Léim ar aghaidh chuig an bpríomhábhar

Seanad Éireann díospóireacht -
Tuesday, 19 Oct 2021

Vol. 279 No. 7

Sláintecare Implementation: Statements

I welcome the Minister for Health, Deputy Stephen Donnelly, for this important debate on Sláintecare, which many Members have been involved in since the previous Oireachtas term.

I thank Members for the opportunity to meet with them this evening. We are here to discuss what I believe is one of the most important projects of our time, which is to make universal healthcare a reality in our country and to have a public healthcare system that provides girls and boys, women and men, with great healthcare when they need it. We allocate a great deal of money to healthcare. We have incredible healthcare workers doing extraordinary work every day. We have wide political agreement that universal healthcare must happen, but let us be honest, there is a long way to travel. Even with the intense pressures Covid-19 brings, our healthcare workers are keeping critical health services going and they deserve immense credit for that, but many children and adults are waiting far too long to see a consultant or to get a scan or to have a procedure. In one of the wealthiest countries on earth, this is completely unacceptable. As I have said in the Dáil and as I have said at the Joint Committee on Health, the Government and myself are absolutely committed to the goal of universal healthcare in our country.

This year has already seen a very significant investment of more than €1.2 billion in new initiatives. We are on track, or on track with minor issues, on more than 97% of the projects tracked under the Sláintecare implementation strategy.

Increased investment in the health service has allowed us to increase capacity, which is fundamental to improving access to care. Hospital bed capacity has increased significantly. Approximately 850 permanent beds have been added to the hospital system this year and more will be added by the end of the year. This is the single greatest increase in hospital beds in any one year. Some €52 million was provided this year to increase critical care capacity and we have delivered a record increase in critical care beds from 255 to a planned 321 by the end of the year, or very early next year. This represents an increase of more than 25% in our national critical care capacity in less than two years. There are 6,000 more staff working in the health service than there were last summer, including almost 1,400 more nurses and midwives and 1,200 health and social care professionals. These staff were hired at the same time that we hired thousands of other professionals to help us with testing and tracing and rolling out the vaccine programme.

Various initiatives and reforms are ensuring that people are receiving care closer to home. A total of €25 million was allocated to our GP access to diagnostics initiative this year. It allows GPs in a community-based setting to refer patients directly for diagnostic scans, such as X-rays and MRIs. I am delighted to inform the House that an estimated 140,000 additional scans will be carried out by the end of the year as a result of this programme.

Waiting lists for funding approvals for home care have seen a real reduction, thanks to a large increase in funding. This is delivering on the objective to keep people well at home and out of hospital or have them discharged from hospital as quickly as possible.

Prevention is an important component of modern healthcare. I am looking forward to launching the new healthy communities programme in Darndale tomorrow, which aims to improve the long-term health and well-being of people living in 19 communities across the country.

All the progress we have made has been achieved while dealing with the worst public health crisis in the history of the State. We now want to build on the investment and progress made so far this year. I am delighted that budget 2022 reiterates and reinforces the commitment to universal healthcare. The allocation of €22.4 billion, the largest ever investment in Ireland's health and social care services, will reduce waiting lists, increase capacity, protect our most vulnerable, address inequalities and deliver the right care in the right place and at the right time.

Tackling waiting lists is my number one priority. Waiting times were unacceptable before the Covid crisis and have worsened since. Many people right across the country are living in pain, some of them in agony. The long waits that many people face to access care are causing immense distress. My Department, the HSE and the National Treatment Purchase Fund, NTPF, are finalising a multi-annual plan that will set out a twin-track approach of investment and reform. It will be overseen by a ministerial task force, following the vaccine task force model that has worked so well, and will include a number of short, medium and long-term actions. The short-term actions are already being implemented as part of the short-term waiting lists plan for this year. Next year, we have allocated €350 million to this approach to tackling waiting lists. Addressing waiting times will also require significant investment in elective care. A proposal for three elective hospitals, which will focus on planned care, has been completed and is being evaluated by my Department.

Universal healthcare must mean higher quality healthcare. There is a lot of focus, very understandably, on access. The general narrative is that sometimes it can be very hard to access our public system but, when one does, the care is excellent. In the vast majority of cases, that is certainly correct. We must continue to invest in supporting our clinicians, in innovation to make things better, and in offering more choice to parents and ensuring there is consistently high-quality care throughout the country. One of the main routes to achieving this is via our clinical strategies, including for maternity care, cancer care, trauma, mental health provision and many more excellent strategies. The problem is that those strategies have not, for some time, had the level of funding they need. This year, for the first time in many years, the national strategies were fully funded and the progress is evident to see. I am delighted to be delivering a further €62 million in new development funding for our national clinical strategies in the budget for next year. We are going to build on the progress that has been achieved thus far this year.

Other new funding for next year includes €45 million to advance the objective that care be accessible and affordable for the most vulnerable. There is €31 million for women's health measures. As I have said before, women's health must be, and is, a top priority for the Government. We have included a broad package of healthcare measures to this end in the budget for next year, building on the progress made so far in 2021. There is €37 million for a range of measures to deliver safe, quality and patient-centred care. We have allocated €30 million in additional funding for health services for older people. There is €65 million in new funding for disability services, on top of which we have a €10 million once-off funding stream for Covid-19. We have allocated €24 million for mental health services. There is an additional €11 million for another 19 critical care beds, which will bring our total critical care capacity to 340 beds by the end of next year. I have Government agreement to keep pushing on after that to bring us up to the level of critical care capacity we need. In addition, there is €9 million to fund accessible contraception for women. We are starting with those aged 17 to 25, the intention being that we move beyond that thereafter.

In spite of all this progress, we need to be honest that serious challenges remain to be faced. As colleagues are aware, three of the 112 Sláintecare projects were reported as having significant challenges. One of these is tackling waiting lists, which I have discussed. Another challenge is the implementation of regional health areas, RHAs. There has been progress on this in recent months. We have had research into international best practice and policy options have been drafted. Consultation has taken place with stakeholders, including patients, clinicians, policymakers, hospital groups and community healthcare organisations, CHOs, and further consultation is planned in the coming weeks. I am establishing an advisory group on this issue. We must ensure we arrive at a structure that works, first and foremost, for patients, while also working for the people employed in our healthcare system.

Our public health system is not where we need it to be when it comes to e-health, which is the third of the three Sláintecare projects that were deemed to have significant issues. There must be much more progress in this area. That progress was negatively impacted by the need to prioritise ICT and e-health resources in support of the pandemic response and recovery from the recent cyberattack, but it would be wrong to solely blame those issues for where we are on e-health. Nevertheless, there has been some very encouraging progress in the past 18 months. Many of the initiatives that were introduced in response to the Covid crisis, and the necessary measures to adapt to it, will stay in place after the pandemic to support a wider agenda. It is anticipated that the next report will reflect a shift towards business as usual for e-health as the impact of the pandemic and cyberattack starts to recede.

