I welcome the Minister for Health, Deputy Stephen Donnelly, to the House.
Health (Amendment) Bill 2023: Second Stage
Question proposed: "That the Bill be now read a Second Time."
I am very pleased to introduce the Health (Amendment Bill) 2023 to the Seanad. This Bill means that adults will, for the first time in our Republic's history, have free access to inpatient hospital care. As colleagues will be aware, people in Ireland are currently charged €80 per night to use a public hospital, up to a total of €800 in one year, which would be a very large bill. Patients and their families have faced this bill when they are very sick, their ability to work might be compromised and their household income can be very low. Last year, we abolished this charge for children under the age of 16. Now this Bill does the same for everybody else.
The measure in this Bill is important in its own right. It is also a clear symbol of our country's path towards universal healthcare and a high-quality, affordable public healthcare system that is available to people when they need it. Over the past three years, we have been radically cutting the costs of healthcare for patients and families. In 2021, we reduced prescription charges, increased medical access for those aged over 70 and extended to two years medical cards for those with a terminal diagnosis. In 2020, we reduced the threshold for the drug payment scheme. Last year, we abolished inpatient hospital charges for children, introduced free contraception for women aged from 17 to 25 and reduced the maximum amount a family pays for medicines to €80.
Already this year, we have expanded the free contraception scheme to women aged 26. The Bill abolishes inpatient hospital charges for adults. In the coming months, we will provide GP cards to nearly half a million more men, women and children. This means that for the first time since the foundation of the State, well over half the people in our country will have either a medical card or a GP card. Later this year, we will expand the free contraception scheme to those aged up to 30 and, for the first time, we will introduce State-funded IVF treatment.
Combined, these cuts in costs for patients amount to a fundamental shift towards our collective vision of universal healthcare provision in this country. The reductions we have already introduced are making a difference to patients and families. We are determined to keep that progress going. The cuts in costs for patients are being introduced at the same time as the provision of new services for patients, including IVF treatment and other women’s healthcare measures such as specialist services for the treatment of endometriosis, perinatal mental health, menopause and other areas. This is being done in tandem with better access to new medicines. I was delighted to share the news last week that Kaftrio has been made available for the 35 children who were last year excluded by the company that manufactures it.
I acknowledge the significant work done by officials in my Department in drawing up this Bill and, especially, the work done by patient advocate groups right across the country. Its provision on patient charges is a measure that has been advocated for by the Irish Cancer Society for years. The society has pointed out that cancer patients, and their families, are already dealing with the extraordinary stress of their disease and its treatment, on top of which they are faced with significant additional bills. I acknowledge the Irish Cancer Society's advocacy over many years.
I will now provide a brief explanation of the sections of this gloriously short Bill. I was told in the Dáil last week that it is the shortest Bill that has been introduced in this Government's term. Section 1 repeals section 53C of the Health Act 1970, which provides that charges shall be made for acute inpatient services provided by or on behalf of the HSE. Section 1 also revokes the Health (Acute In-Patient Charges) Regulations 2021, SI 213 of 2021. These regulations provide the legislative basis for the persons liable for the acute public inpatient charge and specify that the maximum number of days for which the daily charge may be imposed over a period of 12 consecutive months shall be ten days. This amounts to a maximum charge of €800.
Section 2 contains standard provisions setting out the Short Title and citation and providing that the Bill shall be subject to a commencement order. The key effect of these amendments is to remove the acute public inpatient charge of €80 per day up to a maximum of €800 in 12 months for people accessing care as public patients in public hospitals.
I take this opportunity to provide some detail on other eligibility measures we are introducing this year, some of which I have referenced. Eligibility for GP cards will be extended to people who earn up to the median household income, with this provision to be phased in from April. This will remove the cost of accessing GP care from those for whom cost is most likely to prevent access, thereby helping to reduce the cost of living for young adults and young families in particular. More than 400,000 additional people are expected to become eligible based on income. My Department is working with the HSE and the Irish Medical Organisation, IMO, to expand this provision to children aged six and seven, which will amount to another approximately 70,000 people.
We are aware that these measures will increase demand for the services of our already busy GPs. Therefore, a significant funding package is being made available to GPs to support general practice to increase its capacity. The two are being done in tandem. The additional funding this year builds on the significant funding that has been put in place over the past few years. The 2019 agreement saw funding for GPs for General Medical Services, GMS, patients increase by 40%, as well as the provision of increased supports for rural practices and practices in disadvantaged urban areas and improved leave-taking arrangements. There is more to be done and more supports needed for general practice but we are moving rapidly in the right direction.
We launched the free contraception scheme, initially open to women resident in Ireland aged 17 to 25, in September last year. This was an historic initiative providing, for the first time, for free access to prescription contraception and directly supporting women and their partners in their sexual and reproductive health. The scheme will be expanded further later this year to women between the ages of 16 and 30, with the lower age limit subject to various legal advices that are needed.
