Vol. 1048 No. 2
1. Deputy David Cullinane asked the Minister for Health the number of acute inpatient beds in the hospital system; the number of beds he will add this year; and if he has secured funding for the needed and promised 1,500 beds. [2054/24]
My first question is in relation to the number of acute in-patient beds currently in the system, the number of additional acute in-patient beds that will be delivered in 2024 and, crucially, the 1,500 rapid-build beds that were much promised and spoken about last year. When will they be delivered? Has the funding been secured? What is the timeframe for the delivery of those beds?
I thank Deputy Cullinane for the question and his very appropriate ongoing agitation or advocacy for more beds. It is well established and, I think, agreed by all of us that there has been a significant deficit in the number of acute, high-dependency and critical care beds in the system. Since the start of 2020, as the Deputy will be aware, we have been in the process of adding a very significant number of beds. The latest numbers show that since the start of January, we have added 1,126 more hospital beds, a very significant increase. Without a doubt, it is one of the things that is helping to drive down waiting lists. We saw very encouraging results at the end of 2023. We are determined that this year will be the third year in a row in which the waiting lists fall.
Although a significant number of additional beds have been provided, we will all agree that more are required. This year, we have committed to opening an additional 147 beds around the country. In addition, a number of important projects are under way, with either the main buildings now under construction or the enabling works started. These include two 96-bed wards in University Hospital Limerick, UHL, which will provide 192 more beds in the hospital; 42 beds in Sligo where enabling works have been done and we are now looking to tender for the main works; and the net additional beds we will have in the national maternity hospital, where enabling works have commenced, and the national children's hospital, where construction will end later this year.
As I am out of time, I will address the 1,500 beds in my next response.
I welcome any and every additional bed put into the system. The Minister spoke of 1,126 beds that were delivered up to January. That money and those beds were committed to in 2020. In fact, they were to be delivered much quicker. It has taken far too long to deliver all those beds. In my view, that goes back to the need to reform how we deliver major healthcare infrastructure. That is why the 1,500 rapid-build beds were very important. It was my understanding that they would be rapid modular build, could be built much quicker and would not take as long to deliver as the 1,200 beds.
The Minister spoke about 1,126 beds that were delivered. As I said, they were part of the 1,200 beds funded in 2020. We are still delivering some of those. Regarding the 147 beds that will come on-stream this year, I assume some or most of those were also part of the 1,200 beds that were funded many years ago. We need to hear from the Minister what the next step is and where we are as regards the 1,500 rapid-build beds.
Important progress has been made on the 1,500 beds. We are looking at a modular approach and rapid-build technologies, which can cut several years off these projects. Typically, these come in blocks of 24 beds, as do the traditional builds. The Deputy will have seen that they come in blocks of 24 and 48 beds, up to 96 beds, and they come faster. We are looking at them for a number of sites around the country. We have a provisional allocation as regards where we would like to see them in order to provide maximum value. We have already put out an expression of interest to the market. I am happy to say we have had a very strong response to that, both domestically and internationally. I am now working with Government colleagues to find a way to get going on those 1,500 beds. I want to see them being delivered as quickly as possible. We are working on getting to a point where we can announce their construction.
Of course there are plans. That is the problem I have. The frustration is that the Department and HSE have done a lot of work identifying sites and, as the Minister said, looking at where they want the beds to be provided. I assume that will be in areas where there are pressure points. Much of that work has been done. The frustrating part is that these projects can be delivered very quickly. The Minister indicated that work had been done. Expressions of interest have been invited, and it is great there is interest being shown and these projects can happen very quickly, but has the funding been secured? The Minister said he will speak to his colleagues to begin delivering these beds. What does that mean? Will 50, 100 or 200 beds be delivered this year?
Appearing before the Joint Committee on Health, officials promised that 700 of those could be delivered in 2024. I do not see anything like that happening unless significant additional funding is provided. I fear that what will actually happen is that the Department will try to squeeze what it can from the existing capital envelope, which will impact other health projects, rather than doing what should be done, namely, secure the additional capital funding needed to deliver these beds on time, at scale and as quickly as possible.
