I thank an Cathaoirleach Gníomhach for making the time for these statements, which I believe are the first on health in this new Dáil.
The Government and I are fully committed to a vision of a universal health and social care service where people have access to services based on need, and not on their ability to pay. The full implementation of Sláintecare remains one of the most significant reform programmes ever implemented by the State. I am so pleased it is a collective effort in this House that is enabling this. We are doing so against the backdrop of the greatest investment ever in healthcare in Ireland, the largest health and social care workforce, and against the challenge of an increasing and ageing population.
A healthy population is beneficial for society as a whole, and improving the health and well-being of the nation is a major priority for this Government. As a result of the strong continuing investment in our health and social care services and changes in behaviours, our people are living longer, healthier lives. Our life expectancy at birth is now 82.6 years, which is the fifth highest among the EU 27 behind Spain and Italy. Both of those countries have lifestyle and weather advantages we cannot compete with, I am afraid. The aim should not just be to live longer, but also to live healthier for longer, and Ireland’s healthy life years at 65 is the third highest in the EU. Ireland also has the highest self-perceived health status in the EU, with 80% of males and 79% of females rating their health as good or very good. These figures point to a thriving population the members of which in large part are enjoying good health. It is important for us to acknowledge this positive reality and recognise the massive contribution our health and social care workforce makes to the lives of everyone in Ireland.
The Government is committed to further transforming how we deliver health and social care through the implementation of Sláintecare and the programme for Government. Our aim is to ensure that the right care is available, in the right place and at the right time. We are prioritising increasing access to make sure those who need care receive it and that the care they receive is safe and of high quality. We are increasing capacity while expanding eligibility.
The population of Ireland is increasing at an unprecedented rate. In the past decade, the population has grown by 15%. The population of over-65s has grown at more than twice that rate, with an increase of 37%, or just over 220,000 people. By 2044, the number aged between 65 and 84 is projected to increase by more than 65%, while those aged 85 and over will more than double. More people overall and more older people mean more demand for our services, particularly in chronic disease management and long-term care. This is why we have been investing in building our capacity both in infrastructure and workforce.
For many decades, we underinvested in our health and social care infrastructure. We are working hard to address this deficit and increase capacity. Under the new programme for Government, significant public investment in healthcare infrastructure and capacity is continuing. Planning for future capacity requirements ensures that we address longer term challenges and prepare our health and social care service to be fit for the future.
Infrastructure plays a vital role in delivering health services, and we need to ensure that our assets, physical and digital, are fit for purpose and that they help to improve health outcomes and experiences for patients and those who provide their care. In the programme for Government, we have committed to deliver a significant programme of work through our capital programme by: increasing capacity by between 4,000 and 4,500 new and refurbished inpatient hospital beds across the country; increasing ICU bed capacity by at least a further 100 beds; providing more community beds; building four new elective hospitals; establishing six surgical hubs in Cork, two in Dublin, the first of which I was delighted to open in Mount Carmel two weeks ago, and others in Galway, Limerick and Waterford, and exploring the provision of an additional surgical hub for the north west in a timely manner; expanding trauma services, including facilities in Dublin, Cork and Galway; continuing to increase capacity and open more beds at University Hospital Limerick, UHL, and across the mid-west, taking account of the HIQA recommendations, which are yet to come in that regard; protecting diagnostic pathways and investing in infrastructure and equipment to meet target treatment times outlined in the National Cancer Strategy 2017-2026; building the new national maternity hospital, which is a major infrastructural investment on the part of the State for women’s health, providing much-needed facilities for women, girls and babies for generations to come; and the new children’s hospital, which I will be visiting tomorrow, which is going to be an incredible, state-of-the-art facility and Ireland’s first digital public hospital in which there will be 473 beds in total, 380 for inpatients and 93 for day cases.
The construction of the children's hospital is 95% complete against contract value. Once substantial completion is achieved, the hospital will be handed over to Children’s Health Ireland for a post-substantial-completion operational commissioning period of about six to nine months. What we are hoping is to have early access. This is what we are expecting in order for that work to begin in April. To repeat and to be clear, I will be visiting the hospital tomorrow with the Minister for Health for Northern Ireland, Mike Nesbitt. There is good work going on also to develop a children's hospital in Belfast as well so I am excited to speak to him about his project and what is happening Northern Ireland and, of course, to see about the completion of the hospital, which is a priority for everybody in this House.
There has also been an unprecedented level of investment in the health service workforce in recent years. As of December 2024, there were 126,740 whole-time-equivalent staff working in health services funded by the Department of Health. That is an increase of 25% on the numbers for 2020. This represents an increase in our workforce, which is a positive development. It is important that workforce growth is managed in an affordable and sustainable manner and that we get the best productivity we can from everybody who is working in our health service, which is a reasonable expectation of taxpayers and of the people of Ireland.