Colleagues will be aware of a commitment in the programme for Government to introduce publicly funded care for fertility treatment. Phase 1 has involved the establishment of regional fertility hubs that can provide appropriate treatment to a significant portion of people presenting with fertility issues. Phase 2 will see the introduction of tertiary fertility services, including IVF, with State funding for IVF being rolled out later this year.
Since my appointment, we have also provided dedicated funding of almost €100 million for new medicines. The full-year amount is significantly more than that. This new funding has facilitated the approval of 112 new medicines or new uses for existing medicines. I am happy to say that 34 of those 112 approvals, or nearly one in three, have been in respect of orphan drugs or treatments for rare diseases. This is something many Senators have campaigned for, advocated and regularly sought. I am committed to ensuring greater transparency around and greater speed of access to new medicines for patients in Ireland.
The programme for Government sets out a clear path for expanding and achieving universal healthcare that is high-quality, affordable and accessible. We have delivered and are continuing to deliver on that commitment. Colleagues will be aware that last year saw waiting lists fall for the first time since 2015. It was pointed out to me earlier today that Ireland is one of only a few countries internationally that managed to see waiting lists fall last year following the Covid period, with all the additional burden that brought. In fact, when we look at the number of patients waiting longer than the agreed Sláintecare targets versus the Covid peak to the end of last year, we see that 150,000 fewer men, women and children were waiting longer than those targets.
There is a long way to go but this is a good start. The Bill before the House today is one additional measure aimed at reducing costs for patients, specifically the €80 a day inpatient charge. It means the only charges public hospitals will now apply are for emergency department care or minor injury unit care. Once the Bill is passed and implemented, which we hope will happen in the coming weeks, other charges, including for diagnostic and inpatient services, will be a thing of the past.
Cuirim fáilte roimh an Aire. He is always welcome to the Seanad and is one of our most frequent ministerial visitors, such is the pace of the work in the Department of Health, which includes the preparation of all the Bills he is bringing forward. This is a fantastic day. This short Bill is really significant for the people of Ireland. It speaks to the Minister's commitment, reflective of his core republican values, which are Fianna Fáil values, to the achievement of universal healthcare. The fees dealt with in the Bill can be significant for people, particularly for cancer patients, in a single year. It is fantastic to be debating these measures, for which the Minister will find wide support across the House. It is important that we acknowledge this fundamental shift in how we approach healthcare provision in this country, which is reflective of the universality towards which we are trying to move.
The Minister outlined a number of measures that have already been introduced to help families to reduce costs. We cannot overemphasise the importance of all those schemes and the cumulative effect they will have on household finances.
Who would have thought a number of years ago that we would have free contraception for all people up to the age of 30? I know the Minister is committed to moving it beyond that. That is a radical step forward and is already saving people a lot of money every year. It is also an indication of where we see our health service and what we see as essential healthcare in this country. I thank the Minister for his commitment to that in particular.
With regard to State-funded IVF, everybody knows somebody in their family, community or friend group who has gone through the pain and trauma of infertility, infertility treatment and the costs associated with same. It is shocking that something has not been done until this point. We are one of the only European countries that does not have a State-funded IVF scheme. I am glad the Minister has taken that on board and is progressing a scheme because it is no longer acceptable. Infertility affects a large number of couples and there are treatments and solutions. It would help an awful lot of people at a difficult time if they could access those and not have to think about the cost of the treatment on top of it.
GP cards are being provided for more people, which is a movement towards greater access to health services. I mention the endometriosis treatment, the menopause clinics and the gynaecology see-and-treat clinics. The new medicine schemes and funding for new medicine are significant. I know that 35 children and their families are happy this week that they have access to the cystic fibrosis drug they need. I welcome that.
I pay tribute to the Irish Cancer Society and other patient advocacy groups that have called for this measure for a long time. I commend the Minister on moving this legislation forward.
The Minister is welcome to the House. This is a welcome Bill, which abolishes the daily rate of €80 for acute inpatient services, up to a maximum of ten nights or €800 in a 12-month period. The Minister described the Bill in the Dáil as "a very clear symbol of our path towards universal healthcare". Do we have a clear path towards universal capacity? At the start of the month, the Minister for Transport, Deputy Eamon Ryan, stated there were no plans to make public transport free as that would increase the number of unnecessary trips. Does the Minister have any similar fears about universal healthcare?
We welcome the Government decisions to reduce prescription charges and increase medical card access for those aged 70 and over and, in 2022, to reduce the maximum monthly amounts families pay for medicines from €114 to €80. We look forward to strides in specialist services in endometriosis and perinatal, mental health and menopause care. The big issue is waiting lists and the plan in that regard. The 2023 waiting list plan is funding the HSE and the National Treatment Purchase Fund, NTPF, to reduce hospital waiting lists by 10% in 2023. Hospital waiting lists rose again in January due to the widespread cancellation of non-urgent appointments and procedures. In the same month, 589,670 patients were waiting to see a consultant. Overall, waiting lists fell by about 4% last year, well below the target of 18%. The challenges facing the healthcare system include access to care, overcrowding, waiting lists and services not being available during holiday seasons. Christmas, for example, was a mess last year. Others include children's healthcare, particularly for children with disabilities. The length of time children with scoliosis have to wait is scandalous.