That is exactly what we want to do. We want to move forward with this as quickly as possible. I am not familiar with the figure of 700 beds but I will check with the officials as regards the thinking behind it.
The Deputy and I are in agreement on the need for more beds. Many beds have been delivered but we want to deliver many more. If we get agreement on providing all 1,500 beds, on the basis that 147 will be provided this year and in excess of 300 more are in the pipeline, there will be close to 500 in the pipeline. This means we will have 1,126 beds, plus the figure of slightly less than 500 and the 1,500. That number of beds will go a very long way.
We also have to keep the focus on productivity. It is not enough to just add more and more beds. We need virtual wards and beds. Critically, we need to reduce the average length of stay, which will free up the existing beds we have for patients.
2. Deputy Duncan Smith asked the Minister for Health his views on the impact on a number of cancer care programmes arising from the decision not to award any new development funding to the national cancer strategy in budget 2024, specifically the planned centralisation of surgical cancer services, the new model of patient follow-up and survivorship and plans for acute oncology nursing services; and if he will make a statement on the matter. [2015/24]
My question relates to funding for cancer care programmes arising from the decision not to award any new development funding to the national cancer strategy in budget 2024, specifically on the planned centralisation of surgical cancer services, the new model of patient follow-up and survivorship and plans for acute oncology nursing services.
I thank the Deputy for the question, which is on a matter that is very close to my own heart. The advancement of cancer services for patients in Ireland is a priority for me and the Government. The Deputy will be aware that we allocated €40 million to the national cancer strategy. That money has been put to very good use by our healthcare workers. We have hired nearly 400 additional staff with that funding, including more than 140 nurses and 40 consultants. We also allocated €30 million to new cancer drugs in that period. There has, therefore, been a very sizeable investment.
The Deputy's question looks to the future. It says that is great and important but asks what is next. This year, while budget 2024 did not include specific ring-fenced funding for the national cancer strategy, there will be significant investment in the progress of cancer services nonetheless. The Deputy will be aware that I recently allocated €20 million for new medicines for this year. We are also targeting an additional €10 million in savings from the drugs budget. The intention is to provide €30 million for new drugs this year. Typically, approximately one third of that will go to cancer drugs. That will be new investment in new treatments and medicines for patients.
We are also opening and staffing many more beds and we will hire more than 2,000 more healthcare professionals this year. We are hiring several hundred more consultants this year, a number of whom will be oncologists and other healthcare professionals working in oncology.
While there is no ring-fenced funding for the national cancer control programme, there will, nonetheless, be important and additional capacity and, therefore, services available to cancer patients this year through the budget.
That is recognised. The Minister mentioned the €40 million but that is since 2017, when this national cancer strategy came into being. It is said that we need €20 million per year to implement the national cancer strategy. While the funding for new medicines and increased capacity across the health service will help, the Minister will note that the national cancer strategy is aimed at early detection and prevention. We need to see investment in that.
The surgical oncology centralisation project, which supports cancer surgery, the national plan for radiation oncology, the phase 2 expansions and radio therapy services enhancements were not mentioned. These are all specific areas in the HSE's national service plan that need investment. We need to see funding going to them. It is not enough to speak broadly of investment in the health service and hope that investment raises the level of service provision in these specific areas of the HSE service plan. We need more detail and funding, which we have not seen from the Government in the two most recent budgets.
The €40 million was provided for 2021 and 2022, not since 2017. Those were the first two budgets of this Government. I asked exactly the same question the Deputy raised, namely, what is the full amount of funding sought under the national cancer strategy. The answer I was given was €20 million. In budget 2021, I allocated the full €20 million and a lot of money for new medicines. In 2022, I allocated a further €20 million, so that was €40 million for 2021 and 2022. The HSE was not able to use the full €20 million in both years so we retained the money and the HSE's was able to keep hiring sanctioned staff. That happened right through 2023. The Deputy will be aware that the HSE hired over 1,000 more staff than it was funded to hire in 2023. As a result, there have been many important new services and quicker access for cancer patients. I will refer to that in my next response.
