Oireachtas Joint and Select Committees
Wednesday, 19 November 2025
Select Committee on Health
Estimates for Public Services 2025
Vote 38 - Health (Supplementary)
2:00 am
Pádraig Rice (Cork South-Central, Social Democrats)
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This meeting has been convened to consider the Supplementary Estimate for Vote 38 - Health. This amounts to €300 million for current expenditure and €2.1 million for capital expenditure. I welcome the Minister for Health, Deputy Jennifer Carroll MacNeill, and the Ministers of State, Deputies Butler and O'Donnell. I thank them for providing the briefing on the Supplementary Estimate, which has been circulated to members in advance of the meeting.
I advise members of the constitutional requirement that they must be physically present within the confines of the Leinster House complex in order to participate in public meetings. I will not permit a member to participate if they are not adhering to this constitutional requirement. Therefore, a member who attempts to participate from outside the precincts will be asked to leave the meeting. In this regard, I ask any members participating on Microsoft Teams that they confirm they are on the grounds of the Leinster House complex prior to making a contribution.
Members are reminded of the long-standing parliamentary practice that they should not criticise or make charges against any person or entity by name or in such a way as to make him, her or it identifiable, or otherwise engage in speech that might be regarded as damaging to the good name of a person or entity. Therefore, if a member's statements are potentially defamatory in relation to any identifiable person or entity, they will be directed to discontinue their remarks and it is imperative that they comply with any such direction.
To commence our consideration of the Supplementary Estimate, I now invite the Minister for Health to make her opening statement. The Minister has ten minutes.
Jennifer Carroll MacNeill (Dún Laoghaire, Fine Gael)
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I thank the committee for the opportunity to present this Supplementary Estimate for the Health Vote and for its ongoing engagement with me and my Department. I am seeking additional funding for 2025 of €300 million for current expenditure and €2.1 million for capital expenditure. The largest element, €250 million, covers a non-pay overrun across acute hospitals, community care and the primary care reimbursement service. This reflects the portion of last year’s supplementary funding not carried into this year’s base budget. Closing this gap through savings was challenging, as €633 million in savings and cost avoidance was already built into service budgets for 2024 and 2025. This €250 million requirement is among the lowest supplementary dependencies, excluding Covid, in many years, representing less than 1% of the overall health budget.
A further €40 million is a once-off payment to voluntary hospitals to stabilise their finances. This comes with a requirement for much tighter governance and controls, stricter recruitment, seven-day rostering, and adoption of national IT systems, such as IFMS and NISRP. Another €10 million is for the section 39 pay agreement, providing a 9.25% pay increase agreed earlier this year.
On the capital side, €2.1 million is for Brexit-related works at Rosslare Europort. These facilities carry out import checks and inspections on behalf of several State agencies, including the HSE which part funds it. It is important to reflect that despite this overrun, progress on budget discipline is being made. My focus remains on increasing service provision for patients, not reducing it to meet financial targets.
We have strengthened financial governance and control significantly, and continue to do so. The uplift in funding secured in 2024 means managers are now accountable for delivering improved services and staying within budget. Budgetary discipline among HSE managers is improving and must continue to improve in 2026.
We have also sharpened our focus on productivity and value for money. Over the past decade, input growth, specifically staffing, non-pay funding and capital investment, has been high, but activity growth has been slower. For example, outpatient appointments per consultant have fallen by approximately 30% over the past decade, and by another 6% in the past year, while consultant hours have increased by nearly 10% annually. Workforce growth has been substantial, with 25,523 full-time staff added since 2019, which is up 25%, together with an increase in infrastructure capacity, including 1,330 more acute beds compared with 2019. Notwithstanding this, productivity has reduced and activity has not kept pace with investment. Health already accounts for €1 in every €4 of Government expenditure. With the continued change in our demographics caused by population growth and ageing, we cannot meet future demand without substantially improving productivity. I refer Deputies to the ESRI report of this month on projections for regional demand and bed capacity requirements for older people's care, 2022 to 2040, which describes particular findings in respect of the population aged over 65. We might come back to that issue. The demographic pressure is real and increasing, and we have to do things differently with what we have.
In the context of our productivity focus and improvements, a key priority for me is improving productivity and deploying staff more effectively through seven-day rostering and evening shifts. This improves patient flow, safety and access, while making better use of our infrastructure and workforce. It is important to say that if you have a staff of ten people, it is much better to deploy eight people Monday to Friday and two at the weekends, rather than deploying all ten Monday to Friday and allowing a backlog to build up over the weekend that must be with, which causes the cancellation of elective surgeries on Monday and Tuesday. We must accept that principle. It is the basis of the agreements we have made. I have visited many sites around the country and am beginning to see signs of real improvement. For example, trolley numbers have been a huge focus and are a very visible piece for every patient in Ireland coming into a hospital in a vulnerable situation. Thankfully, there have been 7,800 fewer patients waiting on trolleys compared with last year, which is an 8% drop. That happened even as emergency department presentations went up again, with more than 1,100 extra presentations every week, which is a 4% increase. At 8 a.m. today, a total of 238 people were on trolleys. Over last weekend, there were at one point 57 people on trolleys nationally. This is completely possible. I am seeing variance between hospitals. I see improvements in hospitals. This is completely possible. To update the committee, 18 sites are green, eight are red and three are amber. Even St. Vincent's hospital, which has been struggling, performed well this morning, with approximately eight people on trolleys, which is well within the parameters. That is the case in November while we are beginning to experience the flu season. We are getting somewhere and need to continue. Yesterday was our best Tuesday this year, with the exception of a Tuesday after a bank holiday. We really are making progress.
I will give a couple of example, the first of which will relate to Tallaght University Hospital. In the past three months, it has not had a single red breach of its 8 a.m. trolley threshold. Earlier this year, it was averaging 16 breaches a month. It has become a completely different experience since July. There will be difficult days when a large number of people will present with flu or other things but the point is that the hospital was consistently in red and in difficulty and has been consistently good since a new manager took over in July. The impact on the hospital and the people working there is extraordinary.
Mayo University Hospital, which spent 80% of the year in a red situation, has improved enormously over the past six to eight weeks. It had an average of 24 breaches into red per month in the first nine months of the year, which was down to nine in October. That is, of course, nine too many but it is a substantial improvement, which reflects the process changes that have already begun in the hospital. Over the October bank holiday weekend, 14% fewer patients were waiting on trolleys at 8 a.m., which is 81 fewer people compared with the same weekend last year, even though presentations were 5% higher. These improvements have come from efforts by management to improve patient flow and the rostering of consultants and other key staff at weekends. As better data becomes available on changes to rosters, I will share it with the committee and publish it so we can all examine it.
Improved scheduling can unlock thousands of extra outpatient and theatre appointments. The new outpatient toolkit rolled out in Naas, Mercy and Kilkenny hospitals will deliver, based on the evidence to date, 10,000 additional appointments annually from existing resources. Other hospitals are now adopting the toolkit, and we expect to have full roll-out within 2026. That helps to address the underutilisation of infrastructure and staff, and can be replicated in theatres, diagnostics and primary care. There is a big opportunity for us not through additional staff but through the way in which we work.
Virtual care is a big piece. We are opening virtual wards in every region to allow patients to leave hospital sooner and receive care at home. This is better for patients and hospital flow. Kilkenny hospital just opened on Monday, joining St. Vincent's and University Hospital Limerick in having a virtual ward. The Mercy in Cork and Tullamore and Drogheda hospitals are going to be live by the end of the month. We are also implementing it in Galway. Though progress there is a little slower, I expect to see it open soon. Combined with the existing St. Vincent's and UHL wards, our virtual bed capacity will grow to the equivalent of 120 virtual acute beds by early 2026. We will continue to expand virtual capacity through 2026 and beyond.
It is not just about virtual beds. It is also about community-based wards based on the Cherry Orchard model of care, which will also be expanded in 2026 to help strengthen regional capacity and reduce hospital demand, delivering Sláintecare's vision of care close to home.
Surgical hubs in every region will support more efficient care and reduce waiting times, insulated from emergency pressures, which is extremely important. Digital transformation underpins modernisation. The HSE app, shared care records, progress on a national electronic health record and integrated systems for finance, HR and diagnostics are key pieces that enable a connected, efficient health service for patients and staff. We must build a resilient, efficient service through digital transformation, modern infrastructure, workforce deployment and skills. We all agree, and must be clear that we need to shift care from hospitals to the community and have more flexible funding models that will help by enabling resources to be spent where they are most needed in the region.
Our goal is clear: wherever you live in Ireland, we want you to have timely access to high-quality care. The challenge now is making sure that every health region continuously improves its performance to reach the same high standard across all services. Over the past decade, targeted investment has delivered real gains. We have faster diagnosis, improved outcomes and clearer care pathways. We are seeing, however, that those gains are unevenly distributed across the country. We need to do better than that. In some regions, patients are seen quickly. In others, access is slower. That is not fair. Community therapies, for example, psychology, face severe backlogs even in regions that perform well on other things. Let me give a couple of examples of regional contrasts. The south west meets targets for lung rapid access cancer clinics, which is great but it has some of the longest waiting lists for some primary care therapies, such as psychology and physiotherapy. The west and north-west region performs well for adult mental health, yet wait times for surgery and neurology outpatient appointments often exceed 12 months. This is an important change to how we structure our health services and 2026 is year one of that change. Health regions will have autonomy to prioritise resources locally to achieve and be accountable for ambitious targets and national standards. That builds on the progress we are already making with stronger financial controls and a greater productivity focus. It is the first step in devolving budgets alongside clear expectations that I have set out in my letter of determination to the HSE. To enable regional executive officers and national directors to deliver services, we must give regions the flexibility to invest where it matters most, based on national targets and standards. For example, one region might have longer waiting times for physiotherapy than other regions. That same region might also be performing well in a different area. It must balance that and reach the higher standard. We must align with international best practice. Ireland, in the past and up to now, has funded by rigidly separating the funding for services like prevention and early intervention, for example, screening, vaccination and so on, primary care centres, services for older people, hospitals and residential care. If you are the patient, you might need all those different things so separating the funding does not really work. It is a barrier to providing the best care possible for patients and we have been out of step with most of the other countries in the OECD, including France, Spain, the Netherlands, Italy, Canada and New Zealand. We must get to the best-in-class way of doing this.
The World Health Organization and the OECD both say that a more flexible approach to funding allows health services to better meet the needs of their local populations. I recognise that it is a change and that we are trying to meet World Health Organization standards and guidance. It is a change, and one that we need to go through together.
A big piece of this is strengthening accountability for outcomes. We keep talking about inputs but we have not had enough of a conversation about accountability for outcomes, so that means there will be clear targets for each region to improve services and waiting times. They will have regional plans to improve their existing services and move towards the national targets that have been set. They will be held to account for delivery of these targets. All of us together in the Oireachtas will be able to see how they are performing against national targets, such as the Sláintecare waiting times we have all committed to, and in comparison with each other.
Shedding light on the difference in performance in a structured way rather than randomly through pieces of research or a patient complaint gives us the difference and opportunity for regions to develop and learn from each other and to lift each other together form their shared experiences. The workshop I held in September with leaders from across the health service was the first time that they had all come together to listen to each other, learn from each other and to get ideas to see where improvements could be made. I will have further engagements like this in January and April 2026, when the winter period is over.
We also have to move away from the idea or the reliance on marginal increases in staffing being the sole solution to every problem. In the past, new development funding has been about 0.5% of the total budget. All the focus, including my own in the past, has been on this marginal increase as being the only way of improving our health service. The problem is we need to better utilise the other 99.5% of the funding we have in a complete way so that we improve our services. If there are 100 people working in a particular area that is already inefficient and delivering poor services because of the way in which it is organised, adding an extra five people will not be the panacea to that problem. We have to have the 105 people working differently to deliver that solution better. It is obvious that is the case in any other part of Irish life so we have to look at the way in which people are working and scheduled, deploying staff more effectively and using digital tools to improve this. If we do not deal with management capability and operational discipline where they are weak, more staff will not solve the problem. We have to do both.
We are rolling out the first step towards a population-based resource allocation model, something we have all agreed to and want to do. This is year one of a plan to move towards allocating funding based on the needs of the population. Our regions have different populations and different health challenges, whether this is an older population, a particularly distributed population because it is a more rural area or greater areas of social deprivation. We are working towards the regions getting a budget that reflects the health needs of their own population. It is not about ensuring efficiency for its own sake; it is about ensuring the money that patients - the taxpayer - have put into the health system is delivering for them in a fair, effective way.
In closing, I am asking the committee to approve the 2025 Supplementary Estimate of €300 million for current expenditure and €2.1 million capital expenditure. Our progress over the past number of years is visible. Our life expectancy gains are important. We have new and expanded health services. However, it is just not enough. The variations in accessing services is not okay and coupled with increasing demographic pressures we have to look at how we invest and use the resources in the phenomenal people we have in our health service in ways that enable them to deliver the best possible service in the way the absolutely want to.
I am asking for the committee's support to drive these improvements in regional services, in line with Sláintecare, enabled by the new approach to budget 2026.
Pádraig Rice (Cork South-Central, Social Democrats)
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I thank the Minister. We will now move to questions from members and I remind them to direct their questions to the Minister or to the Ministers of State. We have a rota and aim to take a break just before 11 a.m. The first slot is Fianna Fáil's so I call Deputy Daly.
Martin Daly (Roscommon-Galway, Fianna Fail)
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I thank the Minister for attending today. I also thank the Ministers of State, Deputies Butler and O'Donnell, and their teams from the Department of Health. In regard to the pay expenditure projected on the budget, while we are not underspending on core pay, we are overspending on agency staff. That is bad value for money. Why is so much money being spent on agency staff? This has been a recurring problem over a number of years. The public would say that this is bad workforce planning and sometimes it is sometimes short-termism in terms of making changes in recruitment year to year. What are the Minister's reflections on agency staff?
Jennifer Carroll MacNeill (Dún Laoghaire, Fine Gael)
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I thank the Deputy. He is absolutely right. This is a key focus for us. I met the chief people office on this issue recently because the conversion from agency has not been strong enough. We have managed to stay within our budget by taking a total pay approach of whole-time equivalents and agency staff. There is no question that has been a step forward in financial control instead of just continually adding, adding and adding. However, there has not been sufficient agency conversion and part of the reason for that is short-term, emergency reliance on agency staff and insufficient depth in the planning work that is necessary to identify those people who can and would convert and those who, for different reasons, are never going to come within the HSE system. Nevertheless, I want to develop a system within the HSE where staff can apply for additional hours where they want to but within the HSE system and not through agency staff and externally funded sources.