Speaking of waiting, now that the Minister is in the House, I ask him for an update on the Covid-19 inquiry. The Taoiseach has stated the full public inquiry into the State's handling of the Covid-19 pandemic will not be done quickly and will take time but that he is determined to have an inquiry up and running this year, ideally by the middle of the year. He has indicated the inquiry will examine how the pandemic was handled in Ireland, covering healthcare aspects, testing, public health, advice and the economic and social response. I would like the media to be held to account too but we will see how that goes.
On Kaftrio, I thank the Minister for the work he has done. The decision did not come quickly enough but it came. I got an email last week from Vertex, which I have been hounding, as has the Minister. We just want to make sure the children in question are looked after in future. I will read from the email. It states: "We have discussed with the HSE the path forward for other CF patients who could be eligible for our medicines in the future but fall outside the existing reimbursement agreement." Can we get back to the drawing board on that in a timely manner? The email further stated: "We recognize that the Irish Government has put forward some proposals to improve pricing and reimbursement processes following the recent publication of the Mazars report and that the Department of Health is developing a new National Rare Disease Plan." I ask the Minister to outline those proposals.
We all want this process to work well. If we can help the Minister in any way to speed up processes with various companies he is trying to work with, we will do so. Procurement is very important when it comes to these medicines, as the Minister well knows. We must get the deal right at the beginning to make sure it takes in cohorts that may have variations down the line. It is equally important that we lock them in at that price at that time. I thank the Minister for the work he has done but the bottom line as regards Kaftrio is the price per head and the agreement reached with the pharma companies to access all of their drugs for anyone who needs them. We cannot go through this debacle again for the children with cystic fibrosis.
I thank the Minister for coming to the House to discuss this all-important Bill and for introducing this measure. It is all about the cost of living for families and making sure they can afford to meet their costs. As the Minister knows, there are many issues in Limerick where a lot of people are staying away from hospitals. This Bill will encourage people and will help families by reducing costs. The cost of healthcare for some families has been severe, especially for families with cancer care patients. I compliment, as the Minister has done, the Irish Cancer Society and its team, including Averil Power, on the work they have done working with the Minister to bring forward these proposals. It is positive, as are the free contraception scheme and the measures on assisted reproduction. Many families found those to be prohibitive costs and I compliment the Minister on that.
The provision of the cystic fibrosis drug is very welcome. I have been working with a number of families who were concerned about it. I thank the Minister on their behalf.
The removal of the €80 charge per day, which could amount to a maximum of €800 per annum, is most welcome because people are finding the cost of living hard. The reduction in outpatient charges is also welcome. I wish the Minister all the best with the Bill. The Government is committed to reducing costs for families, which is what the Bill does.
I, too, welcome the Bill and the impact it will have on the costs facing families and households. It is a significant amount and it is not to be overlooked.
As the Minister will know, the children's urgent care centre at Connolly Hospital is a satellite centre of the forthcoming children's hospital in the city. This fantastic service was opened in Tallaght and Blanchardstown, initially from 9 a.m. to 5 p.m. from Monday to Friday. After a lot of pushing, it now opens on Saturdays and Sundays. In fairness, that is exactly what management at the hospital wanted to do.
We are in a bizarre situation where Tallaght hospital's urgent care centre is 24-7 for children, and not only is Blanchardstown hospital only operating from 9 a.m. to 6 p.m.- and from 9 a.m. to 5 p.m. at weekends - but it has now become an appointment-only instead of a walk-in service. This has left a lot of people in the wider west Dublin area scratching their heads because it was a service that parents relied on and felt really worked for minor injuries and it has been downgraded as a service to being appointment based. At present, Blanchardstown is doing a mix of walk-ins and appointments but the feedback from parents is that something they felt was working and on which they could rely has been taken from them. When something happens to your child, it is so stressful and then you have to think about where you will bring your child for treatment. While that was a service that simply worked and has been applauded by parents, it feels as though it has been downgraded. Why is it that Tallaght can have a 24-7 walk-in service, while Blanchardstown not only has curtailed hours but is operating on an appointment-only basis? Among the reasons we were given was it was because people were arriving for whom it was not suitable and it was a risk to them, as they were coming to the wrong location for treatment and needed to be going to an accident and emergency department. I believe, however, there are other ways to handle that. It was also said that everyone was arriving all together, either first thing in the morning or late in the afternoon. I am sure people were arriving late in the afternoon but at the same time, if accidents happen then the accidents need to be attended to. Again, if Tallaght hospital can find a way around this why can Blanchardstown not do so? I would really appreciate it were the Minister to address that for me.
Sinn Féin welcomes the Bill. The €80 charge was a barrier to people presenting at hospitals. There are many individuals and families who simply do not have the means to pay that charge, particularly during the current cost-of-living crisis. Sinn Féin believes there should be no restrictions or deterrents for people accessing healthcare. As Sinn Féin has long campaigned for the abolition of inpatient charges, to see this happen is very welcome. Sinn Féin fundamentally supports public health that is free at the point of delivery and is delivered on the basis of need. This Bill is an important step in that direction.
