Marie Sherlock
Question:6. Deputy Marie Sherlock asked the Minister for Health her plans to strengthen the inspection and regulatory regime in HIQA; and if she will make a statement on the matter. [34932/25]
Ceisteanna Eile - Other Questions
Regulatory Bodies
We are all reeling from the revelations about Beneavin nursing home and the nursing home in Portlaoise in recent weeks. It is clear that HIQA has given a wide berth to nursing homes when it comes to its inspection regime, which is in sharp contrast, I might argue, to how other authorities regulate, such as the Food Safety Authority and the Health and Safety Authority. I wish to hear from the Minister and Ministers of State as to how the inspection and regulatory regime will be strengthened within HIQA.
I will answer on HIQA specifically and ask the Minister of State, Deputy O'Donnell, for his perspective as well. HIQA plays a crucial role in ensuring high-quality and safe care for patients using our health and social care services. The Government strongly supports HIQA in maintaining and strengthening its critical regulatory role. While it provides an important role, it also needs improvement. A number of changes to both primary and secondary legislation have been made in recent years to expand and reinforce HIQA’s functions. Under the Patient Safety (Notifiable Incidents and Open Disclosure) Act 2023, HIQA’s remit has been expanded into private health services and hospitals. Other legislative amendments have strengthened the regulatory framework in nursing homes, giving HIQA additional new powers in the areas of enforcement, data collection and compliance notices.
My Department has committed significant financial support to HIQA, reflecting its expanded regulatory role. The budget allocation of non-capital expenditure from my Department to HIQA in 2025 is €35 million, which is a considerable increase of more than 60% compared with the €21.4 million allocation in 2022. It is likely HIQA’s regulatory responsibilities will expand further under future developments, such as the patient safety (licensing) Bill, the provisions of which I took to Cabinet this week.
I met with HIQA last week. Along with the Minister of State and I, it is considering what is needed to further strengthen its regulatory role and processes, in particular to reflect the changing dynamic of the nursing home market and sector and the ownership structures within those. That is important. I will continue to work closely with HIQA in reviewing its powers and exploring ways to improve and strengthen its inspection and regulatory regime. As I said, that includes exploring how HIQA can best deal with regulating larger corporate entities that operate in the nursing home space.
It is important to say - and I know the Minister of State, Deputy O’Donnell, has been strong on this - that there is a need to report in real time, rather than some months later. We must have better visibility over this at an earlier stage. HIQA is an important institution in this State which has done exceptionally good work. I have good confidence in it. Everything, be it this House, HIQA and everything else, needs process and institutional development improvement in response to these events.
I thank the Minister. There are four clear systemic issues within HIQA at the moment, notwithstanding that it is a much-trusted institution in the public's mind. That confidence has been dented, however. Clear legislative change and clarity are needed in four areas. The first issue is in regard to the licensing. I welcome what the Minister is saying about the licensing of corporate institutions and their intervention into the market. The second issue is the inspection regime. There is a large degree of ambiguity as to the point at which HIQA can intervene on the basis of an individual complaint or its own inspections. The third issue is enforcement. It is crazy we are having this debate about whether it can fine. While HIQA has powers to go to the District Court, it has never used them. The final issue concerns liability. There is a glaring gap in that regard. Liability on the part of directors does not appear to be pursuable. While staff are going to be pursued for wrongdoing, and rightly so, there must also be liability on the part of the directors.
The Deputy and I have engaged intensively at the health committee. I will go through the points she raised. With regard to the licensing, there is absolutely a lacuna there at the moment. Within a group of companies, the licensing inspection is on individual nursing homes and who they are run by, but the parent company is not under HIQA's remit. I want that to be changed. There is an acceptance in that regard.
In respect of the inspection regime, HIQA does an inspection on the day. When it publishes its report, which might be a number of months later, it is based on that inspection. I want to see that report updated with the current position of the nursing homes and whether they have complied with any conditions required of them under the inspections. That makes common sense.
