Michael Cahill (Kerry, Fianna Fail)
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We all know that, no matter where you live geographically, there are pros and cons that affect your quality of life. We can have priorities like living close to family or remaining where we were born and reared. Perhaps you visited a place and fell in love with the scenery and people. In any case, you will need to access to the basic human requirements of air, food and shelter where you live. However, without access to the health service, many who have chronic ailments that require regular treatment with modern equipment under the supervision of a health professional simply will not survive. I propose that, as a matter of priority, the two stunning peninsulas of Corca Dhuibhne and Uíbh Ráthach, Dingle and Iveragh, in County Kerry be used for a pilot study or research vehicle into all aspects of the health service being delivered to their residents. I call for this pilot study to be initiated in Kerry, which has issues, so that it can be used as an educational tool that could be rolled out to similarly remote areas all over Ireland. I foresee this project identifying the reasons it is so difficult to attract staff to these areas given that it is cheaper to live there.

We should clarify why all areas throughout these regions are struggling to receive adequate health services, including mental health services, day care, primary care, respite services and palliative care and have difficulty in keeping hospital beds open in the community hospitals in both Cahersiveen and Dingle. Dingle hospital, or West Kerry Community Hospital as it is known to many, opened in 2010 and, to this day, it has never been fully operational. There are ongoing campaigns to get these beds open. Meanwhile, patients from the region are being placed in places such as Kenmare Community Hospital, which is a five-hour round trip. This is absolutely ridiculous. The town of Cahersiveen does not even have a primary care centre. This is a huge issue for the entire peninsula. Many residents in Iveragh are up to 100 km from the accident and emergency department at University Hospital Kerry. Why is it so difficult to get staff to these community hospitals for our mental health services, ambulance services and so on?

Residents of these peninsulas have to travel long distances to receive the standard of service they deserve. That is discriminatory to many of them. They regularly have to utilise the health facilities in University Hospital Kerry in Tralee or those in Cork city. For some, this could entail a round trip of up to 340 km. They also regularly have to utilise the health facilities in Limerick hospital and in hospitals further afield. This can take its toll on patients physically, mentally and financially. In an era when we are striving to reduce greenhouse gases, it also has a large impact on the environment.

Health hubs and centres of excellence play a big part in the delivery of health services in Ireland. I accept that this may be best practice but I am a firm believer in researching other delivery options. The health services in remote areas pilot scheme I am proposing would investigate a hybrid model that could be amalgamated with the present system to improve the lifestyle and health of all our residents. As the Minister of State will know, some areas of our country, particularly along the western seaboard, are really remote and accessed mainly by narrow winding roads. That is part and parcel of their charm and beauty, but many old, young and debilitated patients need to be constantly ferried to and from hospital appointments, which sometimes takes its toll on the entire family. This pilot scheme in the Iveragh and Dingle Peninsulas might provide a window into solutions, big or small, that could help ease stress in many families throughout rural Ireland.

Hildegarde Naughton (Galway West, Fine Gael)
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I thank the Deputy for raising this issue. I am taking this question on behalf of my colleague, the Minister, Deputy Jennifer Carroll MacNeill. The Minister and the Government continue to make progress in improving access to meet the health needs of rural and remote communities. Sláintecare is the roadmap for reform of our healthcare system. A key milestone is the organisation of the HSE into six health regions. This took place last year and a phased transition to the new structures continues. Each region is now empowered to plan and deliver services tailored to the needs of its population. At the same time, we must maintain a national health service with consistent standards across all regions and communities.

I will outline how the health regions are structured to deliver on these commitments. Regions will adopt a population-based planning approach based on the specific needs of their areas. A population-based approach to service delivery emphasises prevention and early intervention. This complements existing programmes such as Healthy Ireland and Sláintecare Healthy Communities. The HSE’s population-based planning framework provides principles and key steps for the teams doing this work. For example, regions now have detailed publicly available population health profiles. These draw on census data and cover both the region as a whole and smaller community health areas of approximately 50,000 people. In addition to planning, we must ensure our workforce is equipped to meet these evolving needs. For example, the University of Galway has recently developed medical and pharmacy education with a specific focus on rural healthcare.

This focus on the broader determinants of health promotes integrated care across all levels of service. Integrated care means patients experience smoother transitions between services with better co-ordination and improved outcomes. To achieve this, the HSE is rolling out the next phase of its integrated service delivery, ISD, model. This is a central part of the health regions reform. Staff are now being reconfigured from care group teams to integrated teams which serve defined geographic areas. There are 20 integrated healthcare areas, IHAs, across the country, including one for the county of Kerry.

Each IHA has a dedicated senior manager at national director level. The IHA manager is responsible for all health services delivered in their area. This reconfiguration promotes joined-up care and accountability across primary, community and acute services.

The Deputy raises the possibility of a study on the health service needs in the Iveragh and Dingle peninsulas. However, this is exactly the kind of insight that the new local teams are designed to address, with support from experts in the HSE centre.

In the south west, the HSE is implementing innovative solutions to improve access in rural areas. Mobile clinics, telehealth services, and digital infrastructure are bringing care closer to people's homes. The telehealth roadmap and the digital for care 2030 framework are expanding remote consultations and health monitoring. These initiatives reduce travel time, improve access, and support continuity of care for rural patients and service users.

While these innovations are promising, the Department of Health recognises that workforce remains a key challenge, particularly in remote and hard-to-reach areas. Under the new HSE structures, the HSE south west is now able to recruit and retain staff across all service areas within their allocated budget.

Michael Cahill (Kerry, Fianna Fail)
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Every week since I have come up here, I am consistently raising issues pertaining especially to the peninsulas that I have named, Iveragh and Dingle. I am also a member of the joint health committee, and I am consistently raising the issues there as well. It is every week, as there is always some issue. By and large, it is in relation to staffing, be it for home care, daycare, primary care, palliative care, mental health as I mentioned already, or respite. Beds remain unopened in both the West Kerry Community Hospital and Cahersiveen Community Hospital. As I mentioned earlier, patients are being relocated to community hospitals far away and families have to spend half a day travelling to see their loved ones. It is not good enough. For that matter, these two areas in particular seem to have more problems than any other part of Kerry. I ask the Minister to look closely at the issue and to carry out a pilot study. It is the very least that the people of Kerry deserve. Everyone should have access to the same level of high quality service as people who are living in our capital. I ask the Minister of State to ensure that this matter is taken on board. I would like to see both Corca Dhuibhne and Uíbh Ráthach being used for pilot studies for the benefit of the entire country.

Hildegarde Naughton (Galway West, Fine Gael)
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I will raise the issue as well with the Minister for Health. The Department of Health encourages regional teams to explore service models that reflect the realities in their communities. It is important that the regions learn from one another and that they share best practices. Such work can then inform broader strategies for improving care in remote areas right across the country.

Looking ahead, this regional innovation can inform national strategy and strengthen service delivery everywhere across the country. Patients need health and social care services that are responsive, integrated and locally informed. The health regions are now empowered to lead on the planning and delivery of community-based care. My colleague, the Minister for Health, thanks the Deputy. She looks forward to working with him and collaborating with him to improve healthcare in the Kerry area.