Dáil Éireann Debate, Thursday - 20 April 2023
3. Deputy David Cullinane asked the Minister for Health when he will publish a multi-annual capacity expansion plan for the health service and for hospitals in particular; and if he will make a statement on the matter. [17405/23]
View answerI am sure the Minister will agree that reducing the health waiting lists, the time people must wait for care and the time people must wait in emergency departments needs to be a Government priority. I strongly believe we need a multi-annual plan that considers capacity throughout the healthcare system. It should set out medium- and long-term goals to increase capacity and start meeting some of the targets. Is it the Minister's intention to publish a multi-annual plan? If so, when will we see it?
The short answer is "Yes, and a consolidated plan". I fully agree. The Deputy and I have discussed this several times. We already have several multi-annual plans in place. The core infrastructural plan is the 2018 capacity review, which gives us targets, agreed by everyone in the House, for acute beds, critical care beds, nursing home beds, elective capacity and so forth. We are reviewing the 2018 capacity review. It probably underestimates fairly significantly the number needed. The report gives us a range of acute beds, from approximately 2,500 to approximately 7,500. We all latched onto the figure of 2,500 beds but the reality is that we need more, based on the 2016 baseline.
Coming up to Covid, we were on track for the annual increase in beds called for in the 2018 review. We are now well ahead of that. The Deputy will be aware that I am seeking Government agreement on an additional 1,500 beds. Since Covid arrived, we have added 970 beds. The plan is to bring the figure up to 1,179 by the end of the year. The addition of 1,500 beds represents a massive increase in hospital capacity.
Intensive care unit, ICU, provision is also going very well. At the end of this year, we will have seen a substantial increase. We have had a substantial increase but we should have more than 350 ICU beds by the end of this year. This will make a big difference. We are going much further. Again, the plan is to exceed the figures in the 2018 review.
The three elective hospitals go way beyond what the 2018 capacity review put in place. We have a multi-annual plan for infrastructure and it is being reviewed. I believe the targets will increase. We are in a good place regarding most of the targets. We probably need a broad political discussion on nursing home beds. The commission on care will be examining this also, determining how we can keep people at home.
My point is not so much about the capacity review because beds comprise only one of the ingredients needed. Having spoken to many hospital managers and front-line healthcare staff, I realise that if we are to reduce waiting lists, we will need more beds. The reason there was such a wide range given for the number of beds that may be required, from 2,500 to 7,500, was the figure was dependent on what would happen in the community, including in respect of nursing home beds, recovery beds and step-down beds and the rolling out of the enhanced community care programme. The more that happens, the fewer beds we may need, but we do need more beds. We may not agree on the precise number.
We just need to get evidence-based approaches to this so we can again agree what we need via a revised bed capacity review. However, we also need public diagnostic capacity and surgical theatre capacity in hospitals and, crucially, all of the enhanced community care roll-out that is needed to ensure people can get the right care at the right time in the right place. That is the joined-up multi-annual plan I want to see - not just a plan regarding beds because beds are only one part of it. We need staff to staff those beds. That has to form part of it, including workforce planning. If we just concentrate on beds alone, we will miss the causes of what is driving waiting lists.
I agree with all that. We have a beds plan and a hospital building plan so the multi-annual bits and pieces are in place, and we also have the community care plan. The enhanced community care programme is the multi-annual plan and is really going from strength to strength. I am opening another three primary care centres tomorrow. That is going really well. We have community care, beds and hospitals. Diagnostics is going very well. The GP access to diagnostics programme did more than a quarter of a million scans last year. Essentially, now via the GP, we are providing free access to all diagnostics for everybody regardless of whether someone has a medical card or GP card. It is going really well. We are using a lot of private capacity for that so this is an area where we can definitely look at building further public capacity. The final piece of the jigsaw is a multi-annual workforce approach. We are involved in a European project on that and that work is being done through this year. Ultimately, what would be great is a single piece of paper that brings it all together and gives a five- or ten-year capacity plan in respect of community care, acute care, workforce and infrastructure.
Hopefully if the electorate has good sense, I will be the Minister who produces that single piece of paper and plan that will deliver a lot of what the Minister talked about but that has not been delivered. All those ingredients are part of what is needed to reduce waiting lists because while there has been some positive movement in terms of long waiters, far too many people are still waiting for access to healthcare.
I welcome the 1,500 beds that have been announced. We discussed this yesterday. We need to do what the Minister spoke about very quickly, namely, doing it at pace and dealing with the layers of bureaucracy in the HSE capital approval process and all the other issues that make it difficult to deliver them at pace. We also need to make sure it is on the basis of need. While it may take a bit longer for some hospitals to deliver these beds for all sorts of practical reasons, we cannot simply say to those hospitals that are ready to go, "Listen, you can have all the beds" and it not be based on health need. I raised the issue in Waterford hospital, where 160 beds are needed, yesterday, so it must be on the basis of need but there also needs to be speed.
Between the Deputy and the Minister of State at the Department of Health, Waterford is well represented in Dáil Éireann. It is also well represented in Seanad Éireann. Let us not lose sight of the fact that over the past three years, we have seen an historic expansion of capacity. More beds have been added than at any time in a very long time, there has been more access to diagnostics than in a very long time and more new hospitals signed off than in God knows how long. We are up to nearly 20,000 additional whole-time equivalents in the HSE. We have built up an entire primary care system from scratch over the past two and a half years and, therefore, we are in the middle of an historic expansion of public service capacity. I agree that we must get faster at delivering beds and physical infrastructure, including e-health. That is the focus of this - not signed off or agreed but progressing this plan around a rapid build programme.