Martin Daly (Roscommon-Galway, Fianna Fail)
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I accept the Minister's answer but the core of this is while the use of agency staff is absolutely necessary at time, it provides workers into the health service but we do not get the continuity of care we get with permanent staff. On one hand, we say we are down on core pay, but we are up on agency. I would prefer to see our core pay overspent because we have permanent staff and continuity of care and proper planning within the health service rather than spending money on agency staff. That is just a reflection but I accept the Minister's answer on that.
Jennifer Carroll MacNeill (Dún Laoghaire, Fine Gael)
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It is a limitation for sure. Even in Mullingar, Deputy Clarke's area, for example, there is far too much agency staff and it is hampering their ability to hire other people. That is largely due to process issues that have to be resolved.
Martin Daly (Roscommon-Galway, Fianna Fail)
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It is just a time issue. On the issue of productivity and value for money it seems clear we are making significant investments in out health service and we have reached international averages now. Are we getting value for our money? One of the areas the Minister outlined in her statement was that we have spent considerable additional money but we are getting no productivity from, for example, consultant-led clinics in our hospitals. Why is that happening?
Jennifer Carroll MacNeill (Dún Laoghaire, Fine Gael)
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I do not know that I can speak to the why, but it can be improved with a different reorganisation. For example, we see with the outpatient toolkit, or the different scheduling of primary care for outpatient clinics in different primary care facilities, there are three clinics running per day instead of two and the focus is on making sure the time is spent so the consultants are seeing patients rather than doing the in between things that have happened in the past. It is very clear. There is no different way of practising now than before that accounts for that loss of time and it is not okay. Does Ms McGirr want to add anything?
Ms Louise McGirr:
There are multiple factors. There is the complexity of different things, of course, but it is also very much the way we organise. The fact is we have put 25% more staff into very much the same working patterns we used to have and the same old ways of working. We have not increased the output, like the number of patients, as the Minister said, and other things.
Martin Daly (Roscommon-Galway, Fianna Fail)
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Yes, I understand.
Martin Daly (Roscommon-Galway, Fianna Fail)
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There are two----- Sorry, Minister, go ahead.
Jennifer Carroll MacNeill (Dún Laoghaire, Fine Gael)
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For example, looking at theatre utilisation, consultants come to me and say they want to do more but the theatres have to start, there has to be knife to skin at 7.30 a.m. or 8 a.m., not different people coming on a shift at 7.30 a.m., 8 a.m. or 8.30 a.m. and it is knife to skin at 9 a.m. If the first team are in and knife to skin at 8 a.m., we can get extra surgeries done throughout the day. It is how these assets are organised. That is not necessarily the consultant's responsibility to do that but it can be seen they want to do more and we have to organise our services and infrastructure so they can do more.
Martin Daly (Roscommon-Galway, Fianna Fail)
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The Minister can see how the public might have a jaundiced eye in relation to the management of our public services. For example, we went through the insourcing issue. We saw a productivity gap there between people who were doing some insourcing work on a Saturday morning and getting through, for example, 30 patients while in a public clinic, fully supported, they were getting through ten patients. I am asking the Minister the question on behalf of the public. They are the questions people ask me on the ground in my constituency in Roscommon-Galway.
Jennifer Carroll MacNeill (Dún Laoghaire, Fine Gael)
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It is a most reasonable question.
Martin Daly (Roscommon-Galway, Fianna Fail)
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This is really important, and I know Mr. Tierney is coming on 3 December to talk about digitalisation, which the Minister is very committed to. I have been attending the Department of Health, HSE and health boards before that for 25 years. We are an unmitigated disaster in terms of digitalisation of our health service. It is my impression that we can only throw so much money at a structure and an organisation that is not fit for purpose and in this modern era, not having our health services digitalised means we can throw as much money as we like at it, but we will not achieve the productivity we require. What does the Minister think about that?
Jennifer Carroll MacNeill (Dún Laoghaire, Fine Gael)
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That is just not going to be acceptable and that is why we are investing in digital. That is why we are also trying to harmonise what we are doing through financial management systems so that we can see what is happening and how money is being used right across the health system. A total of 80% of the system is on the integrated financial management system, IFMS, now and it is the voluntary hospitals that need to come on board. That represents €5 billion worth of funding.
We absolutely have to have the same digital system. It is not acceptable, for example, in the context of money being spent. For example, I was in Mayo University Hospital and there are different diagnostic systems between Galway and Mayo, in the same region. How that has ever been enabled to happen is beyond me. That is not okay. That is why we have to have the same systems throughout. We are a small country with a small integrated health system. People move between regions. People move between public and private. It has to be integrated.
Martin Daly (Roscommon-Galway, Fianna Fail)
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Without labouring on this because we are going to have this next week, the public still are not understanding how we have so many different systems. There is no sense that there is one big heave coming to try to get this over the line. We are a small country. Other jurisdictions have done this. We are so far off the graph, it is unbelievable. I will leave it at that because I know we will be dealing with it. I accept the Minister's commitment to the digitalisation but we need significant funding to do that.
Jennifer Carroll MacNeill (Dún Laoghaire, Fine Gael)
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I am glad to hear the Deputy say so because, of course, I have tried to secure very significant funding in the national development plan for specifically that. I will be coming back to the committee on many occasions to explain how we are getting on with that.
I understand Mr. Tierney, who has been responsible for it, will give the committee a full technical briefing shortly. There might be something that he would like to say at this stage.
Mr. Derek Tierney:
I do not disagree with the Deputy. We suffer from fragmented data and data is our only way to gain insight to drive performance. That is about how we use all our available resource, as the Minister said in her opening speech. It is about how do we get best value out of the 95% of the resource that we have as well as pursuing a reform agenda. The Deputy is right. We have to enable the health service to deliver integrated care and move away from siloed care and fragmentation. My ambition, by the end of this year, is to bring a memorandum forward for a national electronic health record, EHR, roll-out. That is the game changer that the Deputy speaks about.
Martin Daly (Roscommon-Galway, Fianna Fail)
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I thank Mr. Tierney. We need to move away from a situation where we have junior doctors running around hospitals spending unproductive clinical hours seeking out tests. That is not in the interest of patient service.
Moving on to the voluntary hospitals, I have considerable concerns that we have parallel services operating within our small country. We have the HSE on one hand and we have voluntary hospitals on the other, all effectively working in silos. It does not make any sense to me. I see there is an overpay of €40 million that the Minister will have to supplement now but I note from her statement and from the report we got that there is concern about lack of governance, lack of control and lack of accountability.
Jennifer Carroll MacNeill (Dún Laoghaire, Fine Gael)
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The reality is that it has been difficult with different elements of the health system to agree, for example, data sharing in relation to patients and population-based health data. That has been a struggle over the last number of years with the voluntary systems and with the private systems, but the patient is still the patient. Now we have a situation where the State funds public health in the voluntary hospitals nearly completely. Off the top of my head, the National Maternity Hospital, for example, has a couple of hundred public servants and €112 million this year. The Mater hospital has close to half a billion euro. St. James's has half a billion euro and hundreds of public servants. These are State-funded entities that are in some cases directly covered, in that I am the sole shareholder, the Comptroller and Auditor General has oversight of them and everybody there is operating as a public servant with a public service pension. They work for the State and it is very important that is understood. The Irish State is at the centre of healthcare, both in public and in private, in different ways and it is simply essential that we have the opportunity to implement the financial management system that this committee should demand. I have already heard the support in the committee for that project.
Pádraig Rice (Cork South-Central, Social Democrats)
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That is time on that slot. We may come around for a second slot, if the Deputy has more questions. The next slot is for Sinn Féin and Deputy Cullinane.
David Cullinane (Waterford, Sinn Fein)
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I welcome the Minister and the Minister of State. First of all, I will make the point that I have been on the health committee for five years or more, I have seen lots of committee sessions on Revised Estimates, and there is a gap or a hole in the health budget almost every year. It has got smaller this year, thankfully, but we have had years where it has been much more significant. I have been trying to put a focus on what I have been calling "transparent funding". At the start of every year, when we get to budget time, there is a big ask from the Department of Health, because of the nature of health, for existing levels of service funding to pay for pay, demographic changes, etc. That is a huge amount of money every year before we look at new measures. There are many contributing factors, but one of them, we were told in recent years, was that health inflation was very high. What is health inflation running at currently or what was it running at for 2025?
Ms Louise McGirr:
In our forecast, we have a proxy number based on the consumer price index, CPI, and medical inflation is always higher. For 2026, we have estimated price inflation of approximately 3%. It varies. There is no scientific figure and the reason is there is such a complex basket of goods and services. There are drugs and medical supplies. It varies. We have staffing and wage inflation. We estimate approximately 3%.
David Cullinane (Waterford, Sinn Fein)
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It is the case that cost inflation would form part of what is called existing levels of service.
David Cullinane (Waterford, Sinn Fein)
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I know the percentage would vary but it is one of the factors when we look at how much money the health service needs every year. Before we look at new measures, there is additional funding needed simply for the health service to stand still. There are pensions and pay-----
David Cullinane (Waterford, Sinn Fein)
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No. Every year there is an ask.
David Cullinane (Waterford, Sinn Fein)
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Fine. If I come back to the Minister then, how much funding was delivered for budget 2026 as a starting point for existing levels of service?
Jennifer Carroll MacNeill (Dún Laoghaire, Fine Gael)
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As the Deputy will be aware, we have a significant increase. It is a 5% increase on the projected outturn compared with an additional 4.2% on the outturn in 2025. We have additional funding for staff and additional funding for new medicine but the Deputy is correct that there is an element of simple health inflation, which we are trying to offset, of course, with efficiency, better productivity and better procurement across the board.
David Cullinane (Waterford, Sinn Fein)
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I accept all of that but I have been asking this question since the budget. There was €1.5 billion of additional funding going into the health service. Every cent is needed. We will get to efficiencies in a moment because we are back again looking for more money for this year and we had targets set to achieve savings for the last three or four years. In relation to next year, as we start, because we are looking back for this year, we have to have a basic understanding of how the health service is funded. I have been asking a simple question: how much of that €1.5 billion is for existing levels of service and how much of it is new money for new measures? To date, that has not been answered. Somebody, obviously, has the answer and I do not know why it cannot be communicated.
Jennifer Carroll MacNeill (Dún Laoghaire, Fine Gael)
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That is part of the way in which we are trying to change what we are doing. We are not trying to simply identify staff that are exclusively for new developments. We have an additional 3,300 staff going into the health service next year and what we are trying to do is have the region identify what is necessary for-----
David Cullinane (Waterford, Sinn Fein)
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The regions are given money and then they have to decide how that money is spent. I am asking how much money the regions are being given because I had this response from Mr. Bernard Gloster when he said the regions will decide how the money is spent. That is fine. I am looking to know the quantum of money that the regions have that they will be spending.
Jennifer Carroll MacNeill (Dún Laoghaire, Fine Gael)
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That will be set out in the service plan in the next couple of weeks.
David Cullinane (Waterford, Sinn Fein)
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I will make a point to the Chairperson. It is quite incredible, months on from the budget, that we still do not know how much new money for new measures was in the budget. No matter how many times we ask the question, we are not getting an answer. This is the first year that has ever been the case, certainly since I have been a health spokesperson. Every year it is made clear-----
Jennifer Carroll MacNeill (Dún Laoghaire, Fine Gael)
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And-----
David Cullinane (Waterford, Sinn Fein)
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Sorry, I am speaking to the Chair. Every year it is made clear to the health committee and to the public the existing levels of service, new money and new measures. We can all quantify it. Maybe we will not see exactly where it is going because, as the Minister said, it has to go into the regions and they will decide then how it is spent, but not even to be told how much money is new money for new measures is ridiculous. I do not think the Minister is going to answer it. Maybe she wants to answer it.
Jennifer Carroll MacNeill (Dún Laoghaire, Fine Gael)
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This is the first year of a different way of budgeting and I understand that creates challenges and changes. We have always focused on us having an additional four people there, €10 million for this or €5 million for that. We have constantly focused on inputs but it is clear that continual focus on inputs, which might look good on budget day and which we might be able to continue to do-----
David Cullinane (Waterford, Sinn Fein)
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Sorry, I am not looking for a breakdown of how that money is being spent-----
David Cullinane (Waterford, Sinn Fein)
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-----because that is a different question.
Jennifer Carroll MacNeill (Dún Laoghaire, Fine Gael)
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But it is not-----
David Cullinane (Waterford, Sinn Fein)
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I am looking for how much of it is new money for measures and how much of it is for the health service to stand still.
Jennifer Carroll MacNeill (Dún Laoghaire, Fine Gael)
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If I could finish my sentence, we are talking about a different way of funding for the future that does not focus on those sorts of inputs, but focuses on outcomes.
It has been very clear that there is about 3,300 people at a cost of about €90,000 all in. That is all new development. Additional money for new drugs is all new development. The way in which we organise it is going to be different. The reason that we are doing that is the focus that we are discussing in the past where it is constantly a focus on the additional 0.5% or the additional ten people here or five people there that are going to be allocated to this programme or that have been perceived as the panacea to all things, instead of looking at the 130,000 people that already work in the health system and how they are deployed and how they are organised.
David Cullinane (Waterford, Sinn Fein)
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I am very short on time.
Jennifer Carroll MacNeill (Dún Laoghaire, Fine Gael)
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I appreciate that, but the Deputy did ask me a very serious question.
David Cullinane (Waterford, Sinn Fein)
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I did, but the question was not answered.
Jennifer Carroll MacNeill (Dún Laoghaire, Fine Gael)
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I am answering the Deputy's question. That he does not accept it is a different thing.
Pádraig Rice (Cork South-Central, Social Democrats)
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We will let the Minister reply.
David Cullinane (Waterford, Sinn Fein)
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The Minister had two or three minutes and has not answered the question and the clock is ticking.
Jennifer Carroll MacNeill (Dún Laoghaire, Fine Gael)
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That is the Deputy's perception. I do not agree.
