Health

Aontú stands for a new realism and a fresh start in healthcare reform

Our health service is overmanaged, under resourced and crippled with Government red tape and regulation. Only recently did we have a HSE recruitment freeze. Nurses and doctors have been crying out for help whilst Accident and Emergency departments are on their knees.

In a modern European country, the site of ambulances waiting to unload sick patients into hospitals is a disgrace. Primary care services are on the brink of collapse, and it is becoming increasingly difficult to get an appointment with your GP.

Mental health services, when they are available, are an Eircode lottery, especially CAMH services. Aontú will protect essential services and invest in the long-term viability of our health service.

Unscheduled Care

Aontú have uncovered some very concerning statistics through Parliamentary Questions and Freedom of Information Requests in relation to the situation in our hospitals. From 2017 to 2022 some 482,844 people left the ED around Ireland without being seen.

From 2019 until the end of the first quarter of 2024 12,847 nurses left their jobs nationally. Of course, we know that during the first six months of this year there was a recruitment freeze on nurses in our hospitals, with many nurses effectively locked out of working in our health service.

Aontú is opposed the closure of further EDs including Navan ED and will seek an Emergency Department in the Mid West to take pressure off University Hospital Limerick.

Mental Health Services

The under-resourcing of CAMHS has become a national scandal, with over 4,361 on waiting lists. This is particularly concerning as the delay in treatment of mental illness is associated with poorer long-term outcomes.

• Aontú would allocate an additional in €10 million in funding to establish 12 additional CAMHS teams.
• Existing provision for specialist mental health staff in Hospital A&Es, prisons and on-campus medical centres in universities needs to be expanded, including mental health nursing cover out of hours available to respond to mental health challenges and crises as they arise. The cost of this additional cover is estimated to be approximately €4 million.
• Aontú would also aim to hire 40 additional specialist nurses in the areas of mental health, intellectual disability and suicide prevention. These nurses would help to boost existing frontline staff and be transferred to hospitals and centres where they are most needed.

Family Carers

Aontú has brought two motions to the Dáil in the past year seeking the abolition of the means test for the carers’ allowance. We were one of the only political parties in the Dáil to advocate a No vote in the recent Care Referendum, in which the government sought to eviscerate carers by reducing their constitutional grounds for seeking economic support from the State.

Over a half a million people in Ireland provide regular unpaid care to family members or loved ones. Those who provide care within the home should be paid for the work they are doing and should not be penalised based on their spouse’s income rates.

• Aontú seek an abolition of the means test for the carers’ allowance. · We want better access to respite services and increased weeks of respite for those in receipt of round-the-clock care, to alleviate the pressures on family carers.
• Aontú are advocating for more regulated and public home care hours to be provided by the State, rather than agencies, so that people can receive care in their own homes and allow the family carer a daily break from their work.

Ambulance Service

 Aontú has uncovered the fact that the number of people who were dead by the time an ambulance reached them has increased by 70% since 2016.

Correspondence from the Director of the National Ambulance Service to Aontú also shows that in 2016 some 15,395 or 8% of ambulances took longer than one hour to handover a patient in a hospital. By 2022 this figure had risen to 94,639 – 38% of ambulances waited longer than an hour to handover a patient in a hospital before being dispatched on the next call.

The delay in discharging a patient at the hospital is having an impact on response times. One of the biggest reasons for the delays in dispatch or discharging on the hospital grounds is the scarcity of trolleys in ED departments. It often happens that when a patient is transported from the ambulance into the hospital on an ambulance trolley, they are left waiting in ED on the ambulance trolley, and thus the ambulance has to wait until an alternative trolley is freed up.

• Aontú will increase the number of staff employed by the National Ambulance Service, and the number of ambulance vehicles available within the health service in line with population growth.
• Aontú will ensure that each emergency department has a bank of ambulance trollies in storage to ensure that no ambulance is needlessly held up at hospitals due to a scarcity of trollies. Quicker deployment and handover will save lives.

Recruitment

It is a national scandal that in the middle of the crisis in health in this country, the HSE imposed a recruitment freeze/embargo on nurses in our hospitals. This had the effect of locking qualified nurses, particularly those returning from abroad, out of our health service.

One of the many damaging consequences of austerity on our healthcare system was the migration of thousands of health professionals. The effects are still evident on service provision, difficulties in retaining existing staff and attracting much needed consultant and specialist staff.

There has been a breakdown of trust in relation to contractual arrangements, including the first strike by our nursing profession in more than a generation.

Aontú believes that rebuilding the health system requires rebuilding trust between government and the health professions. Staff numbers in Ireland’s acute public hospitals should increase by 15,500 over the next 13 years, according to a report by the ERSI into the healthcare system.

We need more nurses, doctors, physiotherapists, dieticians and occupational therapists. Out of 700 doctors who graduated last year 400 of them emigrated. Nurses are voting with their feet and are emigration in large numbers every year.

To recruit staff we need to improve the wage, terms and conditions. We also need to bring Irish Doctors and Nurses home from Australia and Canada. To do this Aontú will launch Operation Shamrock to attract key Irish workers who have moved abroad to come home.

