Bernard Durkan
Ceist:1. Deputy Bernard J. Durkan asked the Taoiseach when the most recent meeting of the Cabinet committee on health took place. [11562/23]
Amharc ar fhreagraTuesday, 28 March 2023
Ceisteanna (1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11)
Aindrias Moynihan
Ceist:2. Deputy Aindrias Moynihan asked the Taoiseach when the Cabinet committee on health will next meet. [13067/23]
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Richard Boyd Barrett
Ceist:3. Deputy Richard Boyd Barrett asked the Taoiseach when the most recent meeting of the Cabinet committee on health took place. [12864/23]
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Bríd Smith
Ceist:4. Deputy Bríd Smith asked the Taoiseach when the most recent meeting of the Cabinet committee on health took place. [12867/23]
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Gino Kenny
Ceist:5. Deputy Gino Kenny asked the Taoiseach when the most recent meeting of the Cabinet committee on health took place. [12869/23]
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Ivana Bacik
Ceist:6. Deputy Ivana Bacik asked the Taoiseach when the most recent meeting of the Cabinet committee on health took place. [13431/23]
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Mary Lou McDonald
Ceist:7. Deputy Mary Lou McDonald asked the Taoiseach when the Cabinet committee on health will next meet. [14827/23]
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Pádraig O'Sullivan
Ceist:8. Deputy Pádraig O'Sullivan asked the Taoiseach when the most recent meeting of the Cabinet committee on health took place. [14832/23]
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Mick Barry
Ceist:9. Deputy Mick Barry asked the Taoiseach when the most recent meeting of the Cabinet committee on health took place. [14880/23]
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Gary Gannon
Ceist:10. Deputy Gary Gannon asked the Taoiseach when the Cabinet committee on health will next meet. [14890/23]
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Ruairí Ó Murchú
Ceist:11. Deputy Ruairí Ó Murchú asked the Taoiseach when the most recent meeting of the Cabinet committee on health took place; and when the next one is scheduled. [15096/23]
Amharc ar fhreagraFreagraí ó Béal (12 píosaí cainte)
Tógfaidh mé Ceisteanna Uimh. 1 go 11, go huile, le chéile.
The Cabinet committee on health met yesterday and is due to meet again soon. In addition to the meetings of the full Cabinet and of Cabinet committees, I meet Ministers individually to focus on different issues. I meet regularly with the Minister for Health to discuss progress and challenges in the area of health, including the Sláintecare reform programme.
The primary aim in 2023 is to improve access, outcomes and affordability for patients in line with Sláintecare principles. We are committed to expanding the core capacity of our acute hospitals with more health professionals and more acute hospital beds. Over the past three years we have added almost 1,000 additional hospital beds to the system and more than 360 community beds, with further additional beds planned for 2023 and 2024. We have increased the total public health sector workforce by approximately 18,000 including approximately 7,000 more doctors, nurses, midwives, therapists and physiotherapists and we aim to increase the workforce by an additional 6,000 this year.
There is a strong pipeline of capital projects, including several new hospitals and significant new facilities at existing hospitals. Our multi-annual approach to reducing and reforming waiting lists resulted in an overall reduction in the number of patients exceeding the maximum Sláintecare waiting time, which is approximately three months, by 11% in 2022 at a time when waiting lists are increasing in almost every other developed country in the world. The 2023 waiting list action plan was published on 7 March. For 2023, the Government has allocated €443 million to build on the work already done, with a projected reduction of slightly more than 10% in waiting lists by the end of the year. This includes €123 million on a recurrent basis for the HSE to introduce modernised care pathways, and €80 million has been allocated to various primary care and community care initiatives. Enhanced community care programmes continue at a more local level. This programme, which is investing €240 million in community health services, is easing pressure in hospitals and in more acute settings. In the first full year post implementation, it is projected that community healthcare networks and community specialist teams will enable between 16,000 and 21,000 patients to avoid attending an emergency department.
