I must now deal with a postponed division relating to the motion regarding capacity in the health services. On Wednesday, 18 January 2022, on the question, "That the amendment to the motion be agreed to", a division was claimed and in accordance with Standing Order 80(2), that division must be taken now.
Capacity in the Health Services: Motion (Resumed) [Private Members]
The following motion was moved by Deputy David Cullinane on Wednesday, 18 January 2023:
That Dáil Éireann:
recognises that a succession of Fianna Fáil and Fine Gael Governments made decisions which caused and exacerbated the crisis in our emergency departments (EDs) today, including Fianna Fáil's decision to close thousands of beds in their last term in Government and Fine Gael's refusal to invest in an adequate number of beds over the past decade, which have left the public health service with less acute inpatient beds for the last 23 years than when the Tánaiste, Micheál Martin TD, became Minister for Health in 2000;
notes:
— the previous commitments to end the scandal of patients on trolleys made by the Fine Gael party and the Taoiseach, Leo Varadkar TD; and
— that the Taoiseach said that "ED overcrowding is a priority issue for me and for the Government" when he was Minister for Health in January 2015, and has said that overcrowding is "unacceptable" since returning to the Taoiseach's office, and considers that the circumstances in EDs have worsened significantly in the eight years since the Taoiseach became Minister for Health, and that the Taoiseach's rhetoric should be judged against his demonstrable record of failure in Government;
condemns:
— the failure of successive Ministers for Health and Governments to sufficiently invest in hospital capacity, primary and community care, and workforce planning to avoid the record high number of 931 patients on trolleys witnessed on 3rd January, as recorded by the Irish Nurses and Midwives Organisation;
— the current Government's dismal Budget 2023 which failed to provide any additional funding for new acute inpatient hospital beds, failed to set ambitious multi-annual capacity and bed targets, and failed to ramp up or set multiannual targets for healthcare professional training places at the pace which is necessary;
— the decision of the Taoiseach and Tánaiste to retain the same failing Minister for Health, Stephen Donnelly TD, in his post during the recent Cabinet reshuffle; and
— the Government's decision to ignore early warnings last summer of the risk of medicine shortages; and
calls on the Government to:
— immediately make greater use of all public and private health care infrastructure to alleviate pressure on the public system and to minimise disruption for public elective patients;
— increase the number of public beds in the system, including more acute inpatient and sub-acute hospital beds and community step-down beds to speed up admissions and discharges to meet rising demand and demographic change, to expedite the development of elective centres and hubs to provide protected scheduled care capacity in line with Sláintecare, and set out a multi-annual plan for achieving this;
— further increase the number of training places so that we can recruit and retain the doctors, nurses and allied health and social care professionals in sufficient numbers to staff the beds required in the public system on a long-term basis; and
— ensure that the Health Products Regulatory Authority, the Health Service Executive and the Department of Health are engaging proactively to resolve the shortage of medicines and to legislate for a serious shortage protocol to support pharmacists.
