Stephen Donnelly (Wicklow, Fianna Fail)
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Healthcare for everyone is a cornerstone of a decent society. I am pleased to report to the Dáil today on the progress being made in making this a reality. If you need a doctor, nurse or therapist; if you need a simple procedure or a complex operation; if you need home care or a nursing home, it cannot matter how much money you have, where you live or what age you are.

Thanks to four strong years of investment from this Government, thanks to a plan to increase capacity while modernising and reform how care is delivered, and most importantly thanks to the efforts of healthcare workers right around the country, we are now well on our way to making healthcare for everyone a reality. Waiting lists and waiting times are falling. The number of people on trolleys is falling. The cost of healthcare for families is falling. Life expectancy has increased. Survivorship from cancer and other diseases has increased. The number of people getting great care every day from our healthcare workers is up.

I wish to thank our healthcare workers. Every day they hear about the challenges. They talk to me, and I am sure to the Cathaoirleach Gníomhach, about how demoralising they find it to hear so much focus on what is not working and so little focus on the good work they are doing. They know how hard it can be for families and patients. They know we have a long way to go. They also know that things are getting better for more people. We all know we have some of the best trained and most dedicated healthcare workers anywhere in the world. I will take this opportunity to say to all healthcare workers in Ireland: we see their hard work, we appreciate all they do and we thank them.

Given the focus right now on immigration, I would like to say something specifically to our international healthcare workers. One nurse and midwife in every two working in Ireland was trained abroad. More than two doctors in every five working in Ireland was trained abroad. I say to each and every one of them: without them, we could not run our hospitals and community services and we could not provide the care to patients that they need every day. I want to say to each and every one of our international healthcare workers that we are lucky to have them. We are proud to have them and we thank them for all that they do in our country every day.

We need to be absolutely clear on the challenges. Too many people are still waiting too long for care. Critically, however, progress is being made. This is the third year in a row that waiting lists will fall. For example, in Wicklow, Kildare and south Dublin, people were waiting about six years to have cataracts removed. They are now waiting less than 12 months and that time is falling. In Galway, Mayo and Roscommon, people sent by their GP to see a urologist were waiting two years for their first appointment. They are now not waiting two years; they are waiting five weeks. In Sligo, women sent by their GP to see a gynaecologist were having to wait for four years to see the gynaecologist. They are now waiting four weeks.

Nearly 180,000 more patients were removed from waiting lists last year than the previous year. We exceeded our target of a 10% reduction in the number of people waiting longer than the agreed Sláintecare ten to 12-week waiting times. The number of people waiting more than 12 months was reduced by a third, and that was achieved in just one year. The average time people were waiting for an outpatient appointment fell from nearly ten months to seven and a half months. Our goal is to bring that down to ten to 12 weeks but reducing it from ten months to seven and a half months just last year is really important progress.

In emergency departments this year, thousands more people are presenting to the EDs but thousands fewer have been waiting on a trolley. Some hospitals, like Kilkenny, Tullamore, Mullingar and Portiuncula, have more than halved their trolley numbers this year compared to last year. We have also cut the amount of money families need to spend on healthcare in Ireland. In 2021, we reduced prescription charges, increased medical card access for the over-70s and extended to two years medical cards for the terminally ill. In 2022, we abolished hospital inpatient charges for children, introduced free contraception for women aged 17 to 25 and reduced the maximum monthly amount families pay for medicines from €114 to €80 in any month. Last year, we abolished hospital inpatient charges for adults, saving families up to €800 per year. We expanded eligibility to GP cards to more than 500,000 people. That means that for the first time ever in our State, more than half the population is entitled to fully State-funded GP care, and that includes all children under the age of eight.

We introduced free national home STI testing services. We expanded the free contraception scheme up to the age of 30. I extended it to women aged 31 at the start of this year in order that no woman who accessed the scheme would age out of it. Last month, I launched the second women’s health action plan, where we extended the free contraception scheme up to the age of 35. The goal is for every woman in the country to have access to the scheme. We introduced State funding for IVF for the first time and I am delighted to be able to report to the House that more than 500 couples have been referred so far for fully State-funded IVF.

Taken together, these cuts to costs for patients amount to a radical shift in moving towards universal healthcare, which means healthcare must be affordable for everyone in our country.

While making sure people get faster access to care and ensuring that care is affordable, it is also vital that we roll out new services. Our healthcare workers are delivering a revolution in women’s healthcare. We have opened new menopause services, fertility hubs, endometriosis services and same-day gynaecology services. We have expanded services in breastfeeding, fertility, mental health and screening. We recently launched Ireland’s second women’s health action plan and this plan builds on the good work under way in the first plan. It means more same-day gynaecology clinics and post-natal hubs, an expanded free contraception scheme, expanded menopause and endometriosis clinics, more resources for eating disorder teams and screening services, and it adds new services in important areas like osteoporosis, bone health and cardiovascular health.

I would like to credit the Minister of State, Deputy Butler, for her leadership on mental health services and older persons' services. The Minister of State, Deputy Naughton, was until recently leading on addiction services and public health services, and now that has been taken on by the Minister of State, Deputy Colm Burke.

We have taken important action on vaping, making it illegal to sell vapes to anyone under 18. We are looking at new legislation, specifically around controls on colours, flavours and banning disposable vapes. Twenty years ago, the then health Minister, Deputy Micheál Martin, introduced the workplace smoking ban. We would all agree that it has saved many lives. Yesterday, I was delighted to secure a Government agreement to increase the age at which cigarettes can be bought from 18 to 21. This has the potential to save many lives into the future.

Capacity and reform are essential to the improvements we are seeing. We have opened a record number of extra hospital beds and primary care centres. We have hired tens of thousands of additional healthcare workers. For every GP retiring, two new GPs are now entering practice. We are making it easier for people to get the care they need in their own communities, rather than having to go to hospital. To do this, we have built a new community health service with thousands of new healthcare workers who are working right across the country. This includes 96 new primary care teams, specialist teams for older people and specialist teams for those living with a chronic disease.

With regard to reforms, one of the most important reforms we have is that last year, we launched the public-only consultant contract. It is a fundamental reform in hospital care. It means more patients treated by consultants; patients being treated quicker and getting out of the hospital quicker; and public hospitals being used to treat public patients. I am delighted to be able to share with colleagues that just one year on since the launch of the contract, more than half of the consultants in the country have now signed up to the new contract, which really is very encouraging.

The investment and reform are working.

Take, for example, children who are referred to see an eye specialist. Before now, in many counties such as Galway, Wicklow, Dublin and many other counties around the country, children who were referred to see an eye specialist had to wait for two to three years for that appointment. They are now being seen in approximately six weeks. Much of the credit for that goes to our ophthalmology teams, as well as innovations in advanced nurse practitioner-led teams in the community, which see many of these children. We will continue with this project including through a clear focus on productivity across our health service. I have no doubt that we need to continue to invest and grow capacity, but it is also very clear to me that there are opportunities for us to achieve higher levels of patient care, given the level of resources we already have. It is a live conversation between me, my Department and the HSE.

Things are getting better but I will be the first to admit there is still a long way to go. There is still much to do. Waiting lists are still too high in too many specialities. When it comes to children waiting for spinal surgery, I know we all agree that we must reach the aim of seeing every child within four months. Quite frankly, that has not happened yet. I have set up a new task force with surgeons and patients right at the centre of what we are doing on it. I provided new funding again this year with the ultimate goal of every child being treated within four months.

Trolley numbers are still far too high in too many hospitals. We are adding more beds, more options for patients and better ways of working. We are targeting the hospitals that make up the majority of the patients on trolleys. I am very aware that colleagues here today will be keen to discuss the ongoing challenges at the emergency department in University Hospital Limerick. As I expect to receive the review by retired Chief Justice Frank Clarke shortly, I will be cognisant of that in my comments. However, I will say that I visited UHL and met its senior team when I was appointed. The team in UHL put up a very clear challenge to me and this Government. It stated very clearly that it needs more capacity. The capacity that should have been added in 2009 had not been added and that was core to the challenges it was facing. The team said they needed more bed, nurses and doctors and they were right. I fully agreed with them and the Government over the last four years has responded to that challenge.

University Hospital Limerick has received more investment than any hospital in Ireland. University Hospital Limerick has received a bigger increase in staff than any hospital in Ireland. In fact, compared with the start of 2020, there are now approximately 1,200 more healthcare professionals working in UHL than there were, and they are making a difference. As well as the 108 beds that have been added, the 1,200 staff and the record increase in funding, we also have more in the works. Two 96-bed blocks are being built on site. A new surgical hub is coming in as well and other capacity is being added.

As we have seen this year, more capacity on its own will not fix this problem. All around Ireland, hospitals are reducing the number of patients waiting on trolleys. They are doing this in spite of more and more people turning up at their emergency departments. By contrast, the number of patients on trolleys in UHL has gone up a lot this year. As the recent HIQA inspection noted, welcome reforms are now under way at UHL but there is a long way to go. Changes in governance and culture are required. UHL needs to implement solutions that we know work in other hospitals but are still not commonplace at UHL.

The new regional executive officer has my full support in working with the hospital team to drive these reforms. We need to see a partnership between the clinical leadership in the hospital and the administrative leadership at a regional level. We need to make sure that the entire hospital sees the patient on the trolley in the emergency department as the responsibility not just of the emergency department but of the entire hospital. We need to continue to drive down the average length of stay. We need to continue to see increases in weekend discharges. We need investment in more patient flow teams and capacity within the hospital.

As colleagues will be aware, I visited UHL recently and allocated an additional 86 beds. That includes 50 beds that we will take for just one year in Tipperary, 20 beds in Clare and 16 modular beds which will be permanent additions on site. This is in addition to other capacity, including longer opening hours of the medical assessment units, having a GP on the door and other capacity as well. Regardless of the extra capacity we have added and regardless of the significant extra capacity that is in train and will become available, the reality is that far too many people are languishing on trolleys in the emergency department while they are waiting for a bed in UHL. Given the big increase in the number of patients on trolleys in recent months, I have initiated a review by HIQA into emergency care capacity in the mid-west region. This will explicitly include consideration of the case for a second emergency department in the region. I will consider the findings and recommendations in the Frank Clarke report before finalising the terms of reference for this review.

I will conclude with just two points, the first of which is to once again acknowledge that we still have a long way to go. It will take several more years to get the health service that people in Ireland need and deserve - a health service where everyone can get the care they need when they need it. The second point is that while most of the debate in this House and the media focuses on the challenges that people face in healthcare - and we understand why that is so - in spite of this, a huge amount of progress is being made. I have no doubt that if we continue this project, continue to invest and continue to support our healthcare workers and patients, we will achieve one of the most important goals that is the cornerstone of our Republic: universal healthcare for everyone in our country when they need it.

Mark Ward (Dublin Mid West, Sinn Fein)
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The Government is far behind delivering on Sláintecare. Sláintecare's vision is to deliver one universal healthcare service for all, providing the right care in the right place at the right time. You would have to be living under a rock to believe this is actually what is happening on the ground. Tens of thousands of children are waiting for assessments of need, appointments for occupational therapy, speech and language therapy, psychology and the list goes on and on. When it comes to providing the right care at the right time, this Government has failed miserably.

There is also a situation where children are subject to a postcode lottery when it comes to care. For example, a child who is living in one part of the country may have easier access to the child and adolescent mental health services, CAMHS, than a child who is living in another part of the State. Care should be based on need and not based on where somebody is living. When it comes to providing the right care in the right place, the Government has also failed miserably.