Work is ongoing on the establishment of six new regional health areas and elective care centres in Dublin, Cork and Galway, as well as surgical hubs in the interim, including in Limerick. We are also facilitating better access to affordable, high-quality healthcare for people at a time when the cost-of-living crisis is affecting everyone. Among other actions to increase eligibility and reduce costs, last year we removed inpatient charges for children and this year we are removing them for adults. We are also widening the eligibility for the GP card which will allow many thousands more people to attend their GP without incurring fees. The drug payment scheme threshold was reduced to €80 from 1 March 2022, which means no household has to pay more than €80 per month for its medicines. Additional eligibility initiatives include access to IVF treatments, the expansion of the entitlement to free contraception to women aged 26 to 30, a €5 million fund for oral healthcare, and free home sexually transmitted infection, STI, testing.
Our health service has its challenges - all health services do - and this was particularly evident during the winter period. However, our health system has responded and expanded dramatically in recent years. We are treating more people with better outcomes than ever before. Our life expectancy is continuing to rise and is now estimated to be the highest in the European Union. We continue to reduce mortality rates for stroke and certain cancers and report positive trends in preventative health. We will continue to advance these reforms under Sláintecare in 2023.
To what extent was time given to the isolation of the issues that cause the greatest concern in the course of the past year, especially to areas such as logjams, lack of capacity, lack of GPs, lack of access to emergency departments and so on? Was enough time given to ensuring they will not recur in the future and that a renewed effort will be made to introduce the elements of Sláintecare that are most likely to impact positively on those issues?
The Cabinet committee discussed Sláintecare and there was quite a bit of emphasis on community services. Were day centres for older people discussed?
They are important services that give people the opportunity to live independently and remain in their own homes with dignity. They are fundamental to the health and well-being of our older population. Having access is key in enabling older people to live independently in their own communities, providing invaluable support to them and their carers. In Macroom, there has been talk over a number of years about providing the service in the old hospital grounds. While there has been talk about it, there has not been any visible progress for some time. Can a day centre be prioritised for Macroom with specialist services, such as for dementia and Alzheimer's?
Frankie is nearly four years old. A year ago, as he was non-verbal, he was referred for an assessment of need to the HSE on 3 February 2022. On 4 February 2022, he got a letter saying his assessment would be on or before 4 May. His parents rang the HSE at the end of May because he still had not got his assessment and were told it would be two years before he got an assessment. Nearly a year later, there are no services for this child, who remains non-verbal. His parents made an official complaint via a solicitor, which was upheld. The HSE still did not carry out the assessment. The parents then went to court to compel a report, which they finally received, but it was not done to a high standard and has to be done again. A year later, the child still has no services or supports. This is just one child, but this is repeated across the country. A year on, his life chances are being massively impacted by this failure. What can be done about it?
I want to return to the question of community healthcare services and the teams in our community which, as the Taoiseach said, will allow people to access care without being hospitalised. Less than a week ago, along with my constituency colleagues, I asked a Topical Issue Matter, to which there was a very unsatisfactory response from the Government. In fact, on this issue of community healthcare in Drimnagh, the Minister of State, Deputy Noonan, responded instead of any representative from the Department of Health. Deputy Noonan is a Minister of State at the Department of Housing, Local Government and Heritage. The issue of the removal of public health nursing services from the Drimnagh area due to staff shortages has created huge upset in the area. It relates specifically to what previous Deputies spoke about in terms of needing to keep local services local. In Drimnagh, the population is expanding rapidly and will continue to. Not only have nursing services been removed from the area, the community has also been massively disappointed to be waiting since 2013 for a healthcare service to be built in the area. It is not going to happen until the end of next year. Will the Government please address some of those problems?
There are over 900,000 people on some form of public hospital waiting list. The Irish Hospital Consultants Association, IHCA, stated it would take up to a decade to address that legacy issue. Its main thesis regarding the national treatment purchase fund, NTPF, and the figures was capacity in all forms around acute situations and all forms of the hospital environment. This is a legacy issue that goes back decades, particularly to when Fianna Fáil was in government and slashed thousands of beds out of public hospitals. What is this Government doing to address the underlying issues of 900,000 people on some form of waiting list?