The subject of the first round of Operation Shamrock will be Doctors, Nurses and Construction workers.

Aontú PQs have found out that currently over half of all undergraduate medical students in Irish universities are from outside the EU. They pay 130,000 for their fees. This means that many of these will be lost to the Irish health service in the future. We want to significantly increase the college places for Irish medical students.

The cost of employing an extra nurse/midwife in the Irish public health sector into the future is approximately €76,148 per annum. 3,500 new nurses and midwives would cost €259m.

• Aontú seek to change the funding of the health service to a patient engagement model. Where a patient receives an operation, a treatment, an engagement or a consultation, the state will pay the provider. We believe that this will increase the flow of government expenditure to the front line and reduce the layers of management staff within the health service.
• 35,000 management and administrative staff work within the HSE. This works out at 1 in 4 staff within the HSE works in management and administration. Aontú will aim to increase the number of frontline staff and reduce the number of admin and management staff. The latter will be achieved through natural retirement. It’s estimated that 600 people retire from Management and Administration each year within the HSE. A recruitment freeze for admin and management. The non replacement of 600 WTE in this sector would save the HSE €30m.
• Aontú will reduce the use of agency staff in the HSE by a 20% for each of the next 5 years. This will save €123m next year.
• Aontú seek to employ an additional 400 Consultants next year at a cost of €88m.

Patient safety

Last year there were 107,000 adverse incidents in the health service. Over the last 5 years 3,140 people have lost their lives in hospitals due to adverse incidents.

€2.5 billion has been paid out in compensation for adverse incidents in hospitals in 10 years. No one held to account. The Aoife Johnston case is just one example. This is happening because of overcrowding and no one has ever been held to account. The cost of the cyber-attack on the HSE is over €100m and another €657 million on security upgrades.

The human cost, in terms of hundreds of thousands of very ill people not getting the treatment that they need is colossal. We don’t know how many people have died or suffered significant morbidity as a result.

In terms of Cervical Check, the government promised that no woman would have to court to achieve justice for the damage done by Cervical Check. The former Taoiseach even made an apology in front of the Dáil.

Yet since then, 400 women have had to go to court to take cases. Incredibly 85% of Cervical Samples are still being sent abroad. No one held to account. General Practice GPs interact with every individual and every family. They should be at the heart of a responsive, proactive and cost-effective health system.

Aontú believes GP’s should be incentivized to offer a wider range of services, either directly or through an Integrated Group Practice. It is clear that with increased investment in facilities and staff, GP’s can offer a much wider set of services, from minor surgical procedures to mental health, if facilities and space are provided.

This makes sense, both in terms of patient-friendly delivery of care and also relieving pressures on the acute system. Pharmacists must also have a greater role in the delivery of healthcare to citizens. There are not enough GPs in Ireland to meet patient numbers.

The crisis is particularly acute in rural Ireland. It is creating a risk to life and health in many parts of the country. There are 4,300 GPs in Ireland. But we are currently 2,000 doctors shy of what is a safe number and 1,000 doctors will retire over the next 5 years. Last year 442 Irish doctors left to work abroad. That’s out a total 725 doctors that graduated the previous year.

Thousands of people can’t even get on to a doctors list and those who can are now waiting up to 2 weeks for an appointment. This is pushing people in greater numbers into A&E departments, further clogging hospitals.

• Aontú will press for 10% of the current health budget being assigned to the development and delivery of Primary Care in communities. While there has been some increase in college places and some doctors have come from abroad, we are nowhere near fixing this problem.

Between population growth, an older population, doctor retirements and young Irish doctors emigrating the issue is getting worse. When will this government see beyond the M50 and stem the fall in General Practitioners. The dearth of GPs in rural Ireland has to have a material effect on health and life expectancy.

The Government is so Dublin-based that they don’t even recognise the problem. Healthcare in rural communities More than two out of three GPs in rural Ireland are not taking on new patients and some have waiting times of up to two weeks for an appointment, a study by the Irish Independent has shown. But this number rises in rural areas.

Just 32pc of practices outside of the country’s main cities are open to taking on new patients, compared with almost half of urban practices, reflecting a clear divide in access. While exceptions can be made, many practices said they were not in the position to take on new patients unless they fell within their catchment area or fit other criteria, with decisions made on a case-by-case basis by the GP.

The eastern region is the worst affected, with the vast majority of practices contacted revealing they are currently not accepting patients. Wicklow and Wexford practices appear the worst affected by full patient lists.

Information Communication Technology

The HSE has not embraced Information Communications Technology (ICT) to the necessary levels. The Health Service needs to have the ability to manage all aspects of the delivery of healthcare in a digital environment.

One of the oldest truisms of management is ‘what can’t be measured cannot be (effectively) managed’, and this remains of compelling relevance to Healthcare.

This includes staffing and administration, the digitising and transferability of patient records electronically across different domains and developing the capability to align to rapidly evolving E-medicine.