Current Issues Affecting the Health Services: Motion (Resumed) [Private Members]

The following motion was moved by Deputy David Cullinane on Tuesday, 13 December 2022:

That Dáil Éireann:

notes with concern that:

— 12,624 people were admitted to hospital without a bed and left on a trolley or elsewhere in ward corners and corridors in November, the worst November on record for overcrowding according to the Irish Nurses and Midwives Organisation (INMO); and

— on 29th November, the INMO identified that 660 patients were admitted without a bed, one of the single worst days on record;

further notes with concern:

— the findings of the INMO on the emigration intentions of student nurses and midwives which found that 65 per cent of nursing graduates are strongly considering emigrating, and 33 per cent are considering leaving the major cities in Ireland due to the cost of living; and

— that in 2021, 62 per cent of first-time registrants with the Nursing and Midwifery Board were non-European Union workers, which highlights the lack of supply and poor retention of Irish trained graduates;

recognises:

— that without adequate recruitment and retention of nurses and other healthcare professionals our health system cannot function, and conditions will continue to deteriorate for both patients and staff;

— that it is extremely difficult to encourage Irish-trained and qualified nurses, or other healthcare professionals such as general practitioners (GPs), back to Ireland, while there is such a chronic shortage of affordable housing to rent or buy; and

— the widely held belief amongst the public that the current Minister for Health, Stephen Donnelly TD, is incapable of addressing the crisis in our health service and has, along with the wider Government, been making the situation worse;

condemns:

— the failure of the Minister for Further and Higher Education, Research, Innovation and Science, Simon Harris TD, to ensure adequate numbers of training and course places for healthcare professionals;

— the failure of the Minister for Health, Stephen Donnelly TD, to address work related retention issues and training capacity challenges; and

— the failure of the Minister for Housing, Local Government and Heritage, Darragh O'Brien TD, for refusing to recognise the housing emergency, its impact on the health service and to take urgent action to increase the availability of affordable accommodation; and

calls on the Government to:

— commit to urgently review its current housing plan and increase its targets for social and affordable housing to rent or buy, alongside putting one month's rent back into private renters' pockets and ban rent increases for the next three years;

— offer a job guarantee to healthcare graduates;

— urgently identify, examine and consider all potential mechanisms to address the cost-of-living barriers to recruitment and retention of key workers, especially in urban areas; and

— immediately engage with general practice to ensure GPs are supported to take more pressure off hospitals and emergency departments, especially by expanding out-of-hours services, and engage with other primary care professions, such as pharmacies, to ensure late night options are in place across the State.

Debate resumed on amendment No. 1:

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

"recognises:

— the invaluable work carried out by our health and social care workers in providing health services to patients;

— that record funding has been provided to permanently increase capacity in our health service, and this year's budget is €22.2 billion (2022), up from €14.8 billion in 2018;

— emergency departments (EDs) are currently experiencing significantly increased demand due to a combination of factors including the circulation of a respiratory syncytial virus (RSV), flu, Covid-19 and Streptococcus A;

— ED attendances were 1,319,367, up 7 per cent compared to 1,232,992 for the same period in 2019, and 14 per cent higher than the five-year average (2017-2021) for this period; and

— admissions from ED were 332,509, up 3.4 per cent compared to 321,523 for the same period in 2019, and 8 per cent higher than the five-year average for this period;

notes:

— that there has been a significant increase in hospital bed capacity, with an additional 934 acute beds provided since 2020;

— that very significant funding of €77 million has been provided across 2021 and 2022 to add an additional 85 critical case/intensive care unit beds, which has delivered a 25 per cent increase in critical care capacity since 2020;

— that the health workforce is continuing to grow at an unprecedented rate and is on track to grow by 4,600 this year, and this will be the third highest annual growth in the workforce after the large record increases seen in 2020 and 2021;

— that there are 16,275 more people working in our health service than there were at the beginning of 2020, and this includes 4,592 nurses and midwives, 2,654 health and social care professionals and 1,758 doctors and dentists;

— that Budget 2023 provides additional funding to expand the workforce by a further 6,000 in 2023, and work is underway to identify priority posts and expedite recruitment so that the initiatives included in the Health Service Executive (HSE) National Service Plan can be delivered;

— the HSE Winter Plan for 2022/23, published in October, which is supporting acute and community services this winter, is estimated to cost up to €169 million to implement, and adopts a bottom-up approach with bespoke individual local plans that seek to address hospital specific issues in conjunction with Community Health Organisations (CHOs);

— the Enhanced Community Care (ECC) programme is a suite of strategic reform initiatives, which seek to reduce dependency on the hospital system by delivering increased levels of healthcare provision in the community setting, with service delivery reoriented towards general practice, primary care, and community-based services;