However, I would like to draw the Minister's attention to the distress due to the delay in bringing about this Bill. Over the years, many people ran up significant debts to access basic healthcare in public hospitals. The HSE has paid more than €500,000 per year to private debt collection companies to go after people who were not in a position to pay. When my colleague, Deputy Ward, previously raised this issue in the Dáil, the Taoiseach, Deputy Varadkar, who was then Tánaiste, responded by stating that people have a social obligation to pay their bills, taxes, and settle their debts, and have a moral obligation to do the right thing. I have heard the Minister for Justice, Deputy Harris, talk about morals also. That particular statement from Deputy Varadkar was in the midst of a pandemic during which people had their employment curtailed. Now that the Government has belatedly recognised its moral obligation to provide healthcare and access to inpatient care in public hospitals, I ask that it puts an end to this inhumane and degrading practice.
I particularly wish to draw the Minister's attention to the crisis in GP care and the impact this is having on hospital accident and emergency departments. The reality is that 75% of people who present to accident and emergency departments are, for one reason or another, not admitted. In some cases, these people presented to the accident and emergency department because they do not have access to a GP. The expansion of GP numbers is essential to ensure people do not use accident and emergency departments for primary healthcare needs and to allow services in hospitals to flow more freely. In conclusion, adjustments like this Bill, which removes the €80 charge, are welcome. We need the Minister to commit to tackling the issues of overcrowding, long waiting lists, and access to primary care.
It is obvious that the Labour Party welcomes this Bill, which will remove the public inpatient charge of €80 per day up to a maximum of €800 per year. We know that this change is significant and it is important people do not feel like they will be unable to pay their bill when they go to hospital. The notion of people avoiding going to hospital because of inpatient charges is in and of itself enough to justify the removal of these charges. I for one, and a lot of people, believe healthcare should be available to all who need it, regardless of how much they can afford. It should never be about a case of affordability; it should always be about being able to access timely and necessary care. The abolition of these charges is significant but the real value will come only if people can actually access those healthcare services. I do not want to sound like a broken record by talking about some of the things we already have spoken about but we know that waiting lists are still very long. There is a wait to be seen to get a diagnosis and then there is a second waiting list, which is waiting to actually get the procedures and treatments. As there are still insufficient hospital beds and insufficient staff to serve those beds, the crisis in healthcare unfortunately runs a lot deeper than inpatient charges. I do not want to take away from the fact this is very welcome, whether it is talking over the dinner table with my family about those charges or when people who are in distress contact me about them. To a lot of people, €800 may not seem like a lot of money but it is a great deal of money to an awful lot of people. I have spoken to people who have said they have put off attending accident and emergency departments. In common with many people in this Chamber, I have a visceral reaction when people say they are not going because they cannot afford it. I feel that somewhere in my gut. I very much welcome this Bill.
I will not do a round-table discussion of every hospital in Ireland and the various different problems but I will mention my Labour Party colleague, Councillor Conor Sheehan. We hear once or twice per week, if not three or four times every week about the issues in University Hospital Limerick and how it is underfunded, understaffed, and has fewer beds per capita compared with the other six acute hospital groups. I will put that on the record. I will mention again the impact of this crisis on both patients and staff. We talk quite regularly about nurses and midwives, paramedics who are dealing with demand and who are at breaking point, and tens of thousands of healthcare workers who are experiencing unprecedented levels of burnout. The Labour Party had its conference over the weekend and Ms Phil Ni Sheaghdha of the Irish Nurses and Midwives Organisation, INMO, spoke about the impact the health crisis is having on both patients and the staff working there because while a hospital is a place of healthcare, it is also a workplace and it needs to be considered as such. We know and agree the HSE has a duty to provide a safe environment for all health workers and patients and we have also discussed here the INMO's plans to ballot because they feel they have unsafe staff nursing levels and I hope we do not find ourselves in that situation. I will not go on and on. As we need to remove financial barriers from people accessing healthcare, this Bill is incredibly welcome. It might be the only time I will ever say that we can happily high-speed it through and I for once will not stand up and say we are flying legislation through and so on. This is perfectly reasonable legislation to move through both Houses at a fairly lively pace.
I welcome this Bill and congratulate the Minister for Health, Deputy Stephen Donnelly, in the strongest possible terms. It is an unalloyed piece of good news and it is important we celebrate these positive developments that everyone in the Chamber can get behind. Hospital charges for public patients undermined the entire philosophy of the public provision of healthcare and the €800 cap is a small comfort for the very ill people burdened by these charges. I am really glad the Government is taking action and that the Minister has taken action to rectify this injustice.
I am very glad that the Government and Minister have taken action to rectify this injustice.
