Cathal Crowe
Question:6. Deputy Cathal Crowe asked the Minister for Health if he intends to introduce an adult immunisation programme; and if he will make a statement on the matter. [48824/23]
Ceisteanna Eile - Other Questions
Vaccination Programme
This question is to ask the Minister for Health if he intends to introduce an adult immunisation programme and if he will make a statement to the House on the matter.
Covid-19, influenza and pneumonia vaccines are currently available to certain groups of adults most vulnerable to a severe outcome from these diseases. This is available as part of the adult immunisation programme. The immunisation programme is based on the advice of the national immunisation advisory committee, NIAC. NIAC considers the prevalence of the relevant disease, as well as international best practice for immunisation when developing its advice. NIAC continues to revise recommendations to allow for the introduction of new vaccines and to keep abreast of changes in the patterns of diseases. Once a recommendation from NIAC is received and considered by the Chief Medical Officer, CMO, of my Department, a request can be made to NIAC to carry out a health technology assessment, HTA. This assessment looks at the evidence of the effectiveness and safety of the vaccine. The assessment also looks at value for money, cost and the organisational, social and ethical issues of providing a new vaccine. At present, HIQA is carrying out two HTAs in this area. The first is on a shingles vaccine and the second on an enhanced flu vaccine for those 65 and older. The outcomes of these HTAs will inform a decision on whether or not these vaccines will be included in the future in the national immunisation programme. Additional information on the current adult vaccine programme is available from the HSE website.
With the success of the vaccine and the pandemic thankfully behind us, have the Minister, Department and HSE considered a widespread publicity or information campaign on the benefits of immunisation from a public health point of view, the issues facing society and how we can bring information into the public domain? There is a lot of negative information and negativity regarding immunisation, vaccines and so forth. Has the Department or the HSE considered bringing forward a clear message that immunisation works and is important for society?
I fully agree. The shining example in Ireland is the late Laura Brennan and her advocacy on the human papillomavirus, HPV, vaccine. We know Ireland was doing well on the HPV vaccine and then, as the Deputy referenced, a lot of misinformation came into Ireland from abroad through social media. That scared young women and we saw the level of vaccine drop very considerably. Laura Brennan's advocacy was quite extraordinary. We saw the level of uptake of the HPV vaccine go right back up again and we now have a very high level of uptake. Through her work, an awful lot of lives have saved.
Furthermore, the work of her family with the Laura Brennan catch-up programme for girls and young women who might have missed the original HPV vaccine campaign due to misinformation will also save a lot of lives. We need to learn from extraordinary people like Laura and her family in respect of what the Deputy has said about everyone taking the vaccines that are clinically appropriate for them.
I accept the campaign by Laura and the excellent work that has been done, which has hugely benefited society. Has the Department developed an understanding of the challenges that exist? We are getting a lot of misinformation regarding vaccines. A lot of people are reading information on them. It is important that the State, aided by science, the Chief Medical Officer and advice of medical professionals, puts the information in a robust way in order that any attempt to undermine public health or vaccination or immunisation programmes is countered. At this point, we are perhaps taking things slightly for granted. We need a robust rebuttal of some of the information that is being put out there.
I thank the Deputy. We must always be open to being able to do more. I agree with the Deputy. The misinformation and disinformation, largely coming from abroad and through social media, can be very damaging and highly persuasive. I imagine, with the advent of AI-enabled communications we might see more and more of it. While the HSE and Department of Health do a lot, we must always be open to doing more not just in terms of traditional information from the CMO, doctors and scientists, but how we counter at quite a sophisticated level some of the disinformation.
Social media platforms worked well with us during Covid. As we know, Ireland did very well in terms of Covid vaccines. That is probably something we can explore further to make sure that everything that can be done is done to identify and stop what we know to be false information which, ultimately, is a danger to public health.
Mental Health Services
Seán Haughey
Question:7. Deputy Seán Haughey asked the Minister for Health to provide an update on the mental health supports available for stroke victims; to provide an update on the implementation of the national stroke strategy from 2022 to 2027; and if he will make a statement on the matter. [48832/23]
I ask the Minister to provide an update on mental health supports for stroke victims and the national stroke strategy from 2022 to 2027.