At this stage, it is not a revamp of Sláintecare that is needed, it is a revamp of the Government that is needed. Only a Sinn Féin Government would deliver the changes in healthcare that our children desperately need. Sinn Féin has the plan to deliver universal healthcare. Sinn Féin has the ability and the ambition. The Government falsely accuses Sinn Féin all the time of not producing plans. In the last year alone, Deputy Cullinane has produced several health policy documents in order that Sinn Féin in government would hit the ground running. These include his consultation document, Priorities for Change in Health and Social Care, which I have to hand and which outlines the solution to the healthcare crisis the Government has presided over. They are ambitious, realistic, practical and deliverable solutions. Sinn Féin has also published another document I have to hand, Caring for the Communities. I can give the Minister a copy of these afterwards if he wants them although I am sure he has them already. This is Sinn Féin’s plan to improve local GP and health services. Also, in my role as spokesperson for mental health, I published Sinn Féin’s document on priorities for change in child and youth mental health. This includes solutions to reduce the waiting times for CAMHS, prioritising early intervention, and delivering integrated, person-centred care.

Another false accusation the Government constantly throws at Sinn Féin is regarding how we will pay for it. They ask where the money will come from. To underpin all that, we also produced an alternative health budget in 2024 and I will also give the Minister a copy of that. The time for change is now. We have seen waiting lists go on and get longer under this Government. It is not just a matter of waiting lists. It is also a matter of having the right access to care in the right places.

For example, if people cannot get an appointment with their GP, they are going to have to attend an accident and emergency department, which is happening more regularly. That is putting more pressure on some of the accident and emergency services we have.

Some of the key points I want to make are that Government has failed to deliver universal healthcare or make significant progress on affordability; medical card eligibility for most people has not been reviewed for two decades; and thresholds have not kept pace with inflation and rising wages. People are being pushed to the pins of their collars. It is very difficult for somebody when they have to go and see a GP. The minimum cost now for a GP appointment is €70. The decision for people is whether to go and see the GP to look after their healthcare needs or pay the rising gas or electricity bill or put food on the table. These are the real-life decisions people are making.

In 2020, the Government announced plans to extend free GP care for children up to and including 12-years-olds. The Government legislated for under-eights, under-tens and under-12s but stopped the funding at eight-year-olds. The monthly threshold for the drugs payment scheme, which reduces the cost of medicines and equipment for families who do not qualify for medical cards, now stands at €80. In 2001, which was 23 years ago, it was €53. That has not kept up with the cost of inflation or the cost of living. It is seriously pushing people to the pins of their collars. They ask whether they should get the medication they desperately need and collect their prescription or pay the gas bill, mortgage or rent. These are the choices people are being left with in the real world.

Universal healthcare is not just about affordability; it is also about accessibility. Existing entitlements are becoming worthless. Medical card holders struggle to find a dentist. It is great if somebody has a medical card, but then they try to access a dentist. Everyone is struggling to access their GP. As I said earlier, if people cannot get the time to see a GP or a GP has not got the ability to see them, they could ring a GP on a Monday and that GP might not be able to see them until the following Wednesday. If a person has a healthcare issue going on, as I said, he or she is more likely to attend an accident and emergency department, which puts more pressure on already pressurised accident and emergency services. The Minister mentioned UHL and places like that. This is happening right across the country. It is happening in my hospital in Tallaght where we see people waiting on trolleys for way too long in the accident and emergency department.

The Government has not capped or removed car parking charges despite promises to do so. I recall when I came here five years ago that this was one of the promises that was meant to be delivered and it has not happened. Half the population continues to rely on health insurance. Delivering universal healthcare is not just about funding fees or reduced costs. It also requires hospital and community capacity and workforce planning. This has not happened. The Minister announced 1,500 beds for hospitals several times, but the Government did not fund them. As a result, hospitals continue to be overcrowded, and the Minister rightly pointed UHL out.

Sinn Féin has a plan. In our alternative budget in 2024, which I showed the Minister a few minutes ago, we had an expansion of 400,000 medical cards. We had plans to cut the drugs payment scheme monthly threshold to €50. We had plans to reduce, cap and work to remove the car parking charges. Sinn Féin would deliver a transparent framework of income-based entitlements that sets out the path to universal coverage. We would diminish the need for private health insurance by investing in the public system, including 3,000 hospital and community beds that are needed to make hospitals accessible. We would bring accountability for workforce planning. This is something the Government has failed to do.

Pauline Tully (Cavan-Monaghan, Sinn Fein)
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The Government is way behind many of the targets set to deliver Sláíntecare. It is failing in the delivery of universal healthcare and not making any significant advancement on affordability. Medical card eligibility, which my colleague has mentioned, has not been reviewed in two decades. For the majority of people, the thresholds have not increased in line with inflation and rising wages. In fact, the thresholds are so low that many people depending on social protection do not qualify. I know they will be given the medical card if they are depending on social protection, but their income on that level is so low that the threshold does not apply. I want to praise the people working in the section who deal with people applying for discretionary medical cards because they are very accommodating and helpful, and they take into account all the circumstances. However, it should be available to a lot more people. The thresholds need to be reviewed and increased.

The Government also announced plans in 2020 to expand free GP care for children up to and including the age of 12. It has since been legislated for under-eights, under-tens and under-12s but so far, it is only funded for children under eight. That is something that needs to be addressed without delay. The amount a person has to pay on the drugs payment scheme stands at €80 per month; it was €53 in 2001. That needs to be reduced. There are a lot of costs and people should not be out that much money on medication on a monthly basis. Automatic entitlement to a GP visit card for people on a median income should be applied as the uptake has been very poor. Accessibility and not just affordability is central to universal healthcare. More and more medical card holders are struggling to find a dentist or GP, making this entitlement worthless. I deal with constituents on a regular basis who, when their GP retires, have no GP to go to, or if people move home, they cannot access a GP service and must travel maybe an hour or more to actually visit a GP. With regard to dentists, again, I encounter people on a regular basis who cannot find a dentist who will accept medical card holders. I engaged with a constituent this week who has a cancer diagnosis and has undergone chemotherapy. Thankfully, she is in remission and doing well, but the chemotherapy has affected her teeth very badly. She has actually maximised the treatment available to her under the medical card. Perhaps there is something I can put to the Minister in writing whereby some discretion can be given to people who have undergone chemotherapy that has affected their teeth very badly so they would have access to more treatment under the medical card than is currently available.

Hospital and community capacity and workforce planning has not occurred. The Minister announced 1,500 additional hospital beds several times. They are not funded. As a result, hospitals continue to be overcrowded. The car parking charges have not been capped or removed despite promises to do so by the Government. Approximately 50% of the population continues to rely on insurance.

In his opening speech, the Minister mentioned mental health and improvements that have happened. However, I am currently engaging with families who are having great difficulty accessing health services, whether that is through CAMHS, in which there are ongoing problems, or elsewhere. There is also a fall-off then when someone in CAMHS enters adult mental health services. There is supposed to be more joined-up thinking in that area, but that is still not happening on the ground. There has to be co-operation. I know one young man of 19 who has attempted suicide twice. He did receive significant help from the CAMHS underage services team, but he has received practically nothing since. Even though he was promised a support plan, it has not materialised. Unfortunately, he attempted suicide and is in a psychiatric unit again. He is threatened with discharge, but he does not feel he has gotten any help and does not feel any different from when he entered. There are, therefore, serious issues. We need community-based supports. Hospital care and inpatient care is not the answer for everyone. We need robust community supports. He did not receive them. If he had, he might not be in hospital again being threatened with discharge. His parents and family are so worried. He is worried about where he is going to end up. He does not want to die, but that is where he is headed if he does not get the help he needs.

Sinn Féin has a health plan to deliver universal healthcare. In our alternative budget for 2024, we proposed an expansion of 400,000 medical cards, cutting the drugs payment scheme threshold to €50 and reducing,capping and working to remove car parking charges altogether. We would deliver a transparent framework of income-based entitlements that set out the path to universal coverage. We would reduce the need for private health insurance by investing in the public system, including the 3,000 hospital and community beds that are needed to make hospitals accessible. I received word from a hospital last week about a lady who is waiting for an appointment for extreme pain in her knee. The hospital received the referral and said that she is on the urgent list and will be seen in eight months. Eight months is not an urgent list. Again, that is something that needs to be dealt with immediately.

If Sinn Fein was in government, we would bring accountability for workforce planning to government level to tackle shortages of GPs and dentists and expand multidisciplinary primary care teams, which are essential components for improving access and providing capacity for universal healthcare. We would work North and South to plan and deliver accessible, affordable healthcare on an all-island basis, leverage the all-island population to deliver specialist services, end the need for outsourcing abroad and prepare for an all-island public health service. The Government is way behind many of the targets set on delivering Sláintecare. We need a new government with fresh thinking to ignite the process of delivering Sláintecare.

Duncan Smith (Dublin Fingal, Labour)
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I am sharing my time with my colleague, Deputy Alan Kelly. I want to acknowledge and support the Minister's words spoke regarding our international workers in our healthcare service. Without them, our health service would cease to function in any way, shape or form. We have all said it before but it is always worth repeating. However, we have massive issues in our health service, regardless of what the Minister set out in his speech. We need to move towards a system of universal healthcare because we do not have it at the moment. The disparity between public and private healthcare in this country is stark. We see it in waiting times and in access to new medicines in a number of different areas, particularly in oncology. If people have private health insurance, their clinician can ring an insurer, ask for a new medicine and that can be arranged in a relatively short time. If they are in the public system, they are not only going through a multistep process for that new medicine, that process can take upwards to two and a half to three years for the reimbursement. That is what a two-tier health system looks like. Unfortunately, what has become apparent to people is that the difference between the two systems is that one can deliver better outcomes while the outcomes are not as good in the other. Unfortunately, the one in which the outcomes are not as good, more often than not, is the public system. That is not something we can stand over. We need to invest further in primary care. The recruitment ban, which has been batted back and forth across this Chamber now for many months, needs to come to an end. The Minister and the Government will say there is no recruitment ban and that too many people have been hired. I and others will say, in a town like Swords, we have not had a social worker for a year and we are not able to hire any more because of the recruitment ban. That is the reality of it. A town of more than 50,000 people, due to grow to 100,000, does not have a social worker. That is what the recruitment ban is. It is nothing else but a ban on hiring front-line staff who need to provide front-line care in their community and there is no way of the Minister spinning his way out of that one.

We have an issue relating to primary care centres as well. Swords is the largest town in Ireland without a primary care centre. One has been promised now for ten years. There has been planning permission for one, which will include a day hospital, but now the HSE says it cannot afford it because the developer says the price that was agreed is no longer viable. How has that level of poor planning been allowed, given the need in that area? The population of Fingal in 1986, one year before Beaumont Hospital opened, was 138,000. It now stands at 330,000, yet we still rely on Beaumont Hospital, which s spread far too thinly.

I will finish on this last point before handing over to Deputy Kelly. There is a major crisis brewing and existing regarding our medical scientists. We discussed medical scientists a lot during the pay parity dispute but we have a situation now that can be resolved somewhat with changes to CORU registration to make it easier for medical scientists to get registered to work in our public laboratories. I will be bringing this to the Minister again in the coming weeks. I am just flagging it here. We have more tests than ever. We have less staff than ever. To highlight this, we have people walking out of the public health system as permanent pensionable workers, to go work for an agency to come back into the same laboratory to work side by side with public staff. The use of agency staff is highly problematic. It should only happen in an emergency. What we should never have is people feeling it is more financially beneficial to leave the public system and work as agency staff. I will bring this up again soon.

