I must now deal with a deferred division relating to amendment No. 1 in the name of the Minister for Health to the motion regarding hospital waiting lists. On Tuesday, 23 May, 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.
Hospital Waiting Lists: Motion (Resumed) [Private Members]
The following motion was moved by Deputy David Cullinane on Tuesday, 23 May 2023:
That Dáil Éireann:
notes that:
— the average waiting time for emergency department admission so far this year stands at 11.5 hours, which is an hour longer than for the same period in 2019;
— the trolley scandal which Fine Gael pledged to end is now worse than ever and has become a year-round threat to patient safety, with an average of more than 550 patients on trolleys every day so far this month, compared to 350 in May 2011;
— there were 24,000 hospital appointments and procedures cancelled in April 2023, which is an increase of 70 per cent on April 2022 and greater than the number of cancellations in January 2023;
— hospital waiting lists now stand at 888,000 patients, with more than 500,000 people waiting longer than the Sláintecare targets agreed by the Oireachtas, and with more than 225,000 people waiting for a diagnostic scan;
— full capacity protocols have been active across most major hospital sites for significant periods of the year to date, including 118 of the first 120 days in the year at University Hospital Limerick; and
— primary care services, in particular out-of-hours general practice services, are buckling under the strain of demand and historic neglect and underinvestment under successive Ministers for Health;
further notes that:
— the Economic and Social Research Institute (ESRI) has published estimates which reckon that the Health Service Executive is faced with a deficit of 1,000 acute inpatient hospital beds, and that there is a requirement for 330 additional beds every year in addition to this deficit;
— the Minister for Health, Stephen Donnelly TD, has pledged to deliver a multi-annual bed plan for 1,500 hospital beds, which will fall short of the requirements as set out by the ESRI;
— the Minister for Health, Stephen Donnelly TD, has failed to legislate for mandatory safe staffing levels in hospitals; and
— the Minister for Further and Higher Education, Research, Innovation and Science, Simon Harris TD, and the Minister for Health, Stephen Donnelly TD, have failed to outline a multi-annual health workforce plan to develop, train, and retain the requisite number of health and social care professionals to safely staff the health service and deliver universal healthcare; and
calls on the Government to:
— legislate for mandatory safe staffing levels in hospitals;
— publish and deliver on a multi-annual health service capacity plan, which matches the requirements as set out by the ESRI, and provides a 5 and 10-year health service capacity roadmap; and
— publish and deliver on a multi-annual health and social care strategic workforce plan, which develops, trains, and retains the doctors, nurses, and allied health and social care professionals we need to safely staff the health service and deliver universal healthcare.
Debate resumed on amendment No. 1:
To delete all words after "Dáil Éireann" and substitute the following:
"recognises that:
— this Government has invested record funding in our health service and has allocated €23.6 billion net to the health budget in 2023 (Current and Capital), an extra €5.6 billion (32 per cent) over the original net budget allocation for 2020;
— more than 20,000 net additional staff have been hired into our health service since the beginning of 2020, which includes 6,281 nurses and midwives, 3,177 health and social care professionals, and 1,948 doctors and dentists;
— 2020, 2021 and 2022 have seen the biggest staff increases since the Health Service Executive (HSE) was established, and 2023 continues to show large increases;
— the Organisation for Economic Co-operation and Development figures clearly show that Ireland has more nurses per 1,000 population than most other European countries;
— as of mid-March 2023, 970 new acute hospital beds have opened nationally since 2020, and by the end of this year the HSE is due to have added 1,179 beds, against a target of 1,146;
— there are now 323 adult critical care beds, which is an increase of 65 beds, or 25 per cent, since 2020, and a further 29 beds will be added in 2023;
