Health Service Funding: Motion (Resumed) [Private Members]

The following motion was moved by Deputy David Cullinane on Tuesday, 24 October 2023:

That Dáil Éireann:

notes that:

— it is widely accepted that the Government has chosen to underfund the Health Service in Budget 2024;

— comments made by the Minister for Health, Stephen Donnelly TD, recorded in the Irish Times on Thursday, 12th October, 2023, stating "it is entirely likely that a supplementary budget will be required next year";

— comments made by the Chief Executive Officer of the Health Service Executive (HSE) to the Oireachtas Joint Committee on Health on 27th September, 2023, stating that there will likely be a Health Service income and expenditure deficit of "somewhere in the region of about €1.4 billion or €1.5 billion" in 2023; and

— comments made by the Secretary General of the Department of Health to the Oireachtas Joint Committee on Health on 27th September, 2023, stating that "there has definitely been underfunding of Existing Levels of Service (ELS), absolutely. That is a problem";

further notes that:

— the Government have allocated only €708 million for ELS funding in 2024 for the Health Service, which is less than half of the shortfall identified for 2023 before even covering other cost pressures in 2024, such as carryover, demographics, and pay;

— the Government has not allocated additional capital funding to the HSE to deliver the promised and needed 1,500 acute inpatient hospital beds, which are not included in the National Development Plan funding; and

— the new children's hospital will require a significant additional allocation of funding due to the Government's mismanagement of the project, which will add further cost pressures on the HSE's budget;

condemns the Taoiseach, the Tánaiste, the Leader of the Green Party, and the Government as a whole for:

— their reckless decision to underfund the Health Service in Budget 2024;

— embedding an overreliance on outsourcing, agency staffing, management consultancy, and overtime, which has increased costs, hollowed out the Health Service, and burned out the workforce;

— their failure to reform the healthcare system and deliver a single integrated financial management system in the HSE, to invest in digital transformation and to put in place more effective management of waiting lists;

— ignoring warnings from the HSE and the Department of Health that the budget for 2023 and 2024 does not cover the true cost of running the HSE; and

— ignoring warnings from healthcare trade unions and patient advocacy organisations of the potentially catastrophic consequences of dramatically underfunding the HSE for workers and patients;

considers that the Government's budgetary decisions for 2024:

— will have a severe impact on frontline services, clinical programmes, national strategies, access to new medicines, tackling waiting lists, and dealing with manifold crises across Emergency Departments, Child and Adolescent Mental Health Services, and Children's Disability Services;

— have already led to cuts in frontline services with 7,000 unfunded approved posts in the HSE being cut, and a recruitment freeze being put in place on vital frontline Health Service roles, such as non-training scheme doctors, healthcare assistants, and home help workers;

— will have serious consequences for the HSE's ability to meet the already weak targets set out in the Minister for Health's Waiting List Action Plan, which is behind profile and unlikely to hit targets by year-end for a second year in a row; and

— will result in hospital managers and doctors making tough decisions on what services to provide, what services to cut, and which patients will not receive the care they need; and

calls on the Government to:

— immediately increase the funding allocation for the Department of Health for 2024 to:

— adequately cover existing levels of service and cost pressures such as inflation, demographic changes, demand increases, and pay increases; and

— provide for new developments funding to advance vital projects across hospital bed capacity, community care reform, and taking further steps towards universal healthcare and reducing the cost of healthcare such as raising the medical card threshold and reducing the Drugs Payment Scheme threshold;

— urgently bring forward a supplementary budget for 2023 to reverse the recruitment freeze on essential frontline posts as the HSE faces into an extremely tough winter without adequate resources to deliver the quality and quantity of care to avoid thousands of patients languishing on trolleys and exposed to unnecessary risk of delayed care and hospital-acquired infections; and

— put in place a time-bound plan for ending the HSE's reliance on expensive outsourcing, agency staffing, management consultancy, and private healthcare.

Debate resumed on amendment No. 1:

To delete all words after "Dáil Éireann" and substitute the following:

"notes that:

— the Government has allocated €22.5 billion to the health budget for 2024;

— the health additional allocation for Budget 2024 is nearly €2 billion;

— this includes an increase of €808 million in core current funding, €1,032 million in non-core current funding and an additional €120 million in capital funding; and

— Budget 2024 includes funding for Covid-19 vaccinations, testing and tracing, waiting list initiatives, urgent and emergency care initiatives, Ukrainian supports, staffing for new acute beds, intensive care beds, community beds and surgical hubs, investment in our healthcare workforce including in advanced practice and new training posts, mental health and social inclusion measures, and cyber and digital capabilities;

further notes that the Government has focused on increasing capacity:

— in the last three years the Government has added 22,000 healthcare workers (net), including 6,700 extra nurses and midwives, 3,100 additional health and social care professionals, 2,500 extra doctors and dentists;