I thank the Deputy for the important question. As he will be aware, this year is the first time funding has been provided to support the implementation of the national stroke strategy. We launched it last year and last year's budget provided nearly €5 million for this year to roll out the new stroke strategy. The Deputy and various of our party colleagues have been advocating for neurorehabilitation nurses, including in the Deputy's constituency, for a long time. This year, we have seen the roll-out of a modest enough start - I understand there are 23 nurses across the country to begin with. The Minister of State, Deputy Rabbitte, secured additional funding in her budget to continue with the roll out and hiring of more neurorehabilitation nurses, which is important for next year.
It is worth saying that the HSE and healthcare professionals have made huge progress over the past ten years. The number of deaths from stroke have has reduced by a quarter, which is great to see. There has also been a reduction of one third in the amount of time patients have to stay in hospital, in terms of the average length of stay. We have seen improved survivorship rates.
The national strategy affects the needs of those affected by stroke with various interventions, including treatment, supporting recovery and mental health supports. Pillar 3 concerns rehabilitation and restoration of life. This recognises the need for psychological support as an important post-stroke intervention. As we have previously discussed, the feedback I and others get from our constituents is that while the hospital-based services have been getting better and better and many measures are moving in the right direction, many people felt they were at a loss once they were discharged into the community. One of the measures we are rolling out is neurorehabilitation teams. The Minister of State, Deputy Rabbitte, is taking the lead on that.
That is vitally important. One of the most common acquired disabilities in the country is stroke. I am heartened by the reduction in the number of deaths from stroke. I understand it could be the third largest cause of death in Ireland.
Second.
Second. That is fairly substantial. We also need to consider the supports being put in place for stroke victims. Through our work as public representatives, we know people are affected by strokes at quite a young age. We need to provide proper supports in communities. The Minister in his answer alluded to the fact that when people are discharged to the community after a significant amount of time in rehabilitation in hospital settings, their lives have been completely changed. To achieve the best possible outcomes, they need mental health supports. It is a catastrophic change in people's lives. What specific mental health supports have been put in place?
I thank the Deputy. A few important things are happening. In terms of prevention, we have a successful chronic disease management programme with GPs across the country. We have added hypertension to that, which will make a big difference in terms of community support. GPs have mental and physical health capabilities; they are not specified mental health professionals but we know they provide an awful lot of support and psychological support to their patients.
As the Deputy will be aware, the Minister of State, Deputy Butler, has led a significant roll-out of mental health services. As she has said many times, we focus on CAMHS waiting lists, as we must, but adult access to mental health services is in a much better place. As we discussed, the Minister of State, Deputy Rabbitte, is continuing the essential roll-out of the neurorehabilitation nurses in the community to provide the supports the Deputy has said we need. I fully agree with him.
Question No. 8 taken with Written Answers.
Hospital Services
Paul McAuliffe
Question:9. Deputy Paul McAuliffe asked the Minister for Health for an update on plans to expand the provision of services at Cappagh hospital. [49073/23]
Can the Minister update the House on the plans to expand the provision of services at the National Orthopaedic Hospital Cappagh, in my constituency?
I thank Deputy McAuliffe for the question. I acknowledge his ongoing advocacy for Cappagh hospital, which is our national orthopaedic hospital. I have had the opportunity to visit Cappagh on several occasions and I am very strongly supportive of the hospital staff and the work they do. They needed more money. There has been a significant increase in investment but I would like to talk as well about the further investment that is needed.
Since 2019, funding for Cappagh has increased by nearly €50 million. That is about a 27% increase in funding, which is very welcome. What that has allowed the hospital to do is to significantly increase the staff, by nearly a quarter, so it is at 528 staff now. We all know the essential work that they are doing. Cappagh has worked on its overall master plan. It launched Cappagh Kids some time back, which is an incredible service as well. I was out with them recently enough. I believe the project the Deputy is referring to is the master plan that Cappagh has put forward for 76 single-occupancy rooms in one block, ten high-dependency unit beds and initially three operating theatres, which would very significantly increase surgical capacity by about 60%. I am fully supportive of this. After I met Cappagh some time ago on this project, I contacted the HSE immediately and said this project needed to be prioritised and it must happen. Our orthopaedic waiting lists are too long. I would argue that probably the single most important thing we can do to permanently reduce the waiting lists for orthopaedics and make sure people can get the care they need I would argue is this investment in Cappagh. We have seen in Croom, County Limerick, the small orthopaedic facility there has had a huge increase in the number of patients they are seeing with that investment.