As the Minister knows, the national cancer strategy is an ambitious but realistic document. There is a real risk that cancer outcomes, which have been trending in a more positive direction in recent years, will begin to go backwards if we do not see that funding continued in the specific areas that have been outlined.
There seems to be a disconnect between what the Minister is saying here and what the advocacy groups, the Oireachtas cross-party group on cancer, the Irish Cancer Society and other groups are seeing. Some engagement in the first quarter of this year by the Minister and his Department with the Irish Cancer Society on the specifics of the roll-out of the cancer strategy would be welcome. I would look forward to his response on that.
I would look forward to that. For years the Irish Cancer Society advocated for the abolition of inpatient hospital charges. We delivered that last year and the Irish Cancer Society deserves great credit for it. Many of the groups argue that we need quicker access. I am pleased to note that due to the investment in 2021, 2022 and 2023, waiting times are down across the board. Waiting times for patients are down across the rapid access clinics for breast, lung and prostate, which is a great testament to the work being done. Last year, over 46,000 patients were seen, 11,000 cancer surgeries were performed and nearly 90,000 chemotherapy and other systemic anti-cancer treatments were carried out. There is, therefore, a lot of work going on. New services are being provided. The CAR-T cell therapy service in St. James's Hospital for children is revolutionary and mind-blowing. I have also allocated €3 million to the fantastic community cancer support groups this year. We will keep investing in and growing these services. There will be more and newer treatments and quicker access, as well as more holistic support, not just intensive hospital-based support but also community-based and psychosocial supports that patients and families need.
3. Deputy David Cullinane asked the Minister for Health the number of hospital-initiated elective cancellations in 2023; and the number of elective procedures outsourced to private medicine in public hospitals or private hospitals in the same period. [2055/24]
There is lots of information that we unfortunately cannot get through parliamentary questions. I understand the reason, namely, that there is an industrial relations dispute. I respect the right of people to engage in that. The information I am looking for is on the number of hospital-initiated cancellations for elective procedures. As we know, when the pressure is on in emergency departments, often one of the first things to happen is that elective procedures are cancelled, almost wholesale. How many cancellations in 2023 were initiated by hospitals?
I can provide the Deputy with information to the end of quarter 3. Unfortunately, Fórsa workers are refusing to provide information to the HSE, the Department and Parliament. This does not fall within a work-to-rule action, and I have clear advice on that. Nonetheless, that is what they are doing and we have to deal with it.
I acknowledge the distress this has caused to patients and families. I have been in the position, as have many others, I am sure, where a family member or friend has been waiting for a procedure, be it a minor procedure or a major operation. There is a lot involved in that. People look forward to it and they can be nervous. They may be admitted the night beforehand and may go through full preparation only to be told the theatre is not available because there has been a road traffic accident. They may be told a high-dependency bed is not available for them after the procedure, typically because something has happened in the accident and emergency department. That can cause a lot of distress.
As regards the figures the Deputy asked for, at the end of quarter 3 last year, there had been 30,833 cancellations. It is important to contextualise that number. It is 2% of the total number of procedures. While it is a large number, it is in the context of about 1.5 million procedures. Critically, when I was looking through the Deputy's question earlier this week, I asked the Department to talk to the HSE about how many of those cancelled procedures were rescheduled. It is one thing for a procedure to be cancelled but it is important that patients get care. The HSE has indicated that in a large majority of those cases, the procedure will have been rescheduled and the patient will have received either the care or a new appointment.
We all know the majority of cases are rescheduled. The problem is that people end up waiting longer. By cancelling elective procedures because of pressures in accident and emergency departments, we end up just shifting the problem from one part of the health service to another. I respect the fact that there is an industrial relations dispute, but it is extraordinary that the Minister, the Department and the HSE, at a senior level, are not being given information on basic data like the number of hospital cancellations. There is lots more information I have sought that we cannot get. My message to the Minister is to resolve that industrial relations dispute by engaging with Fórsa. It is not tenable to be in the position where basic information cannot be delivered to the Opposition or the Minister for Health.