Alan Kelly (Tipperary, Labour)
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It will be no surprise to the Minister what I am going to raise with him. I welcome his announcement last week regarding consideration for a model 3 hospital in the mid-west. It is so obvious. The Mr. Justice Frank Clarke report into Aoife Johnston's passing is imminent. I hope that the former Chief Justice will actually recommend same. I hope that will help the Minister to make such a suggestion. However, I cannot stand here as a TD for Nenagh and say that the decision by the HSE with the Minister to take over the community nursing unit, CNU, in Nenagh, funding for which was secured when I was in government, is acceptable. It is robbing Peter to pay Paul. I am just after walking out of my office where I was on the phone trying to get nursing home care for an elderly neighbour who worked hard all his life. That is what I currently do. I do it every week because we do not have enough elderly care beds. This was meant to help alleviate that. This is so wrong. There were thousands of people on the streets of Nenagh protesting against the Minister, his party, his Government and his supporters. One Government TD in my constituency claimed that he contacted the Minister to suggest this. It is live and up on his Facebook page for everyone to see. I have asked the Minister whether this is true. He has never responded, just as like the many parliamentary question to which he refuses to respond. I will let the Ceann Comhairle deal with those.

Thousands marched on the streets of Nenagh because we need this unit. The elderly of Nenagh and north Tipperary cannot be sacrificed for what went wrong when we were screwed in 2009 by Fianna Fáil. The investment was never put in place. The Minister wrote a letter back to me after I questioned the Taoiseach and said that consultation had taken place with the staff, the residents and their families. This is simply not true; it never happened. I raised it with the Taoiseach again and he assured me it would happen. It still has not happened. How can the Minister stand over this? The HSE has been taken through the industrial relations process for a lack of consultation as per the national wage agreements. Can you imagine that is happening? That is happening this week. It is not an acceptable way to behave. People cannot be treated like this.

When this kicked off, it was announced by the HSE that this would only be until next year. Then it was said it would be a year and a half from a contract being announced. By the way, we are a long way from a contract being announced, if ever there will be a contract because I do not know who would ever do this work. Finally, in the past few weeks, the HSE announced it would only be until the new 96-bed block was opened in Limerick, which I think the Minister endorsed. There was only one issue. The HSE said it would be open in the first quarter of 2025. We are now in May. What is the likelihood of this having any impact whatsoever or even being open or taken over and having any impact, considering the 96-bed block is going to be opened in the first quarter of next year? Will the Minister please do the right thing by the people of north Tipperary, and indeed the wider mid-west, and facilitate and make sure our nursing home, which was built with €24 million of taxpayers' money, is given to the people who need it? I am aware of more than 50 people waiting for nursing home care whose cases I am working with other people on. That is not acceptable.

Seán Sherlock (Cork East, Labour)
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Before I call Deputy Cathal Crowe, we are ahead of schedule because one of the speakers did not show up so there is a little bit of latitude for every speaker who goes over time.

Róisín Shortall (Dublin North West, Social Democrats)
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Thank you.

Louise O'Reilly (Dublin Fingal, Sinn Fein)
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That is good to know.

Cathal Crowe (Clare, Fianna Fail)
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I welcome the announcement that HIQA will examine the possibility of a model 3 hospital in the mid-west region. It is so essential and we have had many private conversations on this. I thank the Minister, over the past 18 months, for meeting with Deputy Willie O'Dea and myself one evening in his office. he came down to Ennis and met with the Friends of Ennis Hospital Committee and he met with Angela Coll, the chairperson of that committee just recently in Dublin. I thank him for all that background dialogue and we have had many exchanges here in the Chamber. This is essential for our region. While the Minister's focus has rightly been on UHL and working our way out of the incessant crisis there, there has to be a big picture view for the region. This is moment where the wrongs of 2009 can be addressed. That political decision in 2009 was absolutely and fundamentally wrong and it has haunted the mid-west region every day since. I have never held the Minister r personally esponsible for that. He came into the political sphere many years after it and some of his statements he has made from the very seat in which he sits now, have been very positive in the past year where he has addressed the shortcomings of the period between 2009 and 2024. Funding alone does not work its way out. What happened in 2009 was a systematic winding-back and closure of accident and emergency departments in Ennis, Nenagh and St. John's hospitals. My mother was a nurse. She graduated in St. Finbarr's in Cork and came to work in Limerick in the early 1980s. At the time when she was working in what was then Limerick Regional Hospital, now UHL, the region had five accident and emergency departments - Limerick Regional, Ennis, Nenagh, St John's and Barringtons hospitals.. The population of the mid-west has grown exponentially since. Now we are down to one 24-hour accident and emergency department with 500,000 people being funnelled through that system, compared with Dublin where there are 1 million people who can avail of eight accident and emergency departments.

It is incomparable. Time after time, we have seen funding and investment disparities in the mid-west versus the rest of Ireland. This is the grasp-the-nettle moment for our region, for all the people who have suffered on trolleys and for people who lost their lives in the acute hospital system that is UHL. This is also the grasp-the-nettle moment for the Government. I thank the Minister for leading out that initiative. Many stakeholders brought this point forward. There is a unanimous political voice in the region on this issue and also among civil society. Many hospital campaigners have held rallies and protests. The Minister met some of them. One group that I found extremely constructive from County Clare - I have a Clare bias, naturally enough - is Friends of Ennis Hospital. Rather than just protest, it brought a document to the Minister. I think there were 22 pages in that document, which sets out the problems - it is easy to identify the problems - but also sets out the solutions. I pay tribute to the chairperson of Friends of Ennis Hospital, Angela Coll, and Deirdre Culligan and Cillian Murphy. Their work has been outstanding. That body of work formed some of the backbone of what the Minister, Sandra Broderick from the HSE and HIQA will examine. That is positive.

The Minister will tell me we need to manage expectations, that this is a review and whatnot, but I am going to get a bit ahead of that because I believe there is an inevitability. I used this language in this Chamber only a few weeks ago. There is an inevitability that this has to be addressed. My hope is that this review states loudly and clearly that there is a need for an additional model three hospital in the region. It may state there is capacity in existing hospitals to build that and to add on wings or it may state a new hospital is required. That will come out in due course. That work needs to begin in earnest. Mr. Justice Clarke's report is imminent and it will lead to the terms of reference being devised. We cannot delay too much longer on this. There is speculation that there could be a general election in the late autumn. Some say it could be March. I hope this work is completed by then so that the party the Minister and I are members of can have it in our manifestos and so too can Opposition parties. It has to be in the next programme for government, whoever is in government. I hope it will be the Minister and I and I hope the Minister will still be leading health. Who knows, in the world of politics but politics does not matter here because, for patients and public healthcare and safety in the mid-west, this has to be in the next programme for government. It has to be a deliverable that work begins on a model three additional accident and emergency department in the mid-west. It should be in County Clare, not just for bias reasons. I am not just wearing the Clare jersey. I am not just saying it because I am a Clare representative. Looking at the map of Ireland and where the other model three hospitals and accident and emergency departments are, there is no getting away from the peripheral nature of Ennis and north and west of it. People have no access to accident and emergency departments. A reason given to close down Ennis accident and emergency department in 2009 was that there was not a critical flow of patients to justify remaining open. There were also safety issues but the flow of patients was the main reason. I hope my figures are correct; I think in the last year, presentations of Clare patients was 28,000. That exceeds the very figure used as an argument in 2009. It has now been exceeded. We can only put right that woeful decision in 2009 by reopening an accident and emergency department in the region.

Barrington's hospital in Limerick is up for sale. The HSE or Department of Health should buy it. It is configured as a hospital at the moment. An accident and emergency department cannot be shoehorned in there; that day has been and gone. It is a long time since it was equipped like that. Surely, some elective and day surgery cases that UHL ordinarily handles could be moved to that facility. Knee and hip operations and MRIs and whatever else is required could be moved into the city centre and out of the acute environment of UHL in Dooradoyle. I would love to see that examined. Things do not stay for sale forever. I hope the Minister will examine that.

I wish to raise the issue of postpartum psychosis and post-natal depression. I mentioned them to the Minister many times. Approximately 12 months ago, I raised the issue during Questions on Promised Legislation. We all have some awareness - I say this as a man, so my awareness is less than that of female Members. Post-natal depression is a huge issue. I had very little awareness of what postpartum psychosis involved. There are pretty decent, although not perfect, pathways for treatment and therapeutic support for post-natal depression but postpartum psychosis treatment is sadly lacking. When a woman has given birth, that beautiful baby, unfortunately, becomes the trigger for that psychosis and that deep dark place in her mind. The baby is taken from her and that mother receives acute care in a psychiatric care environment. Last year, I mentioned it with the blessing of a woman who had been through such an experience. She said she was brought into an acute environment where the walls were padded. It was more like an exclusion zone in a prison. The people in her unit were largely people coming down from drug-induced psychosis. There is a woman in room one who has given birth and has postpartum psychosis, and in rooms three, four and five, there are people with post-drug-taking psychosis. It is incomparable. At the end of this stay in an acute unit, the baby is presented back to the mother because she has completed her treatment - here is the baby. She is given back the very trigger that caused that psychosis in the first place. There has to be a better way. There could be a facility colocated on a maternity hospital campus that is more caring and allows the child to be colocated with its mother so it is not just presented back to the mother after three weeks. The child and the mother should both get high quality of care and other family members in that care bubble for the child should be allowed to come in; it resembles a home. All the support and therapy are there to build that mum back up again in a safer environment.

I raise the issue of Newmarket on Fergus GP practice. The Minister met a group from the town some months ago. He was fantastic and there was a good outcome. It is one of the largest towns in County Clare without a GP practice. David Griffin, who the Minister knows well, is a candidate in the local elections. He is an outstanding Newmarket on Fergus man advocating for this. David and I and others in the community have concerns that the bungalow being offered in Carrigoran to host the Saffron and Blue practice has been repurposed. It is now being used for something else. There is a risk of the practice leaving the town entirely. I would love if the Minister's team looked at that.

Through a series of parliamentary questions, I examined the capacity for public dental care in the mid-west region recently. In CHO 3, we have been faring rather poorly compared with other parts of the country. Approximately one third of the target for dental screening for children are being seen. I thank the Minister because I received a very good response this morning from some of the officials in the HSE that beyond any recruitment embargo, there is now authorisation to proceed with the appointment of two full dental surgeons and a dental nurse, with, I hope, more to follow. I do not think it is just in County Clare. I imagine it is in all parts of the country that many private practice dentists are simply saying "No" to the medical card at the moment. People have dental problems that could be fixed; I always think things can fixed. I am no dentist but a root canal be treated, fillings can be put in and teeth saved but people are now having teeth extracted. People are also taking the gamble of booking a Ryanair flight to Poland, Romania or Turkey, wherever it might be, to get cheap dental care. The system works quite well with GPs but not perfectly. If we pay dentists to take medical cardholders, we need to double down on that and make sure they are adhering to contractual arrangements. I am far moreau fait with the contract with doctors; I am less au fait,I must admit, with the contract with dentists. Something has gone very awry because right now, if you phone up and you have a medical card, you are asked on the phone if you have one and then told, "We are very sorry, we cannot see you". Something has to be worked out.

The model three hospital review needs to begin in earnest. I thank the Minister for the leadership he has shown on this issue. He has brought us on a long way more than predecessors in his Department have done for many years. He has shown leadership on this issue. It is now time to follow through.

