Maria Byrne (Fine Gael)
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I welcome the Minister of State, Deputy Niall Collins, to the House and thank him for coming in to discuss these important issues.

Teresa Costello (Fianna Fail)
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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featured older residents in my community who had to reduce their attendance or stop altogether once HSE support was withdrawn.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.

Niall Collins (Limerick County, Fianna Fail)
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I thank the Senator for giving me this opportunity to speak on behalf of my colleague, the Minister for Health, and outline the progress being made by the Government in this area. The promotion of physical activity for health is a priority under the Healthy Ireland framework, Ireland’s national strategy for improving the health and well-being of the population. This was evidenced by the publication of the national physical activity plan in 2016. Substantial progress has been made in the implementation of the 60 actions set out in the plan, co-led by the Department of Health and the Department of Culture, Communications and Sport. They are supported by a cross-sectoral implementation group that includes a range of other Government Departments and agencies. Healthy Ireland has used this collaborative approach to inform its support for Sport Ireland, which targets initiatives that promote population levels of physical activity and those with a health dimension. The Department of Health also directly supports national governing bodies for walking, cycling, swimming and running, as well as organisations to promote physical activity such as Parkrun, Age and Opportunity and Men’s Sheds. Increasing physical activity levels in children and young people is a priority. The Departments of Health, education and sport and their respective agencies are collaborating extensively to promote and access physical activity and sport in schools. This joined-up approach is crucial to the roll-out of continued development of the active school flag programme.

The first iteration of the 2016 plan has now reached the end of its timeframe. A successor framework and action plan has been developed and is in the process of being submitted to the Government for approval and publication. The framework seeks to put in place a range of longer term aims and objectives underpinning the need for consistent and coherent policy responses across a broad range of stakeholders to 2040. This recognises that the drivers of behavioural change are complex and challenging. The achievement of the objectives of this framework will be driven by a series of action plans. The first national physical activity action plan will cover the period to 2029 and sets out 59 commitments across a range of stakeholders and sectors.

ExWell is one of a range of organisations providing community-based exercise classes for chronic disease populations. These include patient support organisations, not-for-profit organisations and the publicly funded network of local sports partnerships across Ireland. The HSE works in partnership with many of these organisations to ensure access to exercise provision for adults living with chronic disease. Occasionally, the HSE has established formal working and funding relationships with ExWell Limited to provide access for patients to its exercise programmes. The cost structure of any programme administered by ExWell is a matter for that organisation.

The Department of Health is also working closely with the HSE on the design and implementation of a physical activity pathways in healthcare model of care, which will provide a structured physical activity programme for people with chronic disease or long-term health conditions, with a focus on building their skills and confidence to engage with and maintain recreational sport participation independently. Any future engagement with ExWell Medical will be considered in the context of these structures.

Teresa Costello (Fianna Fail)
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I thank the Minister of State for his response. In the next iteration of the national physical activity plan I would like to see a focus on exercise for older people. The benefits to people of being more active are a no-brainer. People in my community are worried about being able to afford their ExWell sessions. They are living on a pension and trying to make the positive change we all talk about. Cost is a barrier. The Minister of State mentioned that the HSE has occasionally established formal working and funding relationships. These are in situ. I know the physical activity pathways in healthcare model of care. I would be interested to see if that mirrors or is similar to the service provided by ExWell. If something is already working, we should use it to the fullest of its capabilities.

Niall Collins (Limerick County, Fianna Fail)
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As the Senator mentioned older adults, I will outline what my colleague, the Minister for Health, has been doing to make physical activity opportunities available to this group. Physical activity for older adults is promoted by Age and Opportunity, a national development organisation working to enable the best possible quality of life for this population group. This organisation is a key stakeholder for Healthy Ireland and is supported by the HSE and Sport Ireland.

Age and Opportunity has a number of dedicated physical activity programmes, which I will mention. For example, the physical activity leaders, PALs, training programme is provided for anyone interested in physical activity initiatives in their community. Similarly, CarePALs training programme is available for those working or volunteering in care settings to lead suitable physical activities with people in their care. FitLine is a volunteer-led telephone mentoring service, which provides callers with information about clubs, groups and facilities in their area. Healthy Ireland is working with Age and Opportunity and other partners on developing walking football for older adults. This is becoming increasingly popular and has great potential for further development. I again thank the Senator for the opportunity to provide this important information to the House.