Dáil Éireann Debate, Tuesday - 15 September 2020
31. Deputy David Cullinane asked the Minister for Health the measures he has undertaken or will undertake as part of the winter plan to protect capacity in the health service, to ensure maximum possible uptake of the flu vaccine, secure sufficient staffing levels and bed availability, deliver Covid-19, non-Covid-19 and catch-up care; and if he will make a statement on the matter. [23639/20]
View answerMy question relates to the very serious challenge that acute hospitals in our health service will face over the next number of months. We have been hearing for some time from the Minister for Health, Deputy Stephen Donnelly, that he will produce a winter plan. By the way, I want to wish him well and I very much hope that a negative result comes back. He has said that he will produce a winter plan. This is not just about a winter plan but also about Covid, non-Covid and catch-up care and a plan that enables us to do all of that. My question asks how that is going to happen, what supports and measures are being put in place and what funding will be made available.
I thank Deputy Cullinane for his question. As we all know, the Minister for Health has been feeling unwell, has been referred for a Covid-19 test and is self-isolating. We all wish him well.
I will endeavour to answer the questions posed as fully as possible. If any of my answers are insufficient, written answers can also be provided. In reply to the Deputy's very important question, resuming health and social care services and building health sector capacity and capability is a priority for the Government. The coming winter is expected to be particularly challenging due to the presence of Covid-19 and the uncertainty around the level of Covid and non-Covid health care demands. Every winter is challenging but there is no doubt that with Covid-19 this winter is going to be particularly difficult. The HSE is finalising a plan, in line with Sláintecare principles, for delivering services in a Covid pandemic for the period to December 2021 and incorporating winter 2020-21. The initiatives in the plan to mitigate the winter pressures are under three headings, namely, community care, acute care and assistance to support hospital egress. Timely discharge from acute hospital settings is hugely important. Throughflow in hospitals is vitally important so that there will be capacity at the emergency department end. This will include increasing hospital and community capacity, reducing unnecessary hospital admissions by enhancing alternative community care pathways, and enabling timely discharges from acute hospitals, and consequently reduce waiting times in hospital emergency departments. There will be a focus on targeted actions to shift care to home and ambulatory care environments, especially for high-risk cohorts such as elderly patients and those with chronic illnesses.
As the Deputy knows, the pandemic has borne down hardest on our older generation. I have for many years been an advocate for the correct wrap-around supports for our elderly generation living at home, which is what this plan hopes to achieve. Obviously, older people are not in a position to go to day care centres or to be out and about, so they need the supports, rehab and re-ablement at home. Disability and mental health services, e-health and staffing will also be included in the plan.
The resources for the plan will be sought as part of the 2021 Estimates process. In advance of this, the Government has allocated €600 million to support the early roll-out of the winter-specific measures in this plan, with €200 million up to Christmas and €400 million thereafter. This will facilitate the commencement of priority measures from an operational perspective.
A key action will be a comprehensive flu vaccination programme. The HSE has placed orders for approximately 1.35 million doses of the quadrivalent influenza vaccine, as well as 600,000 doses of the live attenuated influenza vaccine, which will be made available to children aged from two to 12 years old, inclusive.
In regard to acute bed capacity, the programme for Government, Our Shared Future, commits to continuing investment in our health care services in line with the recommendations of the health service capacity review and the commitments in Project Ireland 2040. The Minister's Department is working with the HSE to increase both general and critical care acute capacity in hospitals nationwide.
It is very important, as we face into the winter, that we are very conscious of the most vulnerable in our society. We are talking about people with mental health issues, the elderly and people with disabilities, especially those with acute disabilities. I would also like to mention carers, given I hosted a round-table for carers this afternoon. Carers have been to the fore in the past six months, during which they had to cocoon at home with their loved one.
I am very conscious of the most vulnerable people and I am very conscious they are people we have to protect over the next weeks and months. It is not good enough that the HSE is only finalising a plan. We have an unprecedented crisis facing us. Although we thought we saw chaos over recent weeks and months, unless this Government gets its act together, unless a real, aggressive, robust plan is put in place to deal with the challenges facing our healthcare services in the next while, and unless that plan is as robust as it needs to be, then the Minister of State and the Government are failing in their duty.
We have a perfect storm coming at our health services. Our front-line healthcare workers need support. People need to know they will get treatment and that the capacity will be there. I did not hear one word in the Minister of State's answer about how many additional beds or staff will be made available, what capacity will be leveraged in the private sector or how we are going to make sure we can deal with both Covid and non-Covid care. All I got is a statement of the obvious and no plan.
The Deputy is correct we are living in unprecedented times. I do not think it is a statement of the obvious to announce €600 million to support people in the winter plan that runs throughout the winter until after Christmas.
The Deputy is right when he says bed capacity is the most important thing going forward. The whole purpose of this plan is to try to keep as many people in their homes and in the community. The Department of Health is working with the HSE to increase acute capacity in hospitals throughout the country in the context of the current Covid-19 pandemic response. Funding was provided in March for an additional 324 acute beds, which brought the reported acute inpatient capacity to 11,597 beds, excluding critical care beds. This was an average of 11,000 inpatient beds open during 2020 up to the end of July. There were 304 general acute beds and 41 adult critical care beds available in the system on Thursday, 10 September.
The Minister of State gives me a figure of €600 million and no detail of what that will mean. I published a plan in the first week of August and we set out what is necessary. The last figures we got from the National Treatment Purchase Fund, NTPF, showed 610,000 people - record numbers - waiting to see a consultant. They showed that inpatient and outpatient waiting times were up and that, across all of the specialties, people are waiting longer. However, there is no sense of urgency from this Government and no idea what is facing front-line healthcare workers.
As to the planning that goes into putting the extra staff and the extra beds in our hospitals, we know it takes time. However, coming with a plan in the middle of September when we know the crisis is here and now is not good enough, in particular when we have been asking the Minister for months to come forward with a plan. It is not good enough to throw out a figure and say that we will spend a certain amount of money at some point and that we will come in at some point.
We had a plan announced by the Government today on living with the virus but there is no Government time to debate it. I hope that when it announces its winter plan, there will be proper statements in the Dáil so the Minister can be held to account.
I take the Deputy’s point, which is well made, but he has to remember we are living in unprecedented times. We are learning as we go along. When the Covid pandemic hit in March and April, all of our capacity was put into the acute hospital sector because that is what we had learned from seeing what was happening in Europe. Unfortunately, the pandemic bore down hardest on our older generation. We lost 985 people in our nursing home system, and 54% of all those who have died to date were lost in the nursing home sector.
A huge amount of work is being done. Testing, tracing and isolating are the bywords of what we have to face going forward. Even though the Deputy says there is no detail, the detail will follow. I know, for example, that we are looking to double the amount of home care supports for our older generation, and we are looking at rehab in the home and at re-enablement in the home to protect our older generation and to keep them out of the acute hospital setting. While there are many challenges ahead, I believe we have a fantastic front-line service which is well up for the challenge.