One of the pressures that we all feel and that we must address is increasing capacity and access to acute hospital services by building infrastructure elsewhere. Of course what we want to do is to reduce waiting times for access to healthcare services. As Minister for Health, ensuring better access to healthcare in Ireland and reducing the time patients are waiting for care in our acute hospitals is one of my highest priorities. Time is what we must focus on. Which would Members rather, 100 people waiting one year for a treatment or 100,000 people waiting for one month? They would of course prefer the latter, and we must focus our emphasis. Our tests and assessments must be based on waiting times, which are coming down but which need to come down further. Our Sláintecare targets are ten and 12 weeks.
The Waiting List Action Plan 2025, which I published earlier this month, is another milestone on that journey. It sets out four key targets that are all focused on reducing hospital waiting times by the end of the year, including further reducing the proportion of longer waiters and average waiting times, as well as having 50% of patients dealt with within the Sláintecare ten- to 12-week waiting time targets. Since the commencement of the approach set out in this plan in 2021, genuine progress has been made in reducing waiting times in acute hospitals. For example, up to the end of 2024, we had achieved an approximately 25% reduction in the number of people on waiting lists waiting longer than the Sláintecare targets. This equates to almost 150,000 fewer people breaching these targets. Over the same time period, we have also reduced the weighted average waiting time for outpatients from 12.8 months to 6.8 months. Through this year’s action plan, we aim to further reduce the average waiting time for outpatients to 5.5 months by the end of this year. Reducing waiting times for care will obviously bring a number of benefits from a patient perspective, including improved outcomes and a genuinely better experience of the health service and of a person's experience of the difficulty they are facing.
The second point of waiting relates to access to urgent and emergency care and, in particular, that most visible element of it, the trolley count we see, with people unacceptably waiting on trolleys to get access to our healthcare services. The number of patients waiting on trolleys in hospitals at 8 a.m. each day in 2024 was down in comparison with 2023 despite increased attendances. However, in the past eight weeks I have seen an drift in the very important and good work that was done between 2023 and 2024. I am determined to arrest that drift and turn it around. Our emergency departments experienced an 8% increase in the volume of attendances, equating to nearly 119,000 presentations and an 11% increase in attendances for 75 years and older patient cohort. In that period, however, we achieved at that time a significant reduction in the cumulative daily 8 a.m. trolley count over 2024, with numbers down 11% and fewer older patients waiting longer times. We intend to try to reduce that further this year. It is important to acknowledge that our emergency departments see over 5,000 patients a day. The vast majority of patients who need a bed get one in a timely manner and do not spend an extended period of time waiting on a trolley. This is happening while our healthcare service is also experiencing a significant increase in our demand for care.
On waiting lists and waiting times, there are two important points. If our population is growing, if people are getting a better service within our healthcare system and if they are getting better diagnostics and are being referred for more procedures, I would like to see, logically, the number of people waiting for treatments increase as a consequence of population growth and as a result of being diagnosed and being correctly referred for treatment. I would like to see, however, the time for all of those things coming down. That is why we must focus on waiting times. We, and I in particular, have to arrest the drift that has happened in respect of trolley numbers into this year. I have obviously placed a particular focus on the weekend spikes we are seeing. I will be updating the House as regularly as I can - the next occasion will be after St. Patrick's Day - on rostering, scheduling and all of the services that are there to support people and ensure they do not have to wait on trolleys. This includes analysis of admissions, discharges and rostering but also broader community supports and the whole-of-region involvement that is necessary to ensure people can be safely discharged as needs to be the case. There is a body of work to be done to improve on the good progress that was made last year and, indeed, to get it back to where it had been.
There is also the issue of access to community care. As people live longer lives, they want to stay healthy and independent. Government policy is to support people living with dignity and independence in their own homes and communities for as long as possible. The enhanced community care, ECC, programme is a transformative initiative under Sláintecare, shifting healthcare delivery from hospitals to community settings, ensuring patients receive tailored treatment closer to home. We want to strengthen primary care, general practice and integrated community services, preventing unnecessary hospital referrals and admissions while enhancing patient outcomes. This is again consistent with Sláintecare; getting the right care as close to home at the right time.
Since its launch in 2020, the ECC has expanded significantly, with 2,000 additional healthcare staff, the establishment of 96 community health networks and 50 of the planned 60 community specialist teams for older people and chronic disease. Last year, community specialist teams for older people had a total of 133,000 patient contacts. This was a 35.1% increase on 2023. The focus of those teams is on prioritising complex and more frail patients and the vast majority of those patients are discharged home as opposed to having to go to an acute hospital.