Debate resumed on amendment No. 1:
To delete all words after "That Dáil Éireann" and substitute the following:
"recognises that:
- this Government has delivered record funding to permanently increase capacity in our health service, with the Health Vote over €24 billion for 2023 up from €14.8 billion in 2018, and this is the largest allocation ever for the Department of Health;
- since 1st January, 2020, 970 new acute hospital beds and 365 community beds have opened;
- 65 additional critical care beds have opened since early 2020, bringing overall capacity to 323 beds, an increase of 25 per cent over the 2020 baseline;
- thanks to successive large increases in the health budget, there are 17,403 more people working in our health service than there were at the beginning of 2020, this is an expansion of 15 per cent, which includes 5,169 nurses and midwives, 2,870 health and social care professionals, and 1,801 doctors and dentists;
- funding has been secured in 2023 to continue this considerable expansion of the workforce with an additional 6,000 staff to be added this year; this growth will be seen across all service areas and in key staff categories, such as medical staff, nurses and health and social care professionals;
- limited access to diagnostics can result in patients being referred into hospital emergency departments (EDs) and outpatient departments for services; the nationwide general practitioner (GP) Access to Diagnostics programme, which began accepting referrals in January 2021, facilitates direct referral by GPs to diagnostic services for their patients; this structured pathway for GPs to directly access diagnostic tests enables a greater level of care to be delivered in the community, supporting patient-centred care, early diagnosis, and early intervention; and 251,601 scans of various modalities were completed by 25th December, 2022, which far exceeded the 2022 target of 195,000 scans;
- the Enhanced Community Care (ECC) programme is a suite of reforms enabling new ways of working, empowering local staff leadership to meet the needs of local communities and a shift in the focus away from acute hospitals; the Government is strongly committed to this goal, and have allocated very significant resources to ensure that this transformation will be delivered, with annual funding of €195 million provisioned to the ECC programme to enable recruitment of 3,500 additional staff, and with service delivery provided through Community Healthcare Networks (CHNs) and Community Intervention Teams (CITs), that commitment will continue into future years; and significant progress is being made, with 91 of the 96 CHNs and 42 of the 60 CITs now established, almost 2,500 staff recruited to the programme, with the balance of recruitment and establishment of the remaining teams targeted for 2023;
- the Government has strongly endorsed all 16 of the recommendations presented in the Report of the Strategic Workforce Advisory Group on Home Carers and Nursing Home Health Care Assistants (October 2022) and is committed to their full implementation as a priority; the Advisory Group's recommendations are targeted measures which, when implemented in conjunction with the wider sectoral reforms which are in train, will have a lasting impact on the workforce challenges associated with front-line care-workers; however, given the breadth and complexity of the issues that affect workforce-planning, it is not feasible to provide a precise timeframe for the implementation of each recommendation;
- on 16th December, 2022, the Government announced the authorisation of 1,000 employment permits for non-European Union (EU)/European Economic Area home-support workers, as recommended by the Advisory Group, this promises to significantly reduce the shortage of home-support workers in Ireland in the immediate future; and
- the Health Service Executive (HSE) procures home support services via a contractual arrangement with providers and it is envisaged a new contract will be finalised by 30th April, 2023, which presents an opportunity for sectoral reform, and the process of finalising the new tender is underway in the HSE and established procurement protocols apply;
notes that:
- our health service, in common with health systems across the northern hemisphere, is under significant pressure due to a combination of influenza, Covid-19 and respiratory syncytial virus (RSV); and in the United Kingdom (UK) the Health Secretary has said that England is suffering its worst flu season in a decade, and in France, President Emmanuel Macron has outlined his new plan to stop 'endless crisis' in the French healthcare system;
- our population is both growing and ageing, which is welcome but puts additional pressure on the health service, the population has increased by about a third between 2002 and 2022;
- there is a significant increase in presentations to EDs from older patients;
- 194,230 people over 75 years of age attended EDs up to the end of 2022, and that represented an increase of 25,505 (15 per cent) on 2019;
- of these 194,230 some 101,561 people were admitted, an increase of 9,988 (11 per cent) on 2019; and
- significant additional funding was made available to support the HSE's Winter Plan 2022/23, which is supporting delivery of a range of actions to optimise available capacity across community and hospital services by expanding GP access, including within the GP out-of-hours service, facilitating patient flow through the hospital system, and supporting safe and timely discharge to the community upon completion of hospital care;