— the Framework for Safe Nurse Staffing and Skill Mix is an evidence-based approach to determining nurse staffing levels, and it is designed around the care hours required to meet patient needs across a variety of care areas and is focused on delivering positive patient outcomes and safer care environments;
— the framework has been national policy since 2018, and since then has continued to include more care areas, as following Phase 1 for acute medical and surgical care areas the framework was applied to emergency care in Phase 2, it is now in its third phase of development in long-term residential care settings;
— over €31 million has been allocated to date for implementation of the; and
— the Minister for Health recently announced that he is prioritising the full implementation of the framework for safe staffing in all acute hospitals, and this will result in hundreds more posts, both nursing and healthcare assistants, being hired and filled on a full-time basis in 2023;
acknowledges that:
— the Department of Health and the HSE are planning a refresh of the Health Service Capacity Review 2018, which will be informed by a series of scheduled Central Statistics Office statistical releases later in 2023, and this will be a key input to a strategic review of infrastructure capacity planning for the next phase of the National Development Plan (NDP) and beyond;
— as part of the overall NDP funding, the health sector capital allocation is €5.657 billion for the period 2021-2025, an 11 per cent increase in funding year-on-year, to invest in the delivery of strategic reform;
— over 500 health capital projects and programmes across the State and across the sector are underway at various stages of development;
— a Capital Programme for 2023 has been developed and the HSE Capital Plan 2023 has been approved by the Minister for Health as a related document of the National Service Plan, and publication of the capital plan is imminent; and
— the Minister for Health is in discussions with Government colleagues on a proposal to expedite the rapid construction and delivery of 1,500 additional acute beds across the country, using modern methods of construction, including modular construction;
further recognises that:
— the 2023 Waiting List Action Plan was published in March 2023, and many of our individual hospitals have delivered impressive reductions in both their waiting lists and waiting times, with for example, Louth County Hospital, University Hospital Waterford, and Portiuncula University Hospital having reduced the number of patients waiting over 18 months for an Outpatients Department appointment by 97 per cent, 55 per cent and 38 per cent respectively, in the last year;
— the HSE is currently working to replicate this positive performance across the entire hospital system;
— in Budget 2023, funding of €443 million was allocated to tackle waiting lists, and this includes €123 million funding for the HSE to progress longer-term reforms to sustainably enhance capacity, €240 million funding for the HSE and the National Treatment Purchase Fund for additional short-term measures to address acute scheduled care waiting list backlogs exacerbated by the Covid-19 pandemic, and the remaining €80 million will be focused on alleviating various waiting lists in community and primary care;
— 2022 was the first year that waiting list numbers fell since 2015;
— progress is being made, and in 2022 the numbers waiting over the maximum wait time targets of 10 to 12 weeks, fell by 11 per cent, which is 56,000 people, and since the pandemic peaks in 2020/21 to the end of April 2023, there has been a reduction of 135,000, or 21 per cent, in the numbers of people waiting above these targets;
— under the 2023 Waiting List Action Plan, our health service aims to treat and remove circa 1.66 million patients from the lists, resulting in a projected reduction of just over 10 per cent by year-end;
— productive engagement is ongoing with the Private Hospitals Association, to secure additional capacity both in the short- and medium-term to support scheduled and unscheduled care;
— plans are advancing on three new Elective Hospitals in Dublin, Cork and Galway, that will provide significant additional capacity, and combined they will cater for up to 977,700 patients/procedures annually; and
— the HSE is developing a multi-year urgent and emergency care improvement programme to deliver sustainable improvements to unscheduled care, most of which currently occurs in the Emergency Department; and
further acknowledges that:
— the Department of Health is working closely with the HSE on developing the plan for expansion of community care and other measures which will reduce unnecessary attendances and improve discharge supports, such as home support and residential care;
— this Government is committed to a 'home first' approach to health service provision, and the Enhanced Community Care (ECC) Programme delivers healthcare reoriented towards general practice, primary care, and community-based services that prevents admissions to acute hospitals;
— the Government has allocated significant resources with annual funding of €195 million provisioned to the ECC Programme to enable recruitment of 3,500 additional staff, and with service delivery provided through Community Healthcare Networks (CHNs) and Community Specialist Teams (CSTs), that commitment will continue into future years;
— significant progress is being made, with 91 of the 96 CHNs and 44 of the 60 CSTs now established, and 2,600 staff already recruited to the programme, with the balance of recruitment and establishment of the remaining teams targeted for 2023;
— the nationwide GP Access to Diagnostics programme, began accepting referrals in January 2021;
— 251,601 diagnostics were completed last year, which exceeded the 2022 target of 195,000 scans, and of this, 115,477 community radiology scans have been completed to date;
— Primary Care Centres (PCCs) are an essential part of the Government's significant investment and nationally there are 167 PCCs, two of which opened in 2023, with a further 13 currently in construction, and 10 due to open in 2023;
— there are approximately 3,500 general practitioners (GPs) working in Ireland currently, 2,500 of whom hold a General Medical Scheme contract with the HSE, and over 500 further GPs hold contracts for screening or vaccinations services;
— under the upcoming Strategic Review of General Practice, consideration will be given to the possible role of HSE-employed GPs, as part of a wider examination of the GP capacity issue;
— there has been an increase of almost 30 per cent in the number of first-year nursing places in Irish Higher Education Institutions over the period 2014-2021, from 1,570 to 2,032;
— in July 2022, Minister for Further and Higher Education, Research, Innovation and Science, Simon Harris TD, and Minister for Health, Stephen Donnelly TD, announced an agreement with Irish Medical Schools to phase in an increase of 200 additional Irish/European Union medicine student places over the next five years; and
— discussions are ongoing between the Department of Health and the Department of Further and Higher Education, Research, Innovation
and Science, regarding the expansion of student places across health-related disciplines."
-(Minister of State at the Department of Health, Deputy Hildegarde Naughton)
Amendment put:
The Dáil divided: Tá, 67; Níl, 55; Staon, 0.
Tá
- Browne, James.
- Bruton, Richard.
- Burke, Colm.
- Burke, Peter.
- Butler, Mary.
- Byrne, Thomas.
- Calleary, Dara.
- Cannon, Ciarán.
- Carroll MacNeill, Jennifer.
- Costello, Patrick.
- 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.
- Fleming, Sean.
- Foley, Norma.
- Griffin, Brendan.
- Harris, Simon.
- Haughey, Seán.
- Heydon, Martin.
- Higgins, Emer.
- Humphreys, Heather.
- Kehoe, Paul.
- Lahart, John.
- Lawless, James.
- Leddin, Brian.
- Lowry, Michael.
- Martin, Catherine.
- Martin, Micheál.
- Matthews, Steven.
- McAuliffe, Paul.
- McConalogue, Charlie.
- McGrath, Michael.
- McGuinness, John.
- McHugh, Joe.
- Moynihan, Aindrias.
- Moynihan, Michael.
- Murnane O'Connor, Jennifer.
- Naughton, Hildegarde.
- Noonan, Malcolm.
- O'Brien, Joe.
- O'Callaghan, Jim.
- O'Dea, Willie.
- O'Donnell, Kieran.
- O'Dowd, Fergus.
- O'Gorman, Roderic.
- O'Sullivan, Christopher.
- O'Sullivan, Pádraig.
- Ó Cathasaigh, Marc.
- Ó Cuív, Éamon.
- Phelan, John Paul.
- Rabbitte, Anne.
- Ring, Michael.
- Ryan, Eamon.
- Smith, Brendan.
- Smyth, Niamh.
- Smyth, Ossian.
- Stanton, David.
- Troy, Robert.
Níl
- Andrews, Chris.
- Bacik, Ivana.
- Barry, Mick.
- Boyd Barrett, Richard.
- Brady, John.
- Browne, Martin.
- Buckley, Pat.
- Cairns, Holly.
- Carthy, Matt.
- Clarke, Sorca.
- Collins, Joan.
- Collins, Michael.
- Conway-Walsh, Rose.
- Cronin, Réada.
- Crowe, Seán.
- Cullinane, David.
- Daly, Pa.
- Doherty, Pearse.
- Donnelly, Paul.
- Ellis, Dessie.
- Farrell, Mairéad.
- Fitzpatrick, Peter.
- Gould, Thomas.
- Healy-Rae, Danny.
- Healy-Rae, Michael.
- Howlin, Brendan.
- Kelly, Alan.
- Kerrane, Claire.
- Mac Lochlainn, Pádraig.
- McGrath, Mattie.