However, I will take the opportunity to put on record and discuss some of the other unfair costs that patients and their families have to contend with, which I hope the Minister will consider addressing. The issue of car parking fees has been highlighted by campaigners for many years. The accumulated cost of parking for patients and caretakers who need to attend hospitals regularly can be very difficult for them. This issue has been raised by the Irish Cancer Society and others. These charges are also a major drain on the finances of hospital staff on more modest salaries. The charges may not seem like much to a hospital consultant but cleaners, nurses and healthcare assistants are taking a real financial hit. Unsocial work hours and poor public transportation provision outside Dublin mean that many low- and medium-wage hospital workers are totally dependent on driving to work. This needs to be addressed. There is a commitment to cap these charges in the programme for Government, which is good. I hope that promise will be kept.
Since ending charges for public healthcare is on the agenda, the €100 charge for attending accident and emergency departments should be abolished. Defenders of this charge claim that abolishing it would mean our overly stretched accident and emergency departments would be ever busier but I do not think that is true. When people need care they show up. Nobody wants to go to accident and emergency and people avoid it if they can. I know my friends and family will do anything not to go there. Accident and emergency departments are overcrowded because of long-standing staffing and resourcing issues.
I will also raise an issue relating to the HSE. I am a little shocked by the HSE using collection agencies to pursue patients with outstanding debts. Many of these agencies are disreputable and have received significant legal scrutiny for behaviour that skirts harassment and intimidation in order to recover funds from people who are struggling to pay. Sending debt collectors or heavies after sick, poor people is just not acceptable. It makes a mockery of the values of human dignity and social solidarity that underpin a public health system. The best way to resolve this issue is to make public healthcare truly free at the point of access.
We all know more needs to be done to make care accessible in the community to ease overburdened hospitals. We could do this by expanding the number of places for trainee GPs. It is shocking to think that during a time of such an acute shortage of GPs most junior doctors applying to the training scheme are rejected. We could ease the pressures on GPs by expanding the roles of pharmacists and nurse practitioners. That is being done by some GPs but the role of pharmacists could be a good way to deal with this. These are highly qualified, conscientious professionals who are ready, willing and able to take on greater responsibilities. Empowering allied health professionals could make the delivery of essential everyday healthcare more efficient and accessible.
One example of how this could work is allowing pharmacists to dispense contraceptives without a prescription. The Government's provision of free contraceptives to young women is truly an incredible step forward. Well done to the Minister on that. A feminist republic should defray the extra costs women incur by simply existing. The Minister has done great work in this area. However, for women outside the narrow age range, contraception is a significant expense. The requirement to renew prescriptions with a GP adds further cost and expense. The Irish Pharmacy Union appeared before the Joint Committee on Health recently. It indicated that many of its members would be happy to step up and provide the necessary care surrounding contraceptives. This would be a transformative step forward. It is about trusting women and giving them maximum control over their reproductive health.
I reiterate my congratulations regarding this Bill. It is great we are all supporting something and are not all in battle all the time. I am sure it will provide relief for many people who are enduring difficult periods in their lives. When people are sick, or when they are caring for friends or relatives who are ill, they are at the mercy of the bureaucracies and institutions of healthcare and social protection. As legislators, we need to ensure those systems reflect the humanity of the people they impact. We need to ensure that people feel cared for and supported, not badgered and exploited. Well done to the Minister, his Department and the team he works with. I am very happy and glad to be here to support this Bill.
Senator Kearney has seven minutes.
It is Senator Seery Kearney.
Gabh mo leithscéal.
It does not happen to the Boyd Barretts; it only happens to me.
The Minister is very welcome to the House. I thank him very much for this Bill. It is really welcome. In a country where we are intentional about universal access to healthcare, it is very important we remove any impediments that may cause people to not access the care they require.
A central plank - there is a "however" coming - of the Sláintecare plans was primary care centres and ensuring there is a primary care centre in the appropriate area. This morning, I tabled a Commencement matter but, unfortunately, no one from the Department of Health was available so the Minister of State at the Department of Further and Higher Education, Research, Innovation and Science, Deputy Niall Collins, took it. It was in regard to services on Curlew Road for the people of Drimnagh. The population of Drimnagh is just shy of the population of Killarney. A decision was made recently to pull public health nurses out of Drimnagh and relocate them to Armagh Road in Crumlin, where there is no direct connectivity by bus for elderly people who live in Drimnagh. A whole population, the size of Killarney, has been left without their public health nurses in their community. While it is a temporary measure, and there are contingency plans to have a very short-term clinic, it does not bode well when people in Drimnagh were promised a primary care centre in 2011, the funding was released for it in November 2019, and a design team was supposed to be put in place, all of which is trundling along but with the sod only expected to be turned in 2024. For the people of Drimnagh, that is not okay.
The supplementary information I got on this morning's Commencement matter shows that the public health nursing vacancy rate in Curlew Road, Drimnagh, and Armagh Road, stands at 53%. In Old County Road, the vacancy rate is 60%. We are dangerously low in the rate of recruitment and the number of people actually delivering services in community care. Inpatient care is brilliant and fantastic but the objective of it was to try to do as much locally and in local communities as possible. Yet, we have a community in Dublin, with its own distinct needs and connectivity, left with even its public health nurses stripped out from under it because we have chronic under-recruitment. I have attended meetings of the Joint Committee on Children, Equality, Disability, Integration and Youth and the Joint Committee on Disability Matters when HSE representatives came in, talked about recruitment and said it could be up to seven years before this is fixed. That is no use to children and elderly people who are missing opportunities because there is a failure to deliver in their community as there is this chronic shortage.