- building on recent investment across 2021 and 2022, the Department will continue to develop critical care, acute and community capacity, and progress a strong pipeline of capital projects with the HSE, including several new hospitals (including finishing construction of the National Children's Hospital, progress the elective programme/elective hospitals, and relocation of the National Maternity Hospital) and significant new facilities for existing hospitals;
- the Department is also developing a new Strategic Healthcare Capital Investment Framework, including a standardised/streamlined Capital Appraisal Framework for the healthcare sector, refreshing the Health Services Capacity Review, working out a medium-term capital plan to the end of the decade and building the required sectoral capacity, working with the HSE to deliver health infrastructure under the National Development Plan 2021-2030 process;
- the Department of Health is currently engaging closely with all stakeholders in working to mitigate the current immediate medicines shortage issues;
- of the products currently in short supply, there are none that do not have a therapeutic alternative that can be used to meet patient needs;
- the position, as outlined by the Health Products Regulatory Authority (HPRA) last week, remains that alternative strength, brands, and formulation are available for all medicines associated with the current winter surge; HPRA, through the medicines shortages framework, is managing the coordinated stakeholder response to these shortages to minimise patient impact;
- HPRA continues to engage with suppliers to obtain updates and remains open to expediting regulatory procedures to enable supply of additional stock, where possible;
- a subgroup responsible for Antimicrobial Resistance and Infection Control (AMRIC) is meeting with HPRA daily to provide live data to prescribers regarding currently available antibiotics;
- while other countries have introduced Serious Shortages Protocols (SSP) to allow for both generic and therapeutic substitution, Irish legislation already provides for generic substitution of therapeutically appropriate alternatives; the Minister for Health has asked his officials to explore options around developing a protocol to allow for therapeutic substitution in certain circumstances;
- key considerations may include the legislative amendments that would be required (as they were in the UK) to allow for the use of SSPs under Irish legislation, and the framework and governance of such a system; a SSP does not address over-the-counter medicinal products; and in the UK, as in other jurisdictions, SSPs are time-limited and have strict conditions associated with them; and
- there has been an increase of almost 30 per cent in the number of first-year nursing places in Irish Higher Education Institutions over the period 2014-2021 (from 1,570 to 2,032), with an additional increase planned for 2023; and
further notes that:
- the HSE directly engaged with the Private Hospitals Association (PHA) ahead of the Christmas period and asked that any additional capacity available be identified through HSE Acute Operations; and hospitals and hospital groups were also requested to continue to engage locally in this context;
- the HSE is continuing to engage with the PHA to maximise additional capacity, particularly for medical patients and time sensitive or urgent procedures; a series of local arrangements are in place and there are currently approximately 180 public patients in private hospital beds;
- additional GP supports have been made available to enable GPs to extend existing clinics or run additional clinics during weekday evenings and Saturday mornings; the funding grant arrangement for GP out-of-hours cooperatives has been increased by 7.5 per cent and additional funding is being provided to cooperatives to enable them to roster additional doctors, local GPs and locum doctors in treatment centres from 6pm to 10pm;
- these measures allow more patients to be seen by GPs and out-of-hours cooperatives, helping reduce need for ED attendance;
- this Government is committed to achieving one of the core goals of Sláintecare by continuing to invest in reforming and re-organising health and social care services, so that they are expanded and focused on delivering care in the community with a 'home first' approach;
- a number of teams currently operate in the community to provide care for patients at risk of hospitalisation or to facilitate discharge from hospital, for example, referrals to CITs have consistently performed above their annual targets and since October, referrals to the CITs have increased month on month; significant investment in recent years has facilitated an increase in the number of CITs from five in 2014 to the 21 CITs currently in place, ensuring national coverage for the first time and with at least one team in operation per Community Healthcare Organisation area; and we continue to augment and expand this invaluable service, with Winter Plan funding having been provided to target recruitment of additional staff to the CITs;
- the mandate of the European Medicines Agency (EMA) was formally expanded last year by way of Regulation 123 of 2022, which expanded the remit of the EMA to enhance its response to and coordination of shortages of medicines and medical devices at a European level, with a particular focus on driving consistency of approach with respect to mitigation actions; and
- the EMA is liaising with antibiotics manufacturers with a view to increasing supply to the EU market; and the HPRA is taking a lead role in this EMA work on behalf of Ireland.
- (Minister for Health)
Amendment put:
The Dáil divided: Tá, 68; Níl, 58; Staon, 0.
Tá
- Brophy, Colm.
- Browne, James.
- Bruton, Richard.
- Butler, Mary.
- Byrne, Thomas.
- Cahill, Jackie.
- Calleary, Dara.
- Cannon, Ciarán.
- Carey, Joe.