In the context of HIQA’s enforcement powers, it is correct to say that HIQA cannot issue fines directly. We have no issue in this regard. It is something HIQA recommends and we very much support.
When it comes to liability, these are all areas we are looking at. The key thing is that HIQA has acknowledged the need for change in terms of updating schedules. We will work with it on that.
There is an added piece with regard to leadership. In the responses at the health committee last week, in the instance of Beneavin nursing home, there is 100% non-compliance with fire safety systems in that building. We were told that it does not relate to the structure, but rather only to the fire systems.
If the fire systems are not fully operational, there is an immediate fire risk. It may not happen today or tomorrow, but it could happen at some stage and there is a very real patient safety risk. To hear that sort of response and lack of urgency on the part of the leadership of HIQA is deeply troubling. There needs to be very clear action taken to ensure that the leadership team of HIQA is fit for purpose.
The context here is quite simple. I always go back to the needs of older persons in nursing homes. What we saw in that programme with the residents in the nursing homes in Portlaoise and Beneavin was wanton neglect and abuse of older people. We want to look at the regulatory system and how we can improve it. All aspects will be considered. This is ultimately about improvements and ensuring that older persons have the right and entitlement to be in nursing homes that are safe. We are working with HIQA to ensure that we enhance the regulatory system.
It is exceptionally important to acknowledge that our focus here is on HIQA, but HIQA did not do and did not enable what happened in the nursing homes. I want to take a moment to reflect on the fact that the provider and the individuals involved are ultimately responsible. We will also work with HIQA but let us first and foremost direct our ire at the providers of the nursing homes.
Medicinal Products
Shane Moynihan
Question:7. Deputy Shane Moynihan asked the Minister for Health if the Belgian model is being examined in the context of the programme for Government commitment to investigate early access schemes for rare disease treatments; and if she will make a statement on the matter. [34617/25]
The Minister is no doubt aware of the cases of those who suffer with Duchenne muscular dystrophy, a matter which has been raised in the Dáil a number of times, as well as with the Minister directly, not least because of the Thompson boys in my own constituency. This has brought into focus the need for an early access scheme for rare disease drugs. I know there is a commitment to this in the programme for Government that has been discussed before. What considerations is the Department is taking into account? Is it looking at other models internationally of how such a scheme might be applied?
I recognise the importance of timely access for patients to medicines, including new medicines. Supported by €128 million of funding, in the past four years the State has delivered access to 194 new medicines. Of these, 74 were for cancer and 49 were for rare diseases. Budget 2025 allocated €30 million for new medicines, to come from efficiencies to be identified by the HSE.
The Government has introduced a suite of new measures to enhance capacity in the HSE’s pricing and reimbursement system, including 34 additional staff, which is a 100% increase, and a medicines application tracker to increase the transparency and efficiency of the process. Access to medicines requires industry and the State to work together, through timely assessment, reasonable pricing and fully completed health technology assessments. This partnership has already directly benefited patients, for example those with cystic fibrosis and other rare diseases. In this spirit of co-operation, I continue to encourage pharmaceutical companies to submit timely applications for their products so as to increase access for patients with unmet needs. It is also the responsibility of the HSE to improve its efficiency and it has been enabled to do that with the provision of a 100% increasing in staffing in that area.
All medicines are assessed from a clinical, economic and ethical standpoint, with no hierarchy of disease. Upon approval by the European Medicines Agency, applications for reimbursement are assessed by the HSE in the order in which they are received from applicant companies.
As outlined in the programme for Government, as the Deputy correctly identified, consideration will be given to various measures to address access to medicines. As part of this, my Department is looking at reimbursement systems across the European Union, including Belgium. We are working closely with our Benelux partners on access to medicines where we have had some previous success.
