Jennifer Carroll MacNeill (Dún Laoghaire, Fine Gael)

I thank the Deputy. He raised many different issues. I will respond to as much as I can.

Productivity needs digital, but digital is not the answer to productivity. Both need to happen. I am seeing some good evidence in different regions of more productivity. Let me give a couple of examples. In Beaumont Hospital, for example, since August 2025, we have had Saturday clinics operating in endocrinology and haematology. We now have evening clinics on Thursdays in rheumatology and respiratory services. Those are important advancements in how we use our consultants differently. We have also seen a 30% reduction in the numbers of patients on trolleys, despite a 6% increase in emergency department attendance, year on year. Those are some important measures of a different way of managing a hospital bearing some early fruit. I will give different examples throughout the day.

We are happy to offer a detailed technical briefing on our plans on the digital aspects, which are complex. I cannot respond on those aspects in three minutes. Between the implementation of the shared care record, how the app is going and the plans for the broader electronic health record, it would be of value, given how much investment we are asking the State to put into it and the complexity of it, to organise a detailed technical briefing. I suggest that. It would cover where we are and where we are going.

We have the funding for surgical hubs and they are under construction. The Mount Carmel hub saw its 2,000th patient last week. It has essentially eradicated the pain management list for St. James's Hospital, which is important, but I want to see it doing more than pain management. It is building up to full utilisation. We will have a second surgical hub open in Swords at the end of this year or at the very beginning of next year. The hubs in Limerick, Galway and Waterford are under construction. They will make a significant difference. The trick is now how we use them best. In Galway, for example, the scheduling of outpatient appointments has changed from two clinics per day to three clinics per day. They are just running it harder. If we apply the standard of the outpatient toolkit in Naas, we are now checking when consultants are there, what time they are there and how many hours they are putting in. These are making big differences and we must approach the staffing and scheduling of surgical hubs in the same way to try to get two or three rounds out of each day.

We will discuss the issue of acute beds in the round but the Deputy asked specifically about Limerick. The HIQA report identified a significant inpatient acute bed capacity deficit in Limerick in particular. That is creating far too great a pressure on the emergency department. In the past 12 months, I have observed a very different management structure and focus in the region. There has been a very different clinical approach in Limerick, and fair play to Dr. Catherine Peters, the clinical director, in that regard. It is now the only hospital that has managed to get the consultants on different forms of contract working together in a collaborative way and working much more extended hours. The emergency department processes have changed on foot of the recommendations of the Frank Clarke report. The issue there - I always have to be fair to Limerick - is bed capacity. We will have patients moving into the 96 beds there at the end of this week and the beginning of next week. I might just confirm that. We are formally opening that block in October. As the committee is aware, we are awaiting a planning decision on a second set of 96 beds. Enabling works have progressed as far as they possibly can. We will open have opened 138 beds in UHL this year. I hope we will get planning permission for the next 96 beds. We have to drive at least another 66 beds and find additional capacity. The overwhelming patient safety issue in Limerick is, in the first instance, around acute beds.

On private healthcare prices, there is an issue. As we transition to a fully public system, which is the commitment of this committee and Oireachtas, we are reducing instances of private care within public hospitals. That is what we are intentionally trying to do. We should not be confused by that. I want to make it very clear to patients across hospitals that there is no advantage in being a private patient in a public hospital. If they are asked to pay through insurance, it is a double cost to patients. They should be aware of that. It is a cost they should not have to incur. That is driving private health insurance prices.