— the ECC aims to prevent referrals and admissions to acute hospitals where possible, and to facilitate early discharge from acute hospitals where it is safe to do so;

— the key elements of the ECC programme include:

— the rollout of 96 Community Healthcare Networks (CHNs) across the country;

— 90 of the planned 96 CHNs are now established and operational, with over 2,158 staff recruited to the ECC programme to date;

— 33 Community Specialist Teams (CSTs), which provide services to older people and those with chronic disease in the community, have been established; and

— significant investment has facilitated national coverage of Community Intervention Teams (CITs), which help prevent unnecessary hospital attendances and admissions, with 21 teams across all nine CHOs operational and providing services to local communities;

— that in the year 2022 to date, our nursing and midwifery workforce has grown by 1,220, and an Organisation for Economic Co-operation and Development (OECD) report in 2021 saw Ireland ranked 4th among OECD countries for having the highest number of practising nurses per 1,000 people;

— that as of 1st June, 2022, there were 81,431 nurses and midwives on the Nursing and Midwifery Board of Ireland (NMBI) Register, which is the highest ever number;

— recruitment capacity is expanding to ensure that ambitious workforce targets can be met and to maximise the numbers recruited, and this has included the expansion of international recruitment markets, targeted recruitment campaigns and streamlined recruitment processes;

— that since 2019 all Nursing and Midwifery graduates were offered permanent contracts, and this will continue into 2023, also all Health and Social Care Profession graduates who applied for the HSE national campaign were offered permanent positions and this will continue into 2023;

— the Sláintecare public only consultant contract was recently approved by the Government, and the new contract will have a significant impact on the delivery of care, with the working day extended to 10 p.m. and the working week extended to include Saturdays, ensuring that care will be provided when patients need it most;

— that consultant numbers have increased significantly and in the year to the end of October 2022 they increased by 254 to 3,837, the highest number ever, and by nearly 600 since the end 2019, equally, it is recognised that consultant numbers remain low by international standards;

— the non-consultant hospital doctor workforce has increased significantly, and at the end of October it stood at 7,978, over a thousand more than when the Government took office; and

— the Minister for Health has established a National Taskforce on Non-Consultant Hospital Doctor Workforce to address doctor training capacity and retention issues; and

further notes that:

— Ireland, like many other countries, is heavily reliant on international health care workers and the Government is seeking to significantly increase domestic supply production of graduates across all healthcare disciplines;

— in July 2022 the creation of an additional 200 places per annum in medicine was announced, with the first 60 of these places being introduced in September 2022, and the number will grow to 120 in September 2023;

— 135 additional places were also made available across nursing programmes starting from September 2022, with Government seeking to double the number of nursing and midwifery students in the coming years, and Professor Tom Collins is chairing the joint working group on Nursing under the Funding the Future structures, with membership from the Department of Further and Higher Education, Research, Innovation and Science, the Higher Education Institutions, the NMBI, HSE and the Department of Health;

— the Higher Education Authority (HEA) recently conducted an expression of interest from higher education institutions interested in building capacity in dentistry, pharmacy, medicine, nursing, and veterinary from academic year 2024-25 or 2025-26, with recommendations on capacity increases due to be brought to the Minister for Further and Higher Education, Research, Innovation and Science by the end of quarter one of 2023;

— the HEA plans to use a similar process early in 2023 to build capacity in therapy areas;

— both the Department of Health and Department of Further and Higher Education, Research, Innovation and Science are strongly committed to supporting the health of the population through the provision of graduates with the key competencies and skills to be effective;

— in 2021, following the publication of the independent review of clinical placement allowances for student nurses and student midwives, conducted by Sean McHugh (McHugh Review), the Minister announced a number of temporary measures to provide significant additional supports to student nurses and midwives while on clinical placements, and these were worth €12 million;

— the number of general practitioners (GPs), contracted by the HSE under the General Medical Services (GMS) scheme has risen from 2,098 in 2008 to 2,529 in November 2022;

— the number of GP training places has more than doubled in recent years, up from 120 in 2009 to 258 places filled in 2022, and the Irish College of General Practitioners aims to have 350 training places available for new entrants per year by 2026;

— the 2019 Agreement between the Department of Health, the HSE and the IMO regarding GP Contractual Reform and Service Development demonstrates the Government's determination to invest in general practice to ensure that it retains its place at the heart of the health service, and that it remains an attractive option for medical graduates, and as of November 2022, 93 per cent of GMS GPs have signed up to the 2019 agreement;

— the 2019 GP agreement has seen additional investment in GP services of €206 million per year, this will increase to €211 million per year from 2023, representing an increase of 40 per cent on pre-2019 expenditure;

— significant increases in capitation fees have been introduced for participating GPs, a 48.5 per cent increase, as well as additional fees and subsidies for new services;