Cappagh hospital is in my constituency but as the Minister rightly says, it is a national hospital. My colleagues, Deputies Cahill and Brendan Smith, have been plaguing both the Minister and the Ministers of State, Deputies Butler and Rabbitte. We have had extensive visits from Ministers. The Taoiseach himself has been out, as has the Minister, Deputy O'Gorman, and many others. It is a fantastic hospital. There is great energy there. What the hospital did during Covid was really impressive, yet it is operating in many ways within some of the old Nightingale wards that it has in place, and within more limited means.
As the Minister says, the proposal outlined is for a 76-bed single occupancy ward block, three theatres and the refurbishment of the radiology services. A strategic assessment report was due to be undertaken on the proposal. Could the Minister write to me as I would be interested to know whether that has taken place? For clarification, what stages are left in regard to the proposal that require to be progressed before the final decision is made to proceed?
I have some good news for Deputy McAuliffe this morning. I am delighted to be able to tell him that just two weeks ago the HSE board approved this project. That was one really important milestone. The strategic assessment report or preliminary business case is done. It has been approved by the HSE board and has now been sent to my Department for a review. There is an external review that has to be done. I have no doubt but that this project will be supported. It is a very significant capital investment. It has my full support and I will be pushing to have this fully approved, detailed design teams appointed and in place, moved to tender and then get diggers on site as quickly as we can out at Cappagh.
I very much welcome the confirmation that the project has been approved by the HSE board. There is great goodwill here. Sometimes we need to just keep pushing it through the bureaucracy. There is no better man than the Minister to do that. It affects people in my constituency but it is a national resource. There is great energy and effort here and it will go a long way to meeting the needs of patients, many of whom have been waiting too long, and which the Government is doing everything it can to address.
We are in full agreement. One of the priority areas for our waiting list action plan is orthopaedics. We know that when people are waiting for operations, be it a hip operation, a knee operation or whatever it might be, they can be waiting in agony and they can be waiting for a long time. When we were in opposition, I was out in Cappagh and I got a very sobering account from the clinicians as to what their patients were going through. It is one of the reasons we have put such an emphasis on the waiting lists.
Deputy McAuliffe will be aware that where people who are waiting just three months for some of the main orthopaedic procedures, the National Treatment Purchase Fund, NTPF, can now arrange care for them as well. That is going well, but regardless of that we cannot rely on additional private sector capacity for this. We need the capacity within the public sector. Croom has been a huge success and we fully intend for Cappagh to rightfully get the significant investment and to let those good folk do the work that they want to do and they know how to do so well.
Hospital Services
Matt Carthy
Question:10. Deputy Matt Carthy asked the Minister for Health the level of additional core expenditure for new developments, excluding funding for carryover and otherwise maintaining existing levels of service, which has been allocated to Monaghan Hospital for 2024; and if he will make a statement on the matter. [48991/23]
Niamh Smyth
Question:15. Deputy Niamh Smyth asked the Minister for Health to outline the investment and enhancement in services at a hospital (details supplied) since he assumed office; and if he will make a statement on the matter. [48127/23]
My question for the Minister is if he will outline the level of additional core funding that will be provided for new developments at Monaghan Hospital in 2024 outside of carry-over and otherwise maintenance of the existing level of services.
I propose to take Questions Nos. 10 and 15 together. My note says that I am taking this question together with No. 15 tabled by Deputy Niamh Smyth. I thank Deputy Carthy for the question on Monaghan Hospital. As Minister for Health, I am fully committed to the development of the regional hospitals, including Monaghan. As the Deputy will be aware, there has been a welcome and significant increase in investment in recent years into Monaghan Hospital. In fact, between 2020 and 2023 the funding investment into Monaghan Hospital has gone up by almost 50%, which is great to see. Critically, the staffing has gone up by 60%. As Deputy Carthy will be aware, the minor injury unit is now open seven days a week since July. There was an expansion in 2021. We had a 23-bed intermediate care ward added. The Deputy will also be aware of the endoscopy facilities, the echocardiogram, ECHO, and exercise stress test, EST, room for cardiac patients. The third ultrasound room was delivered in 2022. New step-down wards with eight beds are to be delivered this year. There has been a very significant increase in funding.
It is worth saying that the reason this is happening is because we know that our healthcare professionals in Monaghan are doing such a good job. We know that with this investment, they are providing the kind of care in the community that is required.
Forgive my naivety but I thought the Minister might actually answer the question that was submitted and put to him.
I accept there has been increased investment in Monaghan Hospital. It took an awful lot of pressure in order to get it, and it came from a very low base because of the disastrous decisions of previous Fianna Fáil and Fine Gael Governments to remove services. The decisions to remove services had a devastating impact on other hospitals, in particular Drogheda and Cavan hospitals. Could I ask the Minister again, how much additional funding for new services is going to be provided to Monaghan Hospital in 2024?