When I spoke recently at the joint committee, I noted that there would be some changes to governance structures. A new programme board co-chaired by my Secretary General and the head of the HSE, and comprising other members of our senior teams, is being constituted and will have its first meeting in the near future. This new board will ensure that there is high-level accountability for implementation and that the drive for universal healthcare is fully embedded in both the Department of Health and the HSE. This is a really important and ambitious project. The concept is fairly straightforward, namely, the delivery of high-quality care when it is needed. Getting there is not so straightforward and achieving it requires that there be full ownership by the senior teams right across the healthcare community. Access to high-quality healthcare when it is needed cannot, and must not, be a privilege for those who can afford it. It must be available to every girl, boy, woman and man regardless of how much money they, or their parents, have.

That is what universal healthcare means, that is what must be delivered and that is my absolute focus in healthcare.

I welcome this opportunity to discuss the Sláintecare plan. I thank the Minister for his time. One of the first things he did in his opening remarks was to talk about our incredible healthcare workers doing extraordinary work every day. We can never forget that. We have seen that day in and day out over the last 18 months and we must never lose an opportunity to pay tribute to all those healthcare workers.

Moving on to respond to some of his other opening remarks, the Minister spoke about the significant investment of more than €1.2 billion in new initiatives. In the year of the pandemic, when so many resources and so much finance had to be devoted to trying to fight this virus, it is incredible that the Minister has been able to commit finance and time and effort to new initiatives. It is welcome. The roll-out of Patisiran is one of those initiatives. I took up with the Minister personally and raised here the case of Mr. Pat Tinsley, someone I know well and who is a good friend. I refer to the impact of amyloidosis on his health. Having learned so much more about that awful disease and how it impacted Mr. Tinsley, and his peers, I thank the Minister for making a difference in so many lives. I also thank him for his absolute commitment to women’s healthcare and the provision of €31 million to roll out initiatives in women’s healthcare. The Minister has truly put a focus on this aspect of healthcare that has never been put on it before.

My colleagues and I on this side of the House fully support the ongoing policy and financial commitment to the Sláintecare plan. Its implementation is a priority for all of us in Fianna Fáil and, therefore, it is a priority for the Minister and for the Government. Implementation of the programme will certainly result in the largest overhaul of our health system since the foundation of the State. It is a long-term process and it requires adequate planning. Increasing and improving healthcare capacity is a prime focus for us. We were all concerned about the resignations of Ms Laura Magahy, the former executive director, and Professor Tom Keane from the Sláintecare Implementation Advisory Council, SIAC. We must take on board the criticisms levelled by them concerning the operation of SIAC. We must acknowledge that we have heard them loud and clear. It is important that the Minister has committed to setting up a new and more focused group which will advise on regional structures. It is excellent that some members of the original group have agreed to join the new group.

The Minister said that tackling waiting lists is his number one priority. It is important to acknowledge that people are living in pain and distress. In this regard, the Minister is putting together a ministerial task force that will follow the model of the vaccine task force, which worked so well. It is also important that short-, medium- and long-term actions will be undertaken. I acknowledge the substantial work already undertaken in recent months to progress regional health areas. We cannot forget the objective of Sláintecare, which is to deliver universal healthcare "to every girl, boy, woman and man" in this country. That has never been achieved. We have come a long way, and budget 2022 has highlighted the progress we have made in the Government’s commitment to progressing and transforming the healthcare system.

We are moving in the right direction. The issues highlighted regarding Sláintecare must be dealt with quickly and effectively. Delivery on this is our number one priority. In taking stock of where we are, the Government is making progress in health. The Fianna Fáil Seanad group fully supports the Government and the Sláintecare initiative. We want to see the issues within the implementation council addressed and we must ensure that service delivery and patient welfare remain at the heart of everything we do.

I welcome the Minister to the Chamber again. The only question that occurs to me is to ask if we are really going to do this now. As we face into our second winter with Covid-19, and when we have just kicked the reopening ball down the road again, we are revisiting a ten-year-old promise from Fine Gael and the Labour Party to solve the problems in the public health sector by eliminating the private health sector.

In November 2015, we were told that Sláintecare had been put on hold due to the Department of Health finding that universal health insurance would lead to expenditure that was approximately 11% higher than the existing system. Two years later, a committee gave us the slogan that, "A universal healthcare system will provide population, promotive, preventative, primary, curative, rehabilitative and palliative health and social care services to the entire population of Ireland, ensuring timely access to quality, effective, integrated services on the basis of clinical need". That is a lovely-sounding mission statement to be sure, but unless we can sell it for €3 billion, it brings us no closer to delivering universal healthcare.

Four years on, we are still talking about it because the head honchos finally realise that the requirements for implementing this programme are seriously lacking. It is doomed to fail and it simply will not happen. We do not need Sláintecare to get moving on the real and pressing issues with our healthcare system. Some regions are experiencing one in five permanent consultant posts being left unfilled, yet the HSE is cutting 350 junior doctor positions that were provided last year to fight the pandemic. Nursing staffing levels dropped by more than 3,000 from 2007 to 2017. However, the Nursing and Midwifery Board of Ireland accepts less than 10% of work applications from American nurses. Policies and structures in place are exacerbating these problems and not alleviating them. The Minister and the Department do not need to implement Sláintecare to fix them, yet we are discussing this pie-in-the-sky promise rather than simple and practical solutions.

What a time to resurrect it. We have just been told that Friday's D-Day has gone up in smoke and the Government has again foisted the blame and the burden on the people of this country rather than recognising its failure to prepare, adapt and react. On 16 July, the Minister told this House that, "The second-best scenario from NPHET now shows that over 200 people would be in ICU in just a few months’ time". There are now 74 cases in intensive care units, ICUs. We are not even being told how many of those patients are in ICU due to Covid-19 and how many are there for other reasons but have tested positive for Covid-19. The narrative is that ICUs and hospitals are going to be overrun if we do not continue certain Covid-19 measures. This is not exactly a new tune, is it?

It has been 16 months since it was said that we had two weeks to flatten the curve. It seems like a lifetime ago, so I will not blame people for not remembering. The deal was that the people of this country would put their lives on hold for a few weeks and, in return, the Government would put in place the necessary healthcare infrastructure and bolster the capacity necessary to accommodate those falling ill due to the virus. That never happened. Precious little was done. Lockdowns and mandates were instead used as blunt instruments to suppress case numbers. Once again, the ordinary people of Ireland were made responsible for the Government’s remit.