Linked to the GP chronic disease management programme, the community specialist team for chronic disease management provides services for some of our most chronic diseases: respiratory, cardiology and diabetes. They had more than 354,000 patient contacts in 2024, which is a 128% increase on 2023. Significantly, the overall implementation and roll-out of the chronic disease management programme has resulted in a 16% reduction in chronic disease hospital admissions between 2019 and 2023, significantly lower than the 3% reduction for all medical admissions.
Linked to this also is GP access to community diagnostics, with 280,000 scans completed last year. We have a mobile X-ray service, providing services to those residing in nursing homes, community disability units and those in their own homes for whom an attendance for an X-ray in hospital would prove challenging. In 2024, 7,200 patients were provided with a mobile X-ray diagnosis through that service and 95% of them were treated at home and did not require transfer to hospital, the majority of whom were in nursing homes.
The community intervention team service prevents unnecessary hospital admission or attendance and facilitates early discharge of patients for whom that care is appropriate. It provides access to nursing and home care support, usually from 8 a.m. to 9 p.m., seven days a week. There are 23 of these teams operating nationwide and again, in 2024, their activity continued to go upwards with an approximately 16% increase on 2023. That home support is an absolutely essential service for people to be able to live longer in their own homes and live well in their own homes. At the moment, the State is supporting approximately 58,000 people to receive home support. The overall budget for home support stands at €838 million, which is an increase of 70% on 2020. That allocation meant we could provide more than 24 million home support and complex home support hours in 2024, which is more than we have ever done before.
While we are investing more in our health and social care services, it is really important we see that investment used as productively and efficiently as possible. Since 2016, the budget for health has increased by more than 82% from €14 billion to €25 billion in the budget now for 2025. Expenditure on acute care has increased by more than 80% over seven years from €4.4 billion in 2016 to €8.1 billion in 2023. It is a very significant increase in spending but we must make sure we are getting the best from that.
The productivity and savings task force, established 12 months ago, is driving a programme of work designed to achieve savings and efficiencies across the HSE to optimise the use of health funding by delivering safe health services. I am committed to making sure that task force continues its work and we all see the benefit on behalf of the tax payers and people of Ireland, and that we meet our savings targets and continue to implement a range of productivity measures that maximise access to health.
One of the most important reforms in recent years is the public only consultant contract, which was implemented in March 2023, and more than 2,700 or 60% consultants are now in that contract. We now have 4,5000 consultants, which is a very significant increase, and 60% are on that public-only contract. The primary objective of that is to enable the move towards genuine, universal healthcare with public hospitals exclusively used for the treatment of public patients. A core objective of implementing this contract is to enhance the senior decision-maker presence on-site, out of hours and at weekends, and ensure those senior decision makers are present and delivering patient care when demand is at its highest. It means that more patients are treated by consultants, treated quicker and getting out of hospital quicker, where appropriate.
As the House knows, this is an area where I have a particular focus and forgive me for looking at my phone but I want to show the House something that has been important this week and it relates to digital health. Under Sláintecare, funding has significantly increased to expand digital health technologies across the health service, building cyber resilience and progress towards digital health records for patients. The health service has an ambitious forward-looking digital pipeline to deliver on our vision of digital for care 2024-2030 and its accompanying implementation roadmap, coupled with an appetite and momentum for change. This is something for which everybody has been looking for a very long time. It will address a deficit of investment in technology to date and significantly impact on productivity for people working in the system and access for everybody trying to access health and social care services.
This started just yesterday with the launch of the app, which is what I was trying to show the Deputies on my phone. This is my version of the app and if anybody has not downloaded it yet, as health spokespeople and Members of Dáil Éireann, I ask them to download it. A MyGov ID is needed to do that. Not everybody has that to hand, but if they do not have one, they should please get one. It is a fantastic app and provides an opportunity for people to schedule appointments in the public system. It started with a pilot in Cork with maternity patients where they could clearly see their antenatal and other appointments throughout the system, both prior to having a baby and also for some of the follow-up care.
It will enable us to schedule appointments over time. There will be a series of roll-outs relating to this but right now, for example, users can look locally and find a GP wherever they happen to be. If they have an emergency in some other part of the country, they can see where the local urgent emergency care centre or primary care centre is and look up what they need. It will also enable them to track their medication. The idea is this will be a single point of information. If you can do your shopping and your banking on it, you should really be able to look after your own health on your own phone and using the technology everybody in this House has.
For example, I can see on this my flu and Covid-19 vaccination records and I am horrified by the gap between my vaccinations but I can see it. If I had a series of medications or if it was difficult for me to remember, I can track that. How many of our constituents do we know who are tracking their medications on paper? This should make it dramatically easier for them. The reason I pick my phone up is to show Deputies and I ask them to please download the app. They should go to the App Store or Google Play and download the HSE health app. Please do it as it is a big step forward in our electronic health record programme. That is the first step. We will then have a shared care record and ultimately, the electronic healthcare record. I hope this House will put me under great pressure to secure the funding and make sure the electronic health record because, of course, it is in everybody's interest we do so. I want to get lots of PQs about how we are progressing with that
so please do put me under as much pressure as possible.
