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Dáil Éireann debate -
Tuesday, 1 Mar 2022

Vol. 1018 No. 7

Health Waiting Lists: Motion [Private Members]

I move:

That Dáil Éireann:

notes that:

— there are now 1.34 million people on some form of health waiting list;

— there are 893,043 people on hospital waiting lists as of February 2022;

— there are 226,966 people on diagnostic waiting lists for CT, MRI, and ultrasound scans as of December 2021;

— there are 224,631 people on primary and community healthcare waiting lists for mental health, disability, older person, and general community healthcare services as of September 2021; and

— there is a crisis in general practice and many private health and social services, such as in child psychology, which is causing unprecedented and undocumented waiting lists and difficulties for accessing primary and community services outside the public sector;

further notes that:

— the Government has produced a waiting list plan without a strategy for the health service workforce recruitment, retention, and wellbeing crisis;

— health and social care workers have been through an extremely difficult two years and are burned out;

— one in five consultant posts are vacant and the Government have not resolved even minor issues for doctors in training, such as paying them properly when they are deployed to a new training location, ensuring that breaches of the European Working Time Directive are resolved, or ensuring they receive rotas in a timely fashion;

— the Government has set out recruitment targets which are not realistic and were missed by 60 per cent in 2021;

— targets for new acute inpatient beds over 2020 and 2021 were missed by 40 per cent, and according to bed plans detailed in the Irish Times on 22nd February, 2022, they will not be reached by the end of 2022;

— 60 per cent of additional funding committed in Budget 2021 to home support hours was unspent due to workforce shortages and a failure to recruit home care workers; and

— the Government's new waiting list plan does not provide any additional funding above pre-committed levels to expedite capital projects for ward and theatre expansions or new diagnostic equipment;

condemns:

— the Government's slow pace on healthcare reform and moves to water down accountability structures; and

— the Government's plan for Regional Health Areas (RHAs) which may involve only minimal structural changes, no devolution of corporate functions in recruitment and capital planning; and

calls on the Government to:

— fully deliver the promised bed capacity, particularly acute inpatient beds and community recovery beds, and provide for extensions of surgical theatre and diagnostic capacity within the public system;

— produce a health and social care workforce plan, including realistic and transparent multi-annual training and staffing level targets and an assessment of service staffing need;

— train more doctors, nurses, and allied health and social care professionals in line with service need and give graduates a guaranteed job offer, including a provisional offer for those who intend to travel temporarily abroad for training or work experience;

— fully resource and implement safe staffing levels in all hospitals, including emergency departments and community settings;

— undo pay inequality for new entrant consultants while removing private practice from public hospitals to make the health service more competitive as an employer to fill the vacant consultant posts;

— honour public sector pay commitments and fully implement the 2019 Labour Court recommendations on the terms and conditions of nurses and midwives;

— establish RHAs as transparent and accountable delivery structures with the significant devolution of corporate functions and responsibilities in recruitment and capital planning, resourced and empowered to tackle waiting lists, and hold them to account for it;

— reduce management tiers in the health service by establishing RHAs with a single management structure across primary, community, and acute healthcare and prepare for the statutory establishment of RHAs;

— ensure the integration of healthcare services across primary, community, and acute services on the agreed geographic basis;

— expedite and additionally resource the development of essential eHealth and ICT upgrades and reforms, including an integrated financial management system, individual health identifiers, summary care records, a centralised referral system, and an integrated waiting list management system; and

— publish transparent monthly updates on the number of patients added to and removed from waiting lists, including the reason why they were removed, be it treatment, removal of duplication, removal following non-response to validation, or otherwise.

I am sharing time with a number of colleagues. Health waiting lists, as conceded by the Minister for Health, Deputy Donnelly, are dangerously high. The problem is not only the number of people on waiting lists, but the length of time people are on them. There are 893,040 people on an acute hospital waiting lists, 731,797 of whom are on active waiting lists. There are 226,966 people waiting for a diagnostic assessment and 224,631 more people are on primary and community health waiting lists across mental health, disabilities, older persons and many other areas. That is an astounding 1.34 million on some form of health waiting list. Ten thousand more people were added to our acute hospital waiting lists in January of this year.

This month, 10,000 people were left on hospital trolleys in corridors across acute hospitals in this State. In January of this year, 1,100 people over the age of 75 were on a hospital trolley for more than 24 hours in acute hospitals. In one month, 1,100 people over the age of 75 were left on a hospital trolley for more than 24 hours. That is astounding. People are now waiting for GP access sometimes for days, sometimes for weeks. Out-of-hours services are patchy in some areas and non-existent in others. All of this, as we know, is adding to the pressure in our acute hospitals. If people cannot get access to GP services, they are left with little choice but to go to our emergency departments in acute hospitals.

Dentists are leaving the dental treatment service scheme at a rate of knots. There are long waiting times for orthodontic treatment and for children waiting for dental treatment under general anaesthetic. Tens of thousands of children with disabilities are waiting for access to speech and language therapy, occupational therapy, physiotherapy and child psychology. There are long waiting times across the board. In audiology, children and adults are waiting a long time for hearing tests and hearing aids. Children are waiting for grommet insertions. All of these are examples of long waiting times across the system. We also know that the National Ambulance Service is chronically understaffed and needs to be resourced.

The Minister last week published his waiting list strategy. I pointed out at the time that there was no additional funding beyond that allocated through the budget. It was a repackaging of measures that were already provided. The only way to tackle waiting lists is to put capacity into our hospitals. I acknowledge that additional capacity was put in over the past two years. I welcome every single additional cent that is put into our health service. I welcome every additional staff member, consultant, nurse, healthcare assistant and home help worker who is employed in the public service. I support, welcome and celebrate such additions. However, the Minister knows as well as I do that we have had decades of underinvestment that mean many hospitals do not have the inpatient beds to admit patients to hospitals in the numbers who need it. We have a deficiency in community and step-down beds in some areas, which means patients cannot be discharged quickly enough. The Minister also knows there are problems with surgical theatre capacity and diagnostic capacity, not just in cases of children with scoliosis but right across the board.

The HSE service plan, which was announced today, refers to more reporting structures and more bureaucracy when what we really need is fewer tiers of management and more accountability. That is what we need. We must deliver regional health areas that actually devolve responsibility to those regional health areas and onto the floors of hospitals to make hospital managers more accountable. We need to take a zero tolerance approach to waits at emergency department. One of the things this motion calls for is a job guarantee for all health graduates who come through training institutions in this State. The Minister will accept that we need to train more people. We need a workforce planning strategy. We need to recruit more staff and we need to retain them.

I read the Minister's amendment to the motion, which is almost four pages long. What we need is less spin and less spoofing. We need more substance, efficiency and capacity. Without the changes that are necessary, the Minister will be left with more fake targets and missed targets, as previous Ministers have found out to their cost.

The current number of patients on waiting lists in my constituency is difficult to take in. A total of 8,866 people are currently on waiting lists for inpatient care in the Galway University Hospitals. As the Minister knows, there is a story behind every single one of those figures. There is a person in need and a family who are worried. Shockingly, more than 2,000 of those people have been waiting for more than 18 months for an appointment. We have all heard stories of people who are languishing on these waiting lists but it is important to highlight the human cost of these waiting lists and to show that these are not just figures but are real life experiences for thousands of people. One family contacted me during the summer. A man who had been waiting since 2019 for treatment was told it would be at least another year before he would be seen as a public patient. His condition was such that if he waited to get surgery, the disease would spread to other parts of his body and get worse.

For outpatient care in Galway University Hospitals, the figures are even more shocking and staggering. More than 50,000 patients are waiting for an appointment, more than 30,000 of whom have been waiting for more than six months. Those are the figures for adults; they are even higher when children are included. We are failing our children.

Tá na liostaí feithimh do na hospidéil i nGaillimh go hiomlán dochreidte. Tá os cionn 8,800 duine fásta ag fanacht ar choinní othar cónaitheacha, le níos mó ná 2,000 acu ag fanacht níos faide ná bliain go leith. Tá scéal taobh thiar de chuile cheann de na figiúirí sin agus is scéal é de dhuine atá ag fulaingt agus teaghlach atá faoi bhrú. Tá go leor páistí ag fanacht ar na liostaí feithimh seo freisin. Caithfimid chuile shórt a dhéanamh chun cabhrú leo agus tá súil agam go dtacóidh an tAire leis an rún seo anocht.

Tá mé chun iarracht a dhéanamh labhairt as Gaeilge do Sheachtain na Gaeilge. Bhí cruinniú dearfach agam inné le foireann an HSE san ionad cúraim phríomhúil i dTamhlacht. Tugadh cuireadh dom féachaint ar cad is féidir le hionad cúraim sláinte phríomhúil a chur ar fáil. I mBaile Átha Cliath Thiar Meán, fós níl aon ionad cúraim sláinte phríomhúil againn. Tá obair tosaithe i gCluain Dolcáin agus tá maoiniú ann don obair pleanála do Rualach. Tá suíomhanna féideartha ann i gcás Leamhcán agus Baile Adaim. Seo áis atá de dhíth go géar inár gceantar. Dea-scéal nuachta amháin ó mo chuairt ná go bhfaca mé áis tástála croíthe gur féidir le dochtúirí atreorú air go díreach. Laghdaíonn sé seo an brú ollmhór ar rannóga éigeandála. Tá an togra seo maoinithe trí Sláintecare. Tacaíonn an maoiniú seo leis na baill foirne go léir agus teastaíonn níos mó maoinithe. Léiríonn sé seo cad is féidir a dhéanamh má leanann an Rialtas an plean.

Yesterday I had a positive meeting with HSE staff in a primary care centre in Tallaght. I was invited by the HSE to see at first hand what a modern primary care centre can offer. Dublin Mid-West has a large population but we do not have a primary healthcare centre. Work has begun in Clondalkin and only last week we were told that funding is there for design works for a centre in Rowlagh. Possible locations for centres in Lucan and Adamstown are being explored. Our area desperately needs such a facility.

One good news story from my visit which might help the Minister was that I had the opportunity to see a heart-screening facility in Tallaght. GPs can refer patients directly to the primary healthcare centre, which takes considerable pressure off emergency departments. It is an initiative funded through Sláintecare, although the funding provides for only 1.5 staff members. There needs to be more funding but that initiative shows what can be done if the Government follows the blueprints that are there. This is a simple thing that Sláintecare has funded. It is working. More funding would take the pressure off and we would not have the numbers of people on waiting lists that Deputies Mairéad Farrell and Cullinane mentioned. That would be one way to help. If something is working, it is not rocket science to follow it up.