It is not like it could not have been done. Sweden doubled its ICU capacity to tackle the pandemic, with the number of ICU beds in its capital quadrupling. New equipment was ordered and there was a scramble to retrieve old ventilators from basements and emergency reserves. Anaesthetic machines and ventilators were borrowed from private caregivers. All non-essential administrative work was scrapped for staff so they would have more time to look after patients. Volunteers were drafted in, as were staff from other regions less affected by the outbreak of the pandemic and staff from private caregivers in Stockholm. In short, the Swedish authorities reacted accordingly and did their job. How many ICU beds did we get in the last winter plan? It was 17.

Let us be clear. This is not a Covid-19 issue. For those who can remember, the trolley crisis loomed large for some time before the pandemic.

There were nearly 100,000 people on trolleys in 2017. The following year, 2018, was the worst year for hospital overcrowding according to the INMO and it was the same in 2019, long before Covid existed. Any pressure on the healthcare system is not due to a minority of people who have opted not to receive a vaccine. It is due to poor policy, stagnated decision-making and a Health Service Executive mired in bureaucracy.

Nothing exemplifies that more than these lateral flow test kits, more commonly known as antigen tests, first mentioned in this House by me in July 2020 and obstinately ignored by our NPHET overlords who refused to sanction antigen testing for staff, visitors and residents in hospitals and nursing homes even though it might have identified some of the outbreaks earlier. Now, finally, 15 months after their use first being mooted in the Seanad by me, the Government has announced it is considering using them, seven months after the UK. Antigen tests need to be used. In the UK these are handed out in pharmacies free to everyone. Today the Government is only making these available to people who are vaccinated. People who are not vaccinated cannot avail of them, which is ridiculous.

I welcome the Minister, Deputy Donnelly, to the House. He is always very welcome here. I know he has had a long day and a busy few days. We had a very good engagement on the future of Sláintecare at the Joint Committee on Health. I have no doubt about the commitment of the Minister, the Secretary General of his Department and the HSE to Sláintecare. We need to be realistic to some extent. We have just been through the worst pandemic in living memory. There have been many achievements with Sláintecare. Along with everyone else, I pay tribute to Laura Magahy for her leadership and what she achieved with Sláintecare. I also pay tribute to Professor Tom Keane, not just for what he achieved with Sláintecare but also for what he has achieved in healthcare in this country, particularly the cancer strategy.

At this stage we need to move the project on to delivery. I know the Minister is committed to that, as we all are. Universal healthcare is great and we all support it. However, I do not think universal healthcare is a priority for multimillionaires who can afford to pay for their healthcare. In the first instance, the money needs to go to the lower levels in society who needed most. The very last tier to benefit from universal healthcare should be the wealthiest people in our society. That is where I am coming from on universal healthcare. To be fair, most of the very well-off people in society would agree that they can afford to pay for their healthcare, and if they can afford to do so, they should.

Regarding what has been achieved with the Sláintecare model, for too long healthcare has been a political football. It is a political issue but it should not be a political football. We should all be working in unison to achieve the type of healthcare we can stand over. As the Minister has said, we have a long way to go, but we are moving in the right direction. I welcome that €22.5 billion has been allocated to healthcare this year up from €17 billion or €18 billion three or four years ago. When the Minister was Opposition spokesperson on health, he rightly carried out many forensic analyses of healthcare at the Joint Committee on Health. I know he would expect nothing less of anyone in this House but to adopt the same policy in forensically analysing all the decisions he makes to ensure they achieve what he and everyone else wants them to achieve.

I acknowledge the Minister's stewardship of the pandemic since he took up office in July 2020. It has not been easy; it has been difficult. It is much easier to close places down than to open up. I welcome this morning's announcements.

I wish to make a few points as we face into the winter plan, which I welcome. We have achieved enormous success in the vaccination programme, with 92% of the population fully vaccinated against Covid-19. I spoke today on the Order of Business on this issue. I am still concerned that we are still charging people for the flu vaccine, which seems to be penny wise and pound foolish. The flu vaccine should be available to every member of the population free of charge. In fact, we should be running the same campaigns as we have been running for Covid to encourage people to take the flu vaccine. The Minister knows the situation in Limerick and Galway at the moment - not a bed is available and people are on trolleys.

Let us do what we can at the start by encouraging people to take the vaccine by not charging for it. I would go a step further and say we should not be charging for any vaccine. I welcome the commitment the Minister gave to me through the Minister of State, Deputy Rabbitte, in a Commencement debate on the HPV vaccine. It is shocking to think we have been charging between €400 and €600 to people who wanted to catch up and get their children vaccinated against HPV. I welcome the announcement the Minister of State, Deputy Rabbitte, made here in recent weeks that the Government would eliminate those charges. In his summing up, I ask the Minister to give a timeline for when this will happen. I know Laura Brennan's family is anxious, as I am and everyone else is, to know when this policy initiative will be activated.

We have come a long way with health. I want to finish on a positive note which I think is appropriate. We have allocated €22.5 billion to healthcare this year. Most people in society are happy to forgo tax cuts to see money invested in health. We have an obligation to look after the health of our people. I wish the Minister well in his job. Why can we not make the flu vaccine available to everybody for free? When will he eliminate the €400 to €600 charge for the catch-up programme for HPV vaccination, as committed to in this House by the Minister of State, Deputy Rabbitte?

It is nice to see the Minister here and I thank him for coming to the House. I think we can agree this is a difficult topic. I have real concerns over where we stand with Sláintecare. When three of the most senior people on the advisory implementation council resign and say they are resigning because they do not believe the Government is committed to implementing Sláintecare, that is a major problem. Deputy Shortall put it best when she said the Minister's dropping of the advisory implementation council amounted to a hostile takeover, effectively shooting the messenger because people have pointed out that the commitment to Sláintecare - a public system of care and a national health service, if you like - has not been seen in practice. Certainly, in his speech this evening, the Minister has not addressed the issue as to what mistakes were made that led to these people giving up hope and resigning their positions. I ask him to address that and his response.

I want to put this in context. I accept what Senator O'Loughlin said earlier that these things take time. Health services do not mend themselves overnight. Sláintecare is five years old. Fianna Fáil and Fine Gael have been putting together budgets for some time. I believe this is their sixth one in a row. We are now five years into the implementation of Sláintecare and surely to God we should have made more progress than we have.

I am particularly struck by the concerns expressed by one of those who resigned over the Minister's commitment to implementing regional structures. Laura Magahy described those structures as a critical enabler. In fairness to the Minister, he addressed it in his speech. However, I am concerned about what he said about implementing regional structures. He said that substantial work is also ongoing on implementing regional health areas. He then went on to describe a number of actions that really just look like further research options. The term he used was implementing regional health areas.

Here is an easy one for the Minister to come back on. When are these areas going to be implemented? Will he simply tell us when? That would be progress. A simple answer would suffice.

