Stephen Donnelly (Wicklow, Fianna Fail) | Oireachtas source

The next thing the Chair raised was the elective hospitals for Cork and Galway. The preliminary business case, as he will be aware, was approved just over a year ago for St. Stephen's Hospital as the preferred site in Cork, and Merlin Park as the preferred site in Galway. A lot work has been going on. Since then, the HSE is progressing the procurement for the design team, which will include an architect-led design team and a project control team. We hope to appoint the design team in quarter 2 of this year, which will be an important milestone. That is for the architect-led design team.

Oral health is an issue that we have discussed here in committee and in the Dáil on many occasions. The Chair has raised several issues. One is the difficulty that some people with medical cards have getting through the dental treatment service scheme, DTSS. I am very aware of this. In response, we increased payments by about 50% in 2022, I think. It was a very significant increase. As a result of that, we have seen some dentists rejoin the scheme and we have seen more work from those dentists on it. The amount of work that is going on is on the increase.

I raised this matter recently with the Dental Council and I have raised it with the Irish Dental Association as well. What I said to the Irish Dental Association, and I have made these comments in the Dáil, was that I fully accept, and the Government accepts, the current scheme is out of date. The scheme does not provide the clinical flexibility that dentists need to provide appropriate treatments to their patients and it needs to be updated.

On the amount of money being paid, I accept that in many cases it is less than the dentists can get from their private patients. That is true. However, it is also true that funding had increased by a half, which is very significant. It is also true that the funding is significantly higher than the amounts paid by many comparable countries around Europe and in western Europe. The payments made by the State to dentists under this scheme may, indeed, be less money than the dentist can make through private practice but they compare very favourably internationally. We need to bear that in mind.

What I have said to the representative body and the regulator, which I have put on the record of the Dáil, is that we are engaging with the Irish Dental Association and looking at how we can put a new scheme in place. Obviously, that process takes time. In the meantime, I would call on individual dentists to see people with medical cards. I do not believe it is right ethically to say, "I am not going to see you because I can make more money seeing somebody else." I do not think that is right. I understand it from a profit perspective and maybe there is some amount of that is required in order to protect the financial sustainability of the practice and to pay the bills, which I accept as well.

I think one or two of the Chair's colleagues in the Dáil raised examples of constituents of theirs where their dentist had said, "No, I am not treating you as a medical card patient", but I will treat you but you have got to pay me as a private patient. I do not believe doing so is right or ethical. We do not hear GPs doing that and I do not believe dentists should be doing it, so this has to work both ways. I reiterate my call that I believe dentists should see their medical card patients even though they could make more money in the same period. I am sure GPs could make more money treating just private patients but they do not do that and I think that is something which is worth restating.

Second, one of the areas that I am very aware of is the orthodontic waiting list. It is not acceptable and it has not been acceptable for a very long time. We have funded it through the waiting list action plan. I am happy to say that from 2019 to now, we have seen an almost 50% reduction in the number of patients waiting. We have a way to go but a 50% reduction is important and certain things are moving in the right direction. We want these children to be able to get the specialist orthodontic care they need when they are referred for it.

The number of dentists on the Dental Council is increasing. It is 177 more now compared with March of last year. We now have 3,649 dentists. The number is up significantly on 2019. The number of dentists working in this country is increasing. Members will be aware that we are looking at opening another dental school and we are looking at doubling the number of dental college places in the country as well.

On access to GPs, it is absolutely the case that in some parts of the country, be they more rural areas or in some cases urban areas, it is still difficult to get a GP. I fully accept that. A lot of important progress is being made. We have quite radically increased the number of GP training places. It has gone from around 120 about ten or 11 years ago to 350 this year. It was 285 after the intake in September and it will be 350 after the intake this year. We had a record number of applications from medical graduates for those GP training places. The number of training places is increasing very substantially, and just as importantly, the demand from medical students and graduates to be GPs is growing. It is great to see. The increases over recent years up to the 350 means that, even before we start factoring in the ones going into training now, for every GP who retires there are now about two entering practice, which is very positive. It will obviously take several years for that to fully work through.