Hospitals are at breaking point. Some 1.34 million people are on health waiting lists. These are not just statistics; these are real people. Many of them contact their local Deputies, looking for assistance. It should not have to be that way. Why should it take a letter from a Deputy before action is taken, even if it is only in limited circumstances?

A man called to my office before Christmas. He has been on a waiting list for ear, nose and throat treatment in Tullamore for five years. He received a letter approximately a year ago asking if he still needed to be on the list. Unless he had died or experienced a miracle, of course he needed to be on the list. What he has does not go away and we need to be sensitive to people like him.

That man then received a letter inviting him to attend a private hospital where a consultant told him he would have an MRI within ten days. We are now ten weeks on and he still has not had the MRI. We built him up only to knock him back down. It is simply not good enough. Behind each and every one of these numbers is someone who is suffering. Older people are dying while they wait for hospital appointments.

Many people have told me their children are waiting for appointments to have their tonsils removed. There are children who are experiencing recurring sore throats, with all the pain that comes with them. Other children are waiting to get grommets and are being delayed developmentally because hearing problems are not being addressed. This is not acceptable but at least they are in the system, broken as it is. People in south County Kildare or Portarlington in County Laois cannot even get a doctor's appointment because there is a massive shortage. The Government is doing nothing about it. I have written to the Department and the HSE. I have asked parliamentary questions and the answers coming back state that these are private businesses and can operate where they like. That is an absolute cop-out and the Government knows it. We need GPs and we need them now. There is far too much hand-wringing and whataboutery. There is political will on this side of the House to address the shortage of GPs and dentists, and to address the ridiculously long waiting lists.

I call on the Minister to do the right thing by accepting this motion and acting upon it.

At Letterkenny University Hospital today, there were ten ambulances backed up at the emergency department. There is an unprecedented crisis in that department in terms of staffing, with morale extremely low. This is the outcome of a build-up of failures, for far too many years, to invest in beds, nurses and doctors in the hospital. Letterkenny is the major acute hospital in Donegal and the sixth largest hospital in the State, with more than 23,000 inpatients every year. However, it is 13th or 14th in the country in terms of funding. It has been clear for many years that it has not received the budget it requires. There is a profound crisis of morale among staff. They go to work every day in what can only be described as heroic circumstances but they are tired of being called heroes. They need the backing of the State.

That crisis of morale feeds into the waiting list crisis. In Letterkenny alone, there are 21,500 men, women and children on the waiting lists. Adding Sligo would probably take that total to 25,000 or 26,000 people on waiting lists out of a population of 160,000, many of them for more than one year or two years. This crisis has been created out of years of neglect. In community hospitals in Donegal, one in four beds were cut in the past 15 years. Community hospital resources are being cut and major hospitals are not being resourced. The impact of that is what we see today, with ten ambulances backed up at Letterkenny and staff at crisis point. I ask the Minister again to visit Letterkenny University Hospital as soon as possible, speak to the unions, staff and management and make the intervention that is required.

I commend my colleague, Deputy Cullinane, on the work he is doing to highlight the dreadful situation whereby more than 1.3 million people are on waiting lists for some sort of health service. These people are waiting not for months but for years. I am inundated with queries from parents of children with disabilities or additional needs who are looking for assessment of needs or early intervention. The latter is key but it is not being provided.

A parent contacted me recently whose teenaged child has been called for a procedure four times since last April only for it to be cancelled on each occasion. In fact, on two occasions, he and his mother were at the hospital when they were told the procedure could not go ahead because the previous one had overrun. A man contacted me who has been in very poor health for three years. Having had gallstones removed approximately two years ago, he was told he needed his gallbladder removed but has not had a call-back from the hospital and cannot get any information. He has been left very unwell and with no end in sight. A woman told me she cannot sleep at night with the pain in her hands from carpal tunnel syndrome. She needs surgery but has been told she must wait anther four to six months, having already waited four and a half years. A person contacted me who cannot get a procedure done because there are insufficient anaesthetists in the hospital in question. Again, there is no date in sight for the procedure.

At Cavan General Hospital, there are almost 6,000 adults and more than 500 children waiting for outpatient appointments. There are more than 500 adults awaiting inpatient care, 20% of whom have been waiting in excess of 18 months. A total of 219 children are on the inpatient waiting list, with more than half of them waiting more than a year and 42% more than 18 months. The staff in the hospital are excellent but they are exhausted and overstretched. Many healthcare staff are opting to change career or to go abroad, where their pay and conditions are much better. This cannot be allowed to continue.

This debate is about waiting lists and the Minister will not be surprised that I am raising the situation at University Hospital Limerick. Today, unfortunately, an incredible 90 people were on trolleys there. Every day in February, there were 50-plus people on trolleys, which is a record number. The hospital, unfortunately, has broken records all through last month for having the highest number of patients on trolleys in any hospital in any month since records were established. The figures are truly shocking.

When the Minister visited the hospital recently, I called him out for not having spoken to the unions there. They were very disappointed he did not listen to what they had to say, rather than just listening to the management. I have visited the hospital on a number of occasions, including a recent visit with Deputy Cullinane during which we met senior clinicians, the CEO and others. It is under huge pressure from the numbers accessing it. It is the major hospital not just for Limerick but also Clare and north Tipperary, as well as people from north Kerry.

There are multiple reasons for the overcrowding at the hospital. Deputy Cullinane mentioned the issue of people having difficulties in getting access to GPs, which is something that is becoming increasingly problematic in Limerick city. In some cases, people are going to hospital when they do not need to because they cannot access a GP. That needs to be sorted out too.

Some of the promises made in respect of University Hospital Limerick will not be delivered for years, as the Minister well knows. The new 90-bed unit will, in fact, deliver only 48 beds and there has, as yet, been no full commitment to deliver the facility. Building has not commenced and some of the actions that need to be taken, such as moving out patients who are recovering but still need care, have not been done. There are, by and large, no step-down packages for those patients. Some 8,000 home care hours have been approved and assigned for people in the Limerick area but there are no staff to provide them. That is another problem.

This situation cannot continue. It would have been useful for the Minister to have met the unions when he visited the hospital. I encourage him to do so, even if it is by way of a Zoom meeting. We need accurate lists, with monthly updates published on the number of patients added to or removed from lists. This is necessary to ensure an integrated and collaborative healthcare system across primary, community and acute services at a regional level. We need to know exactly how many people are in hospitals, how many are waiting for treatment and how many cannot access a GP. We have all had people coming to our constituency offices to ask about children who are waiting many months for appointments with child psychologists for assessments, with no timeframe given. It is absolutely ridiculous that people have to come to their local Deputy to put in a parliamentary question to the Minister for Health in an effort to access basic health services that are urgently needed.

The longer the Minister waits to address these issues, the worse the outcome will be. We need to get our house in order. We cannot go on as we are and the situation at University Hospital Limerick, notwithstanding the really good job being done by staff in difficult circumstances, is shaming all of us.

I move amendment No. 2:

To delete all words after "That Dáil Éireann:" and substitute the following:

"notes that:

— as of end January 2022, there were 731,797 people on 'active' waiting lists for scheduled care services in hospitals, and 893,043 people on hospital waiting lists overall;

— the active waiting list figure of 731,797 includes people waiting for an appointment for their procedure or their first outpatient consultation, as follows:

— Inpatient Day Case: 77,818;

— Outpatient Day Case: 625,513; and

— gastrointestinal scopes: 28,466;

— the consolidated high-level figure of 893,043 includes the active list plus:

— patients under surveillance or receiving a course of treatments who have received their first treatment but will require further treatment;

— patients who have received an appointment for their procedure within the next six weeks;

— patients who are receiving treatment through an outsourcing or insourcing arrangement; and

— patients who temporarily cannot proceed with their care for clinical, personal or social reasons;

— the 2022 Waiting List Action Plan, which was launched on the 26th of February, allocates €350 million to the Health Service Executive (HSE) and the National Treatment Purchase Fund to reduce waiting lists by 18 per cent this year, which will bring the number of people waiting to their lowest point in five years;

— projections for 2022 show that over 1.5 million patients will be added to active waiting lists this year, that many people understandably stayed away from the health service during the Covid-19 pandemic and, as these people come forward for treatment, it will place huge additional demand on health services;

— under the 2022 Waiting List Action Plan, the health service will:

— deliver urgent additional capacity to treat 1.7 million people in 2022;

— introduce maximum wait time targets to ensure that the vast majority of patients do not have to wait more 12 months for any hospital procedure, or 18 months for an initial assessment, by the end of this year; and

— offer treatment to those waiting over six months for 15 high volume inpatient and day case procedures, including cataracts and hip and knee replacements;

— capacity continues to be built into the health service and this Government has allocated €21.7 billion to the health budget in 2022 (current and capital) – an extra €6.8 billion over the original allocation in the budget for 2018 – to enable the development of more capacity;

— permanent adult critical care capacity is now 301, up from a baseline of 255 beds in early 2020, an 18 per cent increase;

— new development funding enabled more than 800 permanent acute beds to open in 2021, and 347 additional acute beds are funded to open this year to bring capacity to 1,176;

— 51 of 96 new Community Health Networks have been established since 2021, with 1,700 staff either recruited or in advanced recruitment;

— there are 147 primary care centres open nationally (nine opened in 2021) with a further 24 to open in 2022;

— the general practitioners (GP) direct Access to Diagnostics scheme went live in January 2021 with over 138,000 radiology scans delivered and 17,000 radiology scans were completed in January 2022;

— despite the challenges of Covid-19, over 1 million patients/clients were seen across the main primary care therapies (speech and language therapy, occupational therapy, physiotherapy, psychology and dietetics) in 2021;

— specific measures have been developed to tackle waiting lists in primary care psychology, which has since enabled more than 1,600 additional young people to avail of the primary care psychology service and access necessary supports;

— the healthcare workforce has grown at the greatest rate ever in the history of the State in 2020 and 2021 with increases across all staff categories; the total number of HSE staff as at end 2021 was 132,323 whole-time equivalents (WTE); 2020 saw an increase of 6,357 WTE and 2021 an increase of 6,149 WTE – these are the largest and second largest annual increases in staffing since the foundation of the HSE; nursing and midwifery increased by 3,372 in 2020 and 2021;

— health and social care professionals increased by 2,225 in 2020 and 2021;

— medical and dental professionals increased by 1,256 in 2020 and 2021;

— patient and client care professionals, including healthcare assistants, home help professionals and paramedics, increased by 2,323;