Speaking at the Labour Party conference this weekend, Phil Ni Sheaghdha said the health service is excellent but only for those who can access it and pointed to the trolley crisis, which is now a permanent trolley crisis. A key concern and issue in dealing with this is how the housing crisis is impacting the ability to recruit nurses, midwives, doctors and other medical staff because they have seen so much of their salaries going on rent. Are the Taoiseach, the HSE and the Department of Health considering enabling hospitals to provide dedicated housing for healthcare staff or support for accessing housing, particularly for healthcare staff recruited from abroad?
I recently raised the point with the Taoiseach about the need for regulation of counsellors. We need to remove barriers to entry for counselling, psychology and educational psychology. This has been raised with us by a number of people engaged in these programmes.
I raised the following issue with the previous Taoiseach, Deputy Martin, last year. I refer to Geraldine Lavelle, who, as a result of a collision when out cycling nine years ago, suffered a spinal fracture that left her paralysed from the chest down. After her rehabilitation, Geraldine moved into a congregated setting where she thought she would be for a number of months to adjust to life with her injury. Nine years later, she has finally secured adapted social housing from Mayo County Council, which is nearing completion. Despite all of her efforts and determination, she faces a final hurdle with the HSE, which has decided, without explanation, to reduce the number of personal assistance hours Geraldine currently receives in her congregated setting, which is less than that required in the most-recent care plan. Despite repeated efforts by my colleague, Deputy McDonald, and Geraldine, the head of the HSE West disability services and the Minister for Health and the Minister responsible for disabilities have failed to engage with Geraldine. Will the Taoiseach intervene to ensure the Government's policy commitments on decongregation are being delivered?
I have spoken to the Taoiseach on a private basis about this issue in the past, which relates to the reimbursement process. The Government has done some good work of late by publishing the Mazars report and commencing the successor to the National Rare Disease Plan. Of course, we have invested more than €100 million in the last three years in orphan drugs. Last Thursday, I raised this issue again with the Tánaiste and gave the example of Luxturna, which has now been before the drugs group for assessment for reimbursement for 1,280 days. There could be a multitude of reasons why it has taken that long for the drug to go through the process. Whether we blame industry or the drugs group, the bottom line is the process is not working when it takes 1,282 days, and counting, for assessment for reimbursement. I ask the Taoiseach to engage with all partners in government to ensure proper review of the reimbursement process.
The Department of Health signed up to the Safe Staffing Framework, a data-driven, evidence-based system which can pinpoint the staffing levels needed to provide safe staffing in every hospital ward in the State. Cork University Hospital is one of the State's flagship hospitals, yet, according to the Irish Nurses and Midwives Organisation, INMO, only four of the 21 wards at that hospital meet Safe Staffing Framework guidelines. How can the Taoiseach defend the fact that more than 80% of the wards at one of the State's flagship hospitals are operating at unsafe staffing levels? The INMO has commenced balloting for industrial action at the hospital's coronary care unit. What steps does the Taoiseach intend to take to address its concerns to avoid the possibility of industrial action and to ensure safe staffing levels at Cork University Hospital?
We await an inquiry into the State's response to Covid-19. I have spoken to the Taoiseach previously about the 23 people who died in Dealgan House and that the families met with the Minister for Health, Deputy Donnelly, and the Minister of State, Deputy Butler. They were promised a mechanism to provide them with answers, justice and closure. They are still awaiting a response. I want to know if there is any further information about the timeline. Is it going to be set up for the summer? Will there be engagement with the families? Will there be modules? Will we get to grips with what happened in nursing homes?
Concerning individual queries, I am sure these are very difficult cases and if Deputies want to pass on the details to my office or the relevant Minister, we will try to provide a reply. It is not possible in this forum to respond to individual cases because there is always much more to it than can be put across in a minute or two by a Deputy and we need to know all the facts.
Regarding the Sláintecare programme, our programme to bring about universal healthcare, it has three principles: affordable healthcare for everyone, good patient outcomes and timely access. We are making a lot of progress around making healthcare more affordable, of which I mentioned some examples in my reply earlier. Patient outcomes in Ireland are good and much better than in the NHS, for example, which is often used as a model to follow.
It definitely is not. Where we are not doing well is on timely access. That is where we need to make much more progress in the next year or so.