— hospital bed capacity has increased by over 1,000 beds during the same period;

— ICU/crucial care bed capacity has increased by 25 per cent;

— a national network of Enhanced Community Care Network teams is being rolled out, enabling patients to be treated outside of hospitals and closer to home; and

— six new surgical hubs are being progressed with the first due to open within months;

acknowledges that:

— funding has been allocated to clinical strategies and improving access;

— hospital waiting lists fell in 2022 for the first time since 2015;

— the total number of patients removed from waiting lists during the first eight months of the year is higher than target, with over 150,000 more patients removed from waiting lists compared to the same period last year;

— a record 22 million hours of home care are forecast to be delivered this year, up from 17.48 million in 2019;

— important progress for patients has been made in the rollout of national clinical strategies including in cancer care, maternity care, trauma care, palliative care, critical care, dementia care, mental health services, older persons services, health and wellbeing programmes, social inclusion, screening services, and in our National Ambulance Service;

— new services have been introduced in areas including diabetes, stroke, obesity, fertility and genetics; and

— unprecedented investment has gone into women's healthcare with the opening of new menopause clinics, fertility hubs, specialist endometriosis centres, and same day see-and-treat gynaecology clinics all over the country;

recognises that costs have been reduced to patients in line with universal healthcare:

— inpatient hospital charges have been abolished, saving people up to €800 a year;

— free contraception has been rolled out to women up to the age of 30;

— 2023 will see half a million more adults and children have access to free General Practice care;

— state-funded In-vitro fertilisation has been introduced for the first time; and

— the maximum amount that people now pay on their monthly medicines bill has been cut from €124 to €80 per month since this Government entered office; and

further recognises that:

— significant reforms are underway and will continue to ensure strong productivity in provision of health services;

— there has been an unprecedented shift in patient care from the hospital to the community sector, including via 96 new primary care teams, national networks of Chronic Disease Management, older persons and community intervention teams, and a national network of new primary care centres;

— Ireland is now a leading country globally in advanced practice for nursing;

— the introduction of the new public-only consultant contract facilitates extended working hours, and this helps with patient flow and ensures more senior decision makers are available to patients after hours and at weekends;

— significant progress has been made in the roll-out of phase 1 and phase 2 of the safe staffing framework to all hospitals, with 56 million allocated for implementation since 2020;

— investment in Emergency Department (ED) avoidance measures including expansion of injury unit services and National Ambulance Service protocols are providing alternative pathways to EDs to patients; and

— roll-out of a new productivity platform provides, for the first time, detailed productivity information in the acute sector.".

- (Minister for Health)

An Leas-Cheann Comhairle

I must now deal with a postponed division relating to the motion regarding health service funding. On Tuesday, 25 October 2023, 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.

Amendment put:

The Dáil divided: Tá, 73; Níl, 58; Staon, 0.

Tá

Browne, James.
Bruton, Richard.
Burke, Colm.
Burke, Peter.
Butler, Mary.
Byrne, Thomas.
Cahill, Jackie.
Calleary, Dara.
Cannon, Ciarán.
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.
Farrell, Alan.
Feighan, Frankie.
Flaherty, Joe.
Flanagan, Charles.
Foley, Norma.
Grealish, Noel.
Griffin, Brendan.
Harris, Simon.
Haughey, Seán.
Heydon, Martin.
Higgins, Emer.
Humphreys, Heather.
Kehoe, Paul.
Lahart, John.
Lawless, James.
Leddin, Brian.
Lowry, Michael.
MacSharry, Marc.
Madigan, Josepha.
Martin, Catherine.
Martin, Micheál.
Matthews, Steven.
McAuliffe, Paul.
McConalogue, Charlie.
McEntee, Helen.
McGrath, Michael.
McHugh, Joe.
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'Donovan, Patrick.
O'Dowd, Fergus.
O'Gorman, Roderic.
O'Sullivan, Christopher.
O'Sullivan, Pádraig.
Ó Cathasaigh, Marc.
Ó Cuív, Éamon.
Rabbitte, Anne.
Richmond, Neale.
Ring, Michael.
Ryan, Eamon.
Smith, Brendan.
Stanton, David.
Troy, Robert.