I think the question is grouped with Deputy Ó Murchú's Question No. 14.
I have it that it is with No. 15
No. 14 is about the RCSI Hospitals Group.
We can do that one separately.
Okay, yes.
I thank Deputy Carthy for acknowledging that there has been important investment. I know he is asking about the future and I respect that, but when there has been such an increase in funding to Monaghan Hospital, it is important too that we acknowledge it and that we acknowledge the work the healthcare workers have done with that funding on behalf of the local communities.
In terms of the exact funding that will go to Monaghan Hospital next year, that is being worked out now through the process of the letter of determination into the HSE, which will issue very shortly. The HSE will then come back with a draft national service plan and that level of detail is where that gets worked through. What I can say is that at a policy level, safe staffing, safe nurse staffing, which I know Deputy Carthy's party has signed up to, is fully funded next year for every hospital, including Monaghan Hospital, so there will likely be additional investments there.
It is also worth saying - I do not know if I will be seeing the Deputy tomorrow but I may be – that the investment in Monaghan Hospital is one part of the investment into the area more broadly. I will come back in my second response to reference the community-based investment as well.
I would like it if the Minister, in any of his responses, actually answered the question put. We are virtually in the middle of November and it is impossible to provide new developments at Monaghan hospital without a budget allocated. We do not have one. I take it from his response that no additional funding has been allocated to the hospital at this stage.
A computed tomography, CT, scanner was to be provided to Monaghan hospital. That has been removed. Will it be returned? As I understand it, the hospital has sought operational capacity in magnetic resonance imaging, MRI. Will the Minister provide the funding to deliver an MRI service at the hospital?
That level of operational detail is being worked through by the HSE at the moment on a hospital-by-hospital basis. We will have a full account of that when we have the national service plan. What I can say is that I will open two new primary centres tomorrow, in Monaghan town and Clones. This entails an investment of nearly €30 million. These are state-of-the-art facilities. Critically, as we move next year to a regional basis, the people in County Monaghan will see more community care services joining up, including the two new primary care centres and the expanded capacity we are now seeing in Monaghan town. There is very significant additional capacity now by comparison with when the Government came into power in 2020.
Hospital Facilities
Robert Troy
Question:11. Deputy Robert Troy asked the Minister for Health for an update on the 1,500 new hospital beds that he announced earlier in 2023; when he expects these to come onstream; and if he will make a statement on the matter. [48985/23]
On the issue of additional capacity, could the Minister update the House on the additional beds provided by the Government over recent years and the plan to put in place 1,500 new hospital beds, which he had indicated earlier this year?
I thank the Deputy. I am aware that he is asking this question on behalf of Deputy Troy. I might use this opportunity to congratulate Deputy Troy and his wife on the birth of their baby last night. It is a joyous occasion indeed.
With regard to the beds, it is well recognised that there is a need to improve patient flow and ensure sufficient capacity for both scheduled and unscheduled care. Earlier this year, I asked the HSE to put a plan in place to accelerate the construction and delivery of an additional 1,500 hospital beds right across the country. This is on top of the more than 1,000 additional hospital beds that have been added, and this will be on top of the 162 more that are to be added next year on top of the beds that have been added this year.
The HSE has been identifying, through the existing hospitals, the hospitals under pressure and which we all know need more beds, and also those that are in a good state to rapidly deliver the beds. This approach is supported by a demand-and-capacity analysis. I have asked the HSE and the Department to provide me with the additional bed requirement to achieve the 85% capacity rate we are all signed up to.
To reduce the time taken and the cost, it is proposed that the projects would be delivered using rapid build or standardised, repeatable design solutions, with standard schedules of accommodation, using off-site manufacturing techniques and an accelerated project delivery process. It is expected that this approach will result in a bed cost half the cost of a traditional build bed.
An expression of interest was published in March 2023. There was much interest in it in Ireland and elsewhere around the world. I will update the Deputy further in my next contribution.
I thank the Minister for stealing my punchline because I am taking this question on behalf of Deputy Troy. I welcome the arrival of Maria Ginnell Troy, his daughter. It is an example of how, in very important times, we need hospital capacity.