While I am talking about the cancellation of elective procedures, I put it to the Minister that there is an awful lot of foot dragging with the elective-only hospitals. We have not even identified sites in Dublin yet, years after the delivery of those hospitals was promised. We are a long way away from delivering them in Cork and Galway. That will be the real solution to the problem of elective procedures being cancelled.
There are a few things to unpick there, the first of which is around waiting times for inpatient and day-case patients. There is good news in that regard. The Deputy will have seen the releases in recent weeks. We have looked at 2023. Thanks to an enormous effort by healthcare workers across the country, the waiting time versus the Covid peak for someone waiting the longest - over 12 months - has fallen by nearly half. We will continue to make progress. Great efforts have been made in every hospital to make that happen. The waiting time, particularly for long waiters, is falling quickly, which is something we all want to see.
On elective work, I share the Deputy's frustrations with the processes by which the State engages in building hospitals. It is deeply frustrating, which is why I sanctioned six surgical hubs. One of them will be in the Deputy's neck of the woods, in University Hospital Waterford. I visited Mount Carmel Community Hospital, where the first one is under construction. We will take over that hub in the coming months. The surgical teams I am talking to believe these hubs can be a game-changer for people waiting for procedures, both inpatient and day case.
I welcome the surgical hubs, as anybody would, but they are not a substitute for the elective-only hospitals. I share the Minister's frustration but I have also expressed frustration about the slow pace of delivery of elective-only hospitals. We are talking about lots of big infrastructural projects in healthcare. Members of the Joint Committee on Health get frustrated with digital transformation and all the other big projects that take far too long.
The political system will have to deal with the fact that we have to challenge conservative thinking in the Department of Public Expenditure, NDP Delivery and Reform. The political system is prioritising major projects in housing and health, especially projects such s elective-only hospitals which will make a huge difference and provide additional elective capacity. That is the big reform that will drive down wait times like never before. The waiting and foot-dragging is mainly caused by the Department of Public Expenditure, Reform and NDP Delivery but the political system is also at fault for not challenging and changing it. That is one of the big changes that has to happen in 2024.
There have been some important changes. I brought this matter to the Ministers, Deputies McGrath and Donohoe, some time ago in regard to major capital projects in healthcare. There have been some important changes and I will mention two in particular. First, the major capital ceiling was increased by €100 million to €200 million and, second, the four-stage process was reduced to two stages and is now moving quicker. I do not disagree with the Deputy's comments, not so much in terms of the Department of Public Expenditure, NDP Delivery and Reform but in terms of the process itself, which is a painstaking one. Nonetheless, none of us should underestimate the impact these surgical hubs will have. We have seen a massive reduction in long waiters in Tallaght. The hub in Mount Carmel will serve St. James's Hospital and St. Vincent's Hospital. We are going to have one in Swords that will serve the major hospitals on the north side of the city-----
And the city apparently.
We will then have them in Waterford, Cork, Limerick and Galway. They will make a big difference to the national inpatient day-case lists.
I do not dispute that.
4. Deputy Róisín Shortall asked the Minister for Health to respond to the recent ERSI report on the changes and challenges facing the Irish long-term residential care sector since Covid-19; his views on the consolidation of nursing home ownership, with 14 operators controlling 40% of all beds, and the increasing monetisation of elder care; and if he will make a statement on the matter. [2279/24]
I am raising the issue of the recent ESRI report that made fairly damning findings about what is happening in the area of residential care for older people. We have seen the rapid closure of small, community-based nursing homes and a trend towards much bigger and much more commercial nursing homes, which is certainly not in the interests of older people. What is the Minister of State's response to that?