Sláintecare has the support and oversight of the Department of the Taoiseach. That is being enhanced currently. When it comes to the Sláintecare programme, there is now a report to me every two months, as chairman of the Cabinet committee on health. One of my advisors and one of my officials now sit on the Sláintecare delivery board.
With regard to community care, which was raised by Deputies, we are working very closely with the Minister of State, Deputy Butler. The problem we would have had five or ten years ago was that we had the staff, but not the money. It is now the reverse: we have the money, but not the staff, in large part due to full employment. We are working on means to increase the number of people we can get working in home care and community services and that includes increased pay and terms and conditions; payment of the living wage; payment of people during travelling time, as they travel from client to client, and 1,000 new work permits to bring care staff into the State.
I do not have any information on Macroom, but I will take it up with the Deputy and come back to him with a reply, once I have one.
From talking to professionals in the area, in particular, the assessment of need process has become a real difficulty. When the right to an assessment of need was introduced by the Oireachtas, it was done for all the right reasons, but it has now become a barrier, because children cannot get the therapies they need until they have had their assessment of need completed. I am told a full assessment of need takes 20 or 30 hours. It has become a barrier. An abridged system was brought in, that would do shorter or rolling assessments of needs, which meant children were getting the therapies much quicker and waiting lists were coming down, but the court struck that down and said that everyone has to have a full assessment of need. It has created an enormous problem, unfortunately. We need to look at that and revisit it to see how best we can sort it out. It should not be the case that someone who clearly needs speech and language therapy, and a one-hour assessment can determine that, cannot get it until they have gone through a 20- or 30-hour full assessment. It is an example of how rights-based legislation can backfire. An honest attempt to give people a right has now put us in a situation where that right has become a barrier to the treatment they need.
With regard to the 900,000 people on hospital waiting lists, that is true, but it is not the full truth. Many of those people are waiting a few weeks; maybe six or ten weeks. It also includes people awaiting annual checks. One can wait up to a year for an annual check, in fact one has to wait at least a year for an annual check. It includes duplicates, people who have been treated already and people who are suspended from waiting lists for various reasons. In the Sláintecare programme, we agreed good criteria around waiting lists, whereby nobody should have to wait more than ten weeks to see a specialist and no more than 12 weeks for a procedure that they need. When one uses that figure, there are approximately 450,000 people waiting longer than they should have to, but that figure has come down. It was lower at the end of last year than it was the year before. Very few jurisdictions have seen their waiting times go down. Ours have and we have a target to bring them down further this year. It is great to see some progress on it. They are far too high and too long, but we are one of the very few countries that is seeing its waiting times fall, that is, waiting times at end-2022, versus end-2021. They will fall again this year. We are doing it both through expanding capacity and by using the National Treatment Purchase Fund, NTPF, as a source of additional capacity.
Everyone knows that recruitment in the health service is an enormous challenge. We have full employment. We have enormous international competition. Canada, America, Australia and New Zealand are short too. That is why they are bringing in staff from abroad, including from Ireland. The housing crisis does not help, but we should put into a factual context that since this Government came to office, we have hired an extra 7,000 nurses, midwives, doctors and dentists. We have never had more GPs with HSE contracts. We have never had more nurses or consultants working in our public health service. That is, of course, against a backdrop of a rising population and increasing medical need, but we should not give in to this false narrative which would have people believe that we have fewer nurses and doctors, because they are all leaving. The facts are otherwise. There are people coming and going and, in the round, we have never had more staff in our health service and the numbers are increasing every day. We will hire an extra 6,000 this year.
I met with the new HSE CEO for the first time yesterday. We discussed reimbursements. The Deputy was on my mind at the time. He said to me that only in the past couple of weeks, a considerable number of additional medicines have been approved, that is, new molecules and indications. However, we agreed we would make it a specific item for discussion at the next sub-committee meeting or the one after, because we acknowledge we need to speed up the reimbursement process for medicines in Ireland. One thing that was said back to me and I think it is a fair point is that we always hear about the ones that are approved abroad, but not in Ireland. We rarely hear about the ones that are approved in Ireland and not abroad. That was a fair point.