Mattie McGrath (Tipperary South, Independent)
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Ar an gcéad dul síos, gabhaim buíochas leis an gCeann Comhairle for selecting this Topical Issue, albeit to be taken after midnight.

There is a concerning issue affecting the lives and health of many vulnerable people across County Tipperary, namely, the unacceptable and short-sighted cuts to hospital patient transport services. For many in rural areas of Tipperary, especially the elderly, the sick and those on low incomes, access to hospital appointments in places such as Clonmel, Limerick, Cork, Waterford and Dublin depends entirely on the patient transport services provided by the HSE or voluntary organisations, such as the Red Cross, Civil Defence and the Order of Malta, which I salute for the work they do. These are not luxury services; they are essential lifelines. I have been contacted by families, carers and community groups who are at breaking point. They are being told that transport is no longer available, services are being rationalised - that lovely word - and, in some cases, patients must find alternative arrangements. What alternatives do they have in rural parishes?

Public transport is limited or non-existent in much of Tipperary. Many of those patients are already frail, wheelchair users or recovering from major surgeries. They cannot drive themselves. Their family members may be working or living abroad. The result is missed appointments, delayed treatments and worsening conditions. Ultimately, this leads to pressure being piled back on our hospitals through avoidable admissions to accident and emergency departments.

In one case, a man waited four years - 48 months - for an appointment. He has no family. His neighbour who used to bring him to his appointments passed away a month ago and he had no one else to transport him to Cork. He was too frail to use public transport, as it was non-existent in the first place. A taxi would have cost him €120; half of his pension would have been gone in one appointment. It is such a shocking situation.

In another case, a woman with a paraplegic daughter required an ambulance transfer. This woman literally had no other option. She could not just get a neighbour to drive her. In the end, she was forced to beg a voluntary organisation to transfer her and her daughter to her daughter's appointment, which did happen thanks to the volunteers and the voluntary ambulance.

This is not a question of convenience. This is about dignity, equality of access and the right to timely medical care regardless of a person's address or income. Who made the decision to unilaterally cut this without any engagement? Why were the cuts made with no public consultation, no Dáil debate and no local agreement or engagement? Where is the assessment of the human cost to this? Will the Minister of State commit to immediately reviewing the criteria for access to patient transport services in Tipperary with a view to restoring full service? How can faceless bureaucrats decide this?

When I was elected to this House in 2007, the budget for the HSE was approximately €7 billion. Now, it is €24 billion and growing every year. How come it is affecting the most vulnerable? Earlier, the House spent five hours - Cara Darmody was in the Gallery with her dad - debating people's access to assessments of need and how the HSE was breaking the law hourly by not providing those assessments. Why are we allowing this cabal in the HSE to run amok, do what it likes, neglect people and flout the laws?

Jennifer Murnane O'Connor (Carlow-Kilkenny, Fianna Fail)
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I thank the Deputy. What he raised this evening highlights an issue of concern. I want to give him an update on the patient transport service in County Tipperary.

The patient transport service, which provides non-emergency patient transport for some patients in the south-east region, was set up in 2013. It was set up on a discretionary basis by the HSE for the region. Hospitals there were given a budget to provide limited transport for patients to attend other acute services. The cost of providing the non-emergency patient transport service has increased year on year. The cost for providing this service has grown from more than €88,000 in 2019 to more than €127,000 in 2024. Due to this continued increase, Tipperary University Hospital has had to review the eligibility criteria for patients applying for access to the service. The review of the eligibility criteria is aimed at preserving this valuable service in order that those most in need and vulnerable patients can access it. It is important to clarify that patients travelling for radiation therapy and chemotherapy will not be affected by these changes. There are a number of criteria that need to be taken into consideration by Tipperary University Hospital when assessing a patient’s eligibility to access the service, including the patient’s exceptional medical need, patient’s age - 75 years and older - mobility, appointment and so on.

The Government fully acknowledges the concern and inconvenience for patients and their families that these changes at Tipperary University Hospital have caused. It continues to accommodate the patients most in need of this service in line with the revised eligibility criteria. The hospital robustly assesses patients’ eligibility and all patients must meet the revised criteria before being approved for the transport. It is actually done through the HSE. The assessment of a patient’s eligibility for the non-emergency patient transport service is determined by the local HSE service, which aims to provide for those most in need of access to this valuable service.

The Government has invested significantly in Tipperary University Hospital and the budget for the hospital has increased from almost €81 million in 2020 to more than €122 million in 2025, representing a significant increase of 51% in that time. Staffing has increased by 25% since 2020 from 968 to 1,212.

The cost of providing this important service has increased year on year and it is aimed at assisting those most in need.

Mattie McGrath (Tipperary South, Independent)
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I do not know. I remember six months ago, when the Minister of State was not in government and, like me, she was crying out about this. It is not a massive increase from €88,000 in 2019 to €127,000 in 2024; it is nothing in the scheme of things. The Minister of State mentioned all the extra staff. How many of them are penpushers and executives in made-up jobs - that is what they are - and not nurses or front-line staff? It is a shocking situation.

A month ago, I stood in Clonmel in front of St. Joseph's Hospital for the opening of the Slievenamon wing. I met a number of new executives, many of whom were from the Minister of State's area. I mean no disrespect to them, but they had positions that we never had before, namely, executives, directors of this and that and directors of everything, except patient care. We are taking on people - of course we are - in management jobs.

Self-serving officials: that is what is wrong in the HSE. We have spineless Ministers who will not challenge them. We have spent five hours tonight talking about it here, all sides of the House condemning what is going on in the HSE. We have these mean, hungry, desperate cuts to vulnerable people. Thankfully, they will get radium injections or other treatment. What about a person who is paraplegic or an amputee? What about the people who have severe diabetes or many other conditions? We are picking and choosing who is sick and vulnerable while we have fat cats getting fatter and we have board members of the HSE, the runaway cost of the children's hospital and the disgraceful, diabolical lack of management and accountability.

Then we make these mean cuts. We talked about the dirty dozen cuts by Charlie McCreevy in the past. This is so mean-spirited and we expect voluntary organisations like the Order of Malta, Civil Defence and Red Cross to burn out their ambulances and staff, who are volunteers, while officials and fat cats go around the conferences and everything else. Bring back the matrons to the hospitals to make the savings and have the hospitals clean, not plethoras of management who are not managing. They were never managers in the first place. Some of them got into those jobs by pull. It is a shocking situation when we treat vulnerable people in our society like this and the Minister of State cannot argue against it.

Jennifer Murnane O'Connor (Carlow-Kilkenny, Fianna Fail)
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I thank the Deputy for raising the issue and giving me the opportunity to update him on transport in County Tipperary. The Deputy mentioned the Red Cross, Order of Malta and Civil Defence, and it is important we pay tribute to the great work they do. They are excellent. It is important the Deputy recognised them and that we all recognise them. I assure the Deputy the HSE and Tipperary University Hospital are committed to providing high-quality service in response to local needs. Tipperary University Hospital has reviewed the eligibility criteria for the non-emergency patient transport service so the most in need and vulnerable patients can still access it.

Non-emergency transport patient calls are planned for patients who require transport in a special converted taxi or minibus to attend pre-arranged medical appointments and who do not require a stretcher-equipped vehicle. The patient transport service was set up in 2013 on a discretionary basis by the HSE and provides non-emergency patient transport in south-east region hospitals. There is a budget there. I understand the Deputy's concerns. I will go back to the HSE and see whether it can be looked at. I understand there are vulnerable people out there. It is important to reiterate this is HSE-led. I thank the Deputy for highlighting the serious concerns he has raised.