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 Header Item Cabinet Committee Meetings (Continued)
 Header Item Cabinet Committee Meetings

Wednesday, 3 July 2019

Dáil Éireann Debate
Vol. 984 No. 6

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(Speaker Continuing)

[The Taoiseach: Information on Leo Varadkar Zoom on Leo Varadkar] There are more joining it than leaving. The HSE and Medical Council numbers show that. Overall, the number of people working in the health service has increased by 10,000 over the past three years. It is up from about 105,000 to 150,000 across the public health service. One of the reasons we have overruns in the health service is the recruitment surge rather than the recruitment crisis and the fact that extra people are hired every year beyond what is provided for in budgets.

On the number of consultants working in the public health service, as I said, this continues to grow year on year. The number increased by 109 in the past 12 months. There are, however, significant recruitment and retention challenges, especially in certain specialties such as psychiatry where we need to move to a more psychology based model. It will not be possible to find the number of consultants needed using the current model. In certain locations - some smaller hospitals - particular posts are no longer recognised for training purposes and probably never will be.

The HSE recently prepared a report in response to a request from the Minister for Health, Deputy Harris, and the Department of Health to consider the issues raised in the judgment of Mr. Justice Kelly and given the current recruitment challenges. I understand this report and recommendations were submitted to the Department of Health on 13 May and are currently receiving consideration. They will be published as soon as possible.

Several initiatives are being pursued by the HSE to advance consultant recruitment and retention, including improvements to the recruitment process, which is very cumbersome; offering contracts to the hospital groups rather than individual sites; and focusing on more family friendly arrangements such as job sharing and part-time contracts. The HSE has also established a tripartite working group, including the Medical Council, the forum of postgraduate medical training bodies and the HSE's national doctors training and planning unit, to examine posts where consultants are not on the specialist register and recruitment and retention challenges exist.

While several hundred consultant posts are difficult to fill at present, only 20 are currently being advertised. The reason is that many of the posts are filled on a locum or temporary contract basis to ensure the delivery of essential services. While we describe the positions as being vacant, they are not actually vacant in the sense that the job is being done by somebody on a temporary or locum contract rather than someone on a permanent contact.

On the issue of new entrant consultants' pay and the proposals of the Public Service Pay Commission, the Department of Public Expenditure and Reform has said that outstanding matters will be given full consideration by any pay review mechanism agreed by the relevant parties in the context of the next round of pay talks. In the past few months, we secured a new contract for staff nurses and staff midwives, with pay increases and changes to practices and terms and conditions. We have also successfully agreed a new contract with general practitioners to increase funding for general practice by 40%. In return for that, there have been agreed changes such as the adoption of new technology and GPs taking on new work, especially around chronic disease. In negotiations with consultants we will need to adopt a similar approach in which, in return for equalising pay, we ensure it is not just more pay for the same outcomes and changes are made that are patient focused. It must also deal with some of the very difficult and problematic issues around the mix of public and private practice.

Deputy Richard Boyd Barrett: Information on Richard Boyd Barrett Zoom on Richard Boyd Barrett Can I just get my question answered?

Deputy Brendan Howlin: Information on Brendan Howlin Zoom on Brendan Howlin I asked about healthcare assistants.

An Leas-Cheann Comhairle: Information on Pat the Cope Gallagher Zoom on Pat the Cope Gallagher There will not be a third round of questions. That should not be blamed on what happened earlier.

Deputy Richard Boyd Barrett: Information on Richard Boyd Barrett Zoom on Richard Boyd Barrett I deserve some answers.

The Taoiseach: Information on Leo Varadkar Zoom on Leo Varadkar As always, I am happy to continue.

An Leas-Cheann Comhairle: Information on Pat the Cope Gallagher Zoom on Pat the Cope Gallagher We will not have time for a third round. That has nothing to do with the earlier-----

Deputy Brendan Howlin: Information on Brendan Howlin Zoom on Brendan Howlin Perhaps the Taoiseach could come back to us individually afterwards. I asked about healthcare assistants.

The Taoiseach: Information on Leo Varadkar Zoom on Leo Varadkar I am in the Leas-Cheann Comhairle's hands.

An Leas-Cheann Comhairle: Information on Pat the Cope Gallagher Zoom on Pat the Cope Gallagher The Taoiseach may continue.

The Taoiseach: Information on Leo Varadkar Zoom on Leo Varadkar It takes less time to ask a question than it does to answer it, as everyone can appreciate.

On Deputy Boyd Barrett's question, he will appreciate that at this stage I cannot comment on individual cases. We have a system for deciding which medicines are licensed and which are approved for reimbursement in the State. This is not done by private health insurers or the private sector but by public bodies, as it should be. The European Medicines Agency and the Health Products Regulatory Authority decide whether a medicine should be licensed in the State and for what purpose. The HSE, acting on the advice of the National Centre for Pharmacoeconomics, then decides whether a medicine should be reimbursed. Some 30 medicines have been approved this year by the HSE for reimbursement but others have not. If they are not reimbursed, it is often for very good reason. It is not a political decision and I do not believe it should be a political decision.

Deputy Richard Boyd Barrett: Information on Richard Boyd Barrett Zoom on Richard Boyd Barrett There is no good reason in this case.

The Taoiseach: Information on Leo Varadkar Zoom on Leo Varadkar Deputy Howlin asked about healthcare assistants. I am not familiar with the report he mentioned so I will have to check into that. I have not yet had a chance to read the newspapers today but I am aware there is an editorial from Professor David McConnell in The Irish Times today, which I will endeavour to look at. I must read the article before responding.