Pádraig Mac Lochlainn (Donegal, Sinn Fein)
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3 o’clock

The Minister received correspondence late last year from more than 80 GPs and more than 20 consultants in County Donegal about their concerns with Letterkenny University Hospital. I know he met with them and heard face to face the serious concerns they had. As part of the correspondence, they revealed to him that Letterkenny is a model 3 hospital, but the reality is it should be upgraded. Comparing Letterkenny with all other model 3 hospitals in the State, it is clear that we in Donegal are discriminated against. We are failed by the block funding. I ask the Minister to look at that correspondence again. The funding was renewed in recent days and it again demonstrates clearly the need to look at the funding model for Letterkenny. That is the core reason we do not have the nurses, doctors and beds we require.

What I want to raise today, specifically from the correspondence, is the intensive care unit. We have a serious situation with only five critical care beds. There is one extra for overflow and no high dependency unit. There is a single isolation room. There is a lack of an electronic clinical information system. There was a recent examination and there were clear concerns about it. In their correspondence, the GPs and consultants propose an interim arrangement, which is needed, to provide ten intensive care beds on a temporary basis to address what they are facing. That is an immediate ask. I am asking the Minister to seriously consider that. He has the correspondence. I am also asking him to look at this funding model and consider if Letterkenny should be upgraded to a model 4 hospital. I have gone through all of the issues around diabetes and cancer care, the issue with surgeons and consultants, and the fact there is no surgical hub planned for Letterkenny even though it is a bigger model 3 hospital than others that will have a surgical hub. There are many issues and I have little time, but on the issue of the intensive care unit, I ask the Minister to read this correspondence and to engage and meet with its authors as they have requested.

Louise O'Reilly (Dublin Fingal, Sinn Fein)
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I will not say I listened with amusement, but I listened with one eyebrow raised to Deputies talking about what happened in 2009. You would nearly think the accident and emergency departments closed themselves when we know it was the Minister's party, Fianna Fáil, that closed them. They did not close on their own, as appears to have been suggested.

I also listened to the Minister's remarks at the start, and he was dead right to pay tribute to our healthcare workers. They are the glue that holds our health services together. I was privileged to represent healthcare workers for years. They deserve his kind words but, more than that, they deserve to have the recruitment embargo lifted. It was wrong when Fianna Fáil first introduced it in 2007. It was wrong when the Labour Party and Fine Gael continued it, and it is wrong again today. If the Minister does not believe me, he should talk to healthcare workers, and they will tell him. No amount of spin is going to change that. The recruitment embargo is a very poor way to manage staff in the health service. Primary care is the bedrock of universal healthcare. The failure to develop or invest in primary care is apparent right across my constituency. In Balbriggan, County Dublin, a primary care centre was built in fairly controversial circumstances. However, the absence of diagnostics like a scanner or X-ray machine means that my constituents must go to Drogheda or Beaumont hospitals, where they join the many people who wait to be seen by the staff who are absolutely at the end of their tethers because they are overworked. If you live in north County Dublin and need to see a dietician, there is not a waiting list because there is not a dietician. There is no point going on a waiting list because there is nobody to see you. When we look at statistics that tell us eating disorders are on the rise and see how deficient primary care in this area is, it is easy to see why that is happening. We need a funded workforce plan. I fear, actually I know, that it will take a change of government to deliver that.

Róisín Shortall (Dublin North West, Social Democrats)
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I welcome this opportunity for statements on Sláintecare. I do not know why it was not entitled Sláintecare and I do not know why the Sinn Féin health spokesperson is trying to rebrand Sláintecare. Its strength is that it is an all-party policy. That is what gives it real effect. I think we should stick with that and be at one with regard to what we are trying to achieve in this country. I also welcome the progress that has been made in implementing Sláintecare. We have not progressed to the extent we should have. This year, part of that is certainly because of the inadequate budget. I have to say that it is the key responsibility of a Minister and his or her Secretary General to run a strong pre-budget campaign to make the case for adequate funding and to secure it. Unfortunately, that did not happen this year and it is setting back Sláintecare considerably.

Having said that, I welcome the important work that has been done on productivity. The recent assessment of additional funding and staff found there had not been a corresponding increase in productivity. There are some fundamental problems here, and some policies working against each other when it comes to improved productivity. I have to question some of those and I just cannot get to the bottom of them. In my view, however, the more money that is put into the NTPF, the more work that is taken away from the standard working week within our public hospitals. If a lot of work is being funded in private hospitals or public hospitals, then naturally the quantum of work done in public hospitals would seem to reduce. There are two things working against each other in that respect. I understand the reasons behind it, and it is welcome in itself, but the additional funding provided for community diagnostics is being paid to the private providers now springing up all over the place. That is work that should be core to public hospitals, and it is being done outside. Too often we see that the response to waiting lists is to outsource work. That is right across the health and social care system. We will end up in a situation where investment funds own the bulk of our heath service. That is not a place we want to be. It is like what is happening in housing.

Where is the digital health strategy? It was promised last September. It was then promised in March, and we are still waiting for it. While work is going on with aspects of that, there are a lot of people across the health service who are waiting for that strategy or framework to be published. Will the Minister please do it? I hope he is not waiting until closer to the elections. Why is it not being published? It is holding up valuable work that needs to be done.

I spoke to the Minister about public health nurses on the fringes of the INMO conference last week. Often there is not a full understanding of the critical role that public health nurses play. They are the first line of defence for newborns, children and older people, yet they seem to be the least valued within the health service. I tried to get to the bottom of this because one of the impacts is that in large swathes of the country newborns and young children are not being screened at the point they should be. Critical opportunities to pick up conditions that could be treated at an early stage are being missed. I went about trying to establish how many posts there are around the country because it is a postcode lottery. I asked how many posts there are and the vacancy rate. The reply I got from the HSE is that it does not keep records of vacancies. That is incredible. It is another example of how, if you do not measure you cannot manage these things. I have taken it up with the head of the HSE because it seems extraordinary that it cannot tell us how many public health nurse vacancies there are.

A key issue I am now coming across is that while there seems to be an adequate number of places and they are being offered, a considerable number of people are not taking them up because they discover the training allowance is lower than the allowance for other specialist nursing training courses. These are postgraduate courses. People may have family responsibilities, be paying a mortgage and so on and they cannot afford a drop in income. Will the Minister look at that? It is a key problem. This year there are even fewer training places than there were last year. Will the Minister take up that issue?

When will the Government introduce salaried GPs to address the dire shortage that is there? Many young GPs would willingly take on a well salaried post and would be happy to go into public service. They would also be happy to provide out-of-hours cover, which is so desperately needed. For a large part of the 24-hour cycle, people have no choice but to go to an emergency department because fully operational out-of-hours services are not available. There is no blame attached to the GPs who are working during the day, but there should be special separate coverage at night. I ask that salaried GPs be introduced. There would be huge uptake.

On the general issue of outsourcing, when there is a problem the Government goes to the private sector. That might lead to a short-term saving in respect of pension rights and so forth, but ultimately it is not-----

Mattie McGrath (Tipperary, Independent)
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The time is up.

Róisín Shortall (Dublin North West, Social Democrats)
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The previous Chair told us that because we were running behind schedule, there would be a little flexibility with the time.

Mattie McGrath (Tipperary, Independent)
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I was not aware of that.

Róisín Shortall (Dublin North West, Social Democrats)
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There is a dire shortage of dentists and we were told the Minister's response was to put work out to the private sector. That is okay for a short-term stopgap measure. It does not work in the longer term. Will the Minister please try to concentrate on public employees in the public health service?

In budget 2022, 21 neurological nursing posts were approved and 13 of those still have not been filled. The reason is that the approval for the additional nurses only came out of the HSE HR department late last year and there was not sufficient lead-in time to hold a recruitment campaign to beat the recruitment embargo. We are now left with a situation in which 21 nursing posts were approved in 2022 and now, in 2024, more than half of those posts have not been filled and they have been caught by the recruitment embargo. Will the Minister take steps to ensure an exemption is made for those? They should have been filled long ago. The fault is with the HSE, but the-----

Stephen Donnelly (Wicklow, Fianna Fail)
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There is an exemption. They are in disability services.

Róisín Shortall (Dublin North West, Social Democrats)
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I have a response to a parliamentary question that tells me the recruitment embargo is preventing them being filled. I got it last week.

Stephen Donnelly (Wicklow, Fianna Fail)
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Let us talk offline.

Róisín Shortall (Dublin North West, Social Democrats)
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Okay, I will give the reply to the Minister.

This is a no-brainer. There are 860,000 people with neurological conditions.

Mattie McGrath (Tipperary, Independent)
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Go raibh maith agat, a Theachta.

Róisín Shortall (Dublin North West, Social Democrats)
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They need adequate community services. They deserve them, but it is also having a huge impact on the health service, with beds being taken up over a long period and people not being able to rehabilitate, get back to work and so on.

These are the priority areas. I hope the Minister will give them attention.

John McGuinness (Carlow-Kilkenny, Fianna Fail)
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I will focus on a number of issues that are of concern to me and paint a picture of a health service that is not responsive to the issues being faced by families and individuals. I have raised them a number of times and until such time as the services are delivered, I will not be able to say we have a functioning, efficient health service. That is no reflection on the staff on the front line. It is about bureaucracy, the direction of spend, which comes through the Minister to the HSE, and the nightmare of dealing with the HSE for any individual.

The delivery of mental health services is appalling. In my constituency office, I have had numerous complaints from patients and the families of patients that they are not getting the level of service and extent of professional supports that are needed to deal with the issues at hand. Therefore, I cannot say it is a service I have confidence in. We need a new building in Kilkenny hospital to deal with the department of psychiatry. That is programmed in the capital programme. We need to put emphasis on it and deliver it rather than talk about it. While that modern facility is being delivered, the range of professionals that are necessary in any modern mental health service should be recruited. We cannot get young children in to see child psychiatrists. It is absolutely appalling. When dealing with the youngest in society who are challenged in this way, there is an obligation on this House, the Minister and the HSE to insist that those who are vulnerable are dealt with and that the families who know their children need a child psychiatrist are supported. That is not happening and I do not see any changes being made. All I witness is several GPs in Kilkenny referring clients to a child psychiatrist for that psychiatrist to refuse to accept the child for one reason or another. If a GP sees a child and determines he, she or they needs a child psychiatrist and an assessment, no obstacle should be placed in the way of delivering that.

The facilities required by the families of children with autism are one of the biggest problems. There is insufficient focus on that issue. It requires a huge number of various professionals. We do not seem to be making any inroads into recruiting those professionals to deliver the necessary services an assessment has highlighted for any child with autism. Much more needs to be done and greater investment is needed. Again, we are back to the professionals.

Drugs are now a scourge on every community. There is no community that is not affected by them. Families are crippled by having to deal with a son or daughter who is caught up in drugs and the drug barons who threaten the lives of some of those who owe money to them. Despite this, it seems we are not dealing with the issue under the law. We do not have the resources there or through the HSE to support the families of those affected. In fact, in terms of the law, it seems we now can accept a murder, rape, knife attack or beating and it does not raise any heads, whereas before it would not have been common. Now, it is far too common and it is about time the authorities that manage An Garda Síochána woke up to the problems we have in society in that way and look at the drugs epidemic that is the source of many of these problems.

I wholeheartedly agree that primary care is the proper way to deliver healthcare but it needs money. In Kilkenny, people who worked abroad and are now returning home cannot get a local GP to take them on. They either join the queue or are left in limbo. That does not speak to a modern dynamic country and economy. It is backward. Much more needs to be done. If it is a case of bringing back the doctors and nurses who were trained here and giving them better wages and working conditions, so be it.