We have the same thing with children's disability network teams, CDNTs. The Armagh Road CDNT in Crumlin is supposed to supply 43 children into a special education school there. Those children were offered two hours a week, but even those two hours cannot be delivered because we do not have occupational therapists, speech and language therapists or psychologists. In fact, the turnover of staff on Armagh Road is shocking. If it were a private sector facility, there would be a special investigation and a HR task force to find out why people cannot be retained in that service. We talk about universal healthcare and yet we have this massive recruitment problem. People and parents are relying on the Armagh Road facility, which is now being bolstered with public health nurses who have been pulled out of Drimnagh. Parents there believe that at any minute that CDNT will be closed down because, effectively, it is not operating as it stands.
On another announcement, Cariban was to be available and accessible to women suffering from hyperemesis from January this year.
However, the administrative access to this drug is so difficult and complex that women are being admitted to hospital, put on intravenous drips and treated in a way that would not be necessary if access to the medication could be delivered in a simple way. It is not deliverable in a simple way. You have to wait for a consultant, and you will not see a consultant until you are post 12 weeks. You do not get a retrospective refund on the drugs payment scheme for the Cariban you have already paid for. Even the drug payment scheme has a threshold, and you only get support for one third of the cost. It was announced that there would be free access to this medication for women who are in desperate need of it, but they do not get access to it in many cases until they no longer need it. It is prohibitively expensive for those who desperately need it. It is either difficult to access or is reliant on a consultant dealing with administration, meaning that women are left without actual access to it.
I am delighted to hear the Minister speak about IVF funding. There is no question but that it is desperately needed. I am going to remind the Minister of something I raised with him in the past. When we provide access to IVF funding in this State, we need to make sure the criteria are inclusive. They need to include single parents, same-sex couples and people with disabilities. That last category is particularly important. Some of the exclusions for women with disabilities, and the manner in which they are treated when they present with fertility issues, are quite shocking.
The Minister has always said that as part of the IVF funding, it would be a condition that the regulatory authority would have to be in place and the assisted human reproduction legislation would have to be in place. I am anxious to know how that is progressing. Will that legislation be passed by the summer? A vital part of that is the surrogacy element. There are parents up and down the country who do not have a lifelong legal relationship with their child. As each week passes, they are suffering detriment. There is detriment in the cases of people who are seriously and fatally ill and the mother does not have access to that child. There are second parents excluded from access to their child because they have no legal means to go to court unless they take action in the High Court. We need that legislation and we need a deadline on when it will be delivered.
I welcome the Minister to the House. Does he agree it is wonderful to see the welcome for this Bill across the Chamber? It is fantastic to see it. My question is on the Government commitment to provide approximately €30 million to cover the costs that would have been coming in from the €80 fee. I know that we have the highest ever budget in healthcare, at almost €23 billion. It is driving many of the crucial changes we are seeing. The Minister referenced other areas where we have seen real progress. I acknowledge the work and support we have received in our local area, CHO 2, from the Minister and from the Minister of State, Deputy Rabbitte. The allocation of approximately €436,000 for Westdoc has made a huge difference in our area.
It is hard to underestimate the challenges we have with recruitment and retention of GPs in rural areas. I know that the retention of health professionals in regional areas crops up for the Minister across many different areas and in different fields. I have a number of questions on GP access to community diagnostics. It is excellent and was brought in during the winter to handle the steep pressures in GP practices. I know that was for people with medical cards and GP visit cards. I know it will be moving to another phase soon. Is there any other information? This is an area where GPs would have been able to access X-rays, CT scans and MRI scans through private providers and some hospitals.
I also want to highlight the €100 million for new medicines, which the Minister has mentioned. One in three of the medicines being covered are orphan drugs for rare diseases. There is a new cross-party committee on that. I want to welcome Kaftrio and what was done with Cystic Fibrosis Ireland. There was a huge campaign for 35 children outside of those lists. It is great to see waiting lists falling, as the Minister has mentioned. There are lots of different initiatives. Would the Minister like to comment on how the National Treatment Purchase Fund scheme is operating? How is the cross-border directive helping to reduce those waiting lists?
Finally, on the question of capital infrastructure in my area, I am again advocating for emergency departments in regional areas. We saw huge pressure on Portiuncula Hospital last Christmas. We see investment in our GPs, but there is still a high level of presentation coming into our emergency departments, particularly Portiuncula Hospital, which handles parts of five counties. The challenge is for staff working in tight spaces who have been facing burnout in recent months. Any supports around modular infrastructure next Christmas would be very welcome. I thank the Minister for this good news.
I welcome the Minister and invite him to respond.
I thank the Senators for their support. It is great to see. I assure Senator Hoey, who suggested that this might be the only time she and her good Labour Party colleagues would ever support a Government Bill, that we will be back in this House tomorrow morning with the Patient Safety (Notifiable Incidents and Open Disclosure) Bill 2019. If memory serves correct, we will be in a good place in terms of having that supported through the House too. I have no doubt there are many Bills which Senator Hoey and those Senators who are not in government can and do support as we make progress towards universal healthcare.