I welcome the additional beds that the Government has brought on board and the significant funding. In the talk of cuts over recent weeks, I have heard no acknowledgement that funding has increased by nearly 40% over the lifetime of the Government. It is important that we press ahead, however. During the Covid pandemic, several planning derogations assisted with the delivery of hospitals, particularly at St. Luke’s General Hospital in Kilkenny. We need to get to the bottom of the cost per bed and what is actually required. I welcome the comments.
Is there any more information on the rapid-build process and how it might add capacity? Does the Minister have any detailed figures yet on what the cost per bed might be?
I also want to raise the issue of the delivery of beds, having regard to University Hospital Limerick. As the Minister knows, the hospital’s accident and emergency department has broken its overcrowding records twice this year already, despite our not being in the thick of the winter yet. I am wondering whether the Minister can confirm whether we are on track to deliver the first 96-bed block.
I attended a briefing with officials from UL Hospitals Group recently and they explained the position on the second 96-bed block. Could we get confirmation on the construction and delivery of that block also today?
I thank both Deputies. Deputy McAuliffe should note that we had 18 responses from Ireland and abroad to the expression of interest in 2023, all with a view to rapid build. All concerned bring different versions of the technology. In parallel, we have also commenced the detailed design work. The HSE has recently published a standardised questionnaire with a view to procuring the design services to do this. I am engaging with ministerial colleagues on future funding.
On Deputy Wynne’s question, to the very best of my knowledge, the 96-bed block is on track. I gather it has been very well received in Limerick. I was there not long ago. We have started the construction of the enabling works and foundations for a second 96-bed block. I can get the Deputy a report on the exact level of progress.
The use of rapid build is increasingly important in both housing and the delivery of infrastructure but it can pose a challenge at constrained sites. In my constituency, Beaumont Hospital is an increasingly constrained site, although it once had a lot of land around it. The Mater hospital, which is nearby, is beyond maximum capacity. The big challenge will concern how rapid build can be achieved at congested sites or in brownfield areas, where more turnkey or bespoke design is often required.
I thank the Minister for the answers he has given. It is important that we press on and continue to add capacity, as we have done over recent years.
The Mater hospital is a good example of how this can be done. The Deputy is absolutely correct that it is a congested site but we opened the Rock wing there recently. It is a state-of-the-art facility. Some rapid-build technology was used and the process was very efficient. Those responsible probably got the wing built several years quicker than a similar project might have been built in the past. They deserve great credit for it.
At the right-hand side of the Rock wing, a very big build is intended for the regional trauma centre. On the left-hand side, a significant investment is sought for another bed block. The new bed block proposed for the left-hand side is the kind of development that would lend itself to the rapid-build approach.
Hospital Services
David Cullinane
Question:12. Deputy David Cullinane asked the Minister for Health the level of additional core expenditure for new developments, excluding funding for carry-over and otherwise maintaining existing levels of service, which has been allocated to the national maternity strategy for 2024; and if he will make a statement on the matter. [48899/23]
Could the Minister outline the level of additional core funding for new developments, excluding funding for carry-over and the maintenance of existing service levels, that has been allocated for the national maternity strategy for 2024? This strategy is essential to improve healthcare for women, from preconception, pregnancy and birth to postnatal and neonatal care, across acute, primary and community services. The strategy needs year-on-year funding to bring about the new developments, improve the care for women and upgrade their services. Many maternity hospitals are very outdated and require significant capital investment to bring them up to the standard that women deserve.
I thank the Deputy for the question and her support of the national maternity strategy. It is making a big difference. As she will be aware, I have set the progression of women’s healthcare services as a top priority of the Government. We have seen unprecedented investment in women’s healthcare and know this funding is making a big difference in gynaecology, endometriosis, screening and menopause services. We have invested in women’s mental health services, including perinatal mental health teams, as part of the national maternity strategy.
Significant investment over 2021 and 2022 provided renewed momentum to the strategy. It has enabled recruitment of nearly 150 additional full-time health professionals across maternity services. It is funding recruitment across a wide range of specialties of care with more than 70 nurses and midwives, 23 health and social care professionals, seven consultants and also supporting staff.
These staff and this investment improve services for women. They improve women’s lives every day. Each maternity service now has a lactation consultant and bereavement team. Postnatal hubs have been established in Kerry, Cork, Portiuncula and Sligo. The funding is improving home-from-home birthing suites, which I have seen in several hospitals. It is also enabling upgrades to theatres and wards. As the Deputy will be aware, we are establishing a national perinatal genomics service. There is very considerable and much-needed investment across the board in women's healthcare services and specifically, as it relates to the Deputy's question, maternity services.