Níl

Bacik, Ivana.
Barry, Mick.
Brady, John.
Browne, Martin.
Buckley, Pat.
Cairns, Holly.
Carthy, Matt.
Clarke, Sorca.
Collins, Michael.
Conway-Walsh, Rose.
Cronin, Réada.
Crowe, Seán.
Cullinane, David.
Daly, Pa.
Doherty, Pearse.
Donnelly, Paul.
Ellis, Dessie.
Farrell, Mairéad.
Fitzpatrick, Peter.
Gannon, Gary.
Guirke, Johnny.
Harkin, Marian.
Healy-Rae, Danny.
Healy-Rae, Michael.
Howlin, Brendan.
Kenny, Gino.
Kenny, Martin.
Kerrane, Claire.
Mac Lochlainn, Pádraig.
McGrath, Mattie.
McNamara, Michael.
Munster, Imelda.
Murphy, Catherine.
Murphy, Verona.
Mythen, Johnny.
Nolan, Carol.
O'Callaghan, Cian.
O'Donoghue, Richard.
O'Reilly, Louise.
O'Rourke, Darren.
Ó Broin, Eoin.
Ó Laoghaire, Donnchadh.
Ó Murchú, Ruairí.
Ó Ríordáin, Aodhán.
Ó Snodaigh, Aengus.
Pringle, Thomas.
Quinlivan, Maurice.
Shanahan, Matt.
Sherlock, Sean.
Shortall, Róisín.
Smith, Bríd.
Smith, Duncan.
Stanley, Brian.
Tóibín, Peadar.
Tully, Pauline.
Ward, Mark.
Whitmore, Jennifer.
Wynne, Violet-Anne.

Staon

Tellers: Tá, Deputies Hildegarde Naughton and Cormac Devlin; Níl, Deputies Pádraig Mac Lochlainn and Aengus Ó Snodaigh.

Amendment declared carried.

Question put: "That the motion, as amended, be agreed to."

The Dáil divided: Tá, 75; Níl, 59; Staon, 0.

Tá

Browne, James.
Bruton, Richard.
Burke, Colm.
Burke, Peter.
Butler, Mary.
Byrne, Thomas.
Cahill, Jackie.
Calleary, Dara.
Cannon, Ciarán.
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.
Farrell, Alan.
Feighan, Frankie.
Flaherty, Joe.
Flanagan, Charles.
Fleming, Sean.
Foley, Norma.
Grealish, Noel.
Griffin, Brendan.
Harris, Simon.
Haughey, Seán.
Heydon, Martin.
Higgins, Emer.
Humphreys, Heather.
Kehoe, Paul.
Lahart, John.
Lawless, James.
Leddin, Brian.
Lowry, Michael.
MacSharry, Marc.
Madigan, Josepha.
Martin, Catherine.
Martin, Micheál.
Matthews, Steven.
McAuliffe, Paul.
McConalogue, Charlie.
McEntee, Helen.
McGrath, Michael.
McHugh, Joe.
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'Donovan, Patrick.
O'Dowd, Fergus.
O'Gorman, Roderic.
O'Sullivan, Christopher.
O'Sullivan, Pádraig.
Ó Cathasaigh, Marc.
Ó Cuív, Éamon.
Phelan, John Paul.
Rabbitte, Anne.
Richmond, Neale.
Ring, Michael.
Ryan, Eamon.
Smith, Brendan.
Stanton, David.
Troy, Robert.

Níl

Bacik, Ivana.
Barry, Mick.
Brady, John.
Browne, Martin.
Buckley, Pat.
Cairns, Holly.
Carthy, Matt.
Clarke, Sorca.
Collins, Michael.
Connolly, Catherine.
Conway-Walsh, Rose.
Cronin, Réada.
Crowe, Seán.
Cullinane, David.
Daly, Pa.
Doherty, Pearse.
Donnelly, Paul.
Ellis, Dessie.
Farrell, Mairéad.
Fitzpatrick, Peter.
Gannon, Gary.
Guirke, Johnny.
Harkin, Marian.
Healy-Rae, Danny.
Healy-Rae, Michael.
Howlin, Brendan.
Kenny, Gino.
Kenny, Martin.
Kerrane, Claire.
Mac Lochlainn, Pádraig.
McGrath, Mattie.
McNamara, Michael.
Munster, Imelda.
Murphy, Catherine.
Murphy, Verona.
Mythen, Johnny.
Nolan, Carol.
O'Callaghan, Cian.
O'Donoghue, Richard.
O'Reilly, Louise.
O'Rourke, Darren.
Ó Broin, Eoin.
Ó Laoghaire, Donnchadh.
Ó Murchú, Ruairí.
Ó Ríordáin, Aodhán.
Ó Snodaigh, Aengus.
Pringle, Thomas.
Quinlivan, Maurice.
Shanahan, Matt.
Sherlock, Sean.
Shortall, Róisín.
Smith, Bríd.
Smith, Duncan.
Stanley, Brian.
Tóibín, Peadar.
Tully, Pauline.
Ward, Mark.
Whitmore, Jennifer.
Wynne, Violet-Anne.

Staon

Tellers: Tá, Deputies Hildegarde Naughton and Cormac Devlin; Níl, Deputies Pádraig Mac Lochlainn and Aengus Ó Snodaigh.

Question declared carried.

Dáil Éireann díospóireacht - Wednesday, 25 Oct 2023