Spend the money in that way because there is plenty of money being squandered through the health services and through other Departments and agencies. Maybe if we were to manage and plan our spend far better, we would have the services, the professionals and the GPs.

The Ballyhale primary care centre is being held up by the bureaucracy that analyses and assesses it and that has not short-circuited, delivered and properly funded it. The community of Ballyhale and beyond cannot say they have a primary care centre and a HSE that is responsive to all of its needs.

Hospitals will now make a plan with families of patients to take their family member home to be cared for. It is almost as if the hospital will tell the family anything to get their family member out of the hospital bed. The hospital will promise any amount of hours to get the patient home. It will do everything possible to get the person to vacate the bed and once the patient is at home, the services simply fall off a cliff. The services cannot meet the hours and they cannot recruit or deliver. Again, if that is down to money, surely the Department of Health can examine it. I have seen money spent through the HSE that does not deliver value for money and is not worthwhile spending. That needs to be addressed. If it is the case that people need to have home carers or other supports at home, those should be delivered. If they cannot be delivered because of the cost of the professional, worker or carer who goes into the home, then we need to look at salaries. There is no point in failing to deliver a service and then paying outsourced workers an inflated salary to deliver a number of hours of care in support of a family.

Teac Tom is a project in Kilkenny that has applied for section 39 status and funding. It was promised it would be included from January 2024 because it is worthwhile and delivers. Teac Tom has not yet received a response to its application. Will the Minister of State take up the matter with the HSE and the Department and tell me when the application will be processed and the decision made and when Teac Tom will receive its money? This delay is putting enormous stress on the organisation, the families it serves and the individuals who go to Teac Tom for assistance. It is the same story right across the agencies, which face uncertainty about getting funding and having it delivered.

Nursing and care within the Defence Forces are another big issue. Private outsourced nurses are delivering healthcare to Defence Forces members but they are not being made permanent within the Defence Forces. We are paying an outside agency. In spite of pleas to the Minister and the person in charge of James Stephens Barracks to have the individual in question made permanent, it has not happened. The person has been in the job for a long number of years. Surely to God there is an onus on the State to ensure individuals are appointed where it is necessary to do so, including in cases where they are caring for members of the Defence Forces. Many speeches have been made in this House in support of the Defence Forces but with regard to the basic healthcare of Defence Forces members, the staff and professionals delivering these services are not being cared for in their terms and conditions of employment. I ask that this be addressed by the HSE or the Department of Health. It is a necessary service and one that has to be delivered daily. As a result of the trauma now being experienced by those who serve abroad, there will be an even greater demand for mental health services and support services. If we do not have the courage to look at that and make sure Defence Forces members are looked after, then the ordinary citizen of the State has no chance.

In summary, the elderly in our society are being badly served by the HSE. The marginalised and those left forever on waiting lists are badly served by the HSE. I see no real plan to cut all of this down, cut out the bureaucracy and deliver the services that are being demanded.

Denise Mitchell (Dublin Bay North, Sinn Fein)
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The Government has paid lip service to Sláintecare but is miles behind on its delivery. The issue of affordability and a two-tier approach to healthcare is still live. Medical card thresholds have not been reviewed in decades, leaving thousands squeezed by the cost-of-living crisis. We have all heard stories of elderly people who would rather stay at home than attend emergency departments because their previous experiences in EDs was horrific.

The Government's failure to address issues in staffing is having a detrimental impact on patient outcomes. Dental care is inaccessible, with people waiting months for basic procedures. Universal healthcare is not just about affordability; it is about accessibility. Existing entitlements can be worthless when medical card holders are struggling to get access to a dentist or GP.

Sinn Féin's workforce plan would tackle the shortages in GPs and dentists and in multidisciplinary primary care teams. In our alternative budget we proposed measures such as capping the drugs payment scheme at €50 per month, the expansion of medical cards to more than 400,000 additional people and the abolition of car parking charges in hospitals. We need to reduce the reliance on private health insurance by investing in the public system, including 3,000 hospital beds and community beds. Finally, we need to look at our healthcare on an all-island basis with a view to having an all-island system going forward. It is time people started to see action that makes a real difference on the ground in terms of access and affordability for all.

Rose Conway-Walsh (Mayo, Sinn Fein)
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If one lives in Mayo or many parts of the west, the struggle to access neurology services is monumental. The regional inequality and inequity are stark. This is the account from just one young woman who is trying to ease her suffering. She is a 40-year-old mother of three young children living in rural Mayo and suffering with debilitating nerve pain in her face, a condition called trigeminal neuralgia. She cannot access the care she needs. She has been in and out of Sligo hospital where she was left on a corridor in severe pain for over 36 hours and sent home with no help or follow-up. Her GP has done his absolute best but is at the end of what he can do and the young woman has not had a single pain-free moment for over six weeks. She is going back to Sligo hospital again tomorrow to try to access neurology through the emergency department again, and dreading what is ahead of her. Even though she cannot afford to do so, she tried to get a private appointment only to be told the wait is over six months. She cannot live like this for another six months. She is signed off work but is not entitled to illness benefit, which means her husband is now the sole earner, trying to pay the rent and keep the children fed. She needs to sort this pain out so she can return to work as soon as possible. She would appreciate any help in trying to access neurology services so that the pain can be controlled and her life will no longer be on hold.

She said her children are suffering as their mammy cannot function most days due to pain.

How did we get to this? We urgently need consultant neurology services for Mayo University Hospital. Sinn Féin has made funding proposals in its alternative budget for health to fully roll out, staff and manage clinical rehabilitation teams. These teams, if fully resourced and staffed, would provide State-wide coverage of managed clinical rehabilitation services that would fulfil the HSE's strategy and model of care for neurorehabilitation.

Professor Flanagan asked last week how it was that we cannot transfer national strategies into action and how we can free up funds. What is happening is crazy. Every time we come into the House, the Minister will tell us about the amount of taxpayers' money that has been provided for health. There is no accountability, evaluation or measurement of outcomes. There is nothing other than giving money in a scattergun approach, while giving no money to other sectors.

Neurology services in the west have to be funded, in particular in Mayo University Hospital. The next time the Minister, Deputy Donnelly, visits Mayo University Hospital, he should not give it advance warning so it can clear all of the trolleys, have everything pristine and give a wonderful PowerPoint presentation where he comes away thinking that everything is wonderful there. He must lift the bonnet in order to see what is going on and how people are being mistreated in this country.

Gino Kenny (Dublin Mid West, People Before Profit Alliance)
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There seems to be consensus on the concept of universal care. This debate is on universal healthcare or Sláintecare, that is, a national health service. We all try to strive for that system. Such a system has been proven to have better outcomes for everybody. Whether people are on social welfare or are a millionaire, they should have access to universal healthcare. The outcomes are much better in places which have universal healthcare than in systems where there are inequalities and healthcare is based on what people have in their pockets rather than anything else. While you might think that the United States has one of the best healthcare systems in the world, it has one of the poorest in the industrialised world in terms of the outcomes for the population because of the gross inequalities in its health service.

Once people get into the health system in this country, it is brilliant. The nurses, doctors and care assistants are fantastic, highly motivated and well-trained. The vast majority of people will be looked after extremely well. That is really good. Obviously, a huge amount of money is spent on the health system in this country. That is the good part, and I think there would be consensus on that.

There are serious inequalities in terms of health. We have a system whereby 50% of people still rely on private health insurance. There are bottlenecks in the system in terms of emergency departments in the State. There are various degrees of arbitrary treatment in some emergency departments. Waiting lists for surgical procedures, assessments and so forth are huge. I understand Sláintecare is trying to address those issues. There are long-standing inequalities in our healthcare system.

In the 1980s, we had more hospital beds in our public health system than we have now, which is quite extraordinary. There have been huge cutbacks in the health service. That is not a good thing. Once people get timely intervention and treatment, their outcomes are very good. However, when people do not get treatment and timely intervention the outcomes can be detrimental to their health.

Another aspect of our health system is outsourcing and the use of agency staff in the public health system. Huge amounts of money go to the private rather than public system. The private system still exists. There are people in this country who are what I would term Irish oligarchs who make a huge amount of money from private healthcare. I object to that. Individuals make an enormous amount of money from private healthcare, and that is not a good thing.

Deputy Shortall mentioned the chronic shortage of public health nurses in particular CHO areas. In CHO 7, there are no public health nurses at all in certain areas. One would wonder why that is the case, because this is the front line of healthcare for young children and elderly people. Public health nurses cannot rent in particular areas, which has a knock-on effect on recruitment. The embargo is having a knock-on effect whereby CHO areas cannot recruit certain staff. That is a really bad thing.

Public healthcare has been hugely beneficial for society. We have to consider the health system as a societal issue. When people do not receive timely interventions, there are huge divides. We have seen that throughout Covid. If we want to see how our system is divided in terms of class and economics, we can look to our health system. Some 50% of people still rely on private health insurance. Why is that? I am sure the majority would like to rely on our public health system, but they feel - they may or may not be correct – that they can get timely intervention outside of the public health system. That system is fundamentally wrong.

Réada Cronin (Kildare North, Sinn Fein)
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Under this Government, healthcare has become pure hell for those working in the system and those depending on it. Practically every day in North Kildare, people arrive in my office or contact me on the phone in tears due to waiting lists or delays. Since the pain clinic in St. James's was limited so that the space could be used for accident and emergency services, people in agony have been left high and dry. In desperation, I contacted the CEO of the HSE for an appointment for an elderly constituent whose body was contorted with pain. I am glad to say that, following subsequent contact with St. James's, she has received an appointment and I thank the kind and humane staff of the hospital for looking after her. A former member of the Defence Forces in my constituency is in agonising pain. I spoke to him on the phone last week and was not the better for it afterwards. He was very brave but it would put the heart across you to listen to the pain in his voice. The Government is not delivering universal healthcare; rather, it is delivering universal chaos in healthcare.

Medical card eligibility is stranded where it was 20 years ago, with no consideration for soaring rents, rising inflation or wages. The Government might ask what the point is in granting people an entitlement to services when they are simply not available. It is almost impossible to see a GP. Forget about seeing a dentist if you are on a medical card. People have a better chance of getting tickets to Taylor Swift, but there is nothing swift about the Department of Health at the moment. It is never swift to act or deliver. It is not swift about taking responsibility and it is certainly not swift about care.

I agree with the Minister, Deputy Donnelly, on one thing. Delivering universal healthcare also means respecting our immigrant healthcare workers, whether they are surgeons or deliver care to elderly people in nursing homes. There are older people in nursing homes because people cannot mind their parents or grandparents as they are working every hour God sends to pay rent or a mortgage. Immigrant workers are human beings, not service providers, and have been pushed to breaking point and deserve our respect and gratitude.

Sinn Féin has a plan for health and it is a good one. We would provide more medical cards and access to multidisciplinary teams, cut the drugs payment to €50 and cut and cap park charges with a view to removing them. My time is up, and I wish to God that time was up on the Government.

Ruairi Ó Murchú (Louth, Sinn Fein)
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A considerable number of people have said it long before me that we have not seen the movement that we need in delivering Sláintecare and universal healthcare. There is no TD who has not dealt with absolute disaster scenarios regarding people who have just gone through cancer treatment who have suddenly had their medical card rescinded. Constituents go to their TD, the TD goes to the Minister or makes contact and it gets sorted but that is not the way the system should work. That is what leads to dissatisfaction with State services, where people think they are getting a raw deal. We need to make those moves all together.

