. It targets approximately 12,522 additional posts over the period of the plan, to the end of April next year. Budget 2021 provides for the retention of these posts on a permanent basis, plus an additional 3,426 whole-time equivalent posts, funding a total increase of approximately 15,738 positions. To date in 2020, the health workforce has increased by a net 4,292.

The number of staff employed by the HSE is identified through the staff census which is collected monthly.

The HSE staff census for October will not be reported until mid-November and the first progress report regarding the achievement of the winter plan targets will be available at this point. In short, the data for the first month of the winter plan have not come in yet. It is, however, collected on a monthly basis and I will be more than happy to share it with the Deputy. What he is doing is exactly right. Very ambitious targets and goals have been set and he is pushing to make sure they are achieved. I will work with him in that regard. I will be working very hard to ensure those targets and goals are achieved to the extent that is possible. I hope that will mean they are fully achieved.

Recruitment in the HSE has been ongoing at an accelerated pace throughout this year. Current increases were due to a number of measures, including the expedited recruitment from all existing recruitment pools, hiring student nurses as healthcare assistants, as we have just discussed, increasing the hours of part-time staff and rehiring retired clinicians. In recent weeks, the HSE has conducted a successful campaign to retain additional swabbers and contact tracers. It is envisaged that the equivalent of an additional 2,200 whole-time staff in this area will be funded by the end of the year.

I will refresh the Minister's memory and that of the House as to what these commitments are. There is a commitment to hire 8,500 staff by the end of next month, 12,500 by the end of April, and 16,000 by December of next year. Again, that is 8,500 by the end of December. I am really looking forward to getting that document on 15 November because massive progress must obviously have been made over recent months. We know there are issues in respect of recruitment. We have seen this in the area of contact tracing. What really brought this home to me, however, was when I asked a parliamentary question, the answer to which told me that we had 200 fewer permanent nurses in August than we did in December of last year. How could that happen? The Minister told me that we have nearly 2,000 extra contract staff. That is even more concerning. Does the Minister's management consultant experience not tell him that 2,000 whole-time equivalent staff not being offered permanent contracts represents a systems failure?

I am afraid I do not have details in this regard with me as the issue was not mentioned in the question. The Deputy raised a report of the total number of staff being lower, which I looked into because I was very perplexed by it myself. It turns out that the total number of hours being worked when expressed as whole-time equivalent staff had, in fact, increased quite significantly.

It was an increase of 1,800.

Yes, but what the Deputy and I both want to see is faster recruitment. As I said in the House earlier, there is a lot of opportunity to improve recruitment processes. When the Deputy and I joined nurses and midwives on the picket line last year, they were not talking about pay increases but about safe staffing levels. I hope that, as the number of staff increases in accordance with the safe staffing agreement, the HSE across the board becomes a place where our own graduates and clinicians want to stay and work, as it already is in some areas. I hope it becomes a place where people from across the world also want to work.

The Minister is going over old ground. We have been over the issue of whole-time equivalents before. I actually gave him the figures the last time as well. It is perplexing and wrong that these are not full-time positions. It would be helpful it the Minister could listen to me. It is perplexing and wrong. Will the Minister please explain to the House why these 1,800 people are not on full-time contracts? Will he please explain how that is not a systems failure? In the limited time we have, will he also please update the House on what he has done to bring in more consultants? He is really out on a limb on that question.

I have heard the Minister speak about changing the way in which recruitment is carried out, decentralising it and giving more hiring power locally. I actually agree with him 100% on that, but what has he done to achieve it? Will the Minister also inform the House of the percentage of those who have been recruited when he gives us the figures in a week and a half's time? We also need to be careful about the process of recruitment. We may have real issues in other healthcare areas because recruitment will be from a smaller pool, that is to say, we may be taking people from nursing homes and so on.

I will answer the last point first, as it is an issue I have looked into. The HSE has explicitly stated that it is not targeting healthcare professionals in nursing homes. It has, however, stated that it has its own ambitious hiring targets and that it cannot stop people from nursing homes applying. To refer to something I believe I have heard the Deputy mention, one way to keep healthcare professionals in nursing homes would be to carry out a review of that sector and of the pay and conditions within it. One of the reasons people are moving is that they see better pay and conditions elsewhere. That is one of the things I want to see.

With regard to the figures the Deputy is looking for, I take note of the time but I am happy to answer in writing and also to discuss the matter further with him.

Question No. 91 replied to with Written Answers.

Hospital Funding

Pádraig MacLochlainn


92. Deputy Pádraig Mac Lochlainn asked the Minister for Health if his attention has been drawn to the fact that Letterkenny University Hospital had the sixth highest number of inpatients in hospitals across the State in 2019 but only received the 13th highest budget allocation of the hospitals across the State, just 36% of the highest budget allocation to a hospital, the 14th highest allocation of consultants in hospitals and the 12th highest allocation of nurses and midwives in hospitals; and if he will make a statement on the matter. [33172/20]

Letterkenny University Hospital is the sixth largest hospital in the State yet it only has the 13th largest budget allocation and the 13th to 14th greatest number of nurses and doctors. That is discrimination. I wish to engage with the Minister on that now.

