Cathal Crowe
Question:273. Deputy Cathal Crowe asked the Minister for Health the steps his Department has taken for rural Ireland since 2020. [21003/23]
View answerThursday, 4 May 2023
Questions (273)
Written answers
This Government has delivered unprecedented levels of investment in our Health service in recent years, the net core funding allocation for our health services increased from €17.9 to €22.8 billion – that is €4.9 billion more, or a 27% increase in core funding between 2020 and 2023.
€236 million revenue and €40 million capital expenditure was provided nationally as part of the 2020/21 Winter Plan and Budget 2021 to fund an additional 1,146 acute inpatient beds, excluding critical care beds, on a permanent basis in our acute hospitals, representing a significant step towards achieving the recommendations in the 2018 Health Service Capacity Review.
As of 16 March 2023, 970 additional beds have been opened since 2020. 970 beds have been opened nationally since 1st January 2020. Of these, 516 were opened in 2020, 297 were opened in 2021, and 157 opened in 2022.
Adult critical care capacity now stands at 323 beds. This represents a very significant increase of 65 beds, or 25%, over the 2020 baseline of 258 beds. To put that in perspective, we had a total net increase of 18 beds in the three years 2017, 2018 and 2019. And more are planned – the HSE plan to add a further 29 more beds this year, bringing our critical care capacity to 352 beds by the end of this year.
Successive Winter Plans have also supported acute and community services nationwide to respond to high levels of emergency attendances and admissions across the acute sector, long waiting times in Emergency Departments (EDs) and high occupancy rates across acute hospital settings.
Furthermore, my department is continuing to engage with the HSE to ensure the timely delivery of the new Elective Hospitals in Cork, Dublin, and Galway. These Elective Hospitals will specifically cater for low complex and high-volume cases and when established will provide close to one million procedures annually. This will represent real change, helping us to utilise our resources more efficiently by separating scheduled and unscheduled care. It is expected that these Elective Hospitals will commence providing care by the end of 2027.
The National Screening Services (NSS) provide a national service, running four free population-based screening programmes in community settings across the country. Equitable access to population-based screening throughout Ireland, including rural Ireland, is a priority for the NSS. The NSS work continually to ensure all eligible people can access their services, as outlined in their recently-published 5-year strategic plan, Choose Screening.
Under the plan there are a number of objectives aimed at improving equity and participation in screening programmes to reduce health inequalities. The NSS are developing an Equity Framework, which will further ensure everyone has a chance to use population-based screening services. In addition, the NSS programmes are supported annually by large-scale communications campaigns in local and national media and social and digital media which seek to target people in the eligible age range in all areas of the country, including rural Ireland.
Information materials are also provided in up to 22 different languages, including multilingual videos for people for whom English is not their first language, and in easy-read format, in their drive to create more equitable access to information. Each of the four programmes is supported by an Access Officer, who enable greater access to services across the country. Their Equity Report details the recent work increasing access to screening for people in hard-to-reach communities.
The NSS runs four national screening programmes which are delivered equally for people living across Ireland:
• BreastCheck offers all women between the ages of 50 and 69 a breast cancer test (a mammogram) every two years. The programme aims to screen everyone as close as possible to where they live and have 4 screening units and 24 mobile clinics across the country. They have recently introduced three additional mobile units to provide further access for local communities.
• CervicalCheck provides free cervical screening tests to women and people with a cervix. The programme has over 4,500 sample takers nationwide. Women can go for screening to any of their registered providers, available on www.hse.ie/cervicalcheck.
• BowelScreen aims to reduce people’s chance of developing bowel cancer by detecting and removing pre-cancerous polyps in the lining of the bowel. It is a free, at-home test which is delivered equitably to people aged 60 to 69 living in Ireland. Over the past 3 years the programme has opened two new follow-up endoscopy units, one in Waterford and one in Mayo.
• Diabetic RetinaScreen provides eye screening for people from age 12 who have Type 1 or Type 2 diabetes. An estimated 225,000 people in Ireland have diabetes. The programme invites people with diabetes to a diabetic retina screening units in their local area. They have 150 screening locations nationally, see www.hse.ie/diabeticretinascreen. In 2021, the programme extended the surveillance pathway for patients requiring follow-up investigations, reducing the number of hospital visits for people and moving their clinics into the community. In 2023 they are rolling out a new community screening option for women in pregnancy who have Type 1 and Type 2 diabetes.
The development of primary care services – alongside social and community care more broadly – is central to this Government's determination to deliver a high-quality, integrated and cost-effective health care system.
The provision of modern, fit-for purpose primary care infrastructure is essential to the shift in care from acute hospitals and into our communities. The development of Primary Care Centres is tangible evidence of this Government’s commitment to the expansion of Primary Care across the country. As of Q1 2023, there were 167 Primary Care Centres nationwide. These Primary Care Centres serve local communities right across the country, with 139 PCCs located outside Dublin.
In Budget 2023, annual investment of €195m was secured to enable the continued expansion of primary care services through the Enhanced Community Care (ECC) programme. This continued level of investment in primary care reform is unprecedented and is intended to address historical capacity deficits in the sector and is a key element of wider reforms being implemented to deliver on Sláintecare and the promise of care being delivered in the right place, at the right time, and as close to home as possible. The ECC programme includes a number of different elements that will bolster primary care services across the country.
Amongst other initiatives, the funding is facilitating the rollout of 96 Community Healthcare Networks (CHNs) to be completed and enabling the continued development of 30 Community Specialist Teams for Older Persons, and 30 Community Specialist Teams for the Management of Chronic Diseases. To date, over 2,6200 staff have been recruited to the Programme, with full recruitment to be completed this year.
CHNs in particular are central to the development of enhanced and improved primary care services, with each network consisting of between 4 and 6 primary care teams serving a local population of around 50,000.
The CHNs implement a population needs and stratification approach to service delivery and the services which these networks provide locally to patients are crucial to enabling those requiring care, such as older persons, to live more independently in their community, by co-ordinating and integrating services and allowing care to be delivered as close to home as possible for as long as possible.
94 of the planned 96 CHNs are operational nationwide, alongside 44 Community Specialist Teams for Older Persons and Chronic Disease Management. We have also ensured nationwide coverage with 21 Community Intervention Teams fully operational since 2021, and these continue to be expanded this year.
This Government also continues to work to increase the number of GPs practising in the State so that patients across the country, including those in rural areas, have access to GP services. Over the lifetime of the 2019 GP Agreement (2019-2023) the annual expenditure provided for general practice has been increased by over €210m. The Agreement provides for, amongst other things, a 10% increase in rural GP practice supports, significant increases in capitation fees for participating GMS GPs, new fees and subsidies for additional services, and improvements to GP’s maternity and paternity leave.
In addition, the number of doctors entering GP training has increased from 193 in 2019 to 258 in 2022; a further increase to 285 is intended for this year rising to a planned 350 training places for new entrants per year by 2026.