In addition, a shorter term measure is the international GP programme, which is done in conjunction with the Irish College of General Practitioners, ICGP. The latter is planning to bring in several hundred more GPs again this year and is targeting the areas where this real demand. For example, there is the Iveragh Peninsula. The Minister, Deputy Foley, and I have been working through this. They had six GPs on the peninsula and they are now down to three. One one of those will be retiring in June. They are going to go from six GPs to two, which is a real problem. I have spoken with the ICGP to see if we can bring some of its international doctors through, and it believes that might be possible. These are some of the short-term measures we are using as well but that is not to detract from the fact that it is still an issue in different parts of the country.

One of the other points the Chair made was around surgical waiting lists, particularly for those who are quite sick. We are approaching this in two ways. The first is just a general reduction in the number of people waiting longer than the agreed targets of ten to 12 weeks. There has been a modest reduction but, in fact, the number of patients being treated and the number of procedures is going up. What is happening is that because there has been so much additional outpatient activity, the number of referrals to the surgical list and the numbers on the inpatient day-case list have both gone up as well. One of the things we have been putting a lot of focus on is the number of people who have been waiting more than a year. I do not have that number to hand. It is probably in the briefing, but I am happy to say that number in last year versus that when Covid was at its peak has fallen substantially. We obviously have a focus on those who are most urgently in need of time-sensitive care.

Supported living for people with disabilities does not fall within my remit. I hear the Chair loud and clear. It comes under the remit of the Minister, Deputy O'Gorman, and the Minister of State, Deputy Rabbitte.

Those with scoliosis comprise one of the groups in respect of which there is a very time-sensitive need for complex surgery. As stated previously, we are failing many of these children in the context of the length of time they are obliged to wait. The level of activity has gone up. Investment in the service has gone way up. We had a €19 million investment fund. Quite a number of resources came on stream in the past few months, including the second MRI machine in Crumlin, the fifth theatre in Temple Street, additional beds and more staff. From memory, 192 staff or thereabouts were hired specifically in the context of that €19 million fund. I am not yet satisfied that everything that can be done needs to be done. What I want is a specialist spinal service for Ireland. If we look at international best practice, this is what the centres that are the very best at this have. They have dedicated theatres, theatre teams and beds, and we do not. That is something that we want to see.

We have been making some significant changes to how this is run by CHI. We now have a dedicated management team in place that is looking at better waiting list management and better communications with patients and families. It has not been where it needs to be for a very long time, and I am not remotely satisfied with it. A highly experienced surgeon, Dr. David Moore, has agreed to lead this from a clinical perspective. I met Dr. Moore recently to discuss what we are going to do. I am not satisfied that the €19 million has been allocated according to my very clear direction on prioritisation for orthopaedics, with a very clear focus on paediatric spinal work. Some of it has. I do not necessarily believe it has all been allocated in the way I intended, and I have asked the Department and the HSE to engage with CHI on that. I want to see dedicated beds and staff. These surgeons cannot be fighting for resources for these children, particularly when the Government has made such a large amount of funding available.

When the transition to the new national children's hospital happens, it will greatly alleviate the situation. Obviously, we cannot wait for that, however, hence the second MRI machine in Crumlin and the fifth theatre in Temple Street. There has been intensive engagement with the families and some of the stakeholder groups are engaging with Mr. Nayagam on that report. Some of them have decided not to. I fully respect their position but I think it is a missed opportunity. It is important their voices are heard as part of that review. Mr. Nayagam will be reporting directly back to me and the chief clinical officer, Dr. Colm Henry. I have no doubt that he will have some important recommendations in the context of improving the service further.

We have a long way to go but there have been some very important changes recently, in terms of both capacity and how that service is being run. Ultimately, I will not be satisfied until we see a dedicated spinal service and children getting the care they need when they need it.