Teresa Costello (Fianna Fail)

I welcome the opportunity to raise the matter of ExWell Medical. It is a transformative, medically supervised exercise programme supporting people right across our communities. ExWell was founded in 2019 by Dr. Noel McCaffrey, following on from an initiative at Dublin City University. Since then, it has grown and now serves more than 7,500 participants weekly across 48 centres nationwide, including several in south Dublin. The programme often operates in community centres and local authority venues. Its aim is simple but profound: to reverse the physical and social deconditioning that occurs with chronic illness through structured, safe and supported exercise.

What makes ExWell different is its medical grounding. These are not just fitness classes but clinical interventions. Participants are inducted, assessed, monitored and supported by over 70 clinical staff. The benefits are clear, and include improvements in cardiovascular health, strength, balance, mental well-being, reductions in isolation and, ultimately, less demand on our acute hospital services. This is the essence of preventative healthcare. It is Sláintecare in practice, being community led, inclusive and person-centred. Cost barriers are, however, placing access to this programme at risk for many of those who would benefit most. At centres like Citywest, classes were fully funded until 2022, but are now charged at €10 per session or €70 to €80 a month. For pensioners attending twice weekly, this is up to €40 per week, which is an unsustainable cost for many on a fixed income. A report in The Echo newspaper last year featured older residents in my community who had to reduce their attendance or stop altogether once HSE support was withdrawn. They described the programme as a lifeline, not only for their physical health but for their mental health and social connection. While some local authorities have been able to partially subsidise the programme, this varies hugely by region. We now have a postcode lottery, where access to preventative health supports depends on where people live and whether they can afford to pay.

We know that exercise is medicine. ExWell is delivering measurable clinical outcomes that reduce pressure on hospitals and GPs, but we cannot expect it to succeed if we continue to treat it as an optional extra rather than a core public health service. I ask that the Department of Health and the HSE engage with ExWell Medical to review the funding structure, with a view to reinstating or expanding central support, especially for in-person programmes where medical supervision and social engagement are so impactful. I also ask that the Department request greater transparency on cost structures across centres so we can better identify gaps and target supports to those most in need. Preventative healthcare should not be a luxury.