I have great concerns about those on the front line. I speak as someone who used to represent health workers in University Hospital Limerick, UHL. I met with union officials only the week before last and they told me that morale was absolutely on the floor. Why would it not be? The Minister will be aware that, as hospital management conceded to me, UHL is 200 beds short. There were 90 people on trolleys last Wednesday. We are in the tenth year of Fine Gael government and, each year, things have gotten worse rather than better in the hospital. I include in that the six or so years in which we have had budgets from Fianna Fáil and Fine Gael together. That is why the INMO said: "Many of my colleagues across the country are feeling utterly unsupported in their workplace, with no sense that much-needed health service reforms are supported by Government." The Minister can criticise Sinn Féin if he likes, which the Government parties like to do, but will he address the real concerns expressed by front-line workers? He might also consider the SIPTU representative in Tralee who told us there is now one nurse for every 15 patients there. There is a massive problem.

The problem is that there is a revolving door as regards health staff. People cannot cope with the appalling circumstances they are being asked to work in. Fine Gael has had ten years to address this but has failed utterly while Fianna Fáil is on its sixth budget but it has failed utterly as well. There is an ideological issue at the heart of this. Let us be frank: for decades, Fianna Fáil and Fine Gael were committed not to a public healthcare system, but to a two-tier system. That is what they defended. We never had the radical change after the Second World War that social democracy could bring because we never had a social democratic government. I do not see commitment from the Government in practice. The workers on the front line in UHL do not see or feel that commitment either. They do not have any confidence in this Government.

We spoke to staff in the National Ambulance Service, who came up with several good suggestions to divert people so they would not all have to end up in the emergency department. Its representatives told us of their frustrations as regards getting these policies implemented and of their concerns over their own staffing needs. I acknowledge that a review is under way in that regard.

To conclude, the Minister is not delivering. Those are not my words but those of the front-line workers I have met and quoted here this evening. The next time he comes before the House, there will need to have been some fundamental change. Fundamentally, the Government is not working towards a national public health service. That is evident for everyone to see.

I thank the Minister for coming in and I thank the Leader for facilitating this debate on Sláintecare. She had indicated that it would also be a wider debate on health and the health service. Health is a perennial issue in politics and, despite massive increases in health spending over the past 20 years, it is difficult to see the impact of this money or where it has gone. In a spending review conducted last year, it was determined that an additional €324 million would be needed in 2022 just to keep the health service running as it is. As Senator Gavan said, half of the issue is the significant turnover in staff among nurses, consultants and GPs. There is great difficulty recruiting them. Staff are not being retained within the health service because people are under such pressure.

Sláintecare was developed on a cross-party basis with the aim of reforming the system, ending the complicated two-tier system we have and ensuring that waiting lists and access to treatment were based on need rather than ability to pay. It is a laudable concept that the Labour Party is fully supportive of. It was never going to be easy and it is not now, particularly as three key members of the implementation group have resigned in recent months. Sláintecare needs both dedicated funding and political leadership. It needs to be driven and not just left to fall apart. There has been a sense in the past few months that Sláintecare is directionless and lacks advocates at governmental and administrative levels, where such advocates are needed.

My colleague, Deputy Duncan Smith, said that the setting up of a separate group to advise on the regionalisation aspect of Sláintecare is not in the spirit of achieving the aim of full system reform. It was the leader of the Minister's party, when he was Minister for Health and Children, who initially abolished those regional assemblies under the reform programme and the Hanly report. Despite this, we are now going back to that system and this Fianna Fáil Government is setting up a dedicated unit to have a look at just that rather than at the systemic reform needed. There is political support for Sláintecare but we need political will at the governmental and administrative levels to ensure its success.

With the indulgence of the Leas-Chathaoirleach, I will highlight another matter relating to healthcare, as the Leader has said this is to be a wider debate on the health service. I refer to the ownership of the national maternity hospital and the need to ensure the ethos of that hospital is secular and based on need and that it provides all of the services we need, given the investment the State is making in it. We need guarantees that there will be no religious ethos attached to the hospital. In the context of the protest for better maternity care, I find it quite striking that, even though the Taoiseach and the Minister for Health have said that they want to allow partners in, local decision-making has differed significantly from that sentiment. It raises questions as to who is control of the health service and health system. It would be an enormous missed opportunity - and it is a once-in-a-generation opportunity - to allow the St. Vincent's Healthcare Group to be behind the new national maternity hospital, although it is badly needed and is being built on a site that allows for co-location with another hospital. That presents a great danger. When we founded our health and education systems, we did not do it on a State basis such as can be seen in the creation of the National Health Service in the UK. Instead we essentially subcontracted these systems to the church. We are doing that again in this case. In building the new national maternity hospital, it is important that we ensure that it is State-led and secular and that it provides all of the services that people in maternity hospitals may need, including trans healthcare services, abortion services and reproductive health services. I cannot overemphasise how important that is.

I wish the Minister a good evening. He is very welcome to the Chamber. I thank him for taking the time to be here with us I can imagine how busy he has been. It has been an incredibly challenging 18 months for all parties. There is no doubt about that. I acknowledge the Trojan efforts of the Department, the health service and NPHET to keep us all in good health throughout this pandemic. The roll-out of the vaccination programme is an area of particular success. Ireland's place at the top of international vaccination tables in a testament to this good work and to the commitment of the people to keeping one another safe. The pandemic has placed great additional pressure on the Department and the health service, as evidenced by the number of people with Covid-19 in hospitals and ICUs and the number of people awaiting treatment on waiting lists at present. It is important that, over the coming weeks and months, we remain vigilant and mindful of one another. Doing so will ensure our hospitals have the capacity to provide the services required by their patients throughout this next phase of the pandemic. I must give a big shout-out to our front-line workers, who are just incredible. I am proud that they have done such a phenomenal job.

Our health service is in need of significant reform. This was also the case before the pandemic. The pandemic has forced some of our systems to modernise and become more streamlined but significant deficiencies remain. Our hospitals struggle with capacity each winter. There seem to be accounts of individuals being treated on trolleys in hospital corridors every year. I have seen it with my own eyes when my sister was taken into hospital. It was like a war zone. It was scary and frightening. Our waiting lists for treatment remain some of the longest in Europe, with individuals waiting years for critical health interventions and support.

While the pandemic has indeed placed a significant additional strain on the health system, its reformation simply cannot wait any longer. The implementation of Sláintecare is critical to this reform and to the creation of a health service which is fair, equitable and efficient. While I understand that progress has been made in many areas of the implementation plan, I am concerned that three key elements have not yet progressed to a significant extent, namely, the re-establishment of regional health areas, the tackling of hospital waiting lists and the development of the e-health programme. Progress in other areas will be held back by the slow pace of progress in these areas, and the current system, which is inefficient and discriminatory, will be maintained. The slow pace of progress in these areas was named by Laura Magahy as a significant concern in her resignation as executive director of Sláintecare in early September. I must say that I was most concerned to learn of her resignation. This was compounded by the resignation of Professor Keane and, subsequently, Professor O'Connor from the Sláintecare implementation advisory council. I do not want to be an alarmist, but if senior officials involved in the implementation of Sláintecare do not have confidence in its progress, it is cause for concern.