Medical cards and the idea of universal healthcare is something on which we have reached agreement in terms of where we need to go. However, what we are dealing with at this point in time is not what we need to be dealing with. We have straightforward proposals including expanding the number of medical cards by 400,000, cutting the drug payments scheme limit to €50, reducing the cap and working to remove car parking charges, and delivering a transparent framework of income-based entitlements that sets out the path to universal coverage. That is really where we need to get to and that would diminish the need for private health insurance. Then we could see a greater level of investment in the public system, including the 3,000 hospital and community beds that are needed to make hospitals accessible and to deal with some of the issues. We also need to deal with workforce planning. We need an all-Ireland plan.

I will talk once again about dentists. I previously dealt with Mr. Fintan Hourihan of the Irish Dental Association. He told me of engagements with officials from the Minister's office but he said that there needs to be a replacement for the dental treatment services scheme, DTSS. It is very difficult for people on medical cards to get any sort of dental care and we really need to see follow through. Mr. Hourihan said that he last spoke to the Minister in March or April of last year and while there is some sort of official engagement, we need to see progress. The ball is in the Minister's court and he must issue an invite to everyone to sit down and put in place a system that works. I have spoken many times about the disaster in orthodontic services in the Louth County Hospital. I have seen movement in grade five patients, which are the more serious surgical cases. I will be following up on some sub-categories but that is positive. I also brought other issues to the Minister's attention but what frightens me is a case I am currently working on. A woman contacted my office and said that her son currently has braces on his teeth. She has no idea when they will be tightened to ensure they are working or when they will be taken off-----

Seán Ó Fearghaíl (Kildare South, Ceann Comhairle)
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Braces on his feet?

Ruairi Ó Murchú (Louth, Sinn Fein)
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While they wait, his teeth are at increased risk of long-term decay due to the brace. It is a particular issue that keeps happening and we really need to get on top of orthodontic services.

Seán Ó Fearghaíl (Kildare South, Ceann Comhairle)
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I am sorry Deputy. I misheard and thought you said he had braces on his feet.

Peter Fitzpatrick (Louth, Independent)
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Ireland remains an anomaly in Europe in not providing universal healthcare. While there has been some progress in implementing the proposals set out in the Sláintecare report, much more is required to move towards universal healthcare in Ireland. We need to get to a point where we truly have healthcare delivered free at the point of delivery. Three principles should underpin all of our approaches to healthcare, namely affordability, accessibility and accountability.

With regard to affordability, all of us have received great care in the public system but we also know about the issues with costs. There is no denying that achieving this goal will take investment. It is evident that waiting lists are only getting longer and the resources invested are not being utilised efficiently. We only have to look at the children's waiting list for spina bifida and scoliosis surgery. I acknowledge that €123 million in funding was allocated for the delivery of the HSE waiting list action plan in 2023. This should have facilitated, improved, and broadened paediatric orthopaedic service delivery and access to specialists in the area of neurodisability, neurosurgery, orthopaedics, urology, occupational therapy, physiotherapy, and neuropsychology but it did not. It is estimated that between 20% and 40% of global health spending is used inefficiently. Therefore, it is critical that future investments are targeted in a way that gives them the best chance of delivering for people and society, working to widen access to timely and affordable care. Without the requisite funding and follow through, what if reform just makes the system worse? What if waiting lists get longer, not shorter? The answer to all these questions, put simply, is that reform only works if we work together. The achievement of universal healthcare must be an absolutely central aim of all those who wish to bring about a decent and truly modern Irish society, fit for the next century, including for those who work within healthcare.

To make the transition work, medical staff currently working in the private healthcare system will be encouraged to switch to the new public model. Contrary to the norm, consultant doctors who have been incentivised for years to practise privately would be offered a public-only contract worth up to €300,000 a year under Sláintecare, but would be restricted from seeing private patients in public hospitals. The response is mixed. New consultants may still be attracted overseas ahead of a public-only contract. Existing consultants may prefer the greater freedom and private income of their current contract, and decline to move to the new one. Yet, for this to work, we need to ensure staffing capacity is there to meet demand and successfully implement our targets.

With regard to accessibility, while the Government is committed to delivering universal healthcare, how are we to achieve the Sláintecare commitments with few or no staff? I am dealing with issues in my constituency clinics every week relating to people who are unable to access health services. In 2023, nearly 500,000 people exceeded the Government’s maximum waiting times for outpatient appointments and endoscopies. Just last week I spoke to the family of a young boy who has been waiting for an orthopaedics appointment for three years. The problem is chronic. While inpatient charges for public hospital services have been abolished, it remains to be seen if measures to reduce user charges for primary care services and to tackle long waits for a variety of services will be implemented and will have an impact on the current barriers to accessing healthcare services in Ireland.

We have historically placed a strong emphasis on the role of private care, and consequently private health insurance, in the Irish system. Over the years, the proportion of citizens using private insurance has grown, as people sought protection from soaring waiting times for elective procedures. In 2022, 47% of the population used private health insurance. There is an urgent need to identify the role of private health insurance in a universal healthcare system in Ireland, where access to services is based on need rather than ability to pay. We all know that early prevention saves lives. By meeting people’s health needs as early as possible, from health promotion to prevention to treatment, and keeping care close to their every-day environment, primary health care can help save millions of lives.

In the budget we committed to increasing access to GP care without charge for more than half of the population. This is an important healthcare measure that removes a prohibitive cost barrier to accessing GP care. However, the extensions of free GP care require a focus on building additional capacity in terms of training places and support for GPs. We know the challenges faced by patients in accessing healthcare at every level, including long GP waiting lists and long waiting times in accident and emergency departments. The demand for GPs is unreal. The amount of people who are telling staff in my constituency office that when they ring up their GP they are being told that it could be two or three weeks before they can get an appointment. This is not acceptable. I will be honest and say that the Louth County Hospital out-of-hours service provided by the doctors there is second to none but such services are not available in every town so people end up going to accident and emergency units.

Research suggests that up to 18% of GP visits relate to minor ailments. According to the Irish Pharmacy Union, IPU, the Irish health service has the potential to revolutionise community care by empowering pharmacists and allowing them to operate to their full scope of practice, thus presenting a significant opportunity to eliminate more than 1 million clinically unnecessary GP visits. The IPU said the expert taskforce on pharmacy, established by the Minister for Health in July 2023, is a key resource to drive this transformation. We also need to offer more choice by delivering more services through digital channels, where it is safe to do so. A new digital health strategy, "Digital Health Strategic Framework 2024-2030 " is currently being finalised by the Department of Health. It will set out a shared vision and guide a clear roadmap for investment in digital health, including delivery of digital patient records. The framework will be supported by rolling delivery plans developed by the HSE to achieve the desired level of accelerated digitalisation of health and social care services in future years.

We will never deliver or realise universal free care unless we increase capacity and have a plan to increase training places. Healthcare workers are no longer attracted to what the HSE has become, so we are short of staff. The recruitment freeze and lack of funding in this year's budget will surely have a negative effect on staffing. However, the HSE is to offer permanent contracts to all nursing, midwifery and health and social care graduates, who account for 25% of the clinical workforce and 14% of the overall health service workforce, which will be central to our drive toward universal healthcare and delivering health services for our growing and ageing population.

Another issue to consider is accountability. Progress on the Sláintecare programme is painfully slow, with complex structural and legal barriers. The fundamental problem with our health service is that it is inequitable because it denies care. Patients are forced to borrow money to get an assessment of needs done. Allowing a situation like that to continue drives behaviour for patients and also for medical staff, who are incentivised to set up in private practice. The number one responsibility is to make healthcare affordable and ensure adequate supply. We need to recruit staff.

People's health is their wealth. Healthcare is one of the leading issues today, driven by medicine shortages, a staffing crisis, an ageing population and a stalled modernisation agenda. Ireland's population is ageing and requires a constant stream of skilled staff. Poor wages and conditions have triggered an exodus of workers from Ireland in search of better working conditions and pay. Ireland trains approximately 750 Irish and European doctors each year. In 2022, 442 of them emigrated to Australia, according to the Royal College of Surgeons in Ireland. To reverse this tide, the new model will need ample funding. A failure to make progress will have real consequences for people's health, our society and our economy.

I got a telephone call today from a constituent in County Louth. She told me I can name her son in the House. She provided me with the following details:

My son is Leo Lynch. He is almost nine months old. He was diagnosed with Hirschsprung at birth and needs surgery for this. He cannot pass his own poo. We as his parents have been doing daily flushes since he was born. Surgery for this is usually at around four to five months. His surgery has been cancelled three times. He is booked in again next Tuesday, 21st May, and we have been told there is a 50% chance it could be cancelled again.

This cannot happen. It is affecting the child's health and well-being. Leo's consultant is Professor Alan Mortell in Crumlin children's hospital. I will forward the details to the Minister, Deputy Stephen Donnelly. I would appreciate any help with the case. This child is going through serious pain. His family is going through serious pain. Leo is only one patient but any help we can get would be really appreciated.

Leo Varadkar (Dublin West, Fine Gael)
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I welcome this debate. I am thankful for being provided with some time to contribute to it, both as a Member of the House and a former Minister for Health and former Head of Government. When we talk about universal healthcare or universal health coverage, one of the most important questions we need to ask is how it is defined. It means very different things to different people. Perhaps the best definition is that offered by the World Health Organization, WHO, which is that universal healthcare means, simply, that all people have access to a full range of quality health services when they need them, without financial hardship. The WHO definition further states that all forms of healthcare should be covered, "from health promotion, prevention, treatment, rehabilitation and palliative care". This is achievable in Ireland.

Some people talk about universal healthcare in the context of having an Irish NHS or copying the form of healthcare provided in Northern Ireland and Great Britain. That is not a good model for the 21st century. Whatever about in 1948, it certainly is not right for 2024. In the NHS, north of the Border and across the water, we see a system in which patients wait longer and have poorer outcomes, staff are paid less and social care and healthcare are not integrated. That is not a model we should follow in this State. We see much better models on mainland Europe, including in Belgium, Spain and Germany. In those countries, there are very strong community health services but they are not necessarily free at the point of use. There may be co-payments, refunds or systems whereby everyone is required to have some form of insurance. The services are not necessarily run by the state. In Germany, for instance, hospitals are run by voluntary bodies, state entities and private entities, thereby providing maximum capacity, competition and good value.

The Sláintecare report encapsulates Ireland's ambition for universal healthcare provision. It is a very good report but it has limitations. It leaves many policy questions unanswered. It favours affordability over capacity, which I believe is flawed. It promotes making everything free or almost free ahead of creating the capacity to cope with increased demand. That is one of the flaws that has not been identified sufficiently. The report speaks to four objectives, all of which I strongly support, namely, making healthcare more affordable, making it more accessible, ensuring better patient outcomes and making sure healthcare is integrated and reformed.

I take this opportunity to compliment the Minister, Deputy Donnelly, and his team on the very significant progress made in the past four years. It is probably more progress than we have seen in decades. Of course, he had the money and he has been able to build on progress made by previous Governments. I hope the Minister and his team get credit for what has been achieved in the past four years because it is considerable. I congratulate the Minister of State, Deputy Colm Burke, on becoming part of that team, having previously been Fine Gael health spokesperson.