David Cullinane (Waterford, Sinn Fein)
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I am going to move on to the next issue. One of the reasons for the additional asks this year is an increase in agency spend. It is estimated that agency spend might climb to €800 million this year. This committee has been putting a focus on this year on year, yet what we are seeing is increases, as was raised by the previous speaker. I gave the Minister some examples closer to home of nurses who are on panels waiting to be recruited, often for months on end. They want to work in public hospitals and cannot get contracts. Nurses have been told by hospitals to register with an agency because the hospitals cannot hire them. They register with an agency. We are paying a premium of 30% for every one of those nurses who are working through agency. Many of them want to work part time, full time or whatever and they cannot get contracts. Why is it the case, if we have nurses and staff that are ready to work in the health service, we are seeing this increase in agency spend? On a related question, how many recruitment panels are in existence? How many staff or applicants on those panels are waiting to be recruited into the public system?
Jennifer Carroll MacNeill (Dún Laoghaire, Fine Gael)
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On this I agree with the Deputy's every word. The Minister of State, Deputy Butler, informs me that every graduate in mental health has been offered a position this year. This is a subject where there is an awful lot of work to do. I have met the chief people officer asking precisely the same questions the Deputy has asked in respect of panels, process and length of time. I might just-----
David Cullinane (Waterford, Sinn Fein)
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Do the Minister know how many panels there are or how many staff are on them?
Jennifer Carroll MacNeill (Dún Laoghaire, Fine Gael)
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No, and that is part of the difficulty. I would have to check that. It is one that since last month I have been trying to get into with the people officer. I agree with every single question the Deputy asks because I am asking the same ones. Let me give an example of where this is particularly problematic in Deputy Clarke's constituency in Mullingar, where 40% of the staff are agency and, where I know, for example, that they need an extra dietician to meet the diabetic need. Because of the way in which the balance and processes around Mullingar - it is not Mullingar's fault in any way - they are not able to recruit the additional dietician. This balance and process are wrong. There has not been sufficient progress on it. It is something that I assure the Deputy that I am trying to put my attention to to work out exactly the answers to the important questions he is asking. I agree with him.
David Cullinane (Waterford, Sinn Fein)
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I will move on to the children's hospital. We can all agree that we want it opened as soon as possible. We all agree that this will be a game-changer for children when it is opened. I think we will all agree that it has been a mess as well. It has taken so long to get to a point where it will be completed. Is there a new estimated completion date? What is the update on that? We know the most recent one was not going to be met. Has there been any communication between the contractor and the board on a new completion date? Can the Minister tell the committee what the most up to date cost of the children's hospital will be?
Jennifer Carroll MacNeill (Dún Laoghaire, Fine Gael)
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I am informed by recent engagements with BAM who have been on the ground here in a slightly more present way than was the case in the earlier part of my time as Minister. It is here again on Friday from an international perspective. I am informed that we will have early access on 3 December.
David Cullinane (Waterford, Sinn Fein)
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That is early access, but I am talking about a full handover.
Jennifer Carroll MacNeill (Dún Laoghaire, Fine Gael)
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Take early access, get in there and get control of it.
David Cullinane (Waterford, Sinn Fein)
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I know the Minister would take that and that is great, but the completion date is a different question.
Jennifer Carroll MacNeill (Dún Laoghaire, Fine Gael)
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I might pass to Mr. Tierney.
Mr. Derek Tierney:
I will take that. That is part of the engagement this Friday between BAM Ireland and UK and the NPHDB. It is to agree the early access stage 1 for CHI. BAM has submitted a revised programme and that is on the table this Friday for discussion. We will wait to see the outcome of that discussion.
David Cullinane (Waterford, Sinn Fein)
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That revised programme is for a substantial completion date.
Pádraig Rice (Cork South-Central, Social Democrats)
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The Deputy's time is up.
There is clearly a difference of perspective on the question of transparency around budgets and funding between Deputy Cullinane and the Minister. It is perhaps something that we need to examine again and maybe come back with a more dedicated session on it to try to get that transparency that members are looking for. I know in my own case from asking questions about some areas of the budget that there is a lack of clarity or transparency. I take the Minister's point that there is a change in how the budget is operating this year. Perhaps it is one we may need to a dedicated session to try to get that kind of clarity, understanding and that level of transparency that is required.
Our next slot is Fine Gael. I call Deputy Burke.
Colm Burke (Cork North-Central, Fine Gael)
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Following up on the early access, from the time of early access, what is the predicted or planned timeframe for a full handover? Will it be three months, six months or nine months? Have we any idea? If we do not have it today and there is a meeting on Friday, can we get a report back as regards the kind of time plan that we are talking about?
Jennifer Carroll MacNeill (Dún Laoghaire, Fine Gael)
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This is something that we have been working on for quite some time. Getting access is one thing. The commissioning period is the other, as the Deputy correctly pointed out. I have another meeting on Thursday. This will be the third, fourth or fifth on the detail of the commissioning, which we have been trying to truncate as far as possible in every way. Mr. Tierney, others and I, including KPMG, the HSE and CHI, have been trying to push and test every element of this to truncate the period as much as possible. The single biggest issue within it is the situation and testing of-----
Colm Burke (Cork North-Central, Fine Gael)
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Have we still got an idea of what we are talking about?
Jennifer Carroll MacNeill (Dún Laoghaire, Fine Gael)
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What I am trying to do is make sure it is brought down from 12 months to nine months or seven months or how tight can we bring it down and where is the resilience in it.
Colm Burke (Cork North-Central, Fine Gael)
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The Minister is talking about nine months from December.
Jennifer Carroll MacNeill (Dún Laoghaire, Fine Gael)
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It had been nine months. I am trying to bring it down all of the time, test the resilience of that and recognise that something can go wrong within that. I am trying to explain some of the biggest issues within are the testing of the-----
Colm Burke (Cork North-Central, Fine Gael)
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Can I move on to another issue? This is about agency staff. I raise forward planning within the HSE and consultants or nurses retiring out. Going back 25 or 30 years, in each hospital, once a consultant was coming up to retirement age, even two years beforehand, forward planning took place as regards recruitment. Now we have a scenario in all our hospitals where the job the person is retiring from is not advertised until he or she is gone. Is any system going to be put in place to deal with that issue? That is the reason we have agency staff. If we had a breakdown of the money paid out for agency staff, we would also be talking about locum consultants. How many locum consultants are currently working in the HSE?
Jennifer Carroll MacNeill (Dún Laoghaire, Fine Gael)
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We have increased our permanent consultant staff-----
Colm Burke (Cork North-Central, Fine Gael)
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I know that, but as we speak now, how many locum consultants are physically working? They are paid a high level of pay for locum consultants.
Jennifer Carroll MacNeill (Dún Laoghaire, Fine Gael)
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I will need a minute to check that, but I might ask Ms McGirr to speak to the process while I have the opportunity to check that figure.
Colm Burke (Cork North-Central, Fine Gael)
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I raised this issue ten years ago.
Colm Burke (Cork North-Central, Fine Gael)
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The process has not changed. We are waiting for people to retire before we advertise the jobs.
Ms Louise McGirr:
We have sped up recruitment of consultants specifically and significantly since the POCC. We have significant take ups. While we still have an issue with locums in some regional areas and specialties, we have extremely high recruitment of consultants because of the attraction for previously hard to fill posts resulting from the POCC. We are seeing that come through all the time. Our consultant body has increased by about 50%. We are speeding up. I think the time dropped from 18 months to nine months end to end for recruitment processes. There are internal processes-----
Colm Burke (Cork North-Central, Fine Gael)
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What I am saying is forward planning, whether it is nurses or a senior nurse, we are still not even doing interviews until the person who holds the post has vacated. That is across the board in the HSE. It is a huge challenge that has not changed in the past ten years. As a result, we are then paying out crazy money for agency staff.
Colm Burke (Cork North-Central, Fine Gael)
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It is one of the big issues.
Colm Burke (Cork North-Central, Fine Gael)
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That proves the point I am making-----
Colm Burke (Cork North-Central, Fine Gael)
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-----about extra money being paid out to agency staff because the HSE cannot hold on to them otherwise. That would not arise if jobs were advertised long before people retired.
Jennifer Carroll MacNeill (Dún Laoghaire, Fine Gael)
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I do not think it is that simple-----
Jennifer Carroll MacNeill (Dún Laoghaire, Fine Gael)
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I do not think it is that straightforward. There are a number of different agency conversion difficulties. Some people just do not want to work full time. Some people have retired from the health system. We are trying to work out whether there are ways in which they can be brought back. In many cases, while we have largely recruited the number of additional permanent consultants required, there is also a need for locums from time to time. We want the same thing. I do not necessarily accept the point about a position having to be advertised. We are trying to recruit in advance. For example, for the 96-bed block in Limerick, those staff were recruited well in advance of the block opening. We are doing the same thing with surgical hubs and so on.
Colm Burke (Cork North-Central, Fine Gael)
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Can I move on in relation to-----
Jennifer Carroll MacNeill (Dún Laoghaire, Fine Gael)
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However, it was a good question for me to put-----
Colm Burke (Cork North-Central, Fine Gael)
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I will move on to the issue of cost savings and, for example, situations where it is clearly identified, within either a hospital or the health service, that there is a need for change in a particular area. I will provide an example. The Minister of State, Deputy Murnane O'Connor, is here. There is an issue with the integrated homeless hub in Cork. I had a meeting in the Department on 8 October 2024. Thirteen months later, the HSE has still not made a decision. We have 600 people in Cork who are homeless and who have no place to go during the day. Many of them end up in the hospital services. This was proven when the supervised injection facility on Merchant's Quay in Dublin was opened. There have been 120 adverse events there since the facility was opened on 22 December last year. All of those were treated within the centre. Likewise, in relation to a homeless hub, there is a proposal that the HSE will provide support for people. Therefore, it would keep people out of the hospital system. Where there is clear evidence that there will be savings to the HSE and the health service, why does it take so long for a decision on moving forward with a project to be made??
Jennifer Murnane O'Connor (Carlow-Kilkenny, Fianna Fail)
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I spoke to the Deputy during the week about this. As he knows, my Department is committed to the funding for the capital works relating to this project. I also told him that I will be seeking a meeting with the HSE in the south west.
Colm Burke (Cork North-Central, Fine Gael)
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There is no agreement on what works will be done-----
Jennifer Murnane O'Connor (Carlow-Kilkenny, Fianna Fail)
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I am going-----
Colm Burke (Cork North-Central, Fine Gael)
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-----and we are 13 months on. This is what I am saying about cost savings with an agency and about the timeframe involved. If we get the private sector to build something, it will be done in two years. When it comes to the HSE, it takes six or seven years. We have to change the system, because there is a cost saving for the taxpayer.
Jennifer Murnane O'Connor (Carlow-Kilkenny, Fianna Fail)
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I agree with the Deputy. I know how passionate he has been about this. It is a priority for us now within the Department. We have given our commitment, and we will work with others. I told the Deputy that we will arrange a meeting with the HSE. Of course, I know the local council is also involved. Hopefully, I will get word to the Deputy on that meeting as soon as possible. I thank the Deputy because I know how hard he has worked on this.
Colm Burke (Cork North-Central, Fine Gael)
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I will move back to the issue of hospitals and the use of space. The Minister said there is a reduction of 30% of the throughput by consultants. In fairness, there are an awful lot of additional consultants appointed, but the problem is about access to space to work in. That is one of the challenges, especially in the smaller hospitals. For instance, we were in Cork last week where we saw in the bowel cancer screening. If the accommodation was available at the hospital, the unit there could double the number of patients it is dealing with. Again, this comes back to the timeframe relating to rolling out the infrastructure. While we have appointed all these extra consultants, is what I have outlined one of the reasons we have not provided either the necessary equipment or the space for those consultants to operate in?
Jennifer Carroll MacNeill (Dún Laoghaire, Fine Gael)
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No, I would very much not accept that because what I saw in Cork, for example-----
Colm Burke (Cork North-Central, Fine Gael)
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Last week, when I was in Cork with the Minister, the bowel screening unit clearly showed us that it could deal with many more patients if everything it is looking for was delivered.
Jennifer Carroll MacNeill (Dún Laoghaire, Fine Gael)
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What I saw in Bantry was two endoscopy units, only one of which is being used half of the week. The other suite is not used at all. There is an ask and a need in Cork University Hospital for, essentially, a doubling of the endoscopy suites there, which is also important. However, there is infrastructure that has been open in Bantry since February, which was more than available to be used by anybody who wanted to do a scope, but it is in Bantry, and it is delivering care close to home. There is a very considerable waiting list for people who need endoscopy procedures in Cork.
What I also see in the south west and, of course, nationally, is theatre utilisation rate of 66%. What I also see is where people are making changes. They are doing outpatient clinics, which is completely possible, in Limerick in primary care centres. They are doubling up. They are doing three outpatient clinics per day instead of two. There are facilities for dermatology in the evening. People complain that they do not have room or that they do not have an assistant. I do not accept the idea that a well-educated, well-trained medical consultant in Ireland cannot deliver a clinic for the want of a room, when I see rooms empty through hospitals and primary care centres at all different times of the day and evening. I just do not accept it-----
Colm Burke (Cork North-Central, Fine Gael)
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Is that not a case of working-----
Jennifer Carroll MacNeill (Dún Laoghaire, Fine Gael)
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-----and then I see huge utilisation-----
Colm Burke (Cork North-Central, Fine Gael)
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Is that not a case of the administrative staff working with consultants?
Jennifer Carroll MacNeill (Dún Laoghaire, Fine Gael)
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That is what we have enabled.
Colm Burke (Cork North-Central, Fine Gael)
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For instance, the average consultant-----
Jennifer Carroll MacNeill (Dún Laoghaire, Fine Gael)
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That is what we have enabled.
Colm Burke (Cork North-Central, Fine Gael)
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The average consultant who is running a clinic has divided it into three departments-----
Pádraig Rice (Cork South-Central, Social Democrats)
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I thank the Deputy. His time is up.
Jennifer Carroll MacNeill (Dún Laoghaire, Fine Gael)
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That is what we have enabled.