I welcome the fact that the Department has been working on a new delivery mechanism for Sláintecare in recent weeks. However, I would like some assurances from the Minister of State on what the mechanism specifically entails, and detail on who will hold it to account and when we might see progress in the three key areas of regionalisation, reducing waiting lists and developing e-health. It is also important that the progress of Sláintecare is not tied to the day-to-day management of the health service. I understand that the pandemic poses a once-in-a-generation challenge for the Department and the health service in this regard, but Sláintecare must be progressed so that the system is better prepared for any future public health emergencies.

We must engage in long-term thinking, planning and strategising in political decision-making in Ireland. The difficult decisions must be made now to ensure we do not need to make difficult decisions in future. We cannot continue to kick the can down the road. The pandemic provides a justification for doing so, but we cannot abandon long-term planning for what is an undefined period of time. The public health emergency will end at some point in the future, but we must ensure it does not leave another public health emergency in its wake in the form of an inefficient, two-tier health system that is stretched beyond its capacity. I know that the Minister of State is working to prevent this, but we need to hear more regarding the specific strategies and mechanisms that are being put in place to ensure we achieve a fair, equitable and efficient universal health system in Ireland in the not too distant future.

Is í an chéad chainteoir eile ná an Seanadóir Mac Giolla Phádraig. An féidir le Seanadóirí a bheith an-chúramach leis an am? Munar féidir, ní bheimid in ann gach duine a thógáil isteach. Bígí an-chúramach leis an am, le bhur dtoil.

I thank the Minister of State for coming to the House to speak about Sláintecare. It is a most important initiative, and one that has been talked about for a long time. We all support the concept of universal healthcare being provided to people based on their medical need and not just on their ability to pay for that medical care. For our party, it is intrinsic and a priority. We campaigned very strongly on the issue in the election of 2020, and made a very firm commitment that we would introduce and ensure full implementation of Sláintecare were we to have the opportunity to serve the people of our country. That is what the Minister of State and the other Ministers at the Department of Health are dedicating themselves to doing.

We have talked about other individuals. However, it is most important, as we have this discussion today, that we all remember that there are more than 70,000 people working in our health service. They are all providing an input and working not just to care for people's immediate medical needs, but to ensure that universal healthcare will be available in the future. It would be wrong for any of us to take away from that fact. They have come through and served all of us during the pandemic. Fearlessly, they have put their own lives and families at risk. They have done all of that based on their determination and sense of public duty. We all owe them a great debt of gratitude. Everybody has played their part in the response to the Covid-19 pandemic, which has been a once-in-a-century event. Everyone who has been involved in achieving the greatest response in terms of public health, the roll-out of the vaccination programme and testing and tracing has served all of us.

On top of that, in parallel, the Government has managed to make progress with Sláintecare. I believe €1.2 billion has been provided for new initiatives in the course of the last year. A budget in excess of €20 billion has been secured for next year. The sustainable funding of those 70,000-odd front-line workers and healthcare professionals is most important. It is encouraging to see it. Let us deal with the facts. The mid-year review of Sláintecare showed that 109 of 112 identified actions have been progressed, have been completed or are on track to be delivered. The Government has been in place for one year. I am sure that nobody in the Department of Health or the HSE is sitting on their laurels. Everybody must be exhausted after the year we have had. The progress made is an achievement and all those involved must be commended on it.

My party supports the Government's objectives of reducing waiting lists, increasing capacity and delivering the right care at the right time. It would be honest for the Opposition to remind themselves or at least acknowledge that when it comes to talking about waiting lists, there is nobody in this Republic who thinks the waiting lists are acceptable. Nobody believes that those in pain or in need of medical care should have to wait. The Opposition party that talks about waiting lists in this jurisdiction, when they are double per capita in the jurisdiction where it is actually in government, is pushing its luck.

In terms of budget 2022, I wish to commend the Minister of State on the disability budget. Next year, the budget for disability services will be €2.2 billion. The Minister of State has managed to achieve a 92% reduction in the waiting lists for assessment of needs, particularly for young children, which is an issue that is close to my heart. That is tremendous and an historic achievement. All those involved should be congratulated. I hope that next year we will see even further progress in this area. It is that type of progress that makes universal healthcare become a reality for people. When people can access health services that they need when they need them, it makes a difference.

The €1.1 billion provided for mental health services and the €2.3 billion provided for older people in budget 2022 are most welcome. The Government has introduced initiatives in terms of trying to help people who are on low incomes to access healthcare when they need it, including the extension of the provision of free medical care to six- and seven-year-olds, the extension of the provision of dental services to medical card holders and the reduction in the drugs payment scheme threshold. We all know that the job is not done, but it is going in the right direction. We must encourage all those involved in the Sláintecare project. It is ambitious, radical and game-changing. However, we must not forget that our health service has been in place for decades. The change, which I absolutely believe will be achieved, will also include the prioritisation of women's health. That is an issue that is important to my party and to the Minister of State. Initiatives have been taken on ending period poverty, focusing on menopause and endometriosis and providing free contraception, which are issues that are intrinsic to women.

Finally, I ask the Minister of State to take an interest in the extension of the Rotunda Hospital. It is awaiting the approval of a design team for its critical care unit, in the west wing. It would be great if the Minister of State could bring us some good news on that issue.

I welcome the Minister of State to the Chamber and thank the Minister for Health for attending the previous session. First, I wish to acknowledge the increased budget for health this year, with the provision of some €22 billion, including the retention of €4 billion in funding that was committed during the pandemic in 2020.

On the issue of critical care beds, I welcome the €10.5 million that has been allocated to provide an additional 19 critical care beds, bringing the total number of critical care beds to 340, in line with the 2018 health capacity review. That is most important. Some of the highlights of budget 2022 include the provision of €250 million to reduce acute hospital and community waiting lists, and in the Minister of State's area, the provision of €65 million in new funding for disability services.

The focus is to be on the 1,700 young pupils who will be leaving school and looking for services. There is also to be a focus on nursing homes and the provision of better accommodation. There is new funding for mental health services and there is to be accessible contraception for women. All these measures are positive aspects of the budget for the coming year and for the roll-out of Sláintecare.