The first of the four objectives I identified is affordability. We now have free GP care for everyone aged under eight and over 70 and for those in receipt of carer's allowance. The means test is being relaxed to the extent that middle-income, working families can now qualify for free GP care. Approximately 50%, if not more, of the population now qualify for free GP care for the first time, although huge numbers of people who are entitled to it have not yet claimed it. That is an issue we must address. We have seen inpatient hospital charges abolished. Medicine costs have been reduced through the drugs payment scheme, with no household paying more than €80 a month for medicines. There have been real improvements around sexual health, particularly by way of the PrEP programme and the availability of free sexual health testing through the post. IVF is now being funded. Free contraception is available for a lot of women, but not yet all. We have the vaccine programme.

I encourage the Minister and the Government not to forget affordability. We are not there yet. Healthcare is still very expensive for a lot of people. Medication costs, at €80 a month per household, can still be quite high for a lot of people. The cap should be brought down further or perhaps, like Finland, we should have an annual maximum above which nobody has to pay. Another factor to consider in regard to affordability is the difference between a medical card and a GP visit card. The Department argues that the cost of upgrading a GP visit card to a medical card is hundreds of euro. I am sceptical about that, given that hospital charges have been abolished and drug costs have been capped. Over the past couple of years, we have seen the number of full medical cards go down and the number of GP visit cards rise dramatically. The next step should be to convert more GP cards into full medical cards. Frankly, I do not believe the costings from the Department. I do not think the cost is as large as has been stated.

The second objective I mentioned is access. The case for increased bed capacity was well made by other Members. I do not need to repeat it. We also need to improve access to medicines. I still do not understand why so many medicines are reimbursed in the UK, Germany, France and other places long before they are reimbursed here. I say that as somebody who tried to resolve that problem as Taoiseach and Minister for Health and as somebody whose chief of staff knew the pharmaceutical industry very well, having worked there previously. It was a nut we could not crack. It is still not explicable to me, as a doctor or as a politician, why a medicine that was reimbursed some time ago in a relatively parsimonious health service like that across the water in England is not yet reimbursed here. There is a significant problem in that regard.

It is really good to see better access to diagnostics for GPs. It is good to see waiting lists falling for the past two years in a row, thereby bucking the international trend. I hope that happens this year as well. However, we see huge variability, particularly between hospitals. We know from bitter experience that emergency department overcrowding is only resolved when three things are right, that is, capacity, clinical leadership and strong management. If one of those factors is missing, there will be an overcrowding problem. If two or three are missing, there will be a very severe overcrowding problem.

It is good to see the progress we are making in terms of patient outcomes. People are 20% to 40% more likely to survive a stroke or heart attack than they were in 2011. People in Ireland live longer than ever before, with life expectancy now in the top five in Europe. Most people survive cancer rather than die of it. Those things were not the case as recently as 2011. We should not forget the very real progress that has been made. I am disappointed that in some areas, particularly respiratory illnesses such as COPD, not as much progress has been made.

In terms of integration and reform, it is great to see the Sláintecare consultant contract up and running and doctors signing up for it in good numbers. It is good that the regional health organisations have been established. I am not sure whether it is right to put Children's Health Ireland, CHI, under a particular region. It should be a national entity and it should be seen that way. It is regrettable that the regional organisations are not legal entities and do not have their own boards and their own bank accounts.

4 o’clock

One of the reasons schools are generally well run in Ireland is the fact that they have a principal, a board, legal authority, and their own bank accounts. A very large hospital in Ireland might not be able to procure something very simple such as a new set of bins for the offices without having to go to the HSE. There is a lack of autonomy at local level and RHA level.

One of the real difficulties we have is when it comes to IT, which unfortunately is very bad in Ireland. It requires a big investment. We know that when new services are set up with new IT systems, they work very efficiently. That is not the case with the old systems. We need to invest in AI as well, which is going to transform healthcare, particularly diagnostics.

Finally, I want to make a quick point about resources. Of course it is important that we have a health service that is well resourced, not just adequately resourced, but we need push back against people who always use resources as the excuse for problems in our health service. Politicians do not take it on enough. When doing interviews, the media never question it or take it on. There are those who always default and say the reason for a failure or inadequacy in our health service is a lack of resources, money or staff, but it is not that simple. If we just take the big picture, Ireland's health service is now very well resourced. We are mid-table in spending per capita. When it comes to nurses, we have among the highest number of nurses per bed and per head in the world. We are probably in the top five. We are now above average when it comes to the number of doctors per head. For example, we have more than Australia now. We are poor on bed capacity though and infrastructure. In that context the Government is making the right decision by limiting the extent to which staffing levels can increase in our health services. They can add staff this year, but it is an extra 2,000 on top of the 8,000 last year, but it will not work if there is not redeployment and if people's roles do not change because we have a lot of staff. They are working very hard and they are very busy, but we are not getting the outcomes from them that we would get from the same number of staff in other health jurisdictions. That is not their fault. The system needs to be changed and those who resist that change need to be stood up to. For example, in other health services, work that is commonly done by doctors and nurses in the Irish system would be done by medical receptionists, health advisers, healthcare assistants, scrub techs or physician assistants. Those roles are not properly developed in Ireland and a real part of the problem is that we are not getting the best out of our highly qualified people.

We also need a particular focus on more senior staff and more specialist areas. Where public health nurses are appointed and where we have advanced nurse practitioners and consultant-led services, we see dramatically better services than those that operate on the traditional model with one consultant with a very large team of junior doctors backed up by non-specialist nurses. We can see examples around the country where best practice works but it is not being mainstreamed enough.

I accept of course that the Government and the Ministers have an extremely difficult job. If there is one thing that I have learned about politics, it is that describing and identifying a problem is very easy, coming up with a solution is not always that difficult, but actually operationalising it is the real difficulty because that cannot be done by one person, one Department or one agency. It has to be done by 100,000 people working together from the top to the bottom and that is what, unfortunately, sometimes is lacking. Thank you very much for the opportunity to make a contribution, a Cheann Comhairle

Richard O'Donoghue (Limerick County, Independent)
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I wish to share time with Deputies Michael Collins and Mattie McGrath.

Seán Ó Fearghaíl (Kildare South, Ceann Comhairle)
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Is that agreed? Agreed.

Richard O'Donoghue (Limerick County, Independent)
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What we do not have in healthcare in Ireland is accountability. If we want to have proper healthcare, we need accountability. Since I first came to the House I have mentioned UHL. The previous speaker was involved in the appointment of the person who is over UHL. I have sought an investigation into that because of the ongoing crises there. It has been at the top of all the trolley lists for years. If our health system was run like a business, with a person at the top that was accountable, he or she could be fired if he or she did not do his or her job. It does not matter whether the person from the business sector is male or female, once the person is accountable. Their job is to get funding for the medical board, which covers the entire medical sector. If the board gets the funding it looks for and it does not deliver, the members of the board should be removed and others should be put in place to protect people's lives.

That is what should happen, not the situation we had when Aoife Johnston passed away. The person who declared an emergency was asked why they gave the hospital a bad name. Instead of targeting the problem, the person who was looking for help was targeted. The person down the chain, as it were, from the top of the HSE is being targeted and asked why they did that. The person is accused of bringing the cameras and officials in on top of them. We are now blaming the people who ask for help. The management of the hospital are responsible for the hospital and they are responsible for the due care of the people who go to the hospital. We should not target the people who try to help when they are under-resourced and understaffed. When it was a hospital of excellence, it did not take into account the increase in population that would arise and how many counties the hospital would have to serve. We should not target the people who are on the front line. It is management who need to be targeted and held to account and if they do not deliver we should remove them from their position. We should help the nurses, doctors and care assistants who are caring for the people. They should not be targeted if they look for help.

Michael Collins (Cork South West, Independent)
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We do have a very serious health crisis. It is a poison chalice to take on any Ministry relating to health. No one could stand up on the other side of the House and say that things are going well, because they are not. It is a disaster in every aspect of healthcare.

I call on the Minister of State to intervene in the case of some 13 service users in Carrigbeg, Bandon, County Cork, which is run by the Cope Foundation. These adults with special needs are accommodated in Carrigbeg house four nights a week. They now have to return home on a Friday evening until Monday evening as no weekend service is available to them. In some cases, elderly parents are finding it very challenging to care for these adults with special needs. It is totally unacceptable that this is foisted on them. A few of the residents in Carrigbeg have no family to care for them at weekends so they have to go to another Cope Foundation house every Friday until Monday. This is very distressing for these people to have to move out of their homes every weekend. Change and the lack of routine is especially upsetting for people with special needs. They are being forced to do this every weekend and this treatment is inhumane. The simple and obvious solution is for Carrigbeg house in Bandon to remain open seven days a week for these residents. It is their home. It is only right that they can stay there without having to leave every weekend.

I am aware that the business case has been with the HSE for a few years waiting for a decision to be made to open the centre on a full-time basis to accommodate the 13 people. Where are we at in that regard? I ask the Minister of State to intervene in the case immediately.

I could go on forever. There is also the mental health service in Bantry. After years of fighting for them, we are getting rehabilitation and endoscopy units in Bantry but it has taken so long. I have given every minute and every ounce of my being to get these matters resolved for the people of Bantry.

Mattie McGrath (Tipperary, Independent)
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I too am happy to contribute to the debate. It was interesting listening to the former Taoiseach and former Minister for Health, Deputy Varadkar. He provided some different insights. It is a very complex issue. I would not say for one moment that there are not good things happening in the HSE and in hospitals, as there are. I have been in St. Vincent's public hospital myself too many times in recent years and, in fairness, I got top-class service in it. However, there are huge blockages and a lack of accountability, as Deputy O'Donoghue and others have said.

It is shocking what is going on in UHL. Now they have decided to second St. Conlon's community nurisng unit in Nenagh as a step-down facility. They do not know whether they are coming or going. They are like rabbits in headlights. HIQA forced St. Conlon's to build a new place. It took away its licence and gave it a year to get a new facility because it said the other one was so bad. Now HIQA has been instructed by the HSE or someone – it makes a pure farce of it – to say that the existing St. Conlon's unit is okay for some more years.

I wish to raise St. Brigid's in Carrick-on-Suir. Councillor Kieran Bourke and many others fought so gallantly for that. What happened there in the middle of Covid was a shameful situation. It was seconded for Covid and then it was unceremoniously closed down without any accountability. There was no problem with HIQA or anything else. There has been no accountability or no answers about St. Brigid's. It should not have happened. It contained three hospice beds that the community had fundraised for and raised a huge amount. Many people were born there and many of them spent their last days there with excellent hospice care in those three hospice suites.

The funding they have given in has not been handed back by the HSE. It has been promised but not handed back. They do not want the money back; they want those hospice beds returned in Carrick-on-Suir.

I commend Councillor Séamie Morris on his sterling work to help out the situation in University Hospital Limerick and for his fight to save St. Conlon's for the patients who need it and their families who need respite service and long-term care for older people who deserve it, rather than to be hijacked by the HSE to try to put a sticking plaster on UHL.

Seán Ó Fearghaíl (Kildare South, Ceann Comhairle)
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Deputy Connolly is sharing with Deputy Pringle. Then it is Deputy Murnane O'Connor

Thomas Pringle (Donegal, Independent)
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The healthcare system in this country is on its knees and needs a complete overhaul if we are serious about delivering universal healthcare. Waiting lists are constantly breaking record highs and access to sufficient healthcare is becoming increasingly difficult.

Last month, Letterkenny hospital broke another record: the longest ever waiting list for beds. Some 594 patients were admitted to the hospital without a bed, the highest number ever recorded at the hospital for the month of April. The health service in County Donegal and throughout the country is under severe pressure and this is having a detrimental impact on patients and their families, as well as staff. The system is broken and, unfortunately, the Government does not have the energy or ambition to fix it. I do not see why it is such a radical idea to suggest that everyone in this country should have access to treatment when and as needed. We should be prioritising the urgency of care required and not people’s ability to pay.