Colm Burke (Cork North-Central, Fine Gael)
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-----of high risk, medium risk and low risk. Therefore, there could be a team of doctors running the low-risk part, registrars running the medium-risk part and the consultants doing the high-risk work-----
Jennifer Carroll MacNeill (Dún Laoghaire, Fine Gael)
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If I could just-----
Colm Burke (Cork North-Central, Fine Gael)
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-----but a consultant is available for all three, so they can handle the volume.
Pádraig Rice (Cork South-Central, Social Democrats)
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I am sorry; Deputy-----
Jennifer Carroll MacNeill (Dún Laoghaire, Fine Gael)
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I will tell you what, when I see-----
Pádraig Rice (Cork South-Central, Social Democrats)
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We must stick to the time. I ask members to give the Minister and the witnesses time to respond to the questions. We want to stay on track. There will be a chance for people to come back in. We will get through the questions as efficiently as possible. I have a number of questions I would like to put.
I will start by voicing my support for the homeless hub in Cork city, which was mentioned by Deputy Burke. It is a crucially important project. We have been waiting far too long for it. I visited Cork Simon Community earlier this week. There is real concern about the lack of services during the day for people. The need to have those services and supports in place has been long promised. There is also a need for safe injection facilities and drug consumption facilities in that capital spend in that centre. That will be lifesaving for people in Cork city, and we have waited far too long for it.
In relation to the management of funds, I share the concerns of the Deputies around the pay and spending budget, particularly in the context of spending on agency staff. The briefing document we got in advance states:
Pay expenditure is projected to be on budget for 2025, which is a significant achievement and shows that the revised controls over the pay budget have been successful. However, it should be noted that Agency saving targeted for 2025 will not be delivered - instead, overspends on Agency Pay have been offset by underspend on Core Pay arising from recruitment being behind target.
It is a real failure that we are offsetting the overspend on pay for agency staff by underspending on permanent staff. It is a poor use of public funds.
Jennifer Carroll MacNeill (Dún Laoghaire, Fine Gael)
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I agree.
Pádraig Rice (Cork South-Central, Social Democrats)
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It is bad for patient outcomes. It is bad for workers. It really is shocking. Figures released to me by the HSE reveal that by August, €545 million had been spent on agency staff this year alone. If the HSE continues with this level of spending on agency staff, it will exceed last year's shocking figure of €726 million. Despite claims that it is going to cut back, we are going to exceed last year's overspend. At the same time, we have over 370 funded posts that have yet to be commenced. Of those posts approved in 2024, only 73 have been filled. In addition, only 20% of the posts funded for 2025 have been filled. The Minister talks about having these additional staff in place next year, but I think it is a fiction in many ways when we see the statistics showing that only 20% of those funded for this year were in post by September. Those posts are being left vacant, and we are overspending massively on agency staff. Take, for example, the €150 million pay deficit in hospitals. The main driver is locum and agency costs. I accept there is always going to be a requirement for agency spending, but we do need those permanent contracts. People want to take up these jobs. I received emails yesterday from agency healthcare workers. One worker said she has been on a HSE panel for over a year waiting for a job. At the very least, why are we not converting all of the previously committed agency posts? We know that 960 posts were identified for agency conversion over 2024 and 2025. According to a reply I got to a parliamentary question, only 749 have been onboarded. I take it this is the missed agency target that is referred to in the briefing document. Is that right? Is the commitment to convert 960 posts the missed target that was referred to?
Pádraig Rice (Cork South-Central, Social Democrats)
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When does the Minister expect to reach that target?
Jennifer Carroll MacNeill (Dún Laoghaire, Fine Gael)
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It is probably one of the biggest frustrations I have. I agree with every single word the Cathaoirleach said. I am not going to offer any sort of defence of the performance on agency conversion.
I have met with Anne Marie Hoey, who is the chief people officer in the HSE, and asked exactly the same questions the Cathaoirleach has asked. I have probed into the panels and panel process. I receive the same emails and representations from people who want to work in the health system who have not and who are stuck on panels of different kinds. I have funded positions that have not been filled and there is this agency frustration. What I can say is there is a different approach for 2026 but it remains to be seen on a month-by-month basis what progress is made. There are stronger restrictions on off-framework agency and better digital rostering systems with in-built controls to track and, if necessary, restrict agency use. I want to have a HSE internal staff bank whereby HSE staff - entirely legitimately - pick up or do extra hours but within the HSE, as opposed to through agency with us paying all the additional fees, prices and compliance.
I do not want to be here 12 months from now having the same conversation. What I am trying to do is have a month-by-month engagement with Anne Marie Hoey, chief people officer in the HSE, who is responsible for making sure this agency conversion happens at a different pace. That is not all going to happen within 2026, but in the same way we have managed to get some good traction on those areas of focus this year, I can assure the committee it is an area of real focus of mine.
Pádraig Rice (Cork South-Central, Social Democrats)
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Do we have a target for when we are going to reach those 960 posts? Is there a target in place?
Ms Louise McGirr:
We have a much more ambitious target because by freeing up the devolution to the regions, this allows them the flexibility to convert. We are not locking down posts. They are free to convert and are planning conversion wholesale. In certain sites like Naas, for example, they rely on agency because of population growth, and the way we used to do the numbers, where they were restricted within a region on the headcount, meant they could not convert. They were providing services through agency. That is not uncommon. This is changing in the new process where REOs are prioritising high agency areas for allocation of the posts.
Pádraig Rice (Cork South-Central, Social Democrats)
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Will we be spending less on agency next year than this year?
Jennifer Carroll MacNeill (Dún Laoghaire, Fine Gael)
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I certainly hope so.
Pádraig Rice (Cork South-Central, Social Democrats)
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It is really frustrating for people, particularly for nursing.
Jennifer Carroll MacNeill (Dún Laoghaire, Fine Gael)
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I agree, particularly people who want to work in the health force.
Pádraig Rice (Cork South-Central, Social Democrats)
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There was €124 million spent on agency for nursing and over 1,000 vacant posts. To move on, in the interest of time, I want to talk a little about voluntary hospitals. The Minister's briefing documents state one of the overall drivers of this Supplementary Estimate is the non-recurring funding for voluntary hospitals and an additional €40 million. At our meeting two weeks ago, we talked at length about voluntary hospitals and the implementation of an integrated financial management and management system. Again, I reiterate my support for the roll-out of that. The HSE-funded hospitals must be fully aligned with HSE-run sites, particularly when it comes to financial reporting, so I support that. Has the additional €40 million come with a stipulation that all voluntary hospitals must implement the IFMS?
Jennifer Carroll MacNeill (Dún Laoghaire, Fine Gael)
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Yes, but do I see co-operation and enthusiastic engagement with that yet? No. The €40 million is additional once-off funding for the voluntary hospitals and is specifically for Beaumont Hospital, the Mater hospital, St. Vincent's hospital and Tallaght hospital. The allocation is roughly equal between them. We have 16 voluntary hospitals that are, as the Cathaoirleach said, entirely or nearly entirely funded by the public purse and taxpayer. All the staff are public servants and must align themselves with the needs of the State in terms of financial management reporting so that we can achieve better savings in procurement and to ensure the taxpayers' money is being used in the way we expect it to be used. It comes with that contingency or conditionality the Cathaoirleach has described but that has happened before. This has been in the service level agreement, SLA, for some time. It is fair to say that, throughout the 2025 period, it has been a source of considerable frustration to the Department and HSE that there has not been more enthusiastic adoption of IFMS by the voluntary hospitals. It is perplexing because these are entirely publicly funded.
Pádraig Rice (Cork South-Central, Social Democrats)
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Absolutely. Have there been any spending limits placed on the voluntary hospitals for the year end?
Jennifer Carroll MacNeill (Dún Laoghaire, Fine Gael)
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Yes, within the service level agreements, but they continue to overspend. This is not, by the way, a once-off issue. This has happened two or three years in a row, and the difficulty for the Department is, and I know this is well understood by the committee, we have always underpinned this overspend. It has happened in different ways through uncontrolled recruitment, which is part of why the agency piece is so important, or uncontrolled spending. We then have the frustration of things in the service level agreement not being implemented. For example, over a bank holiday weekend, the Smithfield injury unit was closed down. It is in the service level agreement that this be done. Spinal adolescent services have been in the service level agreement for some time. With the Mater hospital, it is only since July this year that it has started to be implemented. This is not acceptable. We have all these agreements in place but they must be implemented. This step on IFMS is very strong. First, it is entirely legally necessary and will be even more legally necessary after the Health Information Bill. It is a step of real good faith and is an appropriate step by the voluntary hospitals to step into what the committee and the committee Chair is asking them to do.
Pádraig Rice (Cork South-Central, Social Democrats)
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Will the Minister be making those amendments to the Health Information Bill to require that?
Jennifer Carroll MacNeill (Dún Laoghaire, Fine Gael)
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Yes, we will be discussing that later in the Dáil today, but I may take further steps in the Seanad to strengthen the requirement further, depending on the engagement over the next few weeks.
Pádraig Rice (Cork South-Central, Social Democrats)
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Would the Minister be able to give us a breakdown of that €40 million that has been provided to the voluntary hospitals?
Jennifer Carroll MacNeill (Dún Laoghaire, Fine Gael)
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As in, to which hospital?
Pádraig Rice (Cork South-Central, Social Democrats)
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A breakdown of the funding overall.
Jennifer Carroll MacNeill (Dún Laoghaire, Fine Gael)
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As in, how much is going to each hospital?
Jennifer Carroll MacNeill (Dún Laoghaire, Fine Gael)
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The allocation is roughly similar across each hospital.
Pádraig Rice (Cork South-Central, Social Democrats)
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It was four, was it?
Jennifer Carroll MacNeill (Dún Laoghaire, Fine Gael)
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It was four: Beaumont, the Mater, St. Vincent's and Tallaght.
Pádraig Rice (Cork South-Central, Social Democrats)
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Very good. I will come back in. I have some more questions but we might take them in a second round. Next is Deputy Sherlock.
Marie Sherlock (Dublin Central, Labour)
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I thank the Cathaoirleach, the Minister, the Ministers of State and officials for attending here today. There is a lot focus on the hospital system in the Minister's opening statement today but I want to first focus on primary care. To me, this is where the greatest value for money can happen, yet we see there is a €15 million underspend with regard to pay in primary care this year. This is, of course, helping the Minister's figures as regards cost overruns elsewhere.
We know we have a disgraceful situation in dental care where we have a third fewer dentists in the public service relative to 2009 and we know we have a massive shortage of psychologists. There are psychologists whose applications are still in the Minister's Department who have come from the UK and are waiting to be recognised to work here. Those applications are waiting several months in her Department. Certainly, when we look at the level of waiting lists across other primary care services, I am perplexed as to how there could be an underspend with regard to pay in primary care. The Minister might explain why that is so because, to me, this is the very antithesis of what Sláintecare should be, which is greater care in the community.
Related to that, I want to ask about the PCRS. I will group the two questions together. This is the single largest cost overrun item or part of the supplementary budget and I have to ask about forecasting and budgeting. First, as regards budgeting, it is noted there is a cost overrun because of HRT. That was announced in the budget last year and was late in being introduced. Why was that not properly budgeted for? The second key question relates to the forecasting of the PCRS. There is a reference here that there were more claims relative to what was predicted. There is an issue here regarding people living longer with chronic conditions requiring medication. Is the Minister satisfied with the forecasting within her Department as regards PCRS, older people and nursing homes? They are some of the very significant drivers of poor forecasting, as I see it here, in estimating what the appropriate amount should be and getting it badly wrong which then requires extra amounts in the supplementary budget.
Jennifer Carroll MacNeill (Dún Laoghaire, Fine Gael)
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The underspend in primary care the Deputy has identified is essentially from not recruiting for primary care. This is the exact difficulty with the focus on inputs, which nearly always goes to acute and not primary care. What will change with this different distribution is the region will be able to recruit based on what it needs to do. It is very clear primary care therapies are not being delivered. The CEO has made a specific intervention regarding primary care therapies for physio, occupational therapy and speech and language but the distribution is uneven.
It has also been the case in the past that money has been moved out of community to meet acute need. We are going to make sure that, from this year onwards, that is no longer allowed and that money can move from acute to community but never from community to acute. That has been to the detriment of delivering primary care services and community services in the first instance. I hope that is one of the benefits of the change we are about to make.
Is that sufficient or should I ask Ms McGirr to speak further to it?
Marie Sherlock (Dublin Central, Labour)
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I am a bit confused by that because we are now moving to a system where both acute and community are under the one framework whereas previously they were separated out.
I hear what the Minister is saying about robbing Peter to pay Paul, but I am still not convinced that we will see sufficient effort put into recruiting within primary care this time next year. We need to see that.
Ms Louise McGirr:
I will speak to that and PCRS.
On primary care, the performance is very poor but there is still very significant variation, even within the regions. The focus and the devolution need to really flip to the outcome and the output. The performance accountability will be much stronger next year. That is the focus. REOs and national services will be held to account for delivery of those. As regards the visibility and the data we now have to do this and move like other countries with, to be honest, very successful health systems and very good outcomes, they have all moved to this output and outcome focus and to what matters to patients. You put yourself in the shoes of the patient and you measure that, not the input. That is where we are going with this, and we have the data now to help us with this. We have comparative data. The development of that over the course of the next year or two, looking at rewarding the outcomes and the performance we want and funding those rather than the input cost, is where more developed systems have gone, enabled by digital, better utilisation, productivity and so on. It is all about safe access.
Jennifer Carroll MacNeill (Dún Laoghaire, Fine Gael)
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In the first instance, the Supplementary Estimate for PCRS is driven primarily by non-pay pressures, an increase in eligibility and demand, and inflationary price increases. I will give just a brief breakdown and then I will ask Ms McGirr to speak to the forecasting.
Marie Sherlock (Dublin Central, Labour)
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May I just say briefly that we know that there are approximately 400,000 people out there who are entitled to the GP-only card and are not taking it up, so I am-----
Jennifer Carroll MacNeill (Dún Laoghaire, Fine Gael)
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Yes, but they would.
Marie Sherlock (Dublin Central, Labour)
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But if they did, the Department's figures would be off the charts altogether with regard to the underbudgeting here in PCRS.