Several colleagues asked questions about the direction of travel, and whether we have the capacity in general practice. Senator Black and others asked whether we have the capacity in the system to realise our objective. Our objective is profoundly important and has never been realised. It is one of the guiding principles of our Republic and is enshrined in the declaration of independence when it speaks about cherishing "all the children of the nation equally". The reality is that has never happened in healthcare. Access to healthcare depends in part upon how much money people have, or how much money people's parents have, and whether they can afford to have themselves or their children treated privately. That is not in line with the values of our Republic. The declaration is very clear when it speaks of treating all the children equally. It is a profoundly important goal.
We have some way to go, but we are now within touching distance of achieving universal healthcare. Why do I say that? There are three tests for universal healthcare. First, is it affordable? Second, is it high quality? Finally, can one access it when one needs it? Today's Bill is about the first test, that of affordability. This is the third year in a row in which costs for patients have fallen. The cost of medicines has fallen, and the cap is now €80 per month, or significantly less for those with medical cards. GP care will this year be fully State funded for more than half of the population for the first time. We will continue on that journey in coming years, in line with increasing capacity. New schemes are in place which are now free. Contraception and IVF will be State funded. The exact details are still to be worked out. We are also abolishing hospital charges. Is healthcare rapidly becoming affordable for those patients who could not afford it? Clearly, it is.
The second test is on our outcomes and whether they are getting better.
As we all know, Ireland has the highest life expectancy in Europe. There are many reasons for that but one of them is that we have extraordinarily gifted, well-trained and passionate healthcare professionals in the community setting, in general practice, in our pharmacies and in our hospitals. We are blessed with an extraordinary group of healthcare professionals. We have been rolling out clinical strategies like the national cancer strategy as well as strategies around stroke, chronic disease management and many others within the community. We have discussed the many new services we are rolling out in terms of women's healthcare. Colleagues will be aware that over the last two years we have been building from scratch an entire community health service with 96 primary care teams and 60 specialist teams in chronic disease management. They are bedding in now. It takes time but the feedback we are getting from patients and GPs is very encouraging. We are going to keep going. In this year's budget, I allocated funding for an additional five clinical strategies, including for stroke, obesity, genetics and genomics and others. As I said, the second test is around outcomes and experiences for patients and whether, broadly, they are good and getting better. Yes, they are. I think most people would say they are. They are not perfect but we are here today to discuss costs and tomorrow we will be discussing the patient safety Bill. We are rolling out new services at a significant pace. Ireland meets the second test for universal healthcare comfortably by international standards. We have to keep going and keep investing in clinical excellence and the patient experience.
The third test has been Ireland's big challenge, namely, access. Access in the community is now getting better and better but access to emergency departments and access to outpatient and inpatient hospital services is not at all where it needs to be. The top focus for this Government, for me, for the Department and for the HSE is improving patient access. We are putting in place an urgent care plan to deal with the unacceptably high levels of patients on trolleys. That will no longer be just for the winter but throughout the year. There is an awful lot of work being done on that and I am sure we will have a discussion on it in the coming months. The second measure being taken is the waiting list action plan, in which we are investing hundreds of millions of euro. We have a long way to go. The waiting lists were completely unacceptable before Covid arrived and Covid made them much worse. In many parts of the world Covid has made waiting lists much worse and the deterioration was worse than we saw here. If we compare the number of patients waiting over a year in the Twenty-six Counties versus the Six Counties in the North, there is a very significant difference. The situation is better in the Republic. It is a lot better and getting better quite quickly. Last year there were very significant reductions in the numbers of patients waiting more than a year to see an outpatient consultant for diagnostics, scopes or inpatient procedures.
We have a long way to go but we are moving in the right direction. We are achieving that because we have record investment and because we are doing two fundamental things. We are expanding capacity in the public health service at a record level, with new beds, doctors, nurses, health and social care professionals, community care, diagnostics, primary care centres and all the other capacity. We are building capacity at a huge level with 1,000 extra beds and about 18,000 extra people working in public health services, including thousands more doctors, nurses and health and social care professionals. At the same time, we are in the middle of a very significant programme of reform. We are bringing in regional health areas and investing in e-health, which Ireland is a serious laggard in. There is a lot more work required there.
We are joining up community care and hospital care. We are also asking our healthcare professionals to work in new ways. For example, senior decision-makers are now in the hospital more in the evening and at weekends. We saw the difference that made to the number of patients on trolleys. Due to all of that and the extraordinary dedication from our healthcare professionals, as well as a huge amount of work from the Department of Health and a lot of legislative work from the Oireachtas, we are rapidly moving in the right direction on this third test. We have a long way to go but we are now moving in the right direction. Last year was the first year since 2015 that waiting lists fell in this country. This is going to be the second year in a row and next year will be the third. Our goal, which is agreed across parties, is that no one should wait longer than the ten or 12 weeks set out in the 2017 report.