Many inequalities exist in this country, but the two-tier health system is an absolute disgrace and one of the most shameful examples of inequality in our society. It is deeply unfair that the only people who have a choice are those who can afford private healthcare. Discussions of the creation of a fully functioning public healthcare system are all well and good but this Government has to start taking action on it. I have given many practical solutions over the years that have not been taken up, but I will continue to raise them, because, unlike this Government and its health Minister, I will not give up on the idea of a universal healthcare system that ensures our citizens are treated well and treated equally.

I have frequently mentioned the possibility of collaborating with Cuba to send doctors to Ireland to relieve current pressures on the health service. This is a solution that has been adopted by many countries and that Cuban officials have expressed an interest in, yet somehow it is not even being considered by the Irish Government and I am still waiting to hear a plausible reason for that. The Minister for Health just ignores it.

This shows that the Government has continuously ignored suggestions from the Opposition. It is as if it has no interest in rebuilding the health service or ensuring universal healthcare. The truth is the Government is actively stripping away universal healthcare, with many treatments and services only geared towards those who can afford to pay significantly for them.

When implemented correctly, universal healthcare benefits everyone in society. We all benefit from a healthy society and we also benefit economically when people’s healthcare issues are addressed straightaway and not left to deteriorate further. Every other European country has a universal, single-tier health service. There is no reason Ireland cannot have this too and there is no reason our citizens should continue to suffer under the current broken healthcare system, except it is Government inaction and Government policy to make sure that happens.

Catherine Connolly (Galway West, Independent)
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I welcome the opportunity to contribute, however briefly. I want to put it in perspective for Galway city. I am conscious of what the former Taoiseach said regarding improvements. I acknowledge improvements, the extra consultant contracts, the abolition of charges and so on. However, we have a jigsaw of pieces with no overall picture of universal care. There is a background to that. It is deplorable that we have made very little progress. Yesterday there were 41 patients on trolleys. Which politician in this Dáil, including myself, ever spent time on a trolley? Yesterday in Galway city there were 41; today, there are 48. There was no mention of that by the former Taoiseach or by the Government. How can we talk about universal healthcare if that is the position - 48 people on trolleys? I acknowledge what the Minister for Health said about the number of staff from outside Ireland that keep our health service going and keep our hospitals clean. One in two midwives and nurses have trained outside the country, as well as two in five doctors. It is important to recognise that, given the deplorable discourse going on about immigration.

In 1948, we finally decided we were a Republic and became a Republic in theory in 1949. In 1948, the World Health Organization recognised: "The enjoyment of the highest attainable standard of health is one of the fundamental rights of every human being without distinction of race, religion, political belief, economic or social condition." Why? Because on every level it is good for us. It has an economic benefit because it reduces the need for expensive emergency care and hospitalisation. It provides better health outcomes. It promotes the common good in terms of solidarity and it leads to improved public health, early detection and consistent care, which can prevent problems. On every level, it is good.

The WHO has over the years since 1948 repeated the message of the advantages of universal healthcare to ensure every individual and community, irrespective of their circumstances, receives the health services they need, not based on money. Moving forward to 1978, the declaration of the Alma-Ata conference on primary healthcare recognised health and access to basic healthcare services as fundamental and quoted the WHO. Despite that, Ireland remains an anomaly in Europe in not providing universal healthcare.

In 2011, for the first time ever the Government committed to universal healthcare financed by universal health insurance. I am not quite in agreement with that but it was a major step. Nothing happened and the reform was abandoned.

Fast forward to 2016, when I came in here for the first time and the all-party committee made progress on an all-party policy, but very little has happened since. We now have a fragmented health service following a Progressive Democrats philosophy of making products of everything and selling them.

Today, in addition to those trolley figures, I was on the phone to somebody. This is anecdotal but it is reality. This person, through the privatisation of our health services, had treatment in Belfast, came back, was in trouble in Galway and was told to go back to Belfast because that was where the doctor in charge now was. We have utterly fragmented our service. While that number of people remain in trolleys in Galway city, the Clifden hospital is closed.

I will finish on a tangential but important point. I am aware I am over time and will be as quick as I can on vulnerability assessments for those vulnerable people coming to our shores. There is an absolute legal obligation on us to carry out vulnerability assessments but they are not being carried out. The last time they were carried out, 4,901 assessments took place over a three-week period and 2,712 were deemed vulnerable coming into the country, yet we have utterly stopped those assessments.

Jennifer Murnane O'Connor (Carlow-Kilkenny, Fianna Fail)
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I welcome universal healthcare. It is important, but I want to talk about the basic issues I face every day in my clinics. I have people with full medical cards coming in to me with some doctors charging them for their blood tests. I also have people applying for a grant. When people are aged 66 or over, they can apply to Carlow County Council for a housing adaptation grant or a grant for windows, doors or a bedroom extension. Some doctors charge them for their notes or medical reports. People with a full medical card cannot be paying for these extra letters or for bloods. It does not make sense.

There is another issue I deal with daily. We need to get these important issues sorted first. It is the number of people unable to access home help, dental, orthodontic, physiotherapy, chiropody, podiatry; I could go on all day. For our system to work, we have to ensure people can access the services they need.

I will give an example. Two weeks ago, a lovely man came into my clinic. He worked all his life and, thank God, was never sick and never needed anything. He came of age to qualify for a full medical card. I had to try to find that man a doctor because he was never in need of a doctor. To qualify for a medical card, an applicant must have a doctor, and this man never had one. We went to a lot of doctors to try to help him before we could get one.

On the last occasion, I was going to contact the HSE. We need to make sure that the services on the ground are staffed.

To go back to the issue of blood tests, which is the biggest issue for me, I contacted the HSE a few weeks ago - I am contacting it all of the time – to be told that if people have a full medical card, they should send in the receipt and it will refund them. However, it does not work that way. People are waiting for so long that they could have three or four blood tests done. I ask the Minister of State to look at these services that are needed urgently.

I want to raise the issue of an injury clinic for County Carlow. I met recently with the HSE and it has told me that Carlow will be getting an injury clinic. That is very welcome because at the last census, the population of County Carlow had grown by 9% and it is now nearly 62,000. The people of Carlow use Kilkenny Hospital all of the time and it is a great hospital, but Carlow needs its own injury unit. An example is the X-ray unit at St. Dympna’s, which provides a great service. That unit was recently done up but it is open just three days a week. I am writing to the HSE on this issue. People tell me they have to get a family member or a friend to drive them to Kilkenny to get X-rays because they cannot use that X-ray facility unless they wait a certain length of time. As the Minister knows, with the three-day opening, it is quite hard to get an appointment. These are the issues we need to look at and address.

If someone breaks a leg or something else happens, they might have to go to Kilkenny Hospital. If we had that injury clinic with beds in County Carlow, people could stay overnight and could access what they needed there. It is vital that we have these services in Carlow. From talking to people, I know that when they get into the system and meet their doctors or when they have to go for an operation, it is good because they then have a pattern of going back regularly. My biggest issue at the moment is trying to get people into the system. Like Deputy Connolly, I know of people who are going to the North for their operations because they have been so long on the waiting list. In the cases I have been working on, that has been very successful, which is welcome, but we need to recruit to make sure we look after the people who need it most.

As was said earlier, the good thing is that people are living longer but the problem is that the system is not able to cater for that. We need a proper universal health system that will cater for everyone. I know that good things are happening too and I do not want to be negative, but the issues I am bringing up today are issues I deal with daily in my clinics around County Carlow. I ask that we get some sort of system in place for those people who need it.

Colm Burke (Cork North Central, Fine Gael)
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I thank all Deputies for their contributions. It has been a useful discussion around delivering on a goal that we all share in this House. The programme for Government set out the pathway for expanding universal access to healthcare in a manner that is fair and affordable. The Government has delivered and is continuing to deliver on that commitment. The final progress report on the Sláintecare implementation strategy and action plan shows that unprecedented progress has been made in transforming our health and social care services to provide the right care in the right place at the right time by the right team.

Since coming to office, the Government has delivered the highest level of investment in health and social care in the history of the State. There are more people working in our health service than ever before. If we go back to 2014, there were 103,000 people working in the HSE whereas the figure is now more than 145,000 whole-time equivalents. There has been the widest expansion in eligibility, with more than half of our population now entitled to a GP visit card, as well as reduced costs for patients through the abolition of inpatient hospital charges and through successive reductions in the drugs payment scheme threshold. We have seen significant investment in women’s health through the introduction of free contraception, free IVF testing and free STI testing. The public-only consultant contract has been signed by more than half of all consultants. There has been a reduction in waiting lists and waiting times, as well as expansion in primary care and community capacity, allowing more care to be delivered in the community or as close to home as possible. The restructuring of our health and social care service through the establishment of the HSE health regions will enable the provision of better and more integrated care along regional lines.

While much has been achieved, more remains to be done. I am completely focused on and committed to building on that progress. In the coming weeks, the Minister will bring the Sláintecare 2024 universal healthcare action plan to Government for its approval. The new action plan will aim to provide universal, accessible, affordable, person-centred, safe and quality health and social care for all the people of Ireland. It will deliver more timely access, higher-quality, lower-cost patient care and better health outcomes in partnership with the people who use our services. We will do this by increasing capacity, improving productivity and delivering more efficient and integrated care.

There will be a combination of existing and new programmes and projects. These will include the following: continuing to provide more care in the community through the enhanced community care programme and ongoing investment in community and primary care; implementing the waiting list action plan and continuing to target reductions in waiting lists and waiting times to meet the maximum Sláintecare target times; tackling overcrowding at our emergency departments through the urgent and emergency care plan; and continuing the foundational restructuring of our health service along regional lines.

Over the course of 2024 and 2025, we will review the existing eligibility framework to clearly assess what is working well and to inform policy proposals to enhance eligibility and access to services based on robust evidence. This is an important step towards delivering on universal healthcare in Ireland. The plan will ensure that we can build a sustainable health and social care workforce to meet future population needs for health services. We will also implement our new digital health strategy, Digital for Care - a Digital Health Framework for Ireland, including the roll-out this year of our new digital app. We will remove private care from public hospitals, including through the ongoing roll-out of the public-only consultant contract to ensure increased public-only activity in public hospitals. We will implement the national elective ambulatory strategy through the development of elective hospitals and surgical hubs. The first two of these hubs will open this year in Dublin, with four more to open next year. We will also progress design and planning for the four elective hospitals, with two in Dublin, one in Cork and one in Galway.

We will focus on prevention and public health, supporting people to live well with and without disease by choosing healthy behaviours. This will ensure that our services are safe and high quality. We will invest further in women’s health, older persons' services and mental health. We will listen to people and ensure that the patient voice is heard and that patients are involved in service design and delivery. We will focus on improving productivity, efficiency and performance across the health service. We will build on the success of the Sláintecare integration innovation fund by embedding a culture of innovation within our health service. In dealing with all of this, it is important to note that life expectancy in Ireland is one of the highest across Europe. We need to ensure we make further progress in that area.

The new action plan will be ambitious and targeted. If implemented successfully, I believe it will be transformational.

It will demonstrate my absolute commitment, and that of the Minister, Deputy Donnelly, and Government colleagues, to delivering our promise to deliver universal healthcare for the people of Ireland. I look forward to sharing the plan in more detail with Deputies when it is published.