Jennifer Carroll MacNeill (Dún Laoghaire, Fine Gael)
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That is reasonable. Of the cost, 35% relates to the drugs payment scheme, 30% related to the threshold reductions this year; 5% relates to improved longevity, which is good; 30% of the additional relates to medical cards and GP visit cards, exactly as the Deputy has said, and that would be higher were people to take it up, so we have to hope they will and we will plan for that; and 25% relates to HSE direct expenditure on high-cost drugs, for which there has been a particular need this year.
Sorry, I can see that the Deputy wants to say something.
Marie Sherlock (Dublin Central, Labour)
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I understand that, but there is poor forecasting at the heart of this. I am asking the Minister if she is satisfied with that.
Ms Louise McGirr:
No, we are not satisfied, in essence. One of the particular issues is around how the drugs costs are not just doubled the next year. Drugs costs from year one can become four or five times more expensive in the preceding years, so forecasting has to improve. It has significantly improved in PCRS this year. We have a much bigger uplift for PCRS versus the rest of the budget as well as older persons for demographics. We have variants across our forecast for 2026 depending on high-pressure areas, including PCRS. The reality is that we also have to live within the budget we are allocated and that has to be spread across different service areas. We should not be artificially deflating demand service areas to improve financial management. We agree with that, and that is the approach we are taking for 2026, so it is higher in 2026-----
Marie Sherlock (Dublin Central, Labour)
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Is Ms McGirr saying we will not see anything near the €143 million when we come back to have this same conversation next year with regard to PCRS?
Marie Sherlock (Dublin Central, Labour)
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Obviously not the exact figure, but I am talking about the scale of it.
Ms Louise McGirr:
In terms of the budget we have, remembering that we do not get everything we ask for or seek in a budget and that savings must be applied, my expectation is that we will have a realistic budget. We have growth of, I think, about 7.5% or 7% in PCRS for next year on the outturn figure.
Jennifer Carroll MacNeill (Dún Laoghaire, Fine Gael)
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A longer term concern of mine is where the drugs budget will go and needs to go. There are very different perspectives on that across the Government. On the one hand, this committee will discuss on a different day, and we will discuss at oral parliamentary questions tomorrow, the need for or request for any named drug that is doing fantastic new things in healthcare and the applications to be on the reimbursement system here in Ireland. We are also looking at an expanding and ageing population, which I have a longer term concern about. We are in renegotiations in relation to price more broadly. Then we have a broader geopolitical question about the cost of drugs. This is a live conversation and it is correct to highlight it. It is one I certainly want to flag a longer term question around and one I think we will need to acknowledge and plan for. Certainly, that was a pretty detailed part of our conversation with the Department of public expenditure and reform in relation to our planning for next year. That has to be well understood.
Marie Sherlock (Dublin Central, Labour)
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I thank the Minister. I want to continue in that vein with regard to what I see as poor forecasting. With regard to home support hours, we know that 1 million more hours were delivered this year-----
Jennifer Carroll MacNeill (Dún Laoghaire, Fine Gael)
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Kieran will take that.
Marie Sherlock (Dublin Central, Labour)
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-----than were budgeted for. Similarly, I think nursing home care is in or around €23.5 million more than what was budgeted for. All of these costs should be forecastable. I do not see that there was any untoward or extraordinary event that took place here, so why is there poor forecasting with regard to this?
Kieran O'Donnell (Limerick City, Fine Gael)
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First, I suppose the-----
Marie Sherlock (Dublin Central, Labour)
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Sorry, but just to be clear, there is, as I understand it, a huge amount of unmet need out there, so what I am really worried about is that the Department is poorly forecasting to meet existing service, the additional service that has been provided this year, and then the whole range of unmet need the Department has not even looked at.
Kieran O'Donnell (Limerick City, Fine Gael)
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To bring home support forward, in terms of the outturn for this year versus next year, we are looking at a 7.4% increase in the budget itself, or €82 million. The home support hours involve a Supplementary Estimate of €22 million. I take the Deputy's point. We are always trying to provide more hours. What was budgeted for was 24 million hours. That will end up at around 25 million, and then we will put another 1.7 million hours on top of that to be 26.7 million hours. When I speak about the 1.7 million hours, it is on the outturn for this year, not in the budget for last year. That is a really important point for people to be aware of.
Kieran O'Donnell (Limerick City, Fine Gael)
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On nursing homes, we are looking at a Supplementary Estimate of around €23 million. There are roughly 309 additional clients in terms of the nursing home itself. The percentage underspend-----
Pádraig Rice (Cork South-Central, Social Democrats)
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Thank you, but we are out of time in this slot. We can come back to this.
Kieran O'Donnell (Limerick City, Fine Gael)
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Sorry, but just very quickly, the percentage Supplementary Estimate here is very low. It is about 1.8%. Nevertheless, we want to see the forecasting be more attuned. I think the key focus is that, in 2026, we will have built in a reasonable increase of about 7% for both nursing home and home support. Obviously, we want to build on that.
Pádraig Rice (Cork South-Central, Social Democrats)
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Thank you. Next, I will call Deputy Cahill. Then, we will take a five-minute break. We will resume with Deputy Clarke, then Deputy Roche. There may be additional time if members have additional questions after that.
Michael Cahill (Kerry, Fianna Fail)
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I welcome the Minister, the Ministers of State and the team.
On an issue I have raised before with regard to the new oncology unit at University Hospital Kerry, I want to inquire about funding. I acknowledge the work of Comfort for Chemo Kerry. It has already raised €1.5 million. There is a need for a new stand-alone unit. Patients are currently making multiple trips to Cork for treatment in other hospitals. Last year, over 5,000 patients were treated in UHK.
Again, I am inquiring about funding. I have raised the need for additional beds in University Hospital Kerry before. It is really with a view to addressing the chronic situation in the accident and emergency unit. I would just like to find out where that is at. In our community hospitals in Cahersiveen, Dingle and Kenmare, there have been beds and wards closed for as long as I can remember. Every second month, there is a protest outside Dingle hospital, or West Kerry Community Hospital, as many more people would call it. It is down to staffing levels and the problems we are having on our peninsulas with attracting staff. That is what I am told. That needs to be addressed. It is just not good enough to leave all these beds closed because, as I have raised previously, we have had cases of patients from Kenmare in Dingle and patients from Dingle in Kenmare and many other different community hospitals.
Many people are making five-hour round trips before they even see their loved ones in hospital. That needs to be addressed. We need to incentivise staff in order to get them into these areas. It seems to be so difficult to attract staff. I cannot for the life of me understand why because it is a lot cheaper to build a house or buy a house in many of the areas to which I refer and the cost of living there is not as high as it is here in the capital.
There is a chronic problem with respite beds in Kerry. Is there funding available to increase the number of respite beds? We need to do that as a matter of urgency. We have a brand new community nursing unit in Killarney, which is a good news story. When will it be opened? That question has been asked a lot by my constituents in Kerry.
With regard to primary care, there was an issue in the recent past about the location of the primary care centre in Killarney. What are the plans in that regard? How soon will plans to develop the primary care centre in Killarney that is urgently needed be implemented? It was supposed to happen on the Áras Phádraig site. There were issues with that. I felt it was the wrong location. What is the position regarding the primary care centre for Cahersiveen? A planning application was submitted but an objection was lodged. I think that has been resolved.
Will the Minister of State, Deputy Butler, provide an update on the child and adolescent mental health services, CAMHS, and where we are at with south Kerry CAMHS? The look-back review has been delayed. We had a lot of issues, which were well documented in the public arena, with regard to children in Kerry, both north and south.
The new maternity unit is another issue I have raised previously. I have received complaints from patients and from families in regard to the distance between the maternity unit and the surgical theatre and the problems that was bringing. Where are we on that matter? On the monthly maternity patient safety statements, earlier this year I received an email from a member of the public about the number of incidents in the maternity unit in comparison with the number of births there. Perhaps I could get a comment on that.
Pádraig Rice (Cork South-Central, Social Democrats)
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We must leave time for the Minister and Ministers of State to reply. In general, will members focus on the Supplementary Estimate? The Minister and Ministers of State are probably happy to take general questions as well, but we should try to stick to the Supplementary Estimate for this year and for the spending for the year. However, the Minister may take some of those points.
Jennifer Carroll MacNeill (Dún Laoghaire, Fine Gael)
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I will ask the Minister of State, Deputy Butler, to speak specifically to CAMHS. Deputy Cahill raised a range of different and really important issues relating to Kerry and the south-west region. I am quite conscious that I have not visited UHK. I want to compliment the very excellent work of the manager, who is really trying to drive process reform to improve the urgent and emergency care situation there. I have had good engagement with the integrated healthcare area managers and the regional executive in relation to the use of community beds across Cork and the south west generally, and increasing the facilities in Bantry, which, of course, would be of benefit to the people of south Kerry.
The Deputy mentioned cancer services in south Kerry. Our engagement looked also at trying to make sure that infusion services and so on can be delivered in Bantry, for example, as opposed to Cork. Something similar is appropriate and possible in separating the need for Kerry patients to go all the way to Cork University Hospital where some of the treatments can be given, including blood tests, infusions and other things, closer to home. I must come and spend a proper day looking at the detail relating to Kerry in the same way as I did in respect of Cork. I commit to doing that. I will ask the Minister of State, Deputy Butler, to speak to the specific CAMHS issues.
Kieran O'Donnell (Limerick City, Fine Gael)
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On the two issues raised regarding the new unit in Killarney, I met with representatives from HSE estates and the HSE last week. I can confirm that there will be a handover in about three or four week's time. We are looking to have it in operation by quarter 1 of next year.
Kieran O'Donnell (Limerick City, Fine Gael)
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The first quarter of 2026, which is a positive story. I take the point on Cahersiveen. It is to do with recruiting the staff. We have met with the HSE, and we will follow up with it.
The final point was on bed capacity. We are doing an overall review of bed capacity in its entirety. We are doing a body of work at the moment with the HSE, and certainly those points will be factored in. If the Deputy wants to come back to us with more precise details, we can factor those in as well.
Michael Cahill (Kerry, Fianna Fail)
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Will West Kerry Community Hospital looked at?
Mary Butler (Waterford, Fianna Fail)
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On the Deputy's question on CAMHS, this is something we have discussed many times down in Kerry. I will just touch on the north Kerry CAMHS review first, which is the north Kerry look-back review. It has taken longer than I would have liked it to. We found it very difficult to get a consultant to take it on. Dr. Sean Maskey was not available to do it. Dr. Colette Halpin, in fairness to her, has been looking at this. My main concern throughout the process has been to ensure that the children, the young people and their families are communicated with directly in advance of the publication of the look-back review. That has happened. I expect to have it by the end of the month. I will then act very swiftly on looking at a situation similar to south Kerry where we had the non-adversarial compensation scheme. The uptake in the non-adversarial compensation scheme for south Kerry has been extremely high. From the perspective of not trying to drag families through the courts, this is really positive. Unfortunately, since 2014 we have not been able to recruit a permanent consultant for south Kerry, which has been a funded post since then. We are dependent on locums and on other consultants, and in how they spend their time. For example, one consultant works two days in Kerry and three days in Cork. It is problematic for us but, at the same time, CAMHS in Kerry has improved greatly and I want to thank all the teams working down there.
Michael Cahill (Kerry, Fianna Fail)
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Very briefly, I am not sure there is an actual need -maybe there is - for a new maternity unit. Maybe we could look at that. There certainly have been issues there-----
Jennifer Carroll MacNeill (Dún Laoghaire, Fine Gael)
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The figure for instances per birth is difficult to assess. the Deputy has had a complaint that the number of adverse incidents per number of births is-----
Michael Cahill (Kerry, Fianna Fail)
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I only received that-----
Jennifer Carroll MacNeill (Dún Laoghaire, Fine Gael)
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If the Deputy does not mind passing that to me, I will have the patient safety office examine the matter. I am always very conscious of what might happen there.
Michael Cahill (Kerry, Fianna Fail)
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There is also the need for additional beds in UHK. I recently raised a call for a pilot study for the peninsulas in Kerry to look at all aspects of the hospital services there.
Jennifer Carroll MacNeill (Dún Laoghaire, Fine Gael)
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Mr. Tierney may be able to answer the infrastructure question.
Mr. Derek Tierney:
The Deputy asked about that and we will get a note anyway through the Chair, but I will give an update on what we have completed and what is under way in terms of construction, and what we have in our design pipeline. We have upgraded and extended the oncology day ward with a rooftop vertical expansion. This has provided 14 day-treatment cubicles, two day-treatment isolation rooms and seven outpatient consulting rooms, including an aseptic compounding unit. That is constructed and operational.
We also have a relocation of the women's health unit from University Hospital Kerry to John Joe Sheehy Road in Tralee. This is under construction. It is a commercial acquisition and fit out. We are also upgrading the MV and LV infrastructure in the Kerry hospital.
On beds specifically, we have nine bed refurbishment projects under way, and we have a detailed design under way for a single-storey vertical extension incorporating 30 new beds.
Pádraig Rice (Cork South-Central, Social Democrats)
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I thank Mr. Tierney. We will now take a short break and resume with Deputy Clarke.
Sorca Clarke (Longford-Westmeath, Sinn Fein)
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I appreciate that the Minister of State, Deputy Butler, is under time pressure because of Leaders’ Questions. What impact has the underspend in primary care had not so much on assessments but on the provision of services, particularly regarding adult ADHD teams and CAMHS?
Mary Butler (Waterford, Fianna Fail)
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I thank the Deputy for the question. I was just speaking to the Minister and noted that, technically, primary care does not fall under my remit.
Sorca Clarke (Longford-Westmeath, Sinn Fein)
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But mental health does.
Mary Butler (Waterford, Fianna Fail)
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Of course, primary care in mental health services.
One of the things about primary care and the waiting lists for psychologists is that there is €750,000 in the mental health budget every year to support ten counselling psychologists through their careers in Trinity College. That is one of the things we did about three years ago because we had to create a pathway so that more counselling psychologists would come through in mental health.
The waiting lists for primary care psychology are off the scale. It is about 18,000 at the moment and the pressure that is putting on the CAMHS waiting list is undeniable. The majority of the primary care waiting list is in the Cork and Kerry region, where about 12,000 children are waiting, off the top of my head. There have been several issues in trying to recruit psychologists to that area. However, I have taken to the road recently and visited 21 different CAMHS teams and in every one there was a clinical psychologist and counselling psychologist in place, which I am pleased to report. However, primary care sits separately from CAMHS and is driving a huge issue.