- Carroll MacNeill, Jennifer.
- Chambers, Jack.
- Collins, Niall.
- Costello, Patrick.
- Coveney, Simon.
- Cowen, Barry.
- Creed, Michael.
- Crowe, Cathal.
- Devlin, Cormac.
- Dillon, Alan.
- Donnelly, Stephen.
- Donohoe, Paschal.
- Duffy, Francis Noel.
- Durkan, Bernard J.
- English, Damien.
- Farrell, Alan.
- Feighan, Frankie.
- Flaherty, Joe.
- Flanagan, Charles.
- Foley, Norma.
- Griffin, Brendan.
- Haughey, Seán.
- Heydon, Martin.
- Higgins, Emer.
- Hourigan, Neasa.
- Kehoe, Paul.
- Lawless, James.
- Leddin, Brian.
- Madigan, Josepha.
- Martin, Catherine.
- Matthews, Steven.
- McAuliffe, Paul.
- McConalogue, Charlie.
- McHugh, Joe.
- Moynihan, Aindrias.
- Moynihan, Michael.
- Murnane O'Connor, Jennifer.
- Naughton, Hildegarde.
- Noonan, Malcolm.
- O'Brien, Darragh.
- O'Brien, Joe.
- O'Callaghan, Jim.
- O'Connor, James.
- O'Dea, Willie.
- O'Donnell, Kieran.
- O'Donovan, Patrick.
- O'Dowd, Fergus.
- O'Sullivan, Christopher.
- O'Sullivan, Pádraig.
- Ó Cathasaigh, Marc.
- Ó Cuív, Éamon.
- Phelan, John Paul.
- Rabbitte, Anne.
- Richmond, Neale.
- Ring, Michael.
- Ryan, Eamon.
- Smyth, Niamh.
- Smyth, Ossian.
- Stanton, David.
Níl
- Andrews, Chris.
- Bacik, Ivana.
- Barry, Mick.
- Berry, Cathal.
- Boyd Barrett, Richard.
- Brady, John.
- Browne, Martin.
- Buckley, Pat.
- Cairns, Holly.
- Carthy, Matt.
- Clarke, Sorca.
- Collins, Joan.
- Collins, Michael.
- Conway-Walsh, Rose.
- Crowe, Seán.
- Cullinane, David.
- Daly, Pa.
- Doherty, Pearse.
- Donnelly, Paul.
- Ellis, Dessie.
- Farrell, Mairéad.
- Fitzpatrick, Peter.
- Funchion, Kathleen.
- Gannon, Gary.
- Gould, Thomas.
- Guirke, Johnny.
- Healy-Rae, Danny.
- Healy-Rae, Michael.
- Howlin, Brendan.
- Kenny, Gino.
- Kenny, Martin.
- Kerrane, Claire.
- Mac Lochlainn, Pádraig.
- McGrath, Mattie.
- McNamara, Michael.
- Mitchell, Denise.
- Munster, Imelda.
- Murphy, Catherine.
- Nash, Ged.
- Nolan, Carol.
- O'Callaghan, Cian.
- O'Donoghue, Richard.
- O'Reilly, Louise.
- O'Rourke, Darren.
- Ó Broin, Eoin.
- Ó Laoghaire, Donnchadh.
- Ó Murchú, Ruairí.
- Ó Snodaigh, Aengus.
- Quinlivan, Maurice.
- Ryan, Patricia.
- Sherlock, Sean.
- Shortall, Róisín.
- Smith, Duncan.
- Stanley, Brian.
- Tóibín, Peadar.
- Tully, Pauline.
- Ward, Mark.
- Whitmore, Jennifer.
Staon
Tellers: Tá, Deputies Hildegarde Naughton and Cormac Devlin; Níl, Deputies Pádraig Mac Lochlainn and Denise Mitchell.
Amendment declared carried.
Question put: "That the motion, as amended, be agreed to."
The Dáil divided: Tá, 68; Níl, 59; Staon, 0.
Tá
- Brophy, Colm.
- Browne, James.
- Bruton, Richard.