— the Government has invested €195 million in 2022 alone to expand primary care capacity through the Enhanced Community Care programme, and some 3,500 new primary care staff will be recruited under the programme by year end, with 1,700 of these either recruited or in advanced recruitment as of early February;

— the number of Non-Consultant Hospital Doctors in formal training places has increased by 309 in the past year to 3,988, and by over 800 in the past four years;

— there are over 300 WTE consultants in post above December 2019 levels;

— the health service are recruiting the first ever Consultants in Public Health Medicine (CPHM) under the ambitious public health reform plan – 34 posts were advertised before end 2021 and it is intended that these will be recruited by mid-2022; by end 2023 all 84 intended CPHM positions should be filled;

— Budget 2022 secured funding for an additional 10,000 WTE;

— the Government has increased annual expenditure on general practice by 40 per cent since implementation of the 2019 GP Agreement, providing for increased fees to GPs and additional services, fully funded by the State, to patients;

— a comprehensive review of general practice, to ensure that it remains at the centre of the delivery of healthcare and can continue to provide services to all patients in their communities in a sustainable manner, will commence this year;

— the Government has supported increased funding for Information Communication Technology (ICT) by 50 per cent over the past two years; total investment in ICT and eHealth (capital plus revenue) is now €333 million, as compared to €222 million in 2019;

— capital funding is €130 million for 2022, an increase of €35 million since 2019, and revenue funding has increased significantly to facilitate the hiring of additional staff and expertise and to provide additional funding for cyber resilience;

— an additional 200 staff for the core ICT team at the HSE (Office of the Chief Information Officer) were hired in 2021 and funding has been provided to recruit a further 200 in 2022;

— work on the HSE's integrated financial management system, which is an extensive multiannual programme of work, is progressing;

— Individual Health Identifiers (IHIs) were deployed extensively during the Covid-19 vaccination programme, where they were used as the primary identifier for vaccination records, and there are plans to deploy IHIs more extensively in 2022;

— the Government is fully committed to the introduction of Regional Health Areas (RHAs) and had paused progression on the introduction of RHAs in mid-2021 for six months in light of the intense pressures experienced by the health service caused by the May 2021 cyberattack and the Covid-19 pandemic;

— the Government has since resumed work at pace on this health and social care system reform;

— the Government's introduction of RHAs will establish them as regional service delivery structures with appropriate devolution of corporate functions and responsibilities;

— RHAs will reduce management tiers in the health service by establishing them as single management structures across primary, community, and acute healthcare;

— this reduction in management tiers has already begun with the dissolution of hospital group boards at the end of 2021;

— RHAs will enable the integration of healthcare services across primary, community, and acute services on the agreed geographic basis;

— the work programme to implement RHAs will be comprehensive and will include reforms to the health and social care system's governance, finance, workforce and human resources, data and capital infrastructure structures;

— the implementation of RHAs is being informed by health and social care professionals via the ministerially established RHA Advisory Group;

— work is progressing to develop elective hospitals for planned care and operations in Cork, Galway and Dublin; in December 2021 the Government agreed, subject to the necessary approvals and requirements under the Public Spending Code being met, a new National Elective Ambulatory Care Strategy;

— the development of additional capacity will be provided through dedicated, standalone elective hospitals in Cork, Galway and Dublin;

— subject to the necessary approval processes under the Department of Public Expenditure and Reform's Public Spending Code, it is hoped to bring a detailed plan to Government in the second quarter of this year; and

— the development of elective hospitals will allow for as many as 940,000 patients to be seen/procedures carried out annually, including 175,500 in Galway and 180,000 in Cork;

acknowledges:

— the Publication of the Sláintecare Implementation Strategy and Action Plan 2021-2023 Progress Report 2021 which noted 200 of the 228 deliverables in 2021 were on track, or progressed with minor challenges; and

— the full embedding of the drive for universal healthcare across both the Department of Health and the HSE through the establishment of a new Programme Board, co-chaired by the Secretary-General of the Department of Health and the Chief Executive Officer of the HSE, reporting directly to the Minister for Health, and comprising the senior management teams of the Department and HSE; and

supports the continued reform of the health service; development of Regional Health Areas; and continued expansion of permanent capacity to meet the needs of patients."

Ba mhaith liom buíochas a ghabháil leis na Teachtaí Dála ar fad as a rún faoi liostaí feithimh. Tá an iomarca daoine ag feitheamh ró-fhada do chúram in Éirinn; fir, mná agus páistí timpeall na tíre san áireamh. Bhí siad ag feitheamh ró-fhada roimh Covid agus tá siad fós ag feitheamh ró-fhada. Tá sé mar thosaíocht agam agus ag an Rialtas go bhfuil fáil ag daoine ar chúram ceart in am.

I thank the Deputies for their motion on waiting lists. Too many people are waiting too long for care in Ireland. They were waiting too long before the Covid pandemic and they are waiting too long today. Providing people with timely access to care is a top priority for me and for the Government. The programme for Government commits to the introduction of universal healthcare, that is, a public health service that provides people with the care they need when they need it. Despite the challenges posed by Covid, we are delivering on that commitment and considerable progress has been made in modernising Ireland's health services and models of care.

The years 2020 and 2021 saw the two largest increases in the workforce since the HSE was established. We have also seen the biggest increases in hospital bed numbers, including acute ward and critical care beds. Last Friday, I launched our 2022 waiting list action plan, which builds on the success of the waiting list initiative in the final three months of last year. It is part of a new multi-year approach to making sure people can access care when they need it.

As Deputies opposite have rightly said, hundreds of thousands of adults are waiting too long for care. About 100,000 children and adolescents are also waiting too long for care. As I am sure my Dáil colleagues have, I have met and spoken to a lot of patients and families, including a lot of Mums and Dads of children. We all know these long waits cause enormous distress, pain and discomfort. We all have a responsibility to do better and that is why I decided to allocate an access to care fund of €350 million and why I established a waiting list task force to ensure delivery. As I said, the waiting list plan is supported by a dedicated fund for this year of €350 million. It has been developed with expert input from clinical leaders. The plan shows how the money will be used. We are not trying to reset to where we were before the pandemic, because before the pandemic our waiting lists were too long. We want to improve and transform access to care. The pandemic resulted in many people, understandably, not coming forward for the care they needed due to concerns about contracting the virus. Others were unable to access non-urgent care due to the pressures on our hospital system. As these people come forward, we are seeing and we will see an understandable additional demand on our health service.

Projections for this year are that a record 1.5 million patients will be added to active waiting lists this year. This is well in excess of the underlying capacity of the HSE to meet demand from its core activity. Without this €350 million access to care fund and the associated plan, the projections I have are that those actively waiting would go up from about 720,000 at the start of this year to over 1 million by the end of the year. The waiting list plan details how we intend to ensure that 1.7 million people are treated and removed from the waiting lists. The plan would see about 470,000 people taken off the lists. This would ensure that the numbers waiting do not increase this from 720,000 to over 1 million this year. It ensures that the numbers will fall from 720,000 to about 590,000, a fall of about 18% that would represent the lowest waiting list levels in five years. By the end of this year we aim to have treated or offered treatment to nearly all of the 75,000 patients currently on active inpatient or day case waiting lists. In other words this includes those scheduled for procedures. Every patient waiting more than six months for 15 high volume procedures will receive an offer of treatment by the National Treatment Purchase Fund, NTPF, and as the year goes on we will expand that list of 15 procedures. These 15 procedures currently include: cataracts; cystoscopies; hip replacements; knee replacements; skin lesions; varicose veins; angiograms; and tonsillectomies. Colleagues will be aware that the list is in the waiting list plan.

At the same time as ensuring much quicker access for procedures, we have to tackle the long waits for outpatient appointments. We are all contacted about this by constituents and as we know, some people are waiting years just to see a consultant. This is not acceptable so what are we doing about it? The waiting list action plan for this year seeks to ensure that by the end of the year, no one is waiting more than 18 months for an outpatient appointment. We have to go much further than that and ultimately the Government target is that no one should wait more than 12 weeks for a procedure and that no one should wait more than ten weeks for an outpatient appointment. However, it will take time and as was rightly said by Deputy Cullinane, there have been decades of underinvestment and years of missed opportunities to get this right.

Our work on waiting lists will be complemented by ongoing commitment and investment in building permanent capacity in the public health service to eradicate this gap between ongoing demand and what the HSE is able to supply year on year. This year the health service will receive €21.7 billion in net funding. On top of large levels of investment, we are doing everything in our power to make sure that we have even more clinicians on the front line. We are investing in more beds, equipment and technology, while reforming clinical pathways and providing care closer to the home. Since the start of 2020, over 12,500 full-time staff have been added to the workforce, as well as thousands of staff who were hired to run the vaccine and testing and tracing programmes. This is a 10% increase on the 2019 staffing levels. Substantial investment in the ongoing expansion of the healthcare workforce is in the budget for this year. As outlined in the programme for Government, the Government fully intends to implement regional health areas, RHAs, which will include reforms to the governance structure, financial management systems and strategic workforce planning across the country. As Deputies will be aware, at the end of last year I stood down the hospital group boards, which was a clear acknowledgement that the current structures are changing. I expect to be bringing a memorandum to Government for decision on RHAs in the near future. A detailed implementation plan is being put together by the Department and the HSE with input from a new RHA advisory group, led by Leo Kearns, and that group has started to meet.

Many countries face huge challenges with waiting lists since the pandemic and I have looked at some of the figures in neighbouring jurisdictions. In Northern Ireland, for example, there are significantly more people per capita waiting for an outpatient appointment than there are in the Republic. When it comes to inpatient and day case procedures, again adjusting for population there are about two and a half times more people waiting in Northern Ireland than there are in the Republic. The point is that the pandemic and the pressures have hit jurisdictions across the world and we are all having to deal with significant pressure. The challenges we are facing here are not unique but that is of no comfort to those who are waiting for care. The waiting list problem has been building for years and I am committed to deploying every resource and idea we can to fix that. No one has a monopoly of wisdom on how to fix this. I am interested to hear from Deputies across the House on the kind of initiatives that should be deployed nationally and locally. I know Deputies will have excellent ideas on the reforms, investment and targeted changes that need to be made in their constituencies.

The Mayo University Hospital waiting list increased by 162% from July 2015 to July 2021. It takes 712 days for people to get general surgery there. There are severe regional imbalances to be addressed. I have listened to what the Minister has said and one of those was about delivering care close to home. I ask the Minister to talk to the workers and managers who have been appointed to make the decisions because they are closing down every local service they possibly can, including Belmullet Community Hospital. We need some joined-up thinking. That is what they are doing and the Minister needs to go and see them and confront them. The Minister for Health needs to prevent this from happening. We have been fighting for Belmullet Community Hospital for years and its closure has the impact of people going to Mayo University Hospital, taking up beds there and trying to get treatment in the acute hospital there. There is a total lack of cohesion and integration between primary care, social care and acute care and that has to be addressed.