Sorca Clarke (Longford-Westmeath, Sinn Fein)
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They supplement one another to a certain degree.
Parents see an underspend in primary care while their children are on a waiting list for psychology in primary care because of their mental health. How can the Minister of State explain that to someone who has been waiting for 18 months or two years?
Mary Butler (Waterford, Fianna Fail)
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Children who reach the standards to be accepted by CAMHS - that is about 2% of the 1.2 million children in the country at the moment - get into the multidisciplinary team where psychology is provided for them, if that is required, by the multidisciplinary team, which includes psychiatry, psychology, clinical nurse specialists, social workers and so on. Psychology under primary care sits outside that for children who may not need the moderate or acute care CAMHS provides. That is where the challenge is.
Sorca Clarke (Longford-Westmeath, Sinn Fein)
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I have an eye on the clock. I will put the same question to the Minister of State I put to Mr. Bernard Gloster when he was here, and to the Minister previously. Where children have a recommendation that clearly states they need, because of various factors including their mental health, to be under the CDNT and the CDNT makes a decision not to adhere to that report, does the Minister of State think that is good enough for children who are struggling with their mental health?
Mary Butler (Waterford, Fianna Fail)
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When parents bring their children to a doctor and the children are referred, whether to CAMHS, the dentist or primary care, they expect a pathway. That is why we are putting in place the no-wrong-door approach. Three pilots are under way at the moment, in north County Dublin, Galway and we will open one in Donegal as well. However, Mr. Gloster has been clear to all six regional executive officers that he wants to see the no-wrong-door approach rolled out completely so that when a referral comes in from a GP, it will be clinically triaged and then it will be determined where that child would best be placed. It might be in a family resource centre or in Jigsaw, for example. We will expand Jigsaw in next year's budget. It might be, for example, CAMHS, NEPS or primary care. We have too many children on multiple waiting lists and they are languishing on them. I accept that. However, I have to say-----
Sorca Clarke (Longford-Westmeath, Sinn Fein)
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I want to ask one last question in the area of mental health and the failure of services to meet the needs of service users. The document we were provided states that the north west performs well. That is a direct quote. The Minister of State will be aware of an individual who was profoundly unwell with his mental health. An Garda Síochána had raised serious concerns about this individual. I understand he had held his mother at knifepoint. Due to the failure of the mental health service, that individual went on to take the life of another. That was almost eight years ago. No proper report was carried out at the time. A report was meant to be completed this July but there is still no sign of it. Has that report been completed? Will the Minister of State make it available to the family of the young man who lost his life at the hands of an individual who was just exceptionally ill?
Mary Butler (Waterford, Fianna Fail)
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I have made inquiries about this. The report has not been completed by the HSE yet.
Mary Butler (Waterford, Fianna Fail)
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I do not know. The Deputy said it was 18 years ago.
Sorca Clarke (Longford-Westmeath, Sinn Fein)
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It was eight years ago. That is not good enough.
Mary Butler (Waterford, Fianna Fail)
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It was eight years ago. I do not know why but I have asked the HSE. I cannot comment on an individual case. I will have to look at the report when it comes to me. The Deputy spoke about the north east of Dublin. Is that the area she referred to?
Sorca Clarke (Longford-Westmeath, Sinn Fein)
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It was the north west, Sligo.
Mary Butler (Waterford, Fianna Fail)
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I will have to wait and see. I do not have a clinical background. The HSE is undertaking the report. It will come to me and, when it does, we will look at it and take it from there.
Sorca Clarke (Longford-Westmeath, Sinn Fein)
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I will not get into a back and forth on this because it has been raised in the Dáil with the Taoiseach as well. There is nothing to be gained today with a back and forth on it but it is not good enough for any health service to effectively shield itself from criticism and investigation because of an ongoing Garda report, which was put out at the time. They are incredibly different things. Whoever made the decision not to provide that man with services needs to be held accountable. Someone lost their life.
Mary Butler (Waterford, Fianna Fail)
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Yes. I have agreed to meet the parents involved as soon as the review is complete because it would be a conflict of interest to meet them in the meantime. As soon as I have sight of the review, I will meet the parents. I have given that commitment.
Sorca Clarke (Longford-Westmeath, Sinn Fein)
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I thank the Minister of State.
I will move on to services for older people. The document provided states that emergency department presentations of people aged over-75 have increased by 46% since 2019 and 7% since 2024. It is my firmly held opinion that many of those presentations are due to the lack of appropriate home care being provided. I will give a specific example. An 84-year-old man who has had two heart attacks, is fighting cancer and lives alone in an isolated area was approved for a home care package in March. That has yet to present itself. That was March. It is now November and he is 84.
Kieran O'Donnell (Limerick City, Fine Gael)
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That should not be the case.
Sorca Clarke (Longford-Westmeath, Sinn Fein)
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He does not need to be in a nursing home. He could function well for another few years.
Kieran O'Donnell (Limerick City, Fine Gael)
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He has been approved for home care. I do not know the specific circumstances. Will the Deputy, with the approval of the gentleman, send it to me and I will follow up?
Sorca Clarke (Longford-Westmeath, Sinn Fein)
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My question is-----
Kieran O'Donnell (Limerick City, Fine Gael)
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That offer is there.
Sorca Clarke (Longford-Westmeath, Sinn Fein)
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How many of these individuals are there? What percentage of need will the additional allocation of funding meet?
Kieran O'Donnell (Limerick City, Fine Gael)
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We have an increase of €82 million in the service. Roughly on the outturn it is about 7.4% on last year. We want to continue to increase that.
Sorca Clarke (Longford-Westmeath, Sinn Fein)
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Yes, but how many of these individuals are there? How many individuals who have been approved for home care packages have not received them six and eight months later?
Kieran O'Donnell (Limerick City, Fine Gael)
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There are a number, as the Deputy is aware. I do not know the specifics about this gentleman. I have met the HSE and through the letter of determination, I want the extra funding to specifically target individual areas where there are long waiting lists and individuals on them. A lot of it is about recruitment of staff. There will be a focus geographically but also on the particular circumstances the Deputy raised with this gentleman. It should not be the case. Once again, the offer is there for the Deputy to send on the details.
Sorca Clarke (Longford-Westmeath, Sinn Fein)
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Absolutely, but it should not come to that. This man has been approved.
Kieran O'Donnell (Limerick City, Fine Gael)
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I appreciate that but there are particular circumstances in particular areas where there is a problem with recruitment of staff. That is something I have met the HSE about.
Jennifer Carroll MacNeill (Dún Laoghaire, Fine Gael)
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May I add to that? I thank Deputy Clarke because this is exactly the outcomes based accountability that is right. We should not be resolving issues on an individual basis at this level. That is why this shift is so important.
I will give an example of the regional variation in this. In September, the HSE West and North West region had 1,243 people waiting for home support services, comprising 553 new service users and 690 in receipt of some care but awaiting additional care. In contrast, HSE Dublin and Midlands had the fewest clients waiting for home support services, with just 346 people waiting. It is still 346 people but I am contrasting with the HSE West and North West region. Forgive me for that presentation. The Deputy will know what I mean. That is made up of 130 new service users, and 216 in receipt of some care but awaiting additional care. Waiting for care is not acceptable. We want people to have the best service as close to home as possible. However, it is also true that the regional variation means that, depending on the complete accident of geography, people can be in a worse position than if they were in, for example, Dublin North.
Sorca Clarke (Longford-Westmeath, Sinn Fein)
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It is an issue I have raised with the Minister previously.
Sorca Clarke (Longford-Westmeath, Sinn Fein)
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I have ten seconds to ask a straightforward question. Are all the staff in place in Regional Hospital Mullingar to operate the MRI machine?
Jennifer Carroll MacNeill (Dún Laoghaire, Fine Gael)
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I do not know. I would have to speak to the manager directly.
Sorca Clarke (Longford-Westmeath, Sinn Fein)
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I will come back to that in the second round.
Pádraig Rice (Cork South-Central, Social Democrats)
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Our final speaker on the first list is Deputy Roche. We will then go to a second round of short slots of four minutes each.
Peter Roche (Galway East, Fine Gael)
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First, I have to say that the statement is quite comprehensive, clear and concise. I feel somewhat relieved that all of the witnesses have such a good grasp of every region in terms of the needs. One of the things we are all reminded about is that the demographics have changed. I am not speaking in the witnesses’ favour but the demographics have changed considerably in the last couple of years. We now have a population of over five million, which you might say is a rapid increase. That did not happen over the past ten or 15 years. Of course, it is also fair to say that more people are presenting to hospitals and GPs, regrettably. That is just the way it is and we have to be cognisant and fair in our assessment of that.
The Minister is not asking for a lot. It is only €300 million. She is pushing an open door in my case because I am quite confident that, based on the report and statement, those moneys will be going to a good home, so to speak. I have a few questions. My first question, which I may have raised before, is that I wish to be confident that the primary care centres that were purpose-built are being utilised to capacity or their best ability. They must be staffed and resourced to a degree where they can take some of the GP referrals, rather than some people having to present to accident and emergency departments and whatever. That was their intention from day one. I would like to think that some assessment or audit has been done in that regard. Regardless of where we live, there is one such centre in reasonably close proximity to us.
I will move on. We all engage with different stakeholders from time to time and, in recent times, I had discussions with people involved in the business of providing cancer care and so forth. One of the things I felt was rather alarming was that we in the west and north west do not have a public PET scan machine or a public screening machine. There is one machine in a private clinic in Galway. In the context of delivering world-class or first-class services and treatment for a region this big, that is one of the basic essentials. My understanding – I stand to be corrected when I say this, of course – is that there is no sight of that happening before 2030, or maybe even beyond that. I will not say that this is something that needs to be looked at, but there is an urgent need for it.
As I engaged with stakeholders, I heard that the LINAC machine in University Hospital Galway, which is the machine that does the radiation therapy, is only operational 40% of the time. It is suggested – again, I stand to be corrected – that some of the issues are related to staffing. The other concern they have regards the age of the machine. What I am reliably informed is that urgent upgrading, or a new machine, is needed. If it is going to be efficient, it has to be available. I will not say it needs to be available 24-7 because that might be an unfair ask. However, the machine is operational for 40% of the time when so many people are presenting with that very need. The basic requirement should be that, if the machine has the capacity and the staff are available, patients would have easy access to it. Those are the guts of my questions because some of the other questions have been presented.
I will say to the Minister, Deputy Carroll MacNeill, that I and others, including Deputy Martin Daly I am sure, are still anxious that we continue to focus on the need to get Portiuncula University Hospital back to where it rightfully needs to be to service that region. Of course, I am very much aware of the issues there that the Minister is working on. I commend her for that. I am just anxious that everything in the west and north west needs to be as good as it can be or as it is in any other region. In many respects, like I said, they should be world-class standards because that is what is now requested. We are no different from any other country. Those issues, such as cancer and mental health, are very prevalent.
Jennifer Carroll MacNeill (Dún Laoghaire, Fine Gael)
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I will give the Minister of State, Deputy Butler, the opportunity to answer on the mental health question and I will take everything else.
Mary Butler (Waterford, Fianna Fail)
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I thank Deputy Roche for all his advocacy on mental health. With regard to private care centres, I will give the Deputy a couple of examples. We moved the CAMHS team out of University Hospital Waterford into the Ferrybank Primary Care Centre because it is a much more suitable environment for young people. It has also made room available in the acute hospital. Similarly, in Clonakilty in west Cork, the CAMHS team moved into a community hospital where there was space on the same site, although it is in a separate building. We will use any opportunity we can.
I wish to mention something else, which will be important to the Deputies in that region. We have had a huge number of mental health presentations from the Traveller community to Portiuncula University Hospital. In the last year, there have been over 350 cases involving self-harm and suicide ideation. There are two SCAN nurses, suicide reduction nurses, something which has never been done with CAMHS, going into that particular area. When we get the data, we identify where there are challenges and we try to react in a timely manner. That is a very positive story for that number of presentations.
Jennifer Carroll MacNeill (Dún Laoghaire, Fine Gael)
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Nothing would make me happier than to see a consistent improvement in maternity services at Portiuncula University Hospital. That would leave every woman in the region comfortable that, in the case of a complex pregnancy, she and her baby will be safe. Nothing would make me happier than to get that point of confidence and for that to be the case for everyone there. We are all working towards that. We see evidence of improvement but it has to continue to improve and be sustained.
With regard to the use of primary care centres, yes, this is exactly what we are trying to do. I am already seeing good evidence of the use of primary care centres. For example, neurology services are being moved out of the acute hospital to deliver services in Newcastle West, Limerick. That is an example of moving services out of acute hospitals for people to be treated more conveniently. We are trying to avoid hospital attendances by having local injury units and other primary care facilities available more locally and in a way that is convenient for the patient. For example, I have just announced the opening of the local injury unit in Ballina. It is my expectation that it will run from 8 a.m. to 8 p.m., seven days a week. Similarly, there is a good acute medical assessment unit, AMAU, in Mayo University Hospital which at the moment is only running five days a week. It absolutely needs to run seven days a week because it provides an intervention, particularly to elderly people, that keeps them from an acute presentation of one kind or another. We need to see more of that and the utilisation of primary care for both hospital avoidance and other treatments. That needs to be done and understood on a seven-day-a-week basis. That is what all of our workforce agreements have enabled us to imagine and that is now what must be delivered.
In respect of cancer and PET scans more broadly, we have a review of the cancer programme and cancer strategy next year, which is really important. This issue comes up repeatedly and I would like to expedite that particular analysis towards the front of that review. I do not want to be having a 2030 conversation; I want to be having a 2026 conversation in relation to the planning for that. It is also important to say that, at the same time, we want to move cancer treatment as close to home as possible. Perhaps we will get to a great day where cancer treatment is delivered in the home in rural Ireland. When that begins to happen, we will know that we are delivering services in an genuinely Sláintecare way.
Pádraig Rice (Cork South-Central, Social Democrats)
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We will be having a dedicated session on maternity services with a focus on Portiuncula University Hospital before Christmas. We will be looking at that issue in detail before the end of the year.
Jennifer Carroll MacNeill (Dún Laoghaire, Fine Gael)
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Is that session on Portiuncula University Hospital specifically or maternity services more broadly?