I did not hear the Minister mention one number - either a financial number or numbers for the year 2024 to which my question related. He has not provided new funding for maternity services in budget 2024. We all know that these strategies need additional year-on-year funding to develop to continually improve and expand on the services. If this strategy does not get new funding, it calls into question a range of measures from upgrading hospitals to relocating services to the community and developing an integrated multidisciplinary approach to maternity care implementing HIQA standards, delivering safe staffing levels in maternity hospitals, rolling out community-based midwifery-led let postnatal care and developing breastfeeding support.
The Minister mentioned lactation consultants. I want to focus on the breastfeeding supports. The national maternity strategy implementation plan identifies that new measure funding is needed to develop these services every year to 2027. How much funding has he secured in 2024 to develop breastfeeding supports for new mothers?
The allocation of resources for next year is not at the same level that it was at for this year or 2022. The focus is on building capacity across the system. For example, I know the Deputy and her party are signed up to the safe nurse staffing framework. That is fully funded to roll out to every ward in every hospital around the country. It is to finish rolling out; a lot of work has been done. Additional capacity is opening up with acute beds, community beds, surgical hubs and other areas. Essentially in many of the women's services, like the see-and-treat gynaecology services, we have gone from a period of rapid expansion to next year consolidating those services and essentially reviewing the services in terms of brand-new services, rapidly expanded services to make sure that we are using the allocated resources to the greatest benefit of the of the patients who need them.
When the Minister says that it is not funded to the same level, I take that to mean none. Zero additional funding will be put into breastfeeding supports. I have concerns about the other care services for women, an issue he touched on in his response, and that is gynaecological services. The budget identifies no new funding for these and the funding to meet the waiting list action plan seems to be far less than in previous years. I am also concerned that this lack of investment in the public services means that the HSE will rely increasingly on outsourcing these services to the private sector. Some 35,000 women are on a gynaecological waiting list with more than 2,000 of them waiting for over a year for an outpatient appointment and 7,000 women have been waiting longer than six months. I acknowledge that in some cases the long-term waiting list has been reduced but I am concerned about the sustainability of this if investment is not continued.
I appreciate the Minister may not have a response to hand on those waiting list figures, on the reduction in the longer term waiting list or on the potential impact the lack of investment will have on this. However, I ask him to come back to me with a written reply. This is causing deep concern for the women of this country. They rely on properly resourced gynaecological services to identify issues early. We have spoken umpteen times about the need for early intervention and the early catching of any issue before it develops into a much more serious condition.
I fully agree, which is why we put such a focus in women's health services on the gynaecological waiting lists and rolling out this new national network of the see-and-treat gynaecology clinics. The clinics that are fully up and running are having it really important effect on the long waiting lists, as the Deputy mentioned, in hospitals such as the Rotunda, Letterkenny and many others around the country. I can confirm that the budget contains new development funding gynaecological services through the waiting list action plan. The three high priority services contained within that are gynaecology, paediatric orthopaedics and bariatrics obesity. There will be ongoing roll-out for exactly the reasons the Deputy articulated.
Question No. 13 taken with Question Written Answers.
Hospital Facilities
Ruairí Ó Murchú
Question:14. Deputy Ruairí Ó Murchú asked the Minister for Health the level of additional core expenditure for new developments, excluding funding for carryover and otherwise maintaining existing levels of service, which has been allocated to the RCSI Hospital Group for 2024; and if he will make a statement on the matter. [48974/23]
I ask the Minister to outline the level of additional core expenditure for new developments, excluding funding for carryover and otherwise maintaining existing levels of service, which has been allocated to the RCSI Hospital Group for 2024.
The RCSI Hospital Group contains model 2, model 3 and model 4 hospitals with one specialist hospital, the Rotunda Maternity Hospital. The hospitals in the main serve populations in five counties – Dublin, Meath, Louth, Cavan and Monaghan. The budget for the hospitals in the group increased by 11% between 2019 and last year. There has also been very significant capital support.
At Beaumont, the €6 million breast care centre opened in last year, and this will benefit approximately 10,000 women every year. Phase 2 of the Beaumont outpatient department was completed in May 2022, at a cost of €1.5 million, benefiting approximately 140,000 patients annually. The minor injury unit at Monaghan hospital is now funded to open seven days a week, allowing more patients to be seen at weekends. Next year a new surgical hub is planned to open in Swords, under the governance of Beaumont Hospital. This is based on the Reeves centre in Tallaght University Hospital and will specifically focus on increasing the speed at which people in these counties can get access to day case procedures for which to date some people have had to wait an unacceptable time.