- Butler, Mary.
- Byrne, Thomas.
- Cahill, Jackie.
- Calleary, Dara.
- Cannon, Ciarán.
- Carey, Joe.
- Carroll MacNeill, Jennifer.
- Chambers, Jack.
- Collins, Niall.
- Costello, Patrick.
- Coveney, Simon.
- Cowen, Barry.
- Creed, Michael.
- Crowe, Cathal.
- Devlin, Cormac.
- Dillon, Alan.
- Donnelly, Stephen.
- Donohoe, Paschal.
- Duffy, Francis Noel.
- Durkan, Bernard J.
- English, Damien.
- Farrell, Alan.
- Feighan, Frankie.
- Flaherty, Joe.
- Flanagan, Charles.
- Foley, Norma.
- Griffin, Brendan.
- Haughey, Seán.
- Heydon, Martin.
- Higgins, Emer.
- Hourigan, Neasa.
- Kehoe, Paul.
- Lawless, James.
- Leddin, Brian.
- Madigan, Josepha.
- Martin, Catherine.
- Matthews, Steven.
- McAuliffe, Paul.
- McConalogue, Charlie.
- McHugh, Joe.
- Moynihan, Aindrias.
- Moynihan, Michael.
- Murnane O'Connor, Jennifer.
- Naughton, Hildegarde.
- Noonan, Malcolm.
- O'Brien, Darragh.
- O'Brien, Joe.
- O'Callaghan, Jim.
- O'Connor, James.
- O'Dea, Willie.
- O'Donnell, Kieran.
- O'Donovan, Patrick.
- O'Dowd, Fergus.
- O'Sullivan, Christopher.
- O'Sullivan, Pádraig.
- Ó Cathasaigh, Marc.
- Ó Cuív, Éamon.
- Phelan, John Paul.
- Rabbitte, Anne.
- Richmond, Neale.
- Ring, Michael.
- Ryan, Eamon.
- Smyth, Niamh.
- Smyth, Ossian.
- Stanton, David.
Níl
- Andrews, Chris.
- Bacik, Ivana.
- Barry, Mick.
- Berry, Cathal.
- Boyd Barrett, Richard.
- Brady, John.
- Browne, Martin.
- Buckley, Pat.
- Cairns, Holly.
- Carthy, Matt.
- Clarke, Sorca.
- Collins, Joan.
- Collins, Michael.
- Conway-Walsh, Rose.
- Crowe, Seán.
- Cullinane, David.
- Daly, Pa.
- Doherty, Pearse.
- Donnelly, Paul.
- Ellis, Dessie.
- Farrell, Mairéad.
- Fitzmaurice, Michael.
- Fitzpatrick, Peter.
- Funchion, Kathleen.
- Gannon, Gary.
- Gould, Thomas.
- Guirke, Johnny.
- Healy-Rae, Danny.
- Healy-Rae, Michael.
- Howlin, Brendan.
- Kenny, Gino.
- Kenny, Martin.
- Kerrane, Claire.
- Mac Lochlainn, Pádraig.
- McGrath, Mattie.
- McNamara, Michael.
- Mitchell, Denise.
- Munster, Imelda.
- Murphy, Catherine.
- Nash, Ged.
- Nolan, Carol.
- O'Callaghan, Cian.
- O'Donoghue, Richard.
- O'Reilly, Louise.
- O'Rourke, Darren.
- Ó Broin, Eoin.
- Ó Laoghaire, Donnchadh.
- Ó Murchú, Ruairí.
- Ó Snodaigh, Aengus.
- Quinlivan, Maurice.
- Ryan, Patricia.
- Sherlock, Sean.
- Shortall, Róisín.
- Smith, Duncan.
- Stanley, Brian.
- Tóibín, Peadar.
- Tully, Pauline.
- Ward, Mark.
- Whitmore, Jennifer.
Staon
Tellers: Tá, Deputies Hildegarde Naughton and Cormac Devlin; Níl, Deputies Pádraig Mac Lochlainn and Denise Mitchell.
Question declared carried.