Pádraig Rice (Cork South-Central, Social Democrats)
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There will be a focus on Portiuncula, yes.
Jennifer Carroll MacNeill (Dún Laoghaire, Fine Gael)
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Okay, great.
Pádraig Rice (Cork South-Central, Social Democrats)
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We will do a second round. The clerk has advised three and a half minutes each. If we stick to that, we might be able to bring most members back in for a second question. Feel free not to use all the time available to you. We will go in the same order as before, starting with Deputy Daly of Fianna Fáil.
Martin Daly (Roscommon-Galway, Fianna Fail)
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I would like to focus on one area because I have real concerns around it. It is a silent increase in cost to the health service, namely the State Claims Agency, medical indemnity and medical litigation. I know it has peaked in terms of what the Minister has applied for in the supplementary budget. I would really like to ask her about the progress of the implementation of Professor Rhona Mahony's report from September 2024. There is a huge cost here. Our overall liability at the end of 2024 is €4.3 billion. It is a huge amount of money. That is notwithstanding the validity of claims or the medical professionals who are defending those claims. It is a source of huge stress, not just for the people who are bringing those claims. The length of time it takes in this country to bring a claim to court or to settle a claim, at 1,462 days, is among the longest in the world. We are 50% higher than the UK, Hong Kong or Singapore, 26% more expensive than Singapore, 56% more than Malaysia and 191% more expensive than our closest neighbour, the UK. That is simply inexplicable. It is an area of huge cost to our health service. What is the Department doing in terms of the implementation?
Jennifer Carroll MacNeill (Dún Laoghaire, Fine Gael)
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I think it is important that I declare an interest in this to the Cathaoirleach. I have a child who had a neonatal brain injury and who goes through the State claims process, so I am not just the Minister for Health but a parent in precisely that situation. It is very important that I disclose that, although it is quite private. It is important that it be understood. I have a personal understanding of this particular process, the interim steps and the way in which it is managed.
I recognise the work of Professor Rhona Mahony. I have taken the time to try to meet some of the women who were behind the UCC research that was done in relation to that, to better understand their experience of the medical litigation system. None of those people want to be in the system. There is not a single parent who is in that system who wants to be there. Every one of them would rather not have had that experience. In every single case, they would like to avoid that for anybody else.
On the report, I recognise that report but I also recognise that it was chaired by somebody who was the master of a maternity hospital where I repeatedly see events being presented in the court, including my own event. I have questions and I had questions at the time. I do not believe that report is the panacea, necessarily. I have questions about accountability within hospitals. I recognise that many of those maternity hospitals are voluntary hospitals, that there is a board structure, and that accountability - I mean real accountability - is considered in a different way.
The real issue here is not about the implementation of a different issue. There are measures in the programme for Government about a dedicated medical negligence court. We, in essence, already have that because we have dedicated lists to this. We, in essence, already have mediation, but it is mediation that is essentially litigation by a different name. What we do not have yet is a culture of real acknowledgement of wrongdoing, of anticipating the mental health and care implications of that and of supporting mothers and babies who will have difficulty, and we just do not understand the nature of that difficulty yet. The programme for Government goes beyond the implementation of this. As Minister, I have tried to begin a body of work on this but there is also so much else to do that is urgent. What I really want to see from the maternity hospitals, as leaders in this field, is a very different attitude to openness, accountability, investigation and responsiveness, and proactivity in wrapping their arms around women and babies who have had very adverse outcomes. The Deputies will be aware that this in particular is why it is so important that where I see patterns that are resulting in really adverse outcomes, in Portiuncula or any other maternity system, we have to make the interventions to protect women and babies.
David Cullinane (Waterford, Sinn Fein)
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In my constituency, in respect of University Hospital Waterford, I have received dozens of representations from patients over the last months in relation to hips, cataracts and hernia procedures. I have spoken to the hospital manager and he says there is a problem and that they are not getting through these procedures as quickly as they should. I am hoping the surgical hub will help in some of these procedures. I dealt with one elderly man who needs both eyes done. He probably will have to go to Belfast to get it done quicker. Day case procedures like that really should be done much more rapidly. This reinforces the need for the elective hospitals. Those types of procedure are really serious for the persons affected and they have an impact on their health. They may not be the most serious cases - obviously cancer and cardiac are very serious cases - but if someone is years waiting for a hernia operation or for cataracts to be done and they cannot see, it has an impact on their quality of life. Will the Minister to respond to that?
My second question is about workforce planning and plans in the South East Technological University. I know there is a crossover here between the Minister for Health and the Minister for higher education. On what is called the new glass site in Waterford, there are very exciting plans for a new pharmaceutical and veterinary building, which I support, and a new 10,000 sq. m One Health building. I also spoke to people in University Hospital Waterford, including senior management, who want to see a new medical school housed on that site as well. That would be a game-changer. As the Minister knows, workforce planning is really important and we need more training capacity. Is that something the Minister for Health could look at, and could she support the local stakeholders such as the professor in the university, the manager in the local hospital and others who are trying to get that project up and running?
Jennifer Carroll MacNeill (Dún Laoghaire, Fine Gael)
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On the latter piece, I may have to look at that. I have not been aware of it but I know my excellent colleague from Waterford will also be very interested in that. We might speak about the surgical hubs and the opportunity to do exactly what the Deputy is talking about, particularly in relation to cataracts, where I notice in Mullingar the facility, I cannot remember the name, possibly Ballinderry----
Sorca Clarke (Longford-Westmeath, Sinn Fein)
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Charter Medical.
Jennifer Carroll MacNeill (Dún Laoghaire, Fine Gael)
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It is just beside Mullingar where we-----
Sorca Clarke (Longford-Westmeath, Sinn Fein)
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It is 3.5 km from it.
Jennifer Carroll MacNeill (Dún Laoghaire, Fine Gael)
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The point is it is doing extremely good work in relation to cataracts, and reasonably quickly. The State has bought a fair amount of the capacity, specifically to do public work. It goes to show how possible this is. I am really just bringing this back to the point that this should also be the case in Waterford. These day-case procedures are a real opportunity in the surgical hub there, which is progressing at pace, as the Deputy will know better than I do. There is a very strong desire in Waterford to open and to get going with the four operating theatres and two minor operations rooms as quickly as possible. The staffing within the region should be a priority but it is a question for the region next year, in the new way of doing things, to allocate the staff to make sure that is so. It is also the case that surgeons in University Hospital Waterford will want to move across. It does not have to be new capacity all the time. That reorganisation is very important and should free up space in Waterford as well. The Minister of State, Deputy Butler, might wish to say something on Waterford.
Mary Butler (Waterford, Fianna Fail)
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As Deputy Cullinane knows, because he sees it as often as I do, we are on target for completion of the surgical hub in the middle of next year. The sooner we can get people into it and get those surgeries started, the better. We had a high-level cataract unit in the hospital, which was a new development over the last couple of years. We felt at the time that it was really going to have an impact on the waiting lists. It is disappointing to hear that is not the case.
Colm Burke (Cork North-Central, Fine Gael)
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I will raise an issue in respect of nursing homes. The HSE had to take over private nursing homes that were not able to operate privately. I am looking at the cost, and there is an additional cost of €24 million. Is that correct?
Kieran O'Donnell (Limerick City, Fine Gael)
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The additional cost in respect of private nursing homes was €4 million.
Colm Burke (Cork North-Central, Fine Gael)
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One of the problems we have in relation to the public and private nursing homes is that the average cost of a bed in a private nursing home is around €1,250, while the average cost in a HSE public nursing home is €1,969. There is a gap of €700. Some of the private nursing homes are running into difficulties because of the funding issues. In this case, the nursing home was no longer able to operate. When we take it over, there will then be additional costs.
Is it not a problem that if this occurs again, an additional cost will be incurred in taking it over? If additional funding was provided from day one, it might obviate the need for that facility to close down or to be taken over by the HSE, which involves an additional cost being incurred by the HSE.
Kieran O'Donnell (Limerick City, Fine Gael)
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Under the legislation, in a range of situations - if HIQA or whoever else moves in - the HSE has to step in and run the nursing home.
Colm Burke (Cork North-Central, Fine Gael)
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There is additional cost.
Kieran O'Donnell (Limerick City, Fine Gael)
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It is a measure of last resort.
Colm Burke (Cork North-Central, Fine Gael)
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One of the problems is that there is that variation in cost.
Kieran O'Donnell (Limerick City, Fine Gael)
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Let me explain this more specifically and then we can move on to the more general point. On the nursing homes, the HSE is required to step in. Some of those nursing homes go back into private ownership. In specific situations, there is a requirement for the HSE to step in because we must keep nursing homes open, particularly for the residents. Traditionally, public nursing homes would have had a higher cost element to what they provide. In this particular situation here, it is about the HSE having to step in and take over private nursing homes.
Colm Burke (Cork North-Central, Fine Gael)
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This argument about HSE public nursing homes having to provide a higher level of care because there are more challenges does not always wash. In the case of a patient who was admitted with minor issues but encounters greater challenges as they get older, there is no increase in the provision to the private nursing home even though the level of care that is required has increased substantially over 12 months or two years. Is there not a need to review that issue?
Kieran O'Donnell (Limerick City, Fine Gael)
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Specifically for 2026, I have secured an increase of €92.2 million for the nursing home support scheme. That is on top of outturn and not on top of the budget.
Colm Burke (Cork North-Central, Fine Gael)
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How many additional nursing home beds will come into place? Remember now-----
Colm Burke (Cork North-Central, Fine Gael)
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Over the next ten years, there will be a population increase among people over 65 or 66 years of age from approximately 860,000 at present to over 1 million. I am not saying that nursing homes are the answer for everyone. Obviously, home care is the ideal scenario but a certain element will require full-time nursing home care. Are we doing enough forward planning in this whole area? We are not going to see any substantial increase in the public sector. Therefore, we have to make sure funding is available to deal with the challenges that are there.
Kieran O'Donnell (Limerick City, Fine Gael)
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There are two aspects to that. First, the ESRI did a body of work, both nationally and more regionally. The regional figures have only been published in the past week. The Department and the HSE are doing a body of work that is looking at a capacity delivery plan and more particularly looking in the public space. Both public and private nursing homes have a role to play. We are doing a forensic body of work with the HSE on forward planning in this space.
Colm Burke (Cork North-Central, Fine Gael)
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Does the Minister of State accept that there is a challenge with gap between the private sector-----
Pádraig Rice (Cork South-Central, Social Democrats)
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The Deputy's time is up.
Colm Burke (Cork North-Central, Fine Gael)
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There is a difference of €700-----
Kieran O'Donnell (Limerick City, Fine Gael)
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One of the reasons I wanted to secure such an increase-----
Pádraig Rice (Cork South-Central, Social Democrats)
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Can we adhere to the time restrictions for each of the members so everyone can get in? We have a restriction on time.
Pádraig Rice (Cork South-Central, Social Democrats)
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I would like my interventions to be listened to and respected by Deputies and Ministers.
Pádraig Rice (Cork South-Central, Social Democrats)
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We are trying to keep on track. I hope we will conclude by 12 noon. Everybody can proceed. I have an additional question on the public-only consultant contract, POCC. We have seen that it has reached an uptake level of 67%. This is a key measure in delivering Sláintecare, as we know. It is key in separating the private and public provision of care. Disentangling these is important and essential. I am glad to see that this is under way. As expected, it will come with a loss of income to public hospitals which must be replaced. A total of €100 million has been allocated to address this deficit in 2026. Has the Department done a forecast for the deficit post 2026?
Jennifer Carroll MacNeill (Dún Laoghaire, Fine Gael)
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This is really the year that it kicks in. This is the difficult year. From now on, we expect it to remain reasonably constant for two reasons. First, we expect that the conversion, whereby people are going to convert from the old contracts to this contract, has happened. It has probably reached a critical mass at this point. New consultants will all, of necessity, will be on the POCC, so there is not going to be a variable in the figure. Second, this is the year when it really crystallises. It had been incrementally growing, but this is the year when it really crystallises as far as I understand. We will see the loss, but I do not think it is going to increase. We just have to bed that into our understanding from now on.
Pádraig Rice (Cork South-Central, Social Democrats)
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When we had the CEO of the HSE here, I asked him when we would get to 100% uptake of consultant contracts. He said:
It will probably be another three or four years before we are close to it. As long as there is a person on the 2008 contract and they have not retired, it will not be 100%. That is the timeline. The cohort of consultants who were there in 2008 will be looking towards retirement in ten years' time. Of the people who are available and willing to convert, we have probably seen most of those for now [which is what the Minister has said].
The CEO referred to a ten-year timeline. Is that what the Minister would see?
Jennifer Carroll MacNeill (Dún Laoghaire, Fine Gael)
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I think so. People are entitled to remain on the contract they were on. That is part of their entitlement. It does not stop them working where they want to work. Just 38% of the consultants in UHL, for example, are on the POCC. It is the best hospital in Ireland for the way in which the other consultants have come on board with weekend working. The two contract holders are working nearly seamlessly under the fantastic direction of the regional clinical director, Dr. Catherine Peters. She has managed to get both contract holders to work seamlessly together. It is a hospital where we have 17 to 20 consultants rostered on every weekend in a way which represents a leadership situation. In other hospitals, like Beaumont Hospital and the Mater, the level of uptake of the POCC is well in excess of 80%. The Mater is doing better. UHL is a leader, even with the lowest level of POCC uptake, entirely because of the commitment and organisation of the regional clinical director; fair play to her.
Pádraig Rice (Cork South-Central, Social Democrats)
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The Minister said that the loss of income is stabilising, but as we go from 67% to 100%, is there not a loss of income?
Jennifer Carroll MacNeill (Dún Laoghaire, Fine Gael)
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The loss of income has sort of happened. The new people who are coming on board were never bringing in an income of a private nature to be lost, if the Chair knows what I mean. That conversion is this year.
Ms Louise McGirr:
It is envisaged in Sláintecare that at some point in the future, there will no longer be private maintenance income, which is what we call the money they get, going into the hospitals. People were getting B type contracts, as they are called, right up until 2023. Depending on the length of their career, potentially that will be in there. They have that right.
Pádraig Rice (Cork South-Central, Social Democrats)
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Deputy Sherlock is up next. She has three and a half minutes.