Every year at this time of year, we go through the process of deciding exactly what funding and additional funding will be allocated to each hospital. I issue a letter of determination to the HSE. That will issue very shortly. The HSE then comes back with a proposed national service plan. Through that national service plan, we can all look at exactly the level of investment and expected activity at a hospital-by-hospital level.
On the national service plan, I will break this down to two particular questions. One of them will relate to one of the issues the Minister dealt with on the radio earlier. I am talking about people, particularly families, who are under severe pressure. If Our Lady of Lourdes Hospital wants to discharge somebody, sometimes the staff are put under severe pressure to discharge into a nursing home. Because of the size of area covered by CHO8, a family from the Cooley Peninsula or Omeath could be under pressure to have their loved one placed somewhere in the midlands. There could be a solution for this. We have a very good discharge step-down unit in Louth County Hospital in Dundalk. It is a matter of whether we can put more resources into that because that is one of the biggest issues we have at the minute. Families are under pressure and a huge level of distress. It gives people time to organise home-care packages and we know the issues that exist there.
I agree that in recent years the hospital in Dundalk has done well in dealing with discharged patients. The hospital team outlined to me that, exactly as the Deputy said, it has good relations and good connections in place. It is a clinically appropriate setting for patients to be discharged to.
Broadly, we know we need to increase community beds. The Minister of State, Deputy Butler, has taken the lead on a massive increase in the number of home care packages and home care hours, with well in excess of 3.6 million hours since 2019. What Deputy Ó Murchú has identified can be looked at within the broader question of a substantial increase in the number of community beds more generally.
I might come back to him on the policy of discharge in my final response.
I welcome that. We need to make sure that people in distress are relieved and that a system that works is created. However, we will have to address the underlying issue, particularly in north County Louth, that there just are not enough people working as home carers at the minute and people cannot get the hours they need to keep their loved ones in home settings. This would provide some level of reprieve, however.
I brought up another issue. We all welcome the likes of Louth County Hospital. There will be a lot less pressure on our accident and emergency department system if we can have more community beds, more community services and more day services. I am talking about the diabetes clinics and so on and making sure they are resourced. There is, however, an issue with orthodontic care. I think we have in Louth County Hospital, in Dundalk, only one orthodontic consultant, and while people, including kids, who are in, I think, category 4, are being seen, the more serious category 5a cases are not being dealt with at the moment. We have a huge waiting list. It will need to be looked at. There is an issue even with computers and laptops that have been lying in Dublin for that particular setting. We need to make sure that is dealt with. Staff are still using older Windows 7 systems in Louth County Hospital. We know the problems we have had with IT and the HSE in recent times, so that is a matter we need to address. First and foremost, however, is the difficulty of kids with severe problems not being able to get the orthodontic care they need. The fact is that can lead to huge surgical interventions being needed later in life.
If the Deputy wants to send me a note on that, I will get back to him with detailed points on it. We are very much aware of the long waiting lists for orthodontics. It is one of the areas that is funded in the waiting list action plan. Good progress has been made, as he said, for the children most in need of the most urgent care. I would like to see the waiting list action plan expanded next year. Waiting list initiatives have funding next year of in excess of €400 million. If the Deputy wants to send me a note specific to his local area, I will make sure the HSE gets back to him.
Question No. 15 taken with Question No. 10.
Hospital Services
Martin Browne
Question:16. Deputy Martin Browne asked the Minister for Health the level of additional core expenditure for new developments, excluding funding for carry-over and otherwise maintaining existing levels of service, which has been allocated to Tipperary University Hospital for 2024; and if he will make a statement on the matter. [49064/23]
I thank an tAire for taking the question. Before I start, I also congratulate Deputy Troy on the new arrival. The fun starts now for him.
I raise this question in light of the fact that €708 million in funding has been allocated for existing levels of service in 2024. That is less than half the shortfall identified for 2023, and that is even before covering other pressures in 2024 as a carry-over and demographics and pay. I would like to know where Tipperary University Hospital fits into the terms of this and the impact on any new developments taking place there and the maintenance of existing levels of service.
I thank the Deputy for his question and join him in acknowledging the work that Tipperary University Hospital does. The hospital has gone from strength to strength in serving the needs of the population.