  On Sligo hospital, I understand that a significant new development at the hospital received planning permission in the past couple of weeks. I may be mistaken. The project will be a major extension to Sligo hospital. On the issue of a catheterisation laboratory, I do not know if a permanent laboratory is intended for Sligo hospital. I understand a mobile catheterisation laboratory is provided but it is not the case that the provision of such a laboratory is directly connected to the recruitment of cardiologists. Connolly hospital does not have a catheterisation laboratory, yet it has three or four cardiologists because they do particular types of work, especially in the area of heart failure. I am not able to give the Deputy a detailed reply on that matter but I will ask the Minister for Health to do so.

Cabinet Committee Meetings

 5. Deputy Joan Burton Information on Joan Burton Zoom on Joan Burton asked the Taoiseach Information on Leo Varadkar Zoom on Leo Varadkar when Cabinet committee D, infrastructure, last met; and when it will next meet.  [25593/19]

 6. Deputy Mary Lou McDonald Information on Mary Lou McDonald Zoom on Mary Lou McDonald asked the Taoiseach Information on Leo Varadkar Zoom on Leo Varadkar when Cabinet committee D, infrastructure, last met; and when it is scheduled to meet again. [26555/19]

 7. Deputy Eamon Ryan Information on Eamon Ryan Zoom on Eamon Ryan asked the Taoiseach Information on Leo Varadkar Zoom on Leo Varadkar when Cabinet committee D, infrastructure, last met; and when it will next meet. [26620/19]

 8. Deputy Richard Boyd Barrett Information on Richard Boyd Barrett Zoom on Richard Boyd Barrett asked the Taoiseach Information on Leo Varadkar Zoom on Leo Varadkar when Cabinet committee D, infrastructure, last met. [26872/19]

 9. Deputy Brendan Howlin Information on Brendan Howlin Zoom on Brendan Howlin asked the Taoiseach Information on Leo Varadkar Zoom on Leo Varadkar when Cabinet committee D, infrastructure, last met; and when it will next meet. [27635/19]

 10. Deputy Micheál Martin Information on Micheál Martin Zoom on Micheál Martin asked the Taoiseach Information on Leo Varadkar Zoom on Leo Varadkar the number of times Cabinet committee D, infrastructure, met in 2019. [28207/19]

The Taoiseach: Information on Leo Varadkar Zoom on Leo Varadkar I propose to take Questions Nos. 5 to 10, inclusive, together.

Cabinet committee D works to ensure a co-ordinated approach in the areas of infrastructure investment and delivery, including housing and climate action. The Cabinet committee last met on 27 May. The next meeting of the committee has yet to be scheduled. There is significant work under way across each of the areas covered by the committee through Government Departments, agencies and a range of interdepartmental groups such as the Project Ireland 2040 delivery board. These matters are also regularly considered at meetings of Government and in bilateral meetings with the relevant Ministers.

Significant progress is being made on the implementation and delivery of Project Ireland 2040 and projects promised for many decades are now well under way. Through the national planning framework, it sets out our strategic 20-year vision for Ireland’s future, balancing rural and urban development and linking it with the national development plan, which encompasses €116 billion in investment in public infrastructure over the next ten years to meet the infrastructural needs of our growing population. In May last, the Government launched the first annual report for Project Ireland 2040 and it is clear it is already delivering better transport links, building new schools, facilitating better health and environmental outcomes and yielding more housing. For the first time in decades, for example, three new hospitals are under construction, while 11 primary care centres will open this year and another 26 are in development. By the end of the year, some 410 school projects will have been completed or will have started construction, providing 40,000 extra or replacement school places, 200 modern science laboratories, 48 new or upgraded physical education halls and the replacement of 600 prefabricated buildings. In addition, work is under way on several long promised projects, including the upgrade to the N4 in Sligo and the new north runway at Dublin Airport.

The four funds launched under Project Ireland 2040 have a total of €4 billion to invest across the areas of rural and urban regeneration and development, climate action and disruptive technologies. The first round of funding allocations under these funds, amounting to just over €300 million, has been announced. These funds will leverage further private sector investment in innovative and targeted projects that deliver on the aims of Project Ireland 2040.

The Land Development Agency, another cornerstone initiative of Project Ireland 2040, was established on an interim basis in September 2018 and is working to ensure the optimum management of State land through strategic development and regeneration, with an immediate focus on providing new homes, including social and affordable housing.

Housing continues to be a priority for the Government and we have seen strong growth in housing completions and leading indicators such as planning permissions, commencement notices and housing registration. Last year, more than 18,800 new homes were built, an increase of 25% on the previous year. More than 2,600 homes were brought out of long-term vacancy and almost 800 dwellings in unfinished estates were completed, meaning the number of new homes available for use increased by more than 22,000 last year. This does not include student accommodation.

There was also strong delivery of publicly funded social housing in 2018. We are aware of significant challenges in meeting housing demand and tackling the ongoing failures in the housing market. For this reason, budget 2019 provided an increase of 25% in the housing budget which, at €2.6 billion, is the biggest ever.

Delivering on our EU climate commitments for 2030 and transitioning to a competitive, low carbon, sustainable economy by 2050 are also priorities. We are investing €22 billion in climate action through the national development plan to ensure that our future growth is regionally balanced and environmentally sustainable.


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