Stephen Donnelly (Wicklow, Fianna Fail) | Oireachtas source

I thank the Deputy. I might address his two points together because they are linked, namely, the private hospital capacity and accessing expert opinion. Specifically on accessing beds in private hospitals, there is a new private hospital framework that was put in place in December. It has various protocols in terms of surge and being able to access more beds as needed. Some hospitals are using it very well. I am not convinced it is being used to the fullest extent in all of the hospitals, especially in some of the most pressured areas. There is more private capacity available than is necessarily being used.

There are other things we are doing. We are now sending specialist teams to nursing homes in terms of moving patients out of the hospital. The HSE is extending GP access to community diagnostics to out-of-hours, which will help as well.

I fully agree with the Deputy's points on accessing expert opinion. That is a central piece to this fundamental shift from hospital care to community care, a shift we are in the middle of. The Deputy will be aware of the chronic disease management programme. GPs can now access consultants, nurse specialists and advance nurse practitioners, either online or in the hubs, for exactly this reason. We are seeing it with the three pathways we have under chronic disease management. We are adding a fourth, which is hypertension, which will make a big difference. It is a big killer and one where the mortality rates have not fallen at the rate they have fallen for other things over the past ten to 50 years. That will make a big difference. Diabetes, respiratory and circulatory, essentially, are under CDM. The GPs I have spoken to love it. They are saying they have a patient with a heart problem, they do not quite know what to do but they can have a five-minute call with a cardiologist in St. Vincent's who can advise. It is going very well. In fact, last week I was talking to the St. Vincent's team which has one of these hubs in Bray, in my constituency. They have just surveyed the patients and 96% of the patients said they preferred this model of care rather than having to go to the hospitals for all of the reasons the Deputy laid out.

The big investment in advance nurse practitioners is making a difference. I was in the Royal Victoria Eye and Ear Hospital last week as well, looking at some of the modernised care pathway work.

This particular one is for cataracts. At its core, the point is that consultants do not need to see everyone who is coming in. Advanced nurse practitioner teams can actually see a significant number of those who would otherwise have to wait to see a hospital consultant. Believe it or not - I had to double-check the figures I was being shown in order to ensure I understood them correctly - the waiting time for a cataract appointment has been reduced from several years to several months through this pathway. It has been revolutionary. In Dublin, the children's waiting list through the school-based programme referral or GP referrals has more or less been eradicated. Children who would previously have waited a lengthy period of up to several years to see an ophthalmologist are now being seen in the community by health and social care professionals and advanced nurse practitioners. As the Deputy stated in the context of GPs having access to specialism, it does not have to be a consultant. Sometimes it is a consultant, but clinical nurse specialists, advanced nurse practitioners, optometrists and health and social care professionals can fully handle end to end a very sizeable number of patients who previously had been waiting to see a consultant. The Deputy made reference to the buses of people going from Cork and Kerry up to Northern Ireland for cataract treatment. That will become a thing of the past. In Ballincollig, there is a new state-of-the-art facility which will see a significant number of people. Many of the ophthalmology services are moving from CUH to the South Infirmary hospital. In fact, the Royal Victoria Eye and Ear Hospital is now seeing lots of people who previously would have gone to Northern Ireland. It is exactly the point the Deputy is making. It is access to specialism, be it nursing, health and social care, medical or dental specialism, that previously was not available. The impact this new approach is having is extraordinary. It is one of the pillars of our waiting list action plan which will be rolling into this year.