I commend the staff. I am conscious that every time we stand up here to speak, there are front-line workers who are absolutely exhausted and worn out. Many of them, in their droves, have told me they cannot take any more and will leave. They do not leave because they do not like the job they are doing but because they cannot stand it any longer. One will have that at all levels of front-line workers because there are not enough of them in it to do the jobs.

They do not have the equipment, more often than not. They do not have basic equipment to do their job. Consultants and surgeons are standing by and do not have the recovery beds to take the patient in or the equipment to do the job. This is disgraceful, given the money we put into the health service. It has to be addressed. Systems have to be there. Who is accountable? We cannot find who is accountable within the system. Nobody is accountable. Is my time up? I apologise. I did not cover half of what I wanted to cover.

Deputy Conway Walsh is very obliging. Bhí rud suimiúil i rith na géarchéime a bhí i CAMHS i gCiarraí agus i rith na géarchéime eile san ospidéal i dTrá Lí maidir leis na leithscéalta a bhí ag an Rialtas mar gheall ar na deacrachtaí a bhí aige le hearcaíocht. One of the curious things about the recent crisis in the child and adolescent mental health services, CAMHS, in Kerry and the ongoing difficulties in University Hospital Kerry has been the excuses about the difficulties faced in terms of recruitment. Bed needs staff and consultant vacancies are widespread say the Government. Why would people not come down if there was a salary of €200,000 on offer?

However, the new waiting list plan essentially amounts to repackaging much of the current difficulties, expenditure and measures. What are we to expect, if the investment and conditions do not improve? The CAMHS scandal, no more than the difficulties that other consultants face, is as a result of the inadequate resources and team and some consultants not even having an office. How does the Government expect to attract new consultants down to places such as Kerry when the necessary resources are not in place?

Worse than that, however, is how the Government claims to be trying to address the issues in the public system, tying one hand behind its back. There may be obstacles to the implementation of Sláintecare, but investment in the public system is the only way to overcome it, such as through directly-employed staff. What about the salary GPs mentioned in Sláintecare? There should be 200 of them throughout the country. I have not seen any of them so far.

Local government representatives, however, continue to advocate and back the private system over the public system. That does not help, either, and will only set up the health system to fail. The Minister asked about the ideas coming from here. Elective surgeries were postponed in Kerry for a period of six months. Most, but not all, of them have only recently come back. Hip and knee replacements are still outsourced to private hospitals. The Minister was looking for other ideas. The orthopaedic ward has not been done. The colposcopy unit still has not been made. The plans the five Kerry Deputies saw in a meeting last November 12 months are still on a desk in Dublin awaiting approval.

I saw what the Minister has said about all the new full-time staff being added to the workforce but the difficulty is that experienced nurses are leaving. I ask all the Deputies, especially Kerry Deputies, to back this plan, keep the job guarantees to health graduates, reduce the inequality in pay and remove private practice from public hospitals.

Waiting lists are completely out of control. They have reached the point of being dangerous and people are suffering because of the Government's failure. The lack of action on this issue is failing children, the elderly, families and those who work in our hospitals. The cost of this inaction is having a real impact on waiting times and people's lives. The Minister's latest plan will not put a dint in the numbers. If we have learned anything from previous plans, it is that its targets will be missed once again.

In my local hospital, Beaumont Hospital, more than 31,000 people are on hospital waiting lists. Nearly 7,000 of these people are waiting more than six months just to be seen. I think the Minister will agree this is totally unacceptable and ordinary people are paying the price. A constituent contacted my office yesterday who was recently in Beaumont Hospital's accident and emergency department. The constituent spent ten hours waiting to be seen. When he was seen, he was asked whether he had any health insurance. When he told them he had not, he was advised to get a loan to go private, which would cost him €7,000. The Minister will agree that says a lot about the state of our hospitals.

We all know the staff are doing their best but are being held back by decision-makers who cannot get their act together. This motion sets out what a Sinn Féin Minister would do to tackle this crisis and to give hope that things will change for the better. We need to see a proper plan which looks at why we cannot get the staff and how we can increase the training places. Healthcare workers are burnt out and cannot get a break. This needs to change.

At the end of January, the National Treatment Purchase Fund reported that there were 72,684 people on waiting lists in Cork hospitals. Almost 30,000 of those had been waiting more than one year for treatment. To be clear, these people are not waiting for minor treatments. They are waiting on life-changing and, in some cases, life-saving treatments. More than 100 people alone are waiting more than one year for cardiothoracic surgery in Cork University Hospital, CUH. People with heart and lung disease are desperately waiting for surgery to give them a chance at hope.

In the Mercy University Hospital, there are more than 900 people waiting for pain management. Anyone who suffers from chronic pain will say that without proper pain management, they are not living, but surviving. We are leaving people on these waiting lists for months and even years to waste their lives away because of the mismanagement by successive Governments of the health service.

Sinn Féin has a plan for healthcare in Cork. We will open a new elective hospital on the northside. We will not play politics with announcements of dates and locations and we will not break promise after promise on these announcements. We will build it and open it as quickly as possible. Sinn Féin and Deputy Cullinane have a vision that would make the health service an attractive place for people to work in order that we would continue to keep those skilled graduates working within the health service.

The Irish Nurses and Midwives Organisation, INMO, said in January that trolley figures were spiralling out of control in Cork. In February, it said that it was a dangerous situation. We are bringing forward solutions. I ask that the Minister takes them on board. Tá daoine ag fanacht le seirbhísí sláinte. It is time for change.

The Minister said earlier that we were here because of decades of underinvestment. Fianna Fáil and Fine Gael have been in power for those decades. The Taoiseach was the Minister for Health. The Tánaiste was the Minister of Health. Fianna Fáil has come in here to say it is the past but Fianna Fáil supported Fine Gael in confidence and supply for four years. It has been in government for two years. Here we are, six years later, in a worse position, outside of Covid. We were in a terrible condition before Covid. People are sick of excuses. They are sick of the blame game. They are sick of the Government not doing its job and the 900,000 people who are on waiting lists are just sick.

The Labour Party will support this motion. I commend Sinn Féin on providing the House with the opportunity to address this very important issue. Any Deputy working in any constituency office is acutely aware of the pressure that is building up now. The figures set out are truly shocking. While the Covid pandemic, understandably, dominated the health focus for the past two years, the general level of our health service waiting lists is truly depressing. I am glad the Minister has acknowledged this and wants to set it right.

We should, as a collective, see how we can bring easement to our constituents and all those people who are waiting for basic diagnostic appointments and treatment.

As I said, I know that the Department of Health produces plans. It likes to produce papers, strategies and targets, and does so very frequently. An integrated plan, however, to systematically and comprehensively reduce the numbers of people waiting for fundamental and basic diagnoses and treatment requires three basic things, that is, beds, expert staff - above all - and equipment. I am under no illusion about their being a magic wand. I know how difficult it is to put all those particular things in place. Medical specialists are scarce. They are sought all over the world and bidders for their skills will offer them, certainly in the private sector, salaries well beyond the scope of our public sector. There are very well-functioning health systems across Europe, however, that actually do not pay even the level of payment we pay here. We are in competition largely with English-speaking countries, but that is a fact.

Although pay is, of course, a significant factor, working conditions and work pressures are even greater factors that inhibit us being able to recruit the staff we require and that we can actually now pay for. In many ways, that is a catch-22 situation. We need the staff to make tolerable working conditions and we cannot make the working conditions tolerable without the staff.

We made a commitment collectively that things would change post Covid. We learned that we needed an integrated acute and community system of healthcare. We have talked about it for long enough. The views on how to achieve it were set out by all-party committee of the Houses when everybody involved genuinely put their shoulders to the wheel to produce the Sláintecare document. That needs to be done quickly, however. The number of people of all ages awaiting appointments to be seen by specialists and of those waiting to be diagnosed is enormous. It is an enormous challenge to our well-being as a people and in maintaining public confidence in our country's capacity to look after the health needs of our people. That is not overstating the fact. If people lose confidence, they think that no change of Government, with all due respect to Sinn Féin, can make a difference because everybody promises they will do the Devil and all. That is why we had a concerted effort to have an integrated plan that worked. In fairness, Deputy Shortall led that and we all bought into it. It now needs to be resourced and put in place, however, and if there are obstacles to it, let us hear about them and have them removed.

There is no Deputy in this House who does not constantly deal with people on various waiting lists. I want to focus on a couple of points. The lack of child and adolescent mental health services, CAMHS, clinicians has meant that at any given time, more than 3,000 children and young people are on a waiting list to be seen by a specialist.

The Minister of State will be very aware of the difficulties in our region in the south east. We might look specifically at children's disability services. I could pick any one of a dozen or more different focused services. The model set out by the HSE is to establish children's disability network teams. Some 91 children's disability networks have been established, each with an assigned children network team. They were required to provide services for children who need specific services up to the age of 18 years.

I requested the numbers of children awaiting treatment up to last October from the HSE, which it provided. There were 9,554 children waiting for psychology services, 14,619 waiting for occupational therapy, 8,166 for physiotherapy, which we hear about repeatedly, and 12,867 waiting for an initial assessment for speech and language therapy. Having been assessed, 8,438 children were waiting for initial treatment. Some 16,838 children were waiting for access to ophthalmology services and 8,457 were waiting for audiology services. These are individual children with specific requirements that are not being met. What have we done for this huge number of children, all with legitimate expectations of the State to support them and give them those services? I am told that since 2019, 285 development posts have been allocated to children's disability services by the HSE. Under the national service plan, 100 posts were provided in respect of children's disability services in 2019. I am always careful about language when I ask the HSE something. I have no idea whether the phrase "have been allocated" means that they are actually there or not. Another 100 posts were allocated in the service plan for 2021. I do not know what happened to 2020; no figures are mentioned for that. I am told that 85 posts for services in special schools were approved to mid-2021. Again, one of the problems when dealing with the HSE and trying to get at the figures and data is transparency. Posts were allocated and places were approved but there is no guarantee at all that those positions have been filled. Even if all those 285 positions over three years were filled, the number is wholly inadequate to meet the pent-up demand for those critical services that need to be provided at the appropriate time in a child's life. If that is missed, it cannot be caught up on later.