- Mitchell, Denise.
- Munster, Imelda.
- Murphy, Catherine.
- Murphy, Verona.
- Nash, Ged.
- Nolan, Carol.
- O'Callaghan, Cian.
- O'Donoghue, Richard.
- 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.
- Sherlock, Sean.
- Shortall, Róisín.
- Smith, Bríd.
- Stanley, Brian.
- Tully, Pauline.
- Ward, Mark.
- Whitmore, Jennifer.
Staon
Tellers: Tá, Deputies Hildegarde Naughton and Cormac Devlin; 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, 67; Níl, 55; Staon, 0.
Tá
- Browne, James.
- Bruton, Richard.
- Burke, Colm.
- Burke, Peter.
- Butler, Mary.
- Byrne, Thomas.
- Calleary, Dara.
- Cannon, Ciarán.
- Carroll MacNeill, Jennifer.
- Costello, Patrick.
- 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.
- Fleming, Sean.
- Foley, Norma.
- Griffin, Brendan.
- Harris, Simon.
- Haughey, Seán.
- Heydon, Martin.
- Higgins, Emer.
- Humphreys, Heather.
- Kehoe, Paul.
- Lahart, John.
- Lawless, James.
- Leddin, Brian.
- Lowry, Michael.
- Martin, Catherine.
- Martin, Micheál.
- Matthews, Steven.
- McAuliffe, Paul.
- McConalogue, Charlie.
- McGrath, Michael.
- McGuinness, John.
- McHugh, Joe.
- Moynihan, Aindrias.
- Moynihan, Michael.
- Murnane O'Connor, Jennifer.
- Naughton, Hildegarde.
- Noonan, Malcolm.
- O'Brien, Joe.
- O'Callaghan, Jim.
- O'Dea, Willie.
- O'Donnell, Kieran.
- O'Dowd, Fergus.
- O'Gorman, Roderic.
- O'Sullivan, Christopher.
- O'Sullivan, Pádraig.
- Ó Cathasaigh, Marc.
- Ó Cuív, Éamon.
- Phelan, John Paul.
- Rabbitte, Anne.
- Ring, Michael.
- Ryan, Eamon.
- Smith, Brendan.
- Smyth, Niamh.
- Smyth, Ossian.
- Stanton, David.
- Troy, Robert.
Níl
- Andrews, Chris.
- Bacik, Ivana.
- Barry, Mick.
- Boyd Barrett, Richard.
- Brady, John.
- Browne, Martin.
- Buckley, Pat.
- Cairns, Holly.
- Carthy, Matt.
- Clarke, Sorca.
- Collins, Joan.
- Collins, Michael.
- Conway-Walsh, Rose.
- Cronin, Réada.
- Crowe, Seán.
- Cullinane, David.
- Daly, Pa.
- Doherty, Pearse.
- Donnelly, Paul.
- Ellis, Dessie.
- Farrell, Mairéad.
- Fitzpatrick, Peter.
- Gould, Thomas.
- Healy-Rae, Danny.
- Healy-Rae, Michael.
- Howlin, Brendan.
- Kelly, Alan.
- Kerrane, Claire.
- Mac Lochlainn, Pádraig.
- McGrath, Mattie.
- Mitchell, Denise.
- Munster, Imelda.
- Murphy, Catherine.
- Murphy, Verona.
- Nash, Ged.
- Nolan, Carol.
- O'Callaghan, Cian.
- O'Donoghue, Richard.
- 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.
- Sherlock, Sean.
- Shortall, Róisín.
- Smith, Bríd.
- Stanley, Brian.
- Tully, Pauline.
- Ward, Mark.
- Whitmore, Jennifer.
Staon
Tellers: Tá, Deputies Hildegarde Naughton and Cormac Devlin; Níl, Deputies Pádraig Mac Lochlainn and Denise Mitchell.
Question declared carried.
Cuireadh an Dáil ar athló ar 8.19 p.m. go dtí 9 a.m., Déardaoin, an 25 Bealtaine 2023.
The Dáil adjourned at 8.19 p.m. until 9 a.m. on Thursday, 25 May 2023.