Letterkenny University Hospital, LUH, is a model 3 hospital, operating as part of the Saolta University Health Care Group. There were 24,141 inpatients in LUH in 2019 and 9,731 inpatients in the first two quarters of this year. The budget allocation for Letterkenny University Hospital is €145.9 million. This is the 12th highest annual budget allocation for a public hospital in 2020. The Deputy will be happy to know that it is also the second highest budget for a model 3 hospital anywhere in Ireland. Data provided by the HSE on staffing levels indicate that 1,745 whole-time equivalent staff are working in Letterkenny University Hospital, which is the fourth highest number in a model 3 hospital nationally.

There have been significant investments in services in the hospital in recent years. These include the completion of the radiology rebuild, including a second CT and interventional radiology suite, and of a 20-bed short-stay ward; the construction of two new wards, Medical 6 and Medical 7; the commissioning of a new mammography machine in the symptomatic breast disease unit; and the appointment of consultants in paediatrics, gastroenterology and urology as well as advanced nurse practitioners. The HSE also advises that a new acute stroke unit will commence operation before the end of the year. I know this news will be very welcome to the local community.

Plans for further investment in Letterkenny University Hospital in 2021 include plans for the commissioning of a new maternity theatre, the commissioning of a second CT scanner, the expansion of the colposcopy service with additional clinic rooms, and the replacement of the haematology oncology day ward aseptic unit. I hope the Deputy agrees that the extent of recent and upcoming developments illustrates the Government's commitment to Letterkenny University Hospital and to patients in the north west.

No, I absolutely do not accept that. This is the first chance the Minister and I have had for an engagement about Letterkenny University Hospital but I assure him it will be the first of many. What the Minister's colleagues who wrote this response did not tell him is that the 24,141 inpatients seen in the hospital last year make it the sixth largest hospital in the State. They have admitted that it has the 12th highest budget. We have the sixth greatest number of inpatients but only the 12th largest budget. I love that somebody decided to change the hospital's name from Letterkenny General Hospital to Letterkenny University Hospital. It was given a big fancy name but, whenever anyone is challenged about the budget allocation given to it, we are told that it is a model 3 hospital and that it is doing great for a model 3. It is a university hospital and part of the Saolta University Health Care Group. I will provide the Minister with additional figures after tonight that show the hospital is heavily discriminated against, which cannot be allowed to continue.

I took a close look at this when I was going over the Deputy's question yesterday. I asked the very same question, which is if the hospital has the sixth highest level of inpatients but the 12th highest budget, what is the rationale? Is it that patients are being short-changed? The simple answer is "No".

The Deputy knows well that in comparing budgets for hospitals, we must look at many different elements. For example, we must consider case mix, complexity, average length of stay and many other factors. There is no easy way to do that but we can use the proxy of model 3 versus model 4. It is not a perfect comparison but it gives a reasonable adjustment to the complexity of cases. If the Deputy is of the view that it should be a level 4 hospital, I am happy to have that conversation. Doing a proxy for case mix adjusting, we can see the hospital has the second-highest budget for that level of hospital. That goes a long way to explaining the discrepancy pointed out by the Deputy.

Nobody in Donegal would argue that Letterkenny University Hospital should get the same allocation per inpatient as the likes of Beaumont, the Mater, St. James's or University Hospital Galway. That is accepted. Let us look at one comparison. In Letterkenny we had more inpatients in 2019 than St. James's Hospital, with Letterkenny having the sixth largest number and St. James's having the seventh largest number. Look at the budgets, with Letterkenny having €145.237 million and St. James's having €396 million. That is almost three times the budget of Letterkenny, despite having fewer inpatients. That cannot be explained other than to be labelled as discrimination. I can provide the Minister with the statistics. I assure him that when he looks at them, he will have to admit that this must change.

I thank the Deputy. We both know St. James's and nearly every other hospital are different. The work going on at St. James's per patient is highly complex and really expensive in all the ways we know. The right comparison would be activity-based costing. I am more than happy to discuss with the Deputy how much Letterkenny hospital is getting for the procedures it performs and the service it provides. Is it being short-changed, for example, and is it getting less money for a given procedure? That would be a concern and it should not be the case. Rather than comparing Letterkenny with highly specialised centres like St. James's, we could look at the volume of known procedures, and if there is a discrepancy, I would be more than happy to take a look with the Deputy. That is definitely something we could look at rectifying.

Sitting suspended at 9.13 p.m. and resumed at 9.33 p.m.