I am not sure if the practice that used to exist still does whereby all moneys allocated could be assigned to different functions. The HSE regarded it as a sort of blancmange of money and if there was a pressure point somewhere else, although the service plan said that X number of posts were going to particular functions, that is not necessarily how it transpired at the end of the year. Therefore, if you like, we vote it, the Department of Health negotiates it but actually the delivery of those might be a matter entirely for the HSE itself.

As I said at the outset, staff are but one of the essential requirements to address these issues. The Joint Committee on Health was told that operating theatres in our hospitals are functioning mostly on a nine-to-five basis. As expensive and valuable as it is, our diagnostic equipment is just not functioning as it should. In contrast to the private sector, it is often functioning a fraction all the time. I know this from when I went to have a scan on my knee with a private company. It was like a conveyor belt working virtually night and day, and certainly seven days a week. We do not utilise our equipment in the public hospitals in that fashion at all. Why is that the case? We need staff to do it but what is the point of providing very expensive equipment if it is not functioning on the same basis that the same type of equipment in the private sector would be expected to function? Have we no expectation of that in the private sector?

Many years ago, I started the very first waiting list initiative that provided what is now a laughably small amount of money - £20 million - to the public hospitals to bid for additional procedures such as hip replacements or whatever needed to be done, and it worked. That was hijacked into the National Treatment Purchase Fund, which basically privatised public medicine. We need to ensure that we resource the public service. In the interim, I suggest that the Minister looks at an old-fashioned waiting list initiative to provide money to get better value out of the infrastructure we paid for.

I commend Deputy Cullinane on the motion he has brought before the House. It is certainly comprehensive. It puts in context the scale of the problems that we are dealing with in our health service. It describes those problems well. The Minister described the problems well also. The difference, of course, is that the Minister is in a position to do something about them. Much of the time we hear commentary from the Minister on the problems in the health service. What are all looking for is action. We are looking for action on the basis of a sustainable approach to tackling the nature of the problem.

The Minister’s recent announcement of €350 million for a waiting list initiative brought to my mind something that happened more than ten years ago. The then Minister introduced a waiting list initiative. Consultants were brought in from outside. Health system consultants were advising on it. I gather that some of those people have been brought in again to advise on some of this. What it boils down to is that the Minister is getting a big pot of money and throwing that money at the health service. Yes, we will get results from that. Additional operations will be carried out. For those people who benefit from that, it will be great. However, it will not do anything at all to reform the system. Not only that, this kind of initiative is about buying services, putting them into the National Treatment Purchase Fund, putting a lot of the money into private sector healthcare and putting some of it into what is referred to as overtime for consultants who are already working long hours. That does not seem to make a lot of sense. That approach of throwing money at the problem actually delays the kind of reform that is required in order to make our health service function properly. As a result, what is proposed is very much a stopgap. While we will get immediate results, once the money stops, the additional operations will stop as well. The Minister might look back to ten or 12 years and see what the experience was like then, because it was not good. I see this as a repeat of that.

A statement was made to the effect that the aim is to ensure that nobody is waiting for an outpatient appointment for more than 18 months. That is pretty shocking. For somebody with a serious health condition to be told “We guarantee that you will not have to wait more than 18 months” is just not acceptable. That is light years away from the kind of waiting time limits that are set out in Sláintecare. The Minister has a clear plan. The solution to this is to implement the reforms that are contained in that plan. While he talks about those a lot, he actually is not doing a huge amount about implementing them. I have to refer to the mistake that was made last year. It was a very serious mistake and I think we will pay a big price for it. That was the circumstances that led to the resignations of people who were leading this Sláintecare reform programme. The original plan was that the Sláintecare implementation office would be entirely stand-alone. It would have its own separate budget. That was what happened initially. Of course, the recommendation was that that stand-alone office would be located within the Department of the Taoiseach. This was so that it would have the clout of the Taoiseach and his Department to ensure that roadblocks were cleared. That is what happened with the cancer strategy, which was very successful. Unfortunately, it was not located in the Taoiseach’s office, but in the Department of Health. However, we still had confidence that this could deliver. It was delivering. It was making substantial progress until things stalled in respect of some key elements of Sláintecare. That, as the Minister knows, resulted in the highly regarded Tom Keane and the equally highly regarded Laura Magahy moving on.

The Minister chose to replace that independent, separate, single-focus office with a board led by the Secretary General of the Department and the chief executive of the HSE. In my view, that was a serious mistake. These are two people who have high-profile, high-pressure jobs. They operate on the basis that they deal with the emergencies that arise on a daily basis. They have little time to devote to a reform programme. A reform programme has to be independently, separately driven. I think we are going to lose out badly as a result of that. Those two individuals recently appeared before the Joint Committee on Health. The committee was seeking an update on the reform programme. Unfortunately, we were disappointed to the extent that the Secretary General, Mr. Watt, indicated that he did not understand one of the central recommendations of Sláintecare, namely, the regional plan. He talked about the community services coming under the remit of the hospital groups. That was just last September. The Minister just spoke about standing down hospital groups. That indicates that there is not a great understanding of what is involved.

It is not just me who is saying this. It is important that we look at the Department’s Sláintecare strategic action plan progress report. That is across the two key programmes in Sláintecare. It is worth going down through the progress report from the Department. It rates various measures as improving, disimproving or trending same. The project on enhanced community care and hospital productivity are both disimproving. This information is based on the last six months of 2021. A large part of that period was when the Sláintecare office ceased to exist and the two leaders to whom I referred earlier left.

The project to streamline care pathways. from prevention to discharge is listed disimproving. The project to develop elective centres in Dublin, Cork and Galway is an essential part of Sláintecare because, as Deputy Howlin just said, we have a lot to learn from the private sector in terms of efficiency and specialisation. Some of the clinics, such as the Sports Surgery Clinic in Santry and others throughout the country, specialise in particular aspects of healthcare and do not have emergency departments. It is a kind of conveyor-belt system. It is highly efficient. That is why a key element of Sláintecare was to recommend three elective-only hospitals. We learned from the experience in Scotland where it has been very successful. They took over a private hospital and are building a second one. That is what we recommended. The position in that regard is actually disimproving. Progress should have been made. We were told that the locations for the three proposed hospitals had been identified and that they were to be announced a number of months ago. We are still waiting to hear about those locations. The position has disimproved.

The project to implement a multi-annual waiting lists reduction plan has disimproved. The project to implement the eHealth programme has also disimproved. What I am referring to are the Department's grades in respect of these different measures. The project to remove private care from public hospitals and implement the Sláintecare consultant contract is disimproving. In addition, the project to develop policy proposal and options for achieving universal eligibility across hospitals and community settings is disimproving. Several other areas have remained the same. Progress was not being made at all in the latter half of 2021.

The Minister needs to take responsibility for all of this. It would seem that Sláintecare has stalled. In spite of the claims he made earlier, the Department is bearing out what I am saying in its progress report. The overriding issue that the Minister has to now deal with is the recruitment issue, particularly of consultants. None of the plans that the Minister has set out in the waiting list initiative will work unless he recruits consultants. He needs to implement the Sláintecare consultant contract. Last October, he said he wanted that done within a matter of weeks. We are still waiting for it to happen. The Minister needs to appoint a new chair for those talks because the previous chair moved on to other duties last month.

We still have not appointed someone to replace that chairperson.

The Minister talked about the need to find out why we cannot recruit consultants. I refer him to the hospital doctor retention and motivation project funded by the Health Research Board, HRB, which is almost complete. Will he please read that research? I will send him the reference. The project sets out clearly the reasons we cannot attract Irish-trained consultants back home. Unless we crack that nut, we will not make any progress.

Táimid buíoch do Shinn Féin as an rún seo a thabhairt agus beimid ag tacú leis. We thank Sinn Féin for bringing forward the motion, which we will support. Ireland's health service is an underfunded shambles by design, held together by the superhuman efforts of undervalued and underpaid health workers who have been pushed to their limit. Every aspect of healthcare is beset by large waiting lists, and the Sinn Féin motion sets out the overall numbers clearly. We should remind ourselves that every one of those numbers represents somebody who needs care. These people are waiting for treatment that would be life changing were they to receive it. Some people, such as the 649 children awaiting orthopaedic surgery who were highlighted recently, are waiting so long that their condition may become inoperable, and often they are condemned to live a life unnecessarily blighted by illness and pain. The spina bifida paediatric advocacy group has reported that 56 children have been waiting between one and four years for orthopaedic surgery to correct the condition, which can cause paralysis of the legs, often accompanied by hydrocephalus, or water on the brain. We all heard recently of large waiting lists for CAMHS and how understaffing leads to the inappropriate medicating of children.

Earlier today, some of our members attended the Patients Deserve Better campaign, which was launched to advocate for the provision of additional neurological nurses to deal with what was described at the launch as a critical resource issue. The campaign set out why the Government needs to recruit an additional 100 neurological nurses to bring the national number to the recommended figure of 142. Apparently, 800,000 people - a shockingly high number - in Ireland live with neurological conditions. They are people with multiple sclerosis, muscular dystrophy, epilepsy and other, less serious conditions. The campaigners outlined how close to 24,000 people are on the public waiting list for neurological outpatient care, 8,600 of whom have been waiting for more than 18 months. Recruitment of additional neurological nurses is required to reduce the current waiting lists. According to the Neurological Alliance of Ireland, Dublin alone needs 57 additional nurses. St. James's Hospital, for example, has four neurological nurses and needs 14, a shortfall of ten; Tallaght hospital has 3.5 nurses and needs 20, a shortfall of almost 17. We fully support the Patients Deserve Better campaign and call on the Government to urgently recruit the additional 100 neurological nurses who are needed. Neurological nurses play a crucial clinical role in providing advice, counselling and educational support. A speaker at the launch indicated how one neurological nurse in her hospital is not available for public patients.

This brings me to one my main points, regarding the question of public ownership of our healthcare system. The Minister did not use the word "Sláintecare" once. It is as though the strategy has gone out of circulation and into the history books. One of the main problems facing our public health service relates to the existence, in a large way, of private practice in public hospitals, and of so many private hospitals and services. At every turn, public moneys are drained off by private interests, and this is central to the dysfunction and lack of resources facing the HSE and the public healthcare system. We saw it starkly during the height of the Covid crisis, when millions of euro was paid out to take the private hospital capacity into public control, but as soon as we were out of the woods, it was handed right back, leaving us short by millions of euro that had been put into the private healthcare system.