It is good to be addressing a Minister of State from Galway. I am sure she is very aware of many of the issues that exist there. I want to recount a story with which she is very familiar, namely, that of our emergency department. I was in the hospital today, as it happens, with my wife. I took a picture of the works that are progressing in the temporary emergency department. A colleague of mine who spoke to a nurse there in recent weeks learned that the nurse is at her wit's end. So are her colleagues. This is evident from the resignation of four emergency department nurses in recent weeks. The nurse my colleague spoke to said Galway is a centre of excellence. On paper, it is. While the staff do a tremendous job, the facility, both physically and spatially, is not at the races by comparison with what is evident in other parts of the country. A Portakabin is the entrance to the emergency department. While there is to be a temporary emergency department during the building works, it is likely that it will be in place for five to six years, assuming we get the planning application lodged for the emergency department, not to mention proceeding to detailed design and construction. The nurse to whom my colleague spoke felt Galway has been forgotten. Being in government, I do not like saying that. Pressure must continue to be exerted to ensure that the planning application for the emergency department is lodged. There seems to be an assumption that we are going to get planning permission. I hope we will, but we have a long history in Galway of projects that were not granted planning permission. I hope that will not be the case here.

The other matter I would like to talk about is the great need for inpatient beds in Galway. The Minister for Health appeared before the health committee two weeks ago tomorrow and was due to bring a memorandum to the Cabinet the next day regarding the elective hospitals. That did not happen. I am not sure whether it was deferred. I am sure the Minister of State is not in a position to say, or perhaps cannot. Saolta has indicated that we need new inpatient beds. Will they be provided? Are we going to get inpatient beds as part of an elective hospital? We need them. Senior Saolta executives were shocked by the Sláintecare team's proposal that only day beds would be provided in Galway. We need way more than that. The announcement was not what we expected. Any and all developments and investments in Galway are welcomed but inpatient beds are needed there, as part of the elective hospital or in conjunction with it. That is not provided for in the national development plan. The elective hospitals are provided for, but there is no mention of additional inpatient beds for Galway. It tends to be forgotten that Galway is a centre of excellence. The centre of excellence covers a region that extends from Letterkenny through Sligo and Mayo and on to Galway. We need inpatient beds. I am sorry that the Minister is not present. I have asked him about this previously. I appreciate that he was here earlier, but we need to get answers on whether there will be inpatient beds for Galway as part of the elective hospital or in conjunction with it as part of future plans.

I welcome the Minister of State. In preparing for today, I took a look at the Sláintecare progress report for the period January to June 2021. The byline is "Right Care. Right Place. Right Time." Would it not be great if that were actually the case?

I take on board that there were three major issues that the Minister rightly identified in his contribution. These are the kernel of the problem. The Sláintecare document states that they are significant challenges. They are highlighted using a green, amber and red colour system with which the Minister of State will be familiar. The three challenges are significant and have been identified as such by the officials in the Department and the Minister. The issues are the implementation of the multi-annual waiting lists reduction plan, the implementation of the eHealth system and the development of the regional health areas. There may only be three such issues but they are three of the most significant, as identified and set out in the report.

The vision for Sláintecare is to achieve a universal, single-tier health and social care system whereby everyone has equitable access to services based on their need, not their ability to pay. That is the strapline; that was the major line that was announced in the press release when Sláintecare was launched, with great ambition, in 2017. It is great that we have ambition for our health services. The ambition was to reform our healthcare system and end the divide between public and private healthcare.

The resignations of two significant members of the Sláintecare implementation advisory council are of genuine concern. How they were communicated internally to the Minister and Secretary General raises serious questions. The matter gives rise to questions about communication, confidence and the team to which we have entrusted our healthcare system. The lack of communication and the question of who saw fit to tell whom raises serious questions. It does not instil confidence in a system. The key concerns are clearly over a commitment to providing for the regional structures of the HSE. We see that the HSE has got too big. Arguments are made about how it handled Covid. There was a centre and people seemed to know what they were doing, yet we see this monolith that is the HSE. There are issues regarding accountability. The Minister of State knows well about accountability in the health service. I commend her on many of her contributions in this House in respect of the shortcomings of the health service. It is not just a matter of talking about the shortcomings, however, it is also about identifying areas where we can address them. I acknowledge the Minister of State's work in this regard.

The key question is whether, if the political establishment is fully behind Sláintecare, the HSE and political establishment are united in their approach and delivery? We have an endless situation in which better-off people can skip the queues. That is the reality of it. I spoke to someone the other day who could not even get cover from the VHI for a scan at the Beacon Hospital and had to pay a few hundred euro to another company in another part of Sandyford to look into potentially serious issues concerning cancer of the throat. This is outrageous; it is crazy.

We need to ask whether we are really committed to providing universal free access to general practitioners. Are we serious about reducing the waiting lists? Time and again, I stand up here and talk about the 907,000 people – just short of 1 million – who are waiting for treatment of some form. This represents an increase of 66,000 in 12 months. I understand the Covid issues, IT issues and all the various setbacks and challenges. I am not realistic in accepting these, and I realise that the Minister of State accepts them too, but we must be realistic.

The Irish Hospital Consultants Association, with which the Minister of State will be very familiar, was scathing about the progress on Sláintecare. It expressed deep concern about waiting lists, the resignations and the lack of meaningful solutions. These are of concern, but I am particularly concerned about how we are going to address the matter of the nearly 1 million people waiting for services.

I was very disappointed by the Department's response regarding the 172 children with scoliosis. This was the subject of a Claire Byrne interview last week. The Taoiseach, the Minister of State's leader, said there was some sort of systemic failure. Today, someone was talking about it on behalf of the Department but there were no solutions or dates set for the 172 children, some of whom have had two, three or four appointments cancelled. I am extremely concerned about this. I realise the Minister of State is also concerned.

Those are just some of the issues I wanted to share with the Minister of State in the small amount of time I had available. I thank her for coming to the House.

There are three speakers outstanding, and a possible fourth. Could the Senators agree to four minutes each? In other words, the Minister of State must respond at 6.20 p.m.

Is that acceptable?

Do your best. That is all anyone can reasonably do.

I am particularly delighted for reasons that will become apparent that it is the Minister of State who is here, although I would have also welcomed the Minister. I will skip all the plaudits for Sláintecare. We are all behind it. There is not any lack of political will in respect of it. There never has been. That is not an issue. The issue is not a lack of money because successive Ministers have put major money behind it. There is evidence of that in the form of new primary care centres. The system and aspects of it, as they were planned to work, are working. The resignations and frustrations have not occurred because of a lack of will on the part of the Government or a lack of funding. I wonder if it comes down to how the HSE does its business. That is a question I would ask. I note the facial comment.