I thank the Deputy for her question. This is a conversation we have had across this floor several times in recent years. I welcomed the recent ESRI report on long-term residential care in Ireland and developments since the onset of the Covid-19 pandemic. The report articulated an awful lot of what we already knew about the challenges facing the long-term residential care sector. The Government continues to address these to provide short-term stability and then long-term growth to this sector.
The ESRI report highlighted long-term residential care supply and care bed ownership. It stated that the private, for-profit sector was driven my new entries into the market financed by international private equity funds. We have 15 companies that now control 10,700 beds. That is one side. On the other side, we have family-run, community-based, voluntary nursing homes that are predominantly located in rural areas and towns and villages. These homes are struggling. The matter is very concerning because 22 or 25 years ago, 80% of nursing home care was run by the State, with the remaining 20% private. That ratio has flipped completely. I am trying to support nursing homes, especially smaller homes. Last year, for example, over 180 nursing homes renegotiated the deals they have, which has resulted in an increase in funding of between 6% and 7%. They can now negotiate yearly as well, which is much more helpful as regards the fees they are receiving.
Before Christmas, I was delighted to put out to public consultation a design guide for long-term residential care settings for older people. Under this, when a private operator, the State or the voluntary sector applies to build or extend a nursing home, it must have a pre-planning meeting with HIQA in advance of applying for planning permission.
With all due respect to the Minister of State, I asked for her response and she described the report. She said we have often have had conversations across the floor. That is the problem. All we have is talk from her. There has been no action. Residential care is not the first choice of many older people. What we should be doing, of course, is expanding other options. In May 2020, at the height of Covid, the Taoiseach spoke about the work done by the previous Government to develop alternatives such as supported housing and housing with care. He stated:
... the new Government can and should build on and operationalise this work. We also need to consider a move away from large, modern, newly-built, 150 to 200-bed, single-room nursing homes towards smaller units ...
What, if anything, has the Minister of State done to develop alternatives to the large-scale, investment-focused facilities we are seeing springing up, which older people do not want to be in and which are not in their interest given that they want more independence?
The majority of people want to age in place. They want to age in their own homes. Working with my colleagues in Government, I have put in place a triangle of supports consisting of home care, day care and meals on wheels. Today, 56,000 people will receive care in the home to support them to age in place. We have 323 day centres open across the length and breadth of the country, plus an additional 52 dementia-specific day centres. We have made great progress in that regard working with the Alzheimer Society of Ireland. About 50,000 people will receive meals on wheels today. That service is so much more than a nutritious meal brought to their house; it is also a social connection. As I said, I have done the new design guide. It is worth taking a look at it because it recommends that we use a household model whereby the nursing homes that will be built will have a maximum of 84 beds each. Action has been taken.
In 2020, the then Minister for Health also made the point that the current model was not fit for purpose. We had two senior people in the middle of Covid saying we had to move away from the model of big nursing homes. I cannot see that the Minister of State has done anything of substance on that. I point to the fact that she continues to allow a situation where nursing home care is incentivised over home care. The promise made six years ago to introduce a statutory right to home care has not yet materialised. What is the Minister of State doing about that issue? What is she doing about expanding the prospect of supported living, which is what most people want, including building new facilities through local authorities with a health element and a care element involved? I cannot see any new initiative on her part. She continues to incentivise the big, commercial, profit-driven nursing homes, which clearly are not in the interests of older people.
I continue to support the 22,700 people who are in nursing homes under the fair deal scheme. The whole purpose of that scheme is to support older people, regardless of their means, to have access to nursing home care. It is important to also point out that the commission on care has commenced. It is led by Mr. Alan Barrett, the chairman of the ESRI. The commission will look very closely at all the issues the Deputy has raised. It is also important-----
The Minister of State is kicking the can down the road again.
Please allow the Minister of State to conclude.
We need action on this.
We have short memories here. When I came into post in July 2020 the nursing home sector was under immense pressure due to Covid. We all know that Covid bore down very hard on older people. For almost two years, the emphasis and focus were on supporting older people in nursing homes.