We have a very low hospital bed number per capita by international standards, as well as a very low number of ICU beds. The lack of capacity in our public healthcare system is one of the main reasons we have such enormous waiting lists, as are detailed in the motion. The Irish Hospital Consultants Association has called for 6,000 additional public hospital beds and 4,500 community step-down and rehabilitation beds to alleviate pressure on the system. The Irish Nurses and Midwives Organisation recently stated that the health service is rapidly returning to the bad old days of overcrowding in every aspect. Those who can afford to do so avail of private hospitals to access the care they need, while those who are dependent on the public service continue to join the waiting lists and wait ever longer. I am reminded of the famous Joan Baez song, recorded in the 1960s and giving voice to poor communities in the US, in which she sang, "If living were a thing that money could buy, you know the rich would live and the poor would die”. In our healthcare system, that often happens, but there is no doubt poorer people suffer more.

We believe it is time for private hospitals to be taken into public ownership to add to the capacity we urgently need in the public healthcare system. If evidence were needed of a lack of commitment to even grappling with that problem, it is to be found in the future of the national children's hospital and the proposed new national maternity hospital. The former is being built with more than a dozen private suites, allowing private medicine to flourish within the hospital, while the latter is being built in the ownership of a private company. That is why I intend to move the amendment People Before Profit has tabled, wherein we call on the Government to take all hospital capacity and private organisations currently delivering healthcare and social care into public ownership as part of a single-tier national health service. This, coupled with the removal of private practice from public hospitals, would give us that single-tier, entirely public system, free at the point of need, at the core of a new national health service, which we so badly need.

Glaoimid ar an Rialtas gach ospidéal príobháideach a chur faoi úinéireacht phoiblí.

I hereby move the amendment.

The Deputy may not move an amendment until the Minister's amendment has been disposed of. In the event that his amendment is defeated, the Deputy will have an opportunity to move her amendment.

There are 436 children awaiting physiotherapy appointments in County Galway, some of whom have been waiting 176 weeks for such appointments. There are 95 children awaiting these appointments in County Roscommon. On speech and language waiting lists, 971 children were awaiting initial assessment in County Galway at the end of January, with an average waiting time of six months, and 119 children in County Roscommon are awaiting initial assessment. With regard to the waiting lists for occupational therapy, 103 children in County Roscommon have been awaiting assessment for up to 18 months. In County Galway, there are 384 children on that waiting list.

The waiting lists in the two counties were appalling even before Covid-19. In March 2020, the Galway-Roscommon autism spectrum disorder service had one child on its waiting list for intervention support for six years, with a further 54 children waiting four years for that intervention support. In fact, a total of 361 children were on that waiting list, not including 81 referrals. It was so chaotic in HSE West that it committed in March 2020 to reconfiguring the Galway-Roscommon autism service, which parents had been complaining about for years. It might have seemed that Covid-19 would provide the ideal opportunity for this reconfiguration to take place. Instead, those staff were sent to answer phones in contact tracing centres.

In September 2020, I highlighted the issue of staff in HSE West being redeployed to do contact tracing on the floor of the House. I raised the matter with the Taoiseach, the Minister for Education and the Minister for Children, Equality, Disability, Integration and Youth and tabled a Topical Issue matter on it to the Minister for Health, Deputy Stephen Donnelly, which was answered by the Minister of State, Deputy Feighan. On each occasion, shoulders were shrugged and we just moved along. Throughout 2020, nothing was done, either for the children in question or on the reconfiguration. We had to wait until 11 October 2021 for the Galway-Roscommon service to be reconfigured and to become operational and until 10 January of this year for the same to happen in County Mayo. We should have started to see progress on foot of that but that did not happen.

We are now moving to the new progressing disability services national reconfiguration and I do not see any progress. The children's disability network teams have been established. More than 200 staff have been configured into nine children's disability network teams across HSE West but that reconfiguration, as I say, is still ongoing. Today, the HSE cannot say when children who have been referred to the expert service can expect to start receiving appointments.

So frustrated was I with this reconfiguration after reconfiguration that I sought a briefing from HSE West last December, which, it was promised, would take place in January but we did not get one. When we sought it again last month we were told we would get a briefing early this month. None has been held as of yet and we still do not know what is going on.

The difficulty is children are being let down as a result of this. For example, John, who is three years of age and has autism and an early developmental delay, was referred to the Roscommon early intervention service in June 2020. He has still not been seen 18 months later. That is not progression.

What is really frustrating is that, as bad and all as it was, and we had a lot of complaints about the service across Galway-Roscommon, the Roscommon early intervention service was excellent. People were proud of it and it was responsive. That service has been washed into the broader mass now and children are being left high and dry.

I thank Sinn Féin for bringing forward this motion and giving me the opportunity to speak.

Despite all of the billions of euro spent year after year on the health service, the waiting list problem is getting worse. In a speech on the Appropriation Bill in December last, I highlighted the degree to which our spending on health has increased over the past six years. In 2016, it stood at €13.6 billion and in 2021, it was €21.7 billion, an increase of €8.1 billion in the period. I will ask the same question I asked in December. What do we really have to show for it? We have waiting lists getting longer, a crisis in the GP sector, orthodontic waiting lists that are off the charts, mental health services that are still understaffed and many other issues. The recent Business Post coverage should also serve as an eye-opener to the horror of the waste that exists in the HSE. The health service is not being underfunded but funding is clearly not being used in the most efficient and effective way.

When it comes to agonising stories of waiting lists, I am sure every Deputy in the House has received a plea from a person on a waiting list asking if anything can be done to shorten his or her waiting time. In many cases, these are people with serious health issues who are often in serious and debilitating pain.

Some of the stories I have heard from constituents would create a sense of anger at the ordeal many of them are forced to endure when faced with illness. Only three months ago, the Wexford People newspaper carried the story of a woman who lodged an official complaint with the HSE after being told she would have to wait 15 months to explore a heart issue. This was not a 15-month wait for a complex operation but to be fitted with a heart monitor. It is 15 months of worry, anguish, anxiety and stress.

This time last year, it was reported that waiting lists in Wexford General Hospital had increased by 69% from January 2020 to January 2021. Wexford has been impacted hard by Covid-19. There was an obsession about Covid to the detriment of those who needed timely treatment for other issues. We do not yet have the true figures for the increased waiting times for the year from January 2021 to date.

The old saying, "A stitch in time saves nine", is apt when it comes to the importance of reducing and getting rid of waiting lists. People waiting for important treatment may develop other problems as a consequence of not receiving timely treatment for their initial ailment. From a health service point of view, surely it is more efficient to provide the first stitch when it is needed and not months, or even years, later.

The 2022 waiting list action plan aims to reduce the numbers on waiting lists from 720,000 to 587,000 but we need to focus efforts on prevention. Prevention starts by identifying how a country with a population of 5 million has ended up with 720,000 people on waiting lists.

We have two main issues, namely, human resources and physical resources. From a physical resources point of view, we obviously have a limited number of specialist theatres and limited equipment and space within the hospitals but from a human resources point of view, it is a clear case of too many chiefs and not enough Indians. There are umpteen positions currently advertised in the health service and I have almost lost count of the number of times I have raised issues with staffing levels in child and adolescent mental health services, CAMHS, in County Wexford. At the same time, we are constantly hearing about general understaffing within the health service.

With both of these resourcing issues, how have we suddenly arrived at a position where the Government can reduce waiting lists by 130,000 over the next ten months with current resources? If this is achievable, how did we end up with so many people on these waiting lists in the first place? I read with interest a few days ago an article in the Irish Independent under the headline "€350m plan to tackle waiting lists as hospital theatres lie ‘idle’ after 5pm despite surgeons willing to operate". I am sure the vast majority of the 720,000 people on waiting lists would take an appointment at any time of the day or night to help solve their problem.

If this plan is successful in gradually reducing waiting lists, we need to ensure we do not return to this position in the next ten or 15 years. I hope the plan is successful and brings faster treatments for the thousands of people who badly need them. If not, it might be time to look at the top-heavy chiefs in the system, consider cancelling some of the wellness conference trips and get to work on dealing with the crisis.

I wish to share time with Deputy Danny Healy-Rae.

I am delighted to speak on this motion and I thank Sinn Féin for tabling it. We have had a waiting list crisis in this country for as many years as I have been in the Dáil and long before that. The stress this is causing staff in hospitals is beyond words. I see at first hand the crisis in accident and emergency in Cork University Hospital, CUH, when I visit. I often wonder how staff work in such conditions. Much of the pressure could be avoided if facilities in hospitals, such as Bantry General Hospital and Mallow General Hospital, were up to standard.

Consider what happened in Bantry hospital last summer when we went for up to three weeks without a consultant. That was down to incompetence because the issue was flagged well in advance. There is not a chance that would have been allowed to happen in the capital but the person in management in the HSE who thought the people of west Cork would sit on our hands and accept being treated like second-class citizens was wrong. Management played games with people's lives but thanks to the great people of Bantry and its surrounds who protested on the streets after waiting weeks for the doors to be opened, consultants were then found and Bantry was back in business a few days later. Let me assure the people of Bantry hospital catchment area, from Dursey Island, Sheep's Head and Mizen Head to Bandon and Innishannon and down to Clonakilty and Kinsale, I will keep this and every Government on their toes every day while I am elected to represent them to provide the best service they can possibly give to Bantry General Hospital.

Bantry hospital has top staff who deserve to be provided with the best facilities, similar to those in other hospitals.

So help me God, if we do not. Simply put, there will be hell to pay. To help alleviate pressure in CUH, the Minister must invest in Bantry General Hospital and deliver an endoscopy unit, a physiotherapy unit, a cataract theatre and a five-day working surgery unit. The people of west Cork deserve no less.

Investment must be made in hospitals like Bantry. In 2017, the then Minister for Health, Deputy Harris, arrived in Bantry and announced with great fanfare that the endoscopy unit was to be built but five years on, in 2022, not a sod has been turned on the project. If it was built on announcements by politicians, we would have had an endoscopy unit in every town and village in west Cork. It is nearly embarrassing to hear year after year that this endoscopy unit will be built. We should be in a situation where an announcement in 2017 means completion no later than 2019. This would see better services on the ground and stop politicians falling over each other announcing something announced five years previously.

Waiting lists are shocking in this country. Like other Members, I have people queuing in my clinics pleading to get them an appointment. From what I see, the queues are getting bigger. Deputy Danny Healy-Rae and I have taken 84 buses to Kingsbridge Private Hospital in Belfast so people in their 70s, 80s and 90s could get urgent cataract surgery, a 25-minute procedure. The Government showed no respect to the people of west Cork, Cork city and Kerry. It left them on a waiting list for five or six years and if they were unlucky, let them go blind.

