Healthcare Waiting Lists: Motion (Resumed) [Private Members]

The following motion was moved by Deputy David Cullinane on Tuesday, 1 March 2022:

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.

Debate resumed on 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."

- (Minister for Health, Deputy Stephen Donnelly)

An Leas-Cheann Comhairle

I must now deal with a postponed division relating to amendment No. 2 to the motion in the name of the Minister for Health, Deputy Stephen Donnelly. On the question, "That the amendment to the motion be made", a division was claimed and in accordance with Standing Order 80(2), that division must be taken now.

Amendment put:

The Dáil divided: Tá, 75; Níl, 57; Staon, 0.

Tá

Brophy, Colm.
Browne, James.
Bruton, Richard.
Burke, Colm.
Burke, Peter.
Butler, Mary.
Byrne, Thomas.
Cahill, Jackie.
Calleary, Dara.
Cannon, Ciarán.
Carey, Joe.
Carroll MacNeill, Jennifer.
Chambers, Jack.
Collins, Niall.
Costello, Patrick.
Coveney, Simon.
Cowen, Barry.
Creed, Michael.
Crowe, Cathal.
Devlin, Cormac.
Dillon, Alan.
Donnelly, Stephen.
Duffy, Francis Noel.
Durkan, Bernard J.
English, Damien.
Farrell, Alan.
Feighan, Frankie.
Flaherty, Joe.
Flanagan, Charles.
Fleming, Sean.
Foley, Norma.
Grealish, Noel.
Griffin, Brendan.
Harris, Simon.
Haughey, Seán.
Heydon, Martin.
Higgins, Emer.
Hourigan, Neasa.
Humphreys, Heather.
Kehoe, Paul.
Lahart, John.
Lawless, James.
Leddin, Brian.
Madigan, Josepha.
Martin, Catherine.
Matthews, Steven.
McConalogue, Charlie.
McGrath, Michael.
McHugh, Joe.
Moynihan, Aindrias.
Moynihan, Michael.
Murnane O'Connor, Jennifer.
Naughton, Hildegarde.
Noonan, Malcolm.
O'Brien, Darragh.
O'Brien, Joe.
O'Callaghan, Jim.
O'Connor, James.
O'Dea, Willie.
O'Donnell, Kieran.
O'Donovan, Patrick.
O'Dowd, Fergus.
O'Gorman, Roderic.
O'Sullivan, Christopher.
O'Sullivan, Pádraig.
Ó Cathasaigh, Marc.
Ó Cuív, Éamon.
Ring, Michael.
Ryan, Eamon.
Smith, Brendan.
Smyth, Niamh.
Smyth, Ossian.
Stanton, David.
Troy, Robert.
Varadkar, Leo.

Níl

Andrews, Chris.
Bacik, Ivana.
Boyd Barrett, Richard.
Brady, John.
Browne, Martin.
Buckley, Pat.
Cairns, Holly.
Canney, Seán.
Carthy, Matt.
Clarke, Sorca.
Collins, Joan.
Conway-Walsh, Rose.
Cronin, Réada.
Crowe, Seán.
Cullinane, David.
Daly, Pa.
Donnelly, Paul.
Ellis, Dessie.
Farrell, Mairéad.
Fitzmaurice, Michael.
Fitzpatrick, Peter.
Funchion, Kathleen.
Gannon, Gary.
Gould, Thomas.
Guirke, Johnny.
Healy-Rae, Michael.
Howlin, Brendan.
Kenny, Martin.
Kerrane, Claire.
Mac Lochlainn, Pádraig.
McDonald, Mary Lou.
McNamara, Michael.
Mitchell, Denise.
Murphy, Catherine.
Murphy, Paul.
Murphy, Verona.
Mythen, Johnny.
Nash, Ged.
Naughten, Denis.
O'Callaghan, Cian.
O'Reilly, Louise.
O'Rourke, Darren.
Ó Broin, Eoin.
Ó Laoghaire, Donnchadh.
Ó Murchú, Ruairí.
Ó Snodaigh, Aengus.
Pringle, Thomas.
Quinlivan, Maurice.
Ryan, Patricia.
Shanahan, Matt.
Sherlock, Sean.
Shortall, Róisín.
Smith, Bríd.
Smith, Duncan.
Stanley, Brian.
Tully, Pauline.
Ward, Mark.