Jennifer Carroll MacNeill (Dún Laoghaire, Fine Gael)
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May I say one more thing? To be clear, that entitlement does not extend to other facilities.
Marie Sherlock (Dublin Central, Labour)
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The Minister referred to population-based resource allocation, PBRA, in her statement. We spoke earlier about how resources are not getting to primary care. Why is primary care being excluded from the new PBRA modelling within the Department? That was the charge in the ESRI report - the planning report - with regard to planning for PBRA in the Irish health system.
Jennifer Carroll MacNeill (Dún Laoghaire, Fine Gael)
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The simple answer is that it is not being excluded. I ask Ms McGirr to speak on it in a more complex way.
Ms Louise McGirr:
The way PBRA works is that it looks at the population size and age, which are the two key biggest factors that determine the size of budget that you would get if it was fairly distributed throughout the country. We overlay social deprivation and rurality onto those things. It is not about a service area. Nowhere is excluded. It is about the needs of the region based on its population. That is the model we are developing. I was saying to the Minister that we should look back to come back to this committee to talk about it as it progresses during the year. It is well advanced.
Marie Sherlock (Dublin Central, Labour)
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To be clear, does GP care fall under the allocation model?
Ms Louise McGirr:
As GP care is a primary care service, we fund it through the GMS and the GP cards. It is part of the overall population need. We have significant portion of our budget that makes GP and GP out-of-hours payments through the PCRS, which we spoke about earlier, and directly from the out-of-hours. All that gets taken into account in terms of the size and scale of the budget. We do not have HSE GPs. They are direct employees.
Jennifer Carroll MacNeill (Dún Laoghaire, Fine Gael)
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That is a gap. We also have the private elements. It is in, but it not all in. We would like to see it more.
Marie Sherlock (Dublin Central, Labour)
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I thank the Minister and Ms McGirr for that. There has been a lot of talk today about the agency spend. It is going to be more than €750 million this year. There has been a lot of talk about trying to bring it under control because it is going up rather than down. What is the plan regarding agency spend? When we have this discussion this time next year, what can we expect to be talking about?
My sense of the conversation is that we are trying and we are not making any progress and a new plan needs to be put in place. For instance, in the UK, some of the trusts have an actual locum organisation within the trust. Is any of that thinking going on in the Department?
Jennifer Carroll MacNeill (Dún Laoghaire, Fine Gael)
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Yes. That is exactly it. I have spoken to Mr. Gloster and Ms Hoey about that directly and that is exactly what I would like to have as a model. They are looking at different models for that. For example, if you were HSE staff and you would like to do extra hours, you should be able to apply on a digital system within the HSE that never, ever interacts with a private third party in any way. You can get your additional hours and be paid for that; that is fine. I think there will always be an element of private agency for people, we accept that, but there is a body of people who could do additional hours already within the HSE.
So what are we doing? I should be able to come and tell the Deputy much better than I am telling her today. I should be able to tell her exactly where the agency distribution is, what the conversion pathways are, how many different panels there are and what are the delays. I am not comfortable with where it is. I do see more activity regionally, I have to say. I am seeing better evidence at a regional level but I am not seeing it nationally yet. It is not good enough for me and I need to be able to come back and describe it to the Deputy better.
Pádraig Rice (Cork South-Central, Social Democrats)
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Deputy Cahill has an additional question.
Michael Cahill (Kerry, Fianna Fail)
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I referenced primary care centres in Killarney and Cahersiveen earlier, so it is just to push on with those please. The importance of good home care cannot be emphasised strongly enough. What is the budget there? I plead with the Minister to push on with the new oncology unit at UHK, as I mentioned earlier.
To go back to CAMHS - the Minister of State, Deputy Butler, is gone but she can write to me or whatever afterwards - many of the children who were affected are young adults today. Their lives were ruined and it was a very traumatic time for them. On the compensation, I would emphasise the need for families and individuals to be treated fairly, promptly and compassionately. It is the very least they deserve.
On a slightly different note, regarding the long-term vacant buildings, properties and lands in the Minister’s ownership, of which there are many valuable ones in Kerry, I reiterate what we would have called for at council meetings, namely that we should sell them and reinvest. Kerry County Council made numerous inquiries about these lands for housing over the years.
I am not sure whether this is relevant, but the Health Insurance Authority, HIA, was in the media about stamp duty levies being increased by 10% on private health insurance. Private health insurance is going up once or twice every year as things stand. People and families are opting out. They simply cannot afford it. That is something we need to watch carefully and reverse if possible.
Jennifer Carroll MacNeill (Dún Laoghaire, Fine Gael)
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On health insurance, our responsibility here is to deliver a public system and a system that people can depend on in a public way. Of course, there will always be the opportunity if people want to have private health insurance. That is absolutely their entitlement for which they can use entirely private facilities. That is an option for them but our responsibility on this committee and in the Oireachtas is to deliver a public health system that people can be comfortable in accessing and have confidence in, and certainly one in which they can have confidence in the outcomes. We know that we need to improve access and that is a huge focus for us.
On oncology, as I said, I will visit and we will progress that. I want to see it delivered closer to home. That is a key target within Sláintecare.
On CAMHS, I note the Minister of State, Deputy Butler, is gone but she has spoken about Cork and Kerry a number of times to this committee, to be fair.
I am sorry, I cannot remember the Deputy’s fourth question.
Jennifer Carroll MacNeill (Dún Laoghaire, Fine Gael)
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Mr. Tierney will take that.
Mr. Derek Tierney:
I can assure the Deputy if there was any properties surplus to health needs, we do two things with it. We offer it to the LDA, which we are obliged to do, with a section 52 notice. It has eight weeks to respond. If it does not respond, we put it on what we call an interstate protocol which gives every local authority a chance to display interest. They may have budget constraints, we get that, but this is not about speculation or making money. If there is a valid use case, we will shift it.
Pádraig Rice (Cork South-Central, Social Democrats)
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I thank Mr. Tierney. We have two final speakers remaining, Deputies Clarke and Aird.
Sorca Clarke (Longford-Westmeath, Sinn Fein)
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I will go back to the subject of the regional hospital in Mullingar. The Minister mentioned the issue of the recruitment of the dietician. There were also issues some years ago with the paediatric diabetes service and recruitment there. However, I want to focus on the MRI machine. It opened in February 2024. It closed six months later. It was approved for 11.2 whole-time equivalents for staff. In November of last year it was available only for inpatients and it was due to be available for outpatients for quarter 1 of 2025. Are the staff in place?
Jennifer Carroll MacNeill (Dún Laoghaire, Fine Gael)
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It will have the additional staffing. It is open five days with the 11 whole-time equivalents, as the Deputy said. It should be open seven days; that is what we need. It is going to get the additional further seven staff in the early part of 2026.
Sorca Clarke (Longford-Westmeath, Sinn Fein)
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The Minister did mention Ballinderry and the eye clinic, Charter Medical, there. This MRI cost the State €8 million. An additional €1 million was collected from the local community over the years for this. To see it not reach its full potential simply is not good enough. I have no issue with Charter Medical. For full disclosure, I have used the service there myself at the minor injury unit - it is not a personal thing with it – but this is a taxpayer-funded MRI machine. We should not be sending people 3 km down the road to the private one. It does not make any sense.
Jennifer Carroll MacNeill (Dún Laoghaire, Fine Gael)
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I agree, and with the needs of the population, both are probably necessary. They are doing good endoscopies, they are doing good cataract operations, the State is buying those services and that suits the State to do that, but the Deputy is absolutely right in relation to the staffing. Mullingar has a particular tension in relation to the scale of agency. I think it is 40% at the moment. There is an excellent new manager there who is doing extremely good work and I know she is trying to resolve that as well as the IHA managers.
Sorca Clarke (Longford-Westmeath, Sinn Fein)
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And really good staff.
Jennifer Carroll MacNeill (Dún Laoghaire, Fine Gael)
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Really good staff. The other thing is I understand the window refurbishment is nearly complete so we will get those beds back as well which I know they have needed because they have been under pressure in a way they have not been before now.
Sorca Clarke (Longford-Westmeath, Sinn Fein)
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There is one other issue which pertains not only to that area but it is an issue across the midlands is patient transport. If an individual has an appointment to be in the Mater at 7 a.m. on a Monday for cataract surgery, there is literally no way for them to get there. Public transport does not exist. The patient transport route is not operational at that hour. It is pointless to offer people hope, first, and then an appointment, second, that they are never going to be able to take up.
Jennifer Carroll MacNeill (Dún Laoghaire, Fine Gael)
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I am aware of this transport issue right across the board. I have to say a couple of things. The HSE is not a land development agency nor is it a transport company, it is a health company, but I am also aware that the HSE is funding and supporting many different rural transport programmes, for example, the Sligo cancer bus or the services for Cancer Care West which are a combination of volunteer services and State services. At the end of the day-----
Sorca Clarke (Longford-Westmeath, Sinn Fein)
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The point I am trying to make is there is a disjointedness there that needs to be addressed.
Jennifer Carroll MacNeill (Dún Laoghaire, Fine Gael)
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At the end of the day, if you are looking for an appointment in the Mater and you have to be there for a particular reason, we are trying to maximise services. What there needs to be - and I have spoken to the Minister, Dara Calleary and the Minister of State, Jerry Buttimer about this - is a better understanding of the rural transport needs, both for health and disability, because there are a number of voluntary services that the State is partnering with that are amplifying each other, and that is good, but the HSE is not a transport company and never should be. However, it is also true to say that we need a better understanding of the combination of State and volunteer services. I have met Volunteers Ireland to try to get a complete list of all the health- and disability-based volunteer services, where the State is partnering or where it is not partnering.
Pádraig Rice (Cork South-Central, Social Democrats)
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Thanks, Minister.
Jennifer Carroll MacNeill (Dún Laoghaire, Fine Gael)
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I have asked the Minister, Deputy Calleary, and the Minister of State, Deputy Buttimer, who sits between rural and transport, to try to look at this separately. However, it is not a commitment that I can make to the Deputy-----
Pádraig Rice (Cork South-Central, Social Democrats)
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Thanks, Minister.
Jennifer Carroll MacNeill (Dún Laoghaire, Fine Gael)
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-----because my responsibility is to make sure that Mullingar is working well and the Mater is working well but I understand it.
Sorca Clarke (Longford-Westmeath, Sinn Fein)
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They are offering appointments that people are never going to be able to take.
Pádraig Rice (Cork South-Central, Social Democrats)
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Thanks, Deputy.
Jennifer Carroll MacNeill (Dún Laoghaire, Fine Gael)
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My responsibility is to make sure they offer the appointments.
Pádraig Rice (Cork South-Central, Social Democrats)
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Can we have order? We have to conclude on time. I have asked a number of times for people to comply with directions to end on time. Perhaps people could adhere to that, please. Thank you very much.
Jennifer Carroll MacNeill (Dún Laoghaire, Fine Gael)
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Apologies, Chair.
Pádraig Rice (Cork South-Central, Social Democrats)
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Finally, Deputy Aird.
William Aird (Laois, Fine Gael)
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I thank the Chair. I do not often get an opportunity to be at the health committee here. I want to say thank you for all the money that has been put into the Midland Regional Hospital Portlaoise. I had occasion to be there recently and I want to say that the staff work over and beyond the call of duty.
I was a member of the Midland Health Board for many, many years, as a very young person. We had three hospitals in Laois that we used to look after - Shaen, Abbeyleix and Mountmellick. Those were hospitals for older people in our community. At that time, it was a lot easier to get into those hospitals than it is today. It is very challenging for anybody or their families trying to get someone into them. We are in a situation where we could provide more beds in Shaen hospital. I look forward to either of the Ministers, or the whole lot of them together on the one day, visiting Laois if they would like to. They would be more than welcome. I would also like to see if we can do anything for extra respite beds in Abbeyleix which feeds from the Midland Regional Hospital Portlaoise. I would also like to ask about Mountmellick hospital which has an extension on it.
Will we be able to keep all the beds that we have in the existing hospital? I have a huge affinity with Mountmellick because my mother worked there as a nurse for many years. We used to visit her there when we were young. It is a great caring hospital. I take this opportunity to thank everybody who works there.
The other question I would like to ask - because I pass them on nearly a daily basis - relates to the houses owned by the HSE. When I was on the health board, we bought the first-ever house for patients. We were trying to bring patients out of Alvernia House and St. Vincent's in Mountmellick. These were young children and older ones with issues. From the outside, the houses seem to be operating very well. I was a member of many visiting committees when I was on the old health board. Who actually visits those houses now? Who goes out and talks to those of the patients in them who can communicate? Dr. Fullam, who was on my visiting committee for many years, was a very good GP. He was able to interact with patients, which is something I would have had a difficulty with.
Pádraig Rice (Cork South-Central, Social Democrats)
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Thank you, Deputy.
William Aird (Laois, Fine Gael)
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Will the Minister or the Minister of State answer those questions? I thank the Cathaoirleach for allowing me in.
Kieran O'Donnell (Limerick City, Fine Gael)
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I will deal specifically with Mountmellick. A new community unit is currently being built there. On the Deputy's question about the existing building, an eight-bed dementia unit will be retained. As to what is going to happen with the remaining part of the building, I have gone back to the HSE to ask what its plans are. A brand-new 15-bed unit is being built next to the existing building. We will come back with more detail that.
Pádraig Rice (Cork South-Central, Social Democrats)
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A written response to some of the remaining questions would be good. That concludes the committee's considerations.
Pádraig Rice (Cork South-Central, Social Democrats)
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Your time is up, Deputy. You were over time. There are only 26 seconds left. Does the Minister want to say a brief word?
Jennifer Carroll MacNeill (Dún Laoghaire, Fine Gael)
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I compliment the management and staff of Portlaoise. This year, there have only been 15 days on which the red-trolley threshold of ten trolleys has been breached. It has done extraordinarily well, and it is an example to every other model 3 hospital in the country.
William Aird (Laois, Fine Gael)
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Will the Minister come to visit us in the Midland Regional Hospital Portlaoise?
Jennifer Carroll MacNeill (Dún Laoghaire, Fine Gael)
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Of course.
Pádraig Rice (Cork South-Central, Social Democrats)
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I thank the Minister for Health and the Ministers of State for attending and for their engagement. If there are no other matters that members wish to raise, we will adjourn.