Where is the money going? It is time to come clean. The top brass in the HSE are getting better than a couple's wages in most homes in expenses alone and there is no accountability. It is astonishing. They get a top-up bonus of another €50,000 or €100,000 whenever they want. What has the Minister done any different to his predecessor, Deputy Harris, in whom I tabled a vote of no confidence due to his handling of the health crisis at that time, which toppled the Government? He will be lucky if the same is not done with him. Due to Covid and now the war in Ukraine, the eye will be off the ball in this country. While the eye is off the ball, people will suffer. We must change our model of hospital care. We must look at the private hospital model. They are open and working the full seven days and nights of the week. We cannot be in a situation that a hospital almost closes down on a Friday evening until Monday morning. We cannot have people waiting for surgery that cannot have it as the clock strikes five in the evening. We must look at the private model in hospitals such as the Kingsbridge in Belfast and probably plenty of others that operate on a 24-7 basis. That way, things will get done.

While I have the floor, I wish to raise Clonakilty Community Hospital. Perhaps the Minister will have an opportunity to inform me when the funding will be made available to bring the hospital up to HIQA standards. We have been told year in, year out that the hospital is not up to standard. It is a beautiful hospital, but it is still not up to the standard set by a previous Government. I do not have anything negative to say about hospitals like the ones in Schull and Bandon. They are fabulous community hospitals, and Clonakilty deserves the same as other hospitals.

I thank Sinn Féin for bringing this debate to the floor of the Dáil tonight, as it is very important and urgent. The HSE system is failing many sick and vulnerable people all over the country, young and old. Starting with older people in University Hospital Kerry in Tralee where people have been waiting on trolleys for anything up to two or three days in recent months. I refer to people over 80 years, including some who are 90. These men and women have given their lives to rearing families and working all their lives for their families, their communities and their country. They have got us to where we are today, and they are being badly let down.

We do not have enough GPs. Young and old who develop medical problems have to wait for as much as a week before they can be seen by a GP. This is not good enough. Patients have to wait months for MRIs, scans or X-rays. That is not acceptable. In the case of cancer, the disease may have progressed to another stage, making a successful outcome less achievable. Why can we not ensure that machines are kept working 24-7, like in the North of Ireland, for instance?

I thank the nurses, doctors and all the front-line staff who worked so hard, especially in the past two years with the coronavirus. They worked in terrible conditions and had to contend with staff shortages and expose themselves to contracting the virus.

We see what has happened with the CAMHS debacle in south Kerry where the HSE has failed to hire a senior consultant psychiatrist since 2016 and senior management failed to monitor what was going on for five years and the interventions meted out have permanently damaged the health of many. This is criminal. There is an urgent need to recruit psychologists to deal with children at an early age to prevent their mental health being damaged.

I firmly believe that abolishing the regional health boards was a major mistake, since the boards ensured that accountability was provided by departmental officials to elected members and senior consultants and doctors who ensured that a respectable level of service was in place for the sick and vulnerable. The Taoiseach has added to his CV that he is proud of getting rid of the regional health boards. He needs to look at that again.

I am pleased that Deputy Michael Collins from west Cork and I have successfully operated a cross-Border system for people who would have had to wait for three or four years to get their cataract removed and the same for hips and knees. To date, 84 buses have travelled to the North with the 84th bus going last Friday. One of the first patients on the first bus told me that his grandfather's cataract was removed in St. Catherine's Hospital in Tralee in 1986. That proves that it is backwards that we are going and not improving. The Minister must listen to that.

The HSE has totally let down boys and girls affected by scoliosis and spina bifida whose little spines are going out of shape more each day. The Taoiseach said he allocated €5.2 million, yet those who cannot afford to go abroad are still waiting and getting worse each day. That is not good enough. The Taoiseach will not say who is responsible, but Cappagh Hospital says it has consultants available to carry out the procedures.

I will give one example about the regional health boards that are so important. In 1986, the Department of Health proposed that six of the district hospitals in the Southern Health Board region would be closed. It was hell-bent on doing it, but lo and behold, wherever he is today, he is dead, but Jackie Healy-Rae was chairman of the Southern Health Board and he and the other elected members stopped the health board and the then Minister, Dr. Rory O'Hanlon, from doing that at the time. We have a new hospital in Kenmare today that is stretched to the limit, but we do not have all the beds open there. We need to open the beds. At least when elected people were responsible for deciding what was needed in an area, whether it was community care, a district hospital, if a public health nurse or doctor was needed or whatever else, those matters were dealt with in a progressive manner at the time. Now, there is no accountability at all from the HSE for what it is doing. It is a monster that has gone out of control, not the staff, doctors or nurses working in it, but the management. They are out of order. They are responsible to no one. We must give them as much as they want, be it €400,000 or €500,000 a year, but the people are suffering.

I support the motion. I congratulate Sinn Féin on bringing it forward on the basis that it clearly outlines the scale of the ongoing and increasing crisis in the public healthcare system. It also clearly identifies the fault lines in the latest announcement of yet another plan to tackle waiting lists.

We have to ask why we have these outrageous waiting lists in the first place. To my mind, the answer is very simple. It is a two-tier service which offers access to those who have private health insurance, and not just access to private healthcare facilities but also to our public hospitals. Those who are above the limit for a medical card or do not have the means for private insurance are left in limbo. I note that this latest plan will have only a limited, if any, effect on the lists. Of the €350 million budgeted, €200 million will be used for the National Treatment Purchase Fund or, in other words, almost 50% of the money provided by the State will be spent in private medical facilities. As long as we maintain the two-tier system, with chronic underfunding of the public sector patched up with occasional sticking plasters from the private sector, we will have an ongoing waiting list crisis. I agree with the spirit of the amendment from People Before Profit but, of course, to move from what we have now to a single-tier service will be a transition that needs to be well planned, properly funded and resourced and carried out over time.

I also attended a webinar today organised by the Neurological Alliance of Ireland, NAI. It dealt specifically with the crisis in the Dublin hospitals, which have 28 neurological nurses when they need 85. That is a shortfall of 57 nurses to care for the people in Dublin South-Central who are living with a neurological condition. St. James's Hospital needs 14 and it only has four, so it is short ten nurses, and similar numbers were given for hospitals all over the city. There are 23,979 people waiting for neurological outpatient appointments, with 8,601 waiting more than 18 months.

It is said that neurological nurses make clinics 40% more efficient. Increasing the number of these nurses would ensure that people with neurological conditions have improved access to healthcare supports and would reduce the time they are waiting for appointments. Patients who have access to nurses have reported improved psychological well-being and an improved sense of involvement in their care, and they are more prepared for tests and investigations. Their knowledge of their condition and related issues increases and they have more confidence to self-manage their condition. To have more neurological nurses will also ensure that patients get quicker access to outpatient appointments, thereby reducing waiting lists and ensuring that any deterioration in the patient's health status can be mitigated. This will also ensure that additional hospital resources can be focused on those who need it. The NAI will be coming back again with regard to national waiting lists and what is needed at national level.

I was contacted by a constituent who attends the long Covid clinic in St. James's Hospital, which has been advised it will lose its occupational therapist for long Covid care. I contacted the hospital to ask whether this was the case because the occupational therapist there has provided a fantastic service to people with long Covid in regard to their limbs, fatigue and so on. The reply was that, in the past month, St. James's Hospital has received confirmation from T. J. Dunford, primary care, national community operations, of permanent funding resourcing for the post-acute Covid clinic programme, and occupational therapy, OT, has not been resourced. It awaits confirmation of permanent resourcing for the long Covid clinic and this is expected imminently. There are concerns that OT was not included in the HSE’s draft long Covid model of care in June 2021, although this may change in the final version. I want a commitment from the Minister that this will be changed in the final version in the second quarter of the year. OT is an integral part of any therapy in regard to long Covid services.

My final point concerns Sláintecare, which is not perfect and does not deal with section 38 and section 39 bodies, which means the State is fully funding what are in reality private hospitals, nursing homes and other healthcare groups. Sláintecare would be a good start in reforming the system and that is why I want to refer to the situation in regard to the new national maternity hospital. For me, this is a crunch issue. A private healthcare group, St. Vincent's, is demanding an operating licence for a €1 billion new hospital to be built by the State and fully funded and operated by the State. I cannot think of any other country where this could even be contemplated, yet it is becoming increasingly clear that the Government will possibly cave in and agree to the demands of St. Vincent's Holdings and, behind it, the Sisters of Charity, the Vatican and the Irish Catholic bishops. If this happens, it will be the death knell of any meaningful reform of healthcare, the killing off of Sláintecare and goodbye to any vision of a single-tier public health service funded by the State and controlled by the State, that is secular and provides all services allowed by the law and free for all at the point of use.

I thank Deputies for the opportunity to speak to some of the key issues and to address some of the points made in the course of this debate. The 2022 waiting list action plan is delivering targeted investment of €350 million to get many more people treated as quickly as possible. At the same time, we are reforming and investing in our public health service to eradicate the gap between demand and permanent capacity. As the Minister, Deputy Stephen Donnelly, said earlier, we are not trying to reset to where we were before the pandemic, when our waiting lists were unacceptably high. We want to improve and transform access to elective care.

I am particularly pleased the plan provides for a dedicated €5.5 million to significantly reduce the number of children and young people under 18 waiting to avail of these vital services. This will build on the €4 million initiative that I launched last August to tackle these challenging waiting lists, which has since enabled more than 1,600 young people to avail of the primary care psychology service and access necessary supports.

The additional investment will enhance the capacity of primary care psychology services, placing them on a more sustainable footing over the longer term. This investment will allow recruitment of additional psychologists, psychology assistants and counsellors to provide supports to those who need them most, as early as possible. I have set a target of a further 3,300 children and young people to be seen by the service and removed from the waiting list as these new staff come onboard during 2022. I was also very pleased to secure the allocation under the plan of a further €1.3 million for counselling in primary care and €9.1 million to support priority community areas, including child and adolescent mental health services, autism and other areas.

All of the 45 actions outlined in our waiting list action plan will make a huge difference. We plan to bring the number of patients on active waiting lists to its lowest point in five years. We will also introduce maximum waiting time targets to ensure that many people who have already been waiting too long will finally receive their hospital procedure or initial assessment by the end of the year. We had 75,000 patients on active inpatient and day case waiting lists at the end of 2021. We aim to have treated all, or almost all, of those patients by the end of 2022.

While our targets are ambitious, we need to be honest about what is achievable in the coming months. Our waiting list crisis has been building up for very many years and there are no instant fixes. Our waiting lists are unacceptable but we will overcome this challenge too, and deliver immediate and long-lasting improvements for our healthcare professionals and patients of the future.