It is great to hear about the progress that has been made in implementing the recommendations of the Mazars report on this subject that was published some years ago. That goes to the heart of the extra resourcing that the Minister spoke about. She is right; there needs to be a partnership between industry and the State to make sure that these applications are put through immediately and that the HSE can adjudicate on them accordingly. I am very encouraged to hear that the Department is considering other systems internationally, like the Belgian model. This model is particularly interesting because it shows a way in which timely access to these drugs that is not necessarily contingent on EMA approval can be provided. That is based on EU Regulation No. 726/2004. Article 83 of the regulation provides access to medications that are in late stage clinical development, expected to receive EU marketing authorisation and targeting patients with serious conditions. If we had those sorts of parameters for a scheme focused on early access to rare disease drugs, it would be a game-changer for many families that are afflicted with these conditions.
I want to put a little bit of context on this. The State spent more than €3 billion in 2023 providing medicines to patients. We sometimes forget that €3 billion of the health spend goes to providing medicines. That is appropriate but it is a major budgetary consideration as well. With the early access programmes, we have to get the balance right between being able to get access to the drugs and also being able to work out how that programme intersects with the State's ability to negotiate the right price for the drugs.
Regarding Duchenne muscular dystrophy, which the Deputy mentioned, I do not see how the State could be more proactive in trying to support this. On approval from the European Medicines Agency, I asked the CEO of the HSE and the Secretary General of my Department to find ways to support this. The HSE has proactively reached out to the company to ask it to submit an application. I made it my business to speak with the Italian Minister of Health at the EPSCO Council in Luxembourg to ask him to encourage the company to submit an application to Ireland. We will do everything we can because we recognise the life-changing implications of some of these drugs. However, as Minister, I must also point out that we have to get an early access programme right in a way that enables the State to get the best negotiating price for the delivery of drugs for everybody.
I appreciate the efforts of the Minister in this regard and I have conveyed that to the families involved. I am very grateful for the Minister's proactive approach. The beauty of getting an early access scheme right is that it does not necessarily rely on the proactivity of the State to be involved in that process but, rather, the partnership is hardwired into every piece of the system and the State is empowered to get value for money but also to ensure timely access to these drugs. In many cases of patients with rare diseases, time is the issue when it comes to stopping the deterioration of their conditions. I ask the Minister to keep us updated on the Department's progress in looking at these international models and to ensure that the best practice we learn from those is applied in any such Irish case.
I will do so, Deputy.
Questions Nos. 8 and 10 taken with Written Answers.
Hospital Procedures
Ruairí Ó Murchú
Question:11. Deputy Ruairí Ó Murchú asked the Minister for Health the mechanism by which parents whose children were and are deemed to need hip dysplasia surgery at CHI hospitals at Temple Street and Cappagh will be able to get independent second opinions by experts of their choosing paid for by the HSE; and if she will make a statement on the matter. [33749/25]
I want to ask the Minister the mechanism by which parents whose children are deemed to need hip dysplasia surgery at CHI hospitals such as Temple Street and Cappagh will be able to get independent second opinions by experts of their choosing, paid for by the HSE? I have spoken to the Minister on this previously and I believe she was working with Bernard Gloster on finding a solution to this issue, which is absolutely necessary.
I agree completely with the Deputy. However, my immediate priority is to ensure that there is clinical follow-up and care for patients who have undergone pelvic osteotomy surgery in accordance with the recommendations of the Thomas audit report. I am very aware that there are families around Ireland who are receiving letters and follow-up to say that surgery was not necessary on their child. I cannot imagine the distress that those families experience when they receive that sort of communication. I have spoken to families who are having that experience and it is so utterly distressing for them.
Clinical follow-up to skeletal maturity for children in CHI Crumlin, CHI Temple Street and the National Orthopaedic Hospital Cappagh, NOHC, is already under way for patients. These children have been identified and categorised by age, with a proportion of them being close to skeletal maturity and likely to need just one appointment. The clinic is structured as a one-stop multidisciplinary team model for assessment, and that includes consultation with a doctor, a physiotherapy assessment, an X-ray, if clinically indicated, and immediate documentation of findings. After this, patients enter the recommended normal follow-up process.