There has been, as he will be aware, a very big increase in the amount going into the hospital from the Government, and rightly so. In fact, the budget has gone up nearly 30% since 2019. That has helped the hospital to hire an additional 270 healthcare professionals, who are making a big difference in the care being delivered. I am delighted that the additional capital investment in the hospital will provide an extra 33 inpatient beds in the newly developed unit. This new unit is planned to reduce the number of patients who end up on trolleys in the emergency department. That will also help the hospital to reconfigure beds internally and give the older people of Tipperary, who make up nearly half of all inpatients there, greater access to inpatient services at the hospital. I imagine the Deputy will join me in welcoming that development at the hospital. It will make a big difference.
Additional funding specific to the hospital will be determined through the ongoing process. I will shortly issue a letter of determination to the HSE. It will then develop a detailed national service plan for consideration. That will be where we will see its proposals on a hospital-by-hospital basis in terms of the level activity and, therefore, requisite funding to be allocated.
I appreciate that work is going ahead there and that there is funding there. It is, however, beyond unacceptable, at a time the pressure on all our hospitals is at its greatest, that the hospital is now faced with tightening its belt even further, with the added complication of it being unsure precisely what the impacts of the cuts will be. The year began with a total of 2,467 scheduled care cancellations and, as the year progressed, the hospital has been continuing to deal with the increase in presentations and admissions. Thankfully, however, it does not plan to close any inpatient beds due to the funding shortfall. I commend the hospital on that and on the work it has been doing. Staff did note, however, when we talked to them - and this will come as no surprise locally or to anybody else - that they have been operating at 100% capacity daily. That they are being forced to operate in that manner is unfair on them given the pressure they are under. It also poses issues for patients because it presents little room for any manoeuvre in those situations. The uncertainty with the funding just adds extra pressure that neither staff or patients should be under. Currently, the hospital has a small number of projects, which the Minister will be aware of, that are working through the capital steering process. Can I get a guarantee that those will not be affected as a result of the shortfall in funding?
Any projects working their way through the process will be assessed on a project-by-project basis, as they always have been. When we look at Tipperary, Clonmel, the hospital there and the county as a whole, what we see in terms of health services is a story of more and better services being provided. We have gone through the very big increase in funding, staff and services for Tipperary hospital. We have talked about the extra beds and the big difference they will make. As the Deputy will be aware, at the same time there has been a big increase in investment in community services, new primary care centres, new primary care teams, new older persons teams and new chronic disease management teams. When all that is combined, the story of healthcare in Tipperary, while we have a long way to go, as we do across the country, is one of progress and of our healthcare professionals providing more and more and better services to the people of the county.
I am confident that the management will do all it can to maintain the existing levels of service there. It is committed to advocating for the community locally and for the service demands to meet people's needs. We need, however, to hear the same commitment come back from the Government on this. The Minister mentioned primary care centres. I have brought up several times here, as we have brought up locally, the matter of primary care centres trying to get doctors into them in the first place. I had a case recently in which a woman went to a primary care centre at 4.30 p.m. only to be told, "No, we finish at half four because we are out the door at five." That is no good. Unless these primary care centres are up and running properly, it will always add pressure to the accident and emergency departments.
To conclude on this, the hospital has also acknowledged to me that the recruitment freeze has the potential to have a negative impact on patient care. The Minister himself spoke about how well they have been working. The longer the freeze and the more money the Department takes out of the system - and the recruitment freeze itself is adding pressure on the system as it is - the more likely it is at some stage to collapse. How does a recruitment freeze on healthcare workers in the community square with the role of taking pressure off our emergency department?
We are way over time.
I will make one last point about home care. I have a situation in Carrick-on-Suir involving a family, a man and a wife, depending on their neighbour for home care. She has applied since May and cannot even get an answer back as to whether or not that family can have home care. If I give the Minister the details, will he look into it for us? That family is depending on a neighbour who is working-----
Deputy, we are way over time. Go raibh maith agat. I call the Minister.
I certainly will look into it. The Deputy can give the details to me or the Minister of State, Deputy Butler, and we will certainly take a look. The Minister of State and I are very much aware that while there are millions more home care hours being delivered and they are providing an awful lot of support to individuals and families right across the country,l a little more than 3,000 people have been approved for funding and are waiting. The Minister of State led a really important new contract that has been taken up, which improves the terms and conditions for home carers.
It sets out a minimum base for the living wage and it has payments for travel time. Our aim is to go from 21.5 million hours delivered this year to adding another 0.5 million hours next year as well. Our hope is that is exactly the kind of expansion that will help the families the Deputy references, who we are acutely aware are in need of that support.