Questions were asked about scoliosis in particular. There is a lot more to do. The waiting lists are not where I want them to be at all. Our commitment is that no child should wait more than four months unless there is a clinical reason. That has not yet been achieved but I want to see that achieved this year. However, last year there was a 34% increase in the number of children being seen in comparison with 2019. The number obviously went down during Covid. That is 129 more boys and girls being seen last year than in 2019 because the doctors, quite frankly, are working harder. The nurses are working harder and we have invested more money. This year I hope to see that number go up again. The fifth theatre in Temple Street is coming online. More people are being hired. More beds are being opened.
On CHI Blanchardstown, I have to say I have been in the children's service in Tallaght as much as a father as I have as a Minister. That service is second to none. I just inquired while we were here as to the current situation. CHI is saying that the feedback it is getting from patients has been very positive with regard to the booking system, where people can book at reasonably short notice to go in. It is saying that those who go in are finding it better and that a lot of the sicker patients who probably should not be there but need to be seen in one of the bigger hospitals, in a fully equipped emergency department, are being diverted to the appropriate place. It is something we will keep under review. What I want to see, not just in these centres but in other minor injury units right across the country, is expanded hours and enhanced services.
Senator Black raised the various other fees, such as car parking fees and the emergency department fee. The reason the emergency department and injury unit fees are staying in place is that if it becomes cheaper to go to hospital than to go to a GP for that group who still have to pay, inevitably more people will go to the hospital. That is why that fee was brought in years ago. The purpose is not to be hitting people with costs. The purpose is to make it a place where people go in an emergency rather than the GP out-of-hours service. However, I take the Senator's point. As we reduce GP costs for patients, we should be able to reduce these costs as well, maintaining a differential but bringing the cost down. I have paid that fee more than once in the last 12 months for my own children. That €100, or even €75, is a lot of money for people and it is something we need to look at.
The Senator also asked if there is an enhanced role for pharmacists here. Yes, there is. We are working very closely with the Department and we are talking with the Irish Pharmacy Union, IPU. Pharmacists should be able to dispense oral contraception, although there are some situations where they probably should not. We should have minor ailment schemes in place. Medical card holders should not have to go to their GP to get a prescription for over-the-counter medicines, taking up GP time. Pharmacists should be able to prescribe. There is a very significant amount of additional work pharmacists can do. As the Senator quite rightly said, they are absolutely up for that challenge.
We can also deploy more practice nurses in general practice. In fact, I think that is probably the single biggest opportunity in this regard. We need more GPs and are doubling the number in training. That will be tripled. It will go from what it was to double and then to triple in the coming years. We are expanding medical school places and training places. We are looking to support international GPs coming into Ireland. However, we have a low number of practice nurses relative to some countries in Europe. There is a big opportunity there. I speak to people who say they have gone to a GP numerous times when in fact they never needed to see a GP; they just needed to see a nurse or whatever it may be. More and more use of practice nurses is what some of this money can and will be used for.
GP access to diagnostics is expanding. We spent €25 million on this two years ago, €35 million last year and €45 million this year. I would expect close to 300,000 scans of all the various modalities that were referenced this year. That is going down very well with the GPs. They are very happy with it and we are going to keep pushing on that.
I will get Senator Seery Kearney a detailed update on the assisted human reproduction Bill. It is not what today's debate is about so I do not have an update but I can certainly get one. The Senator can rest assured that it remains an absolute priority. As we prepare the legislation, which is incredibly technical and detailed, we should note that Ireland will be the first country in the world to bring in legislation like this. We have to get it right because it will be open to challenge. It is incredibly complex legislation. We will be putting into this robust legislation all the recommendations from the report.
It is happening and, at the same time, the regional fertility hubs are ramping up and hiring, services are being provided, a sixth hub will be in place this year and we are engaged with both the HSE and the private providers on IVF. To begin, we will use private providers. It will take years for the HSE to build up IVF capability. The ultimate goal is for the service to be fully publicly delivered. We are years away from that, so the options were to wait for years while we build up capability and then fund the service, or to fund it using private providers now and then transition. The latter is the option we have taken, for all the obvious reasons. We wanted this to be available as quickly as possible.
I am sure I have missed some of the contributions in my response. I apologise if I have. We have done a run-through of many parts of the healthcare service. I again thank my Seanad colleagues for their support for the Bill. I very much look forward to the discussion on the Patient Safety (Notifiable Incidents and Open Disclosure) Bill tomorrow.
Question put and agreed to.
When is it proposed to take Committee Stage?
Next Thursday.
Is that agreed? Agreed.
Committee Stage ordered for Thursday, 6 April 2023.
Before we suspend, I welcome former US ambassador to India, Mr. Richard Verma, who is here with his family and Deputy Creed. They are very welcome to Seanad Éireann. Céad míle fáilte.
Cuireadh an Seanad ar fionraí ar 6.22 p.m. agus cuireadh tús leis arís ar 6.35 p.m.
Sitting suspended at 6.22 p.m. and resumed at 6.35 p.m.