There are some difficulties in respect of which answers to our questions are warranted. For instance, the HSE works alongside organisations in the delivery of services, particularly in the area of disabilities, with which it is aligned. There is not pay parity between the section 38 and section 39 organisations. There ends up being a migration of staff and front-line service challenges arising as a consequence. There needs to be some innovation to change, fix and deal with that. Even where there are HSE and Tusla staff under the same roof, at times there are differences in how they are funded and in their terms and conditions of employment. Many of the services that provide residential services for people with disabilities have been chronically underfunded for years. There is a serious need to address that. As people are living longer, their needs are changing. We need to ensure the viability of these services that have been so faithful in their delivery. I refer, for example, to WALK in Drimnagh, which runs the most credible service. I had the honour of speaking at one of its events the other day. Those in that service are extraordinary in the context of what they deliver. What are we doing to ensure that the delivery of that service is future-proofed?

The Minister of State travelled to Donegal last Friday. I will not get into the specifics of that for many reasons. Let us take the example there of decision-making and management decision-making. What I am talking about is not unique to that service. At the weekend, many concerned and frightened parents contacted me to express their concerns about what will happen when their children need to go into residential care of the State. How will they know they will be safe? Who will advocate for them? Who will support them? Who will make sure safeguarding is in place? One of the organisations that contacted me at the weekend commented that it has a large number of safeguarding issues, that it has been trying to work with the HSE for the past five years and that it has reached a situation whereby it will have to move an individual to a new house. The HSE will not fund that. The organisation in question has asked the HSE to met the families involved but it has refused to do so . The house involved has been deemed by HIQA to be non-compliant due to the safeguarding issues to which I refer. The organisation has put forward solutions but the HSE's community healthcare organisation area 7 has refused to engage with it. There is something there that needs to be discussed. Perhaps there is an impediment among those involved and, to be fair, it is not their fault. We need to be solution-focused in how we ensure that there is the political will regarding Sláintecare is there, that there is funding available and that there is administrative accountability to ensure we are getting the delivery our people demand and deserve. I was not bad in sticking to the time.

Táimid buíoch díot as ucht an chomhoibrithe sin.

I welcome the Minister of State and wish her well with delivery of Sláintecare. I welcome this opportunity to say a few words about Sláintecare. As Senator Seery Kearney stated, it is not an issue of money. We have never had more money allocated to our health services. The current allocation of €22 billion is an unbelievable amount of money when one weighs it up. It includes the allocation of an extra €4 billion last year. There is no doubt that there is something wrong in the health service. Money is not the problem. I would love if we could have a hospital that would provide services with respect to which the Minister of State could say this is how a hospital should be run, regardless of how much money or staff it would take, and to know what the capacity and efficiencies could be. It would be the type of hospital we need and would be a benchmark for other hospitals throughout the country.

I wish to concentrate for the remainder of my contribution on the National Ambulance Service. The Minister of State, as well as every Deputy, Senator and other Minister will be well aware of the ambulance service throughout the length and breadth of the country. That service is not working properly either. We have the National Ambulance Service and a private ambulance service. I do not understanding why they cannot work better together locally. We have had farcical situations. For example, an ambulance based in Kerry could be sent to Mayo under the emergency rule put in place by HIQA whereby an ambulance must be on the road to an emergency within 90 seconds of receiving a call. That ambulance might arrive in Galway when an ambulance in Castlebar could become free. Then the ambulance from Kerry is stood down and returns home. On the way, it may be redirected again. That is farcical. Ambulances based in Kerry are probably operating in the west and ambulances based in the west operating in the south. It does not add up. It makes no sense. Everyone in the ambulance service will tell us that it is not working. Those in the private ambulance service will tell us that service is not working either. The Minister of State should consult the senior Minister and something should be put in place.

The unions are involved and they must be consulted on this issue. They are an obstacle to dealing with this. We have heard much about unions every day in both Houses. This is a typical issue where unions can play a part. We can have a more efficient ambulance service. Its role is to deal with emergencies for the benefit and welfare of our people. I ask the Minister of State to make addressing this issue a priority. From my investigations and on the basis of the information provided by the people I have talked to, I believe it can be resolved. We have a two-tier system. We have an emergency ambulance service and intermediate care ambulance service. This matter could be dealt with straight away. I have been advised that the driver of an ambulance need not be a fully qualified paramedic. The unions are an obstacle in that regard. That is why they must be brought on board. There will be problems in getting all of this together. I plead with the unions in this respect, as it is not only in their interests but also in the interests of the public. That message should go out loud and clear to them. I ask the Minister of State to consult the senior Minister and HSE staff in order to resolve this issue. It can be resolved.

I welcome the Minister of State. I thank her for being here for this all-important debate. I know of her passion for health. I thank her for her response to the Commencement matter I raised last week in respect of the shortage of neurology nurses, not only in University Hospital Limerick but also nationally.

The Sláintecare programme has delivered 6,000 new staff, be they nurses or doctors, and 800 additional beds. I will concentrate on University Hospital Limerick in which there were 98 extra beds and then 60 extra beds, as a number of them had to be closed during the pandemic. Some 91 people are on trolleys along the corridors of that hospital waiting to be treated today. It has the highest number waiting to be treated in the country. That trend has been consistent.

There were 90 people on trolleys on Monday. Approximately 67 were on trolleys last Friday and the numbers have gradually increased. We have extra beds. I agree with Senator Seery Kearney that this is not about a lack of resources, given that so much money has been invested in the health service, but we are not solving the issues. There is an issue there about which we need to have a conversation. As Senator Burke said, perhaps we need a master plan to set down how a hospital should work in principle. There must be a reason the system is not working despite all the investment and extra beds. I know the population is growing. The HSE sanctioned the filling of positions for two diabetic nurses at the hospital last year. Those positions have still not been filled. It is not that there is a shortage of nurses. Why have those positions not been filled? I raised the matter of neurological nurses the other day. There is a shortage of eight because there are currently only three in place. The work the staff do is fantastic and I do not take from it. However, I believe there are many key areas in which we need to fill positions. The money has been appointed to fill these positions. If we could fill them, it would help to reduce waiting lists, which are enormous. Most of the clinics and outpatient services in University Hospital Limerick and St. John's Hospital were cancelled this week, and will only reopen tomorrow. That is serious. The cancellation of procedures, X-rays and tests leads to further backlog. It is not acceptable.

St. John's Hospital, which is part of the group, was mentioned in the capital plan. There was mention of 120 beds and increased procedures that could be carried out. There are currently only ten day beds in St. John's Hospital. Perhaps that is something that could be looked at in terms of solving the problem in the mid-west. Our population is growing and there are many more companies in the area. There have been many job announcements recently, which means people will be moving to the area. The hospital is now too small for the size of the population. That is an ongoing issue. I believe something has to happen. Perhaps someone should be assigned to see how areas of the system are failing and what the problems are. I compliment the staff and the investment that has been put into the hospital. For the sake of good morale for the staff, we need to look at where the problems are and solve them.

I thank the Senator. No one could accuse her of forgetting the people from her home area. I invite the Minister of State to conclude the debate.