— the Rural Practice Support Framework rate for eligible GPs has been increased by 10 per cent;

— a €2 million annual fund for GPs in areas of urban deprivation has been introduced;

— under the Government's Housing for All - a New Housing Plan for Ireland, the supply, which is key to improving our housing system, is increasing, and a substantial uplift in housing supply is expected in the coming years;

— this year, the target is for the delivery of 24,600 homes, and the Government expects to exceed this target, with some 28,000 dwellings forecast to be completed, and in the period January to September 2022, 20,807 new homes were completed, more than for the full year in 2021;

— while this is very positive, the Government acknowledges that issues have emerged over the past number of months, including those arising from the war in Ukraine, with unprecedented inflationary pressures and rising interest rates having an impact on the momentum of home delivery;

— the Government is responding to these challenges and on 2nd November published its first annual update of the Housing for All plan, which focuses on priority measures that will improve viability and accelerate supply, across all tenures; and

— coupled with record State investment of €4.5 billion in 2023, this will ensure the ambitious 2023 targets, and the targets for the following years, will be met.

- (Minister for Health, Deputy Stephen Donnelly)

An Ceann Comhairle

I must now deal with a postponed division relating to the motion on current issues affecting the health service. On Tuesday, 13 December 2022, on the question, "That the amendment to the motion be agreed to", a division was claimed and in accordance with Standing Order 80(2), that division must be taken now.

Amendment put:

The Dáil divided: Tá, 72; Níl, 53; Staon, 0.

Tá

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

Níl

Andrews, Chris.
Bacik, Ivana.
Berry, Cathal.
Boyd Barrett, Richard.
Brady, John.
Browne, Martin.
Buckley, Pat.
Canney, Seán.
Carthy, Matt.
Clarke, Sorca.
Collins, Joan.
Collins, Michael.
Connolly, Catherine.
Cronin, Réada.
Crowe, Seán.
Cullinane, David.
Daly, Pa.
Doherty, Pearse.
Ellis, Dessie.
Farrell, Mairéad.
Fitzmaurice, Michael.
Fitzpatrick, Peter.
Funchion, Kathleen.
Gould, Thomas.
Guirke, Johnny.
Howlin, Brendan.
Kenny, Martin.
Kerrane, Claire.
Mac Lochlainn, Pádraig.
McGrath, Mattie.
Mitchell, Denise.
Munster, Imelda.
Murphy, Catherine.
Murphy, Paul.
Mythen, Johnny.
Nash, Ged.
Ó Broin, Eoin.
Ó Laoghaire, Donnchadh.
Ó Murchú, Ruairí.
Ó Snodaigh, Aengus.
O'Callaghan, Cian.
O'Donoghue, Richard.
O'Reilly, Louise.
O'Rourke, Darren.
Pringle, Thomas.
Quinlivan, Maurice.
Ryan, Patricia.
Sherlock, Sean.
Shortall, Róisín.
Stanley, Brian.
Tóibín, Peadar.
Tully, Pauline.
Whitmore, Jennifer.

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, 72; Níl, 53; Staon, 0.

Tá

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

Níl

Andrews, Chris.
Bacik, Ivana.
Berry, Cathal.
Boyd Barrett, Richard.
Brady, John.
Browne, Martin.
Buckley, Pat.
Canney, Seán.
Carthy, Matt.
Clarke, Sorca.
Collins, Joan.
Collins, Michael.
Connolly, Catherine.
Cronin, Réada.
Crowe, Seán.
Cullinane, David.
Daly, Pa.
Doherty, Pearse.
Ellis, Dessie.
Farrell, Mairéad.
Fitzmaurice, Michael.
Fitzpatrick, Peter.
Funchion, Kathleen.
Gould, Thomas.
Guirke, Johnny.
Howlin, Brendan.
Kenny, Martin.
Kerrane, Claire.
Mac Lochlainn, Pádraig.
McGrath, Mattie.
Mitchell, Denise.
Munster, Imelda.
Murphy, Catherine.
Murphy, Paul.
Mythen, Johnny.
Nash, Ged.
O'Callaghan, Cian.
O'Donoghue, Richard.
O'Reilly, Louise.
O'Rourke, Darren.
Ó Broin, Eoin.
Ó Laoghaire, Donnchadh.
Ó Murchú, Ruairí.
Ó Snodaigh, Aengus.
Pringle, Thomas.
Quinlivan, Maurice.
Ryan, Patricia.
Sherlock, Sean.
Shortall, Róisín.
Stanley, Brian.
Tóibín, Peadar.
Tully, Pauline.
Whitmore, Jennifer.

Staon

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

Question declared carried.

Dáil Éireann debate - Wednesday, 14 Dec 2022