Separately, I want to mention improving patient safety outcomes. My Department leads the direction of patient safety policy and legislation via the work of the national patient safety office. This is something that is important. The office is responsible for notifiable incidents and open disclosure but I am particularly sensitive this is something that is deeply relevant today with Portiuncula Hospital. I met more families this week on Monday in Portiuncula who have been impacted by patient safety.
Members will possibly see an over-indexation in the programme for Government on patient safety. It is very important to the Government that we get on top of responding to patients in a timely and a caring way and making the experience of having a difficulty in hospital easier. One of the families I spoke with in Portiuncula this week identified the experience. Some of the situations in Portiuncula appear to be emergencies that have been responded to by the hospital. Others are different types of cases. I will not pre-empt the investigations and the analysis of the reports but the experience is so important - not just the facts, but the experience.
For example, one family told me about the experience of coming to Dublin with their baby who had been transferred to the Rotunda Hospital for cooling, which was a completely appropriate response in the case. If a mother has just had a baby and her baby has been appropriately taken for cooling and taken away, that is a traumatic experience to go through. The family described the experience of coming to Dublin and while all the care was correct, the experience around the care was different. It would have made their lives easier to know there was discounted parking available in the Spire car park and it would have made their lives easier to know they could get discounted food in the staff canteen downstairs.
It is the little things that would have made their lives easier, for example, knowing people do not wear sleeves in a neonatal intensive care unit. The family would have felt more comfortable had they known that coming up.
Yesterday, I met the Master of the Rotunda, Sean Daly, and I made these points to him and asked him to set up a dedicated liaison for anybody coming from anywhere around the country to make that experience a little easier. This extraordinary family offered to even share pictures of their little baby or of the cooling process itself, just to, as they said, take the edge off that terribly traumatic experience. The Master of the Rotunda has already come back to me to say he will implement those changes and put together a practical care pack for people coming. I will ask the other maternity hospitals to do the same where that sort of cooling process is used. It is the gentle changes that are a bit more compassionate and more understanding of the patient's experience. If any Deputy has any examples of where we can make the patient experience when things go wrong a little gentler, softer, kinder, a little more compassionate and perhaps more thoughtful by all the parts of the State working together, will they please bring those to me and I will do everything I possibly can to make sure they are implemented?
Separately, on patient safety, obviously HIQA are doing an important body of work. I am running out of time. We will be dealing with those issues over time in any event.
If I could summarise our health system more broadly as I come in as Minister for Health for the first time, every time I look at our public policy questions and challenges around health, I am struck by our very long life-expectancy relative to our EU peers and by our extremely good outcomes in care right across the spectrum. Whether it is cardiac care, stroke care or cancer care, our outcomes are extremely good when people are in the health system. That is a good public policy situation to be in. Where we struggle, and we all know this, is access to care such as to diagnostics and treatment. That is why a focus on waiting times and on access to urgent and emergency care is so important. I say to the Members of this House, to whom I am accountable, that my focus is on improving access as much as I possibly can. What that means is making sure we get the funding and the process in place to deliver the remaining surgical hubs, the elective hospitals, the national maternity hospital and our digital health programme, to make what I genuinely hope can be a leap in the infrastructure for our healthcare system to try to keep as many people as possible out of our acute hospitals. We have heard some examples this evening of what we are trying to do in the community whether it is enhanced community care or the community interventions schemes. We try to keep people away from acute hospitals in the first instance and try to keep them at home rather than in hospitals for different types of care. However, we also have this body of people who should be getting surgical treatment in elective hospitals and in surgical hubs and it is my intention to try to get the funding and make sure we manage the delivery to ensure we have those.
The week before last, I opened the Mount Carmel surgical hub facility, which is the first of six such facilities. This will do about 11,000 small surgical procedures every year, whether it is carpal tunnel surgery or a pain relief medication that has to be done in a clinical setting, but it will also have 18,000 outpatient appointments. It is appropriate that people are not going to acute hospitals for outpatient appointments of that kind. However, I also want to see outpatient clinics delivered by consultants in hospitals on Saturdays. That is what our public-only consultant contract enables us to do. That is the expectation we should have for our healthcare system, trying to use not just the infrastructure for better care outside of the acute hospital system but also making sure we are getting the productivity we expect of the people - public servants, as we are - who are employed by our healthcare system to ensure they are delivering for the people of Ireland. I assure the House that as Minister for Health I will work every day to ensure we are fully realising the benefits of the very considerable investment Irish taxpayers have put in to our healthcare system, that we are building on the outcomes we already have and that we are improving access for everybody in Ireland.