I will split my time. I will spend eight minutes delivering the Minister's speech and I will then take two minutes to address some of the issues that have arisen.

I thank all of those who have contributed to this evening's debate. As the Minister said in his opening remarks, access to high-quality healthcare when it is needed must be available to every girl, boy, woman and man if we are to be true to the vision of universal healthcare. It is pleasing to hear voices from all sides expressing their strong support.

A number of issues and themes have been raised in the course of the session. I will try to get to them all but if I fail to do so, the Minister will ensure there is a response on the issue concerned. Reducing dependency on the hospital model of care and supporting capacity in the community is pivotal to the Sláintecare vision. These measures will help people to stay in or near their homes for longer, either preventing hospital admissions or allowing for discharge earlier than would have been possible without these supports. The record level of investment of €21 billion in the health and social care system is absolute testament to this and will support us in creating an integrated health and social care system where patients can have access to the right care in the right place at the right time. It is worth reiterating where the funding has been allocated. I do not need to go through all of it because I think Senators are well briefed, particularly in respect of the €250 million, the €50 million for the NTPF model and the €10.5 million that has been provided for an additional 19 critical care beds in 2022, bringing the total number of critical care beds to 340, representing a significant increase of 85 critical care beds. Some €45 million has been committed for a range of family-friendly measures to progressively move health services to being provided free at the point of delivery, based entirely on clinical needs, which is a critical tenet of Sláintecare. This funding will advance this objective specifically to ensure that care is accessible and affordable for the most vulnerable in our society.

Some €32.2 million will be available to expand GP care. Some €30 million of new funding has been committed to care of the elderly and €16 million has been provided in measures for Healthy Ireland and the national drug strategy.

Senator Kyne mentioned elective hospitals. On the question of whether new elective care centres should include inpatient facilities, I would like to say a little more about the elective facility programmes and why their establishment will be so important. Greater elective care capacity created by elective centres will release capacity in existing hospitals for non-elective and inpatient activity. In addition, being able to dedicate more resources towards non-elective and inpatient care could enable patient pathway improvements, as well as operational performance. All of these impacts could result in faster treatment of patients and enable them to receive better health outcomes and experiences. The additional delivery capability provided by the proposed elective care centres would create significant value for the wider public hospital network. This initiative will, in particular, free up significant theatre space and bed capacity and further enable the separation of elective and non-elective care. Surgical stay has not been included in the scope of these new elective care centres because it is assumed that these procedures, which are by definition more complex, will be carried out within the public hospital network. It is also likely that this approach will better suit patients, for example, making it easier for families to visit. At the same time, we are cognisant of the infrastructural needs in Cork, Galway and elsewhere. Those needs have informed the development of the business case, and the development of inpatient facilities in later phases is not excluded.

Significant progress has been made in several aspects of the e-health programme but there is still much to do. I would go further, in fact, and say there is a lot more to do for e-health. The e-health programme requires continued commitment and ongoing investment for people and infrastructural systems to sustain existing assets and facilitate reform through the introduction of new systems and processes. As Senator Burke mentioned, we also need to engage with the unions on e-health. It is a change in performance and working relations. That is a big piece within e-health about which we sometimes forget.

Capital investment in e-health has increased threefold since 2012. The 2021 service plan approved funding for an additional 300 ICT, e-health, health informatics and clinical staff to support the e-health programme. The pandemic demonstrated the value of e-health and ICT solutions. They were used to support contact tracing and the timely collection of data required to inform daily reporting and modelling of the trajectory of the disease. As vaccinations became available, the national COVAX system and self-service registration portal was crucial in enabling logistics, scheduling and the speed at which vaccines could be deployed, and for the smooth operation of the mass vaccination centres themselves.

I will try to address some of the concerns that have been raised about the regional health access areas. In the second quarter of 2021, given the immense pressure the health system experienced as a result of Covid-19 pandemic and the cyberattack, the HSE asked the Minister to pause the implementation of the regional health areas for a period of time in recognition that structural and functional change is time-consuming. The Minister agreed to the request in order that HSE senior officials could devote time to managing the vaccination roll-out and the cyberattack recovery. Nonetheless, the Department of Health is actively progressing the delivery of a business case for the implementation of regional health areas.

Sustainable work has been undertaken over the past several months in progressing regional health areas within the Department. As noted earlier, research into international best practice has been completed and policy options have been drafted. Consultation with stakeholders including patients, clinicians, policymakers, hospital groups and community healthcare organisation officials has taken place. An advisory group of clinicians and patient representatives is being established to inform the implementation process.

A number of speakers referred to the accountability and the governance of Sláintecare and the new structures that are being put in place, including the establishment of a new Sláintecare programme board comprising the Secretary General of the Department of Health and the CEO of the HSE, along with senior members of their respective management teams. The assignment of responsibility and accountability for delivery of Sláintecare to the senior leadership across the Department and the HSE will ensure that Sláintecare is embedded across the healthcare system and is fully owned by the healthcare system.

Budget 2019 provided €20 million for the establishment of a ring-fenced Sláintecare integration fund to support service delivery focusing on prevention, community care and integration of care across all health and social care settings.

I will finish with items which were raised by Senators. One of the biggest issues from my short experience of working in the Department is in regard to recruitment. There is no shortage of money. Some of the Senators spoke about that. There is absolutely 150% political support on this. The funding has been provided. Unfortunately when engaging in a 50-week process to recruit an individual, therein lies one of our problems. That is one piece. The other issue is the lack of agility within the HSE. If one were in a business and had to manage one's funding and meet the needs, one would be flexible and willing to move. The lack of agility within the HSE is very apparent to me. It is always a race to spend the money, as opposed to, start spending it and start bringing people on board, cranking it up to get it started. We sometimes talk about talk about talk as opposed to actually putting in the foundations and building the blocks upon them, and keep building around that. It is not quick enough either to say when something is not working, to actually call it to a halt. There is that lack of movement within it.

Reform and sustainability of the disability sector is badly needed and that reform and sustainability will ensure the longevity within the providers. They need to know if they are investing that it is a partnership. It is no longer them and us. It has to be the Department, the HSE and the various providers. That is how we must ensure business is done and ensure that there is sustainability within the sector.

As regards the National Ambulance Service, and this is not unique to Mayo, I have heard it from a number of Deputies and Senators who bring it up at parliamentary meetings and various meetings where they have the opportunity to speak to a Minister. This needs political intervention. It needs that willingness across the Department, the HSE and unions to come together. Everybody has a role to play, nobody has a monopoly on preventing a person from getting quick access to healthcare. A three-second turnaround time is deemed to be on-call, the ambulance has moved. That is not what I deem successful. Rather, success is when one gets to the person.

Sitting suspended at 6.33 p.m. and resumed at 6.45 p.m.