Staon

Tellers: Tá, Deputies Jack Chambers and Brendan Griffin; Níl, Deputies Pádraig Mac Lochlainn and Denise Mitchell.

Amendment declared carried.

Question put: "That the motion as amended be agreed to."

The Dáil divided: Tá, 76; Níl, 57; Staon, 0.

Tá

Brophy, Colm.
Browne, James.
Bruton, Richard.
Burke, Colm.
Burke, Peter.
Butler, Mary.
Byrne, Thomas.
Cahill, Jackie.
Calleary, Dara.
Cannon, Ciarán.
Carey, Joe.
Carroll MacNeill, Jennifer.
Chambers, Jack.
Collins, Niall.
Costello, Patrick.
Coveney, Simon.
Cowen, Barry.
Creed, Michael.
Crowe, Cathal.
Devlin, Cormac.
Dillon, Alan.
Donnelly, Stephen.
Duffy, Francis Noel.
Durkan, Bernard J.
English, Damien.
Farrell, Alan.
Feighan, Frankie.
Flaherty, Joe.
Flanagan, Charles.
Fleming, Sean.
Foley, Norma.
Grealish, Noel.
Griffin, Brendan.
Harris, Simon.
Haughey, Seán.
Heydon, Martin.
Higgins, Emer.
Hourigan, Neasa.
Humphreys, Heather.
Kehoe, Paul.
Lahart, John.
Lawless, James.
Leddin, Brian.
Madigan, Josepha.
Martin, Catherine.
Matthews, Steven.
McConalogue, Charlie.
McGrath, Michael.
McGuinness, John.
McHugh, Joe.
Moynihan, Aindrias.
Moynihan, Michael.
Murnane O'Connor, Jennifer.
Naughton, Hildegarde.
Noonan, Malcolm.
O'Brien, Darragh.
O'Brien, Joe.
O'Callaghan, Jim.
O'Connor, James.
O'Dea, Willie.
O'Donnell, Kieran.
O'Donovan, Patrick.
O'Dowd, Fergus.
O'Gorman, Roderic.
O'Sullivan, Christopher.
O'Sullivan, Pádraig.
Ó Cathasaigh, Marc.
Ó Cuív, Éamon.
Ring, Michael.
Ryan, Eamon.
Smith, Brendan.
Smyth, Niamh.
Smyth, Ossian.
Stanton, David.
Troy, Robert.
Varadkar, Leo.

Níl

Andrews, Chris.
Bacik, Ivana.
Boyd Barrett, Richard.
Brady, John.
Browne, Martin.
Buckley, Pat.
Cairns, Holly.
Canney, Seán.
Carthy, Matt.
Clarke, Sorca.
Collins, Joan.
Conway-Walsh, Rose.
Cronin, Réada.
Crowe, Seán.
Cullinane, David.
Daly, Pa.
Donnelly, Paul.
Ellis, Dessie.
Farrell, Mairéad.
Fitzmaurice, Michael.
Fitzpatrick, Peter.
Funchion, Kathleen.
Gannon, Gary.
Gould, Thomas.
Guirke, Johnny.
Healy-Rae, Michael.
Howlin, Brendan.
Kenny, Martin.
Kerrane, Claire.
Mac Lochlainn, Pádraig.
McDonald, Mary Lou.
McNamara, Michael.
Mitchell, Denise.
Murphy, Catherine.
Murphy, Paul.
Murphy, Verona.
Mythen, Johnny.
Nash, Ged.
O'Callaghan, Cian.
O'Reilly, Louise.
O'Rourke, Darren.
Ó Broin, Eoin.
Ó Laoghaire, Donnchadh.
Ó Murchú, Ruairí.
Ó Ríordáin, Aodhán.
Ó Snodaigh, Aengus.
Pringle, Thomas.
Quinlivan, Maurice.
Ryan, Patricia.
Shanahan, Matt.
Sherlock, Sean.
Shortall, Róisín.
Smith, Bríd.
Smith, Duncan.
Stanley, Brian.
Tully, Pauline.
Ward, Mark.

Staon

Tellers: Tá, Deputies Jack Chambers and Brendan Griffin; Níl, Deputies Pádraig Mac Lochlainn and Denise Mitchell.

Question declared carried.

Dáil Éireann debate - Wednesday, 2 Mar 2022