I am aware of the concerns raised around recruitment but we must be ambitious, and I will not apologise for that. We have funded the recruitment of 10,000 staff this year but it is a challenging recruitment environment. As the HSE chief executive outlined recently, it will be doing everything it can to achieve that. He also outlined that the HSE had 675 net recruits in January of this year, which is a good start. To ensure ambitious recruitment targets are being achieved to the greatest extent possible in 2022, the HSE has adopted various measures. This includes expanding international recruitment frameworks with specified targeted recruitment approaches; broadening domestic recruitment markets by working with the Department of Enterprise, Trade and Employment, education bodies and training boards; and improving the efficiency of the recruitment process by greater use of technology.

All units within our Department are now responsible for driving universal healthcare and Sláintecare reform while individual members of the Department’s management board at deputy secretary and assistant secretary level are directly pushing the Sláintecare Implementation Strategy and Action Plan 2021-2023. They are in turn reporting progress to the programme board.

I would like to highlight some other progress made in 2021 that is continuing at pace. In December last year, the Government approved our national elective ambulatory care strategy which will change the way in which scheduled procedures, surgeries, scans and outpatient services can be better arranged to ensure greater capacity in the future and help to address waiting lists. The development of scheduled procedure or outpatient capacity will be provided through dedicated, stand-alone elective hospitals in Cork, Galway and Dublin. These elective hospitals will provide coverage for 60% to 70% of the overall population, catering for up to 940,000 procedures annually, including 180,000 in Cork and 175,000 in Galway.

These new facilities will be of a size and scale to implement an elective care programme that will tackle waiting lists on a national basis. This means that the new facilities will be designed to maximise their capacity and in doing so will operate to cover as wide a catchment area as possible, extending beyond existing and future health areas. Subject to approval processes under the public spending code, detailed plans for these could be brought to Government before the end of June.

We are continuing to invest in new care pathways, new technologies and new ways of working. Our National Ambulance Service provides a good example. It successfully continued the development and implementation of alternative care pathways in 2021 with the aim of hospital avoidance and an improved use of healthcare resources. The total number of patients treated by these alternative care pathways was over 18,000 with 44% treated at home or in the community.

There has also been significant investment in enhancing community care and capacity to affect the shift from a hospital-centric model of care to delivering more care in the community. Approximately 20.46 million hours of home support were delivered in 2021 with over 55,000 people in receipt of the service by end December. This is about 2.9 million, or 17%, more hours compared with 2020 with increased funding maintained for 2022. I accept this is not without challenges around putting care services in place but we will continue to do our absolute best to encourage more healthcare workers into the sector.

The GP chronic disease management programme recently received a prestigious United Nations award for developing a structured illness and preventive care programme in general practice. Over 85% of GPs are registered with the programme which delivered close to 220,000 consultations in 2021. The GP direct access to diagnostics scheme resulted in over 138,000 radiology tests being accessed by GPs in the community with another 17,000 undertaken in January 2022 alone.

We have very many challenges in respect of access to healthcare. Sometimes, I fear we lose sight of some of the very real progress that is being made. This can be demoralising for staff. The last two years have seen record increases in staffing and bed numbers. This was no mean feat during a pandemic. The last two years have been very difficult for those working in healthcare. No group of workers has felt the burden of the pandemic more than our health and social care professionals. In spite of enormous challenges, our healthcare workers responded with determination and distinction. Our waiting lists are a challenge, and a big one, but we will overcome this challenge too and make long-lasting improvements for our healthcare workers and patients of the future.

When I spoke about hospital waiting lists in the Dáil in 2018 they were the longest on record with 707,000 patients waiting for treatment. Deputy Harris was the Minister for Health then. He stated that reduced waiting times for patients was a key priority for himself and the Government. He gave reasons the lists were so long and outlined a series of measures to reduce them over time. However, four years later there are 879,000 individuals on waiting lists of which 96,000 are children. Some 40,600 were added to the hospital waiting lists in the past year. Throughout 2021, 114 people were added to hospital waiting lists each day. Some public hospitals had 100% increases in outpatient and inpatient waiting lists. This was despite the fact that one in five hospital consultant posts remain vacant or are filled on a temporary basis according to the Irish Hospital Consultants Association.

Tá an rud seo ag cur brú mór ar an gcóras sláinte. Many patients have also had their appointments cancelled. Those left waiting long periods for treatment are often left in pain as their conditions get worse. Their well-being and mental health deteriorates with the stress of not knowing when they will have their appointment and receive care. The Euro Health Consumer Index, EHCI, questions why some countries have no or minimal waiting lists in healthcare. They have achieved their goal by introducing an integrated national real time e-referral system. The EHCI asks an important question, that is, if countries with limited means can achieve a virtual absence of waiting lists, what excuse can there be for countries such as Ireland to keep having waiting list problems. In my constituency work in Dublin North-West I have found many cases of people being effectively turned away from hospitals because of a lack of bed capacity or as a consequence of a lack of hospital resources, particularly around staffing. This has been exacerbated during the pandemic. Last year, the Government committed itself to implementing a monthly annual plan to reduce waiting lists in hospitals. Where are we with this? When will we see the results of this commitment?

Ba mhaith liom an rún seo a mholadh chuig an Dáil. Gabhaim buíochas leis an Teachta Cullinane as ucht an rúin a chur faoi bhráid na Dála. There are now 1.34 million people in the State on health waiting lists. Some 893,000 of those are on hospital waiting lists. It is an absolute scandal that has been decades in the making. It is the result of mismanagement, incompetence and a lack of political will to address the gross inequalities that lie at the heart of Ireland's health service. This inequality is illustrated by the undeniable fact that access to healthcare is often determined by one's wealth and where one lives. Week after week, I speak to people waiting for essential treatment for themselves or their children who have been blatantly told that if they can go private the care that they need will be provided virtually immediately.

Those dependant on the public system tell me, and they will tell the Government if it will listen, that geography can determine the level of care they receive. All too many of the problems that we face originate in the failure to deliver proper working primary care services. In County Monaghan the decisions by previous Fianna Fáil and Fine Gael Governments to remove services from Monaghan hospital continue to have serious negative repercussions. Emergency services were withdrawn from Monaghan and resulted in drastic overcrowding at Cavan and Drogheda hospitals. A minor injuries unit, MIU, was eventually established. It is a great service that should serve to ease pressure on both GP and emergency departments. However, the MIU only operates Monday to Friday, 9 a.m. to 5 p.m., in contrast with most other minor injury units which operate seven days a week, 8 a.m. until 8 p.m. On top of that, for non-GP referrals there is now a fee of €75 for patients to attend. The result of this is that the numbers attending the MIU are falling while the demands on GPs and on emergency departments are ever growing. It is as if the Government is trying to make a bad situation worse. The Minister asked for practical solutions that can help ease the crisis in our health services. Here is one: open all minor injury units, and specifically Monaghan, to seven days a week with long-hour services and remove the fees associated with MIU presentations.

Governments refused to listen when we warned them of the consequences of withdrawing services from Monaghan Hospital. I sincerely hope the Minister and Minister of State will listen now.

I am proud of the wonderful staff we have in our health services. Over recent months, as they battled through Covid, we all gave them a clap on the back and commended their heroics, and rightly so. I have met many of them and can tell the Minister they are hungry for change in healthcare. They want things to be different. They want the tools to do the job. They do not want any more claps on the back from politicians. They want us to do our job, which is to provide the resources to the public system to enable them to give better treatment to patients. They are at the coalface of this. We are talking here about 1.3 million people who are on hospital waiting lists and community waiting lists. The people who are dealing with these patients every single day are staff and they want the tools to do the job to provide better healthcare.

One of the features of the Irish healthcare system is outsourcing. It is something we are very good at. We outsource treatment to private hospitals, and even in the Minister's plan that he announced, we are going to see more of that. We outsource diagnostic tests even though we have 225,000 people waiting for a diagnosis. We outsource cancer screening and, let us be honest, we have seen the consequences of that in recent years. We outsource employment of staff through agencies, which costs huge amounts of money. More and more outsourcing means less and less capacity in the public system. However, we do not just outsource the hiring of staff or outsource services; we also outsource responsibility. It seems we have an absolute failure of accountability and responsibility in the Irish healthcare service.

The people at the top who run the health services get mega salaries that are multiples of what anybody in this Chamber will get, yet we do not have accountability or transparency. At the top of the health services targets set are missed over and over again and it permeates right down to local hospitals where we can again say there are major problems in some hospitals. In some cases, I have to say it is simply bad management. If I were the Minister for Health, I would of course put capacity into hospitals where it is needed. We must of course look at minor injuries units like the ones in Monaghan that need to be properly supported, and if I was Minister, I would do that.

There is also much more we can do. We must bring about a new culture of accountability and transparency in the Irish healthcare system. The Minister outsourced responsibility for the waiting list plan and Sláintecare to the two people whose responsibility it is to manage the day-to-day running of our health services, namely, the Secretary General of the Department and the head of the HSE. The Minister should have taken responsibility. The people who were leading healthcare reform and whose sole job it was to drive reform of healthcare left. They resigned from Sláintecare because they saw the Minister and his Government are not committed to the necessary reforms. They did not see action on waiting lists, and they are right. They did not see action on e-health, and they are right, and they did not see action on regionalisation. When the Minister outsources responsibility and there is failure, he as the Minister for Health must take responsibility.

I was being 100% sincere earlier when I said I welcome and celebrate every additional cent that has been put into our health services over the past two years and I recognise additional investment was made. I celebrate also every single additional staff member who has been brought into the health services, and we need many more. However, we also have real problems with recruitment and retention. The Minister knows we are not training enough healthcare professionals and railed against it himself when in opposition. We need to train more. There are real problems with recruitment and we need to deal with that. There are real problems with retaining staff and we need to deal with that. We do not have enough surgical theatre capacity or diagnostic capacity. We do not have enough beds in our acute hospitals so patients cannot be admitted quickly enough. We do not have enough capacity in the community sector. We do not have the cohesion and the integrated healthcare system we need. Unless we deal with those structural problems, the Minister is going to come into the House with reports and strategies he believes in his heart will work but that I can tell him will not. Listen to the INMO. Listen to the IMO. Listen to the Irish Hospital Consultants Association, IHCA. They are all saying the Minister's plans and strategies will fail because he is not making the investment and changes in healthcare necessary to take people off trolleys and off waiting lists and to deliver better healthcare for patients.

Amendment put.

In accordance with Standing Order 80(2), the division is postponed until the weekly division time tomorrow evening.

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