As of Monday, 23 June 2025, 115 appointments have been offered to CHI and NOHC patients. A total of 86 patients have been booked and 71 patients have been seen so far. Patients who request attendance at another hospital or with another consultant will have their request facilitated by CHI. It is important to say that the consultant who did the surgery is not the one who is doing the review, in the clinical follow-up. I will get to the expert review as well. I just want to make sure that this is on the record.
In relation to the retrospective reviews of cases, which is the second process, to determine the indications for surgery and whether they were warranted, the HSE is establishing a separate process, involving external experts. Professor Deborah McNamara, the president of RCSI, has agreed to assist the HSE in establishing the expert panel and terms of reference.
I have more information for the Deputy on that.
I do not think anyone will disagree with the assertion that we have had an absolute disaster and failure around children's care. Many have gone through operations they did not need. We need to deal with those children and make sure they are reviewed correctly and properly from a medical point of view and that they get the correct pathways afterwards.
I bring it up and brought it up before because I am thinking of a case in my constituency. A mam has three kids, two of whom had the operation. She has the question mark over their care, whether they needed the operations and all those terrible questions she is dealing with. She has another child who was to have an operation. We are talking about osteotomies. Her issue previously was it was delayed. Most people would believe what a medical expert tells them about whether an operation is needed.
I thank my colleague for tabling this question. We recently had CHI and the HSE in the committee on this issue. In the Gallery were representatives of the hip dysplasia advocacy group. Afterwards, I met one of those dads in the car park, a young dad and an awful nice guy. He was in a ball of tears. I do not know this man. I had never met him before and he had never met me. That is the level of distress these parents are under - crying to a perfect stranger in the car park of Leinster House. It is not something I ever thought I would see or something I ever want to see again.
I ask the Minister for two things. First, will she meet with the hip dysplasia advocacy group? Second, the HSE gave me a commitment that day to make all supports available to the parents. I ask that each and every one of them be offered psychology or counselling supports, given the level of distress these parents are under.
My practice, as much as I possibly can, is to meet people. Like Deputy Clarke, I have met parents and seen the distress. I have parents in my constituency in this situation. There is no difference between our experiences of this. I cannot believe the distress being experienced by the parents of the 71 children. We are already identifying children. Parents are being told through this initial clinical follow-up that their child did not need this.
I will now update the Deputies on the expert review process to follow. We are in the process of establishing that panel. It is not complete but there are a number of experts from Canada and the United Kingdom. It is not surgeons within the system; it is very different. The clinical review follow-up, the first process, is expected to take about six months and for the secondary review panel, the independent expert one, it will take until September for the establishment of the team. We have four at the moment and there are a number of others to come. They need to agree the terms of reference; it is not for us to impose the terms of reference on them. They can assess each case as appropriate once they have begun.
I appreciate the timelines. The clinical review is six months and the Minister is saying it is September for the expert review process. The terms of reference are not set. We would like to think this will deal with the issue of the considerable timeline that would need to be taken into account, the huge number of cases and the disparity. In the case of my constituent, can we find a process to ensure she can get the follow-up care for her daughters and can get an independent review she can trust in relation to her other child, who has been told she needs surgery? Trust is at an all-time low in relation to CHI. We need this work done as soon as possible. I ask the Minister to take into account many of the cases we have brought forward, particularly the parents who got reviews and, on that basis, did not go ahead with operations. I brought an issue like that to the Minister previously.
I do not know the exact details of the Deputy's constituent's case but for any child now indicated for surgery, the assessment is done in a very different way from how it happened before. Any such assessment is done by a multidisciplinary team, including a doctor. It is a cross-site piece of work including a physiotherapist assessment. It is not, as had been the case, that an individual consultant makes decisions in his or her own bubble. This is a multidisciplinary team. The Deputy's constituent or any Deputy's constituent who has a child indicated for surgery can, depending on the timing, get the assessment through the multidisciplinary team. It is very different from what was there before. I hope that will give her more confidence where she has questions relating to her child.
I agree with Deputy Clarke on counselling and psychological supports. Parents who take the advice of clinicians do so in the best interests of their child and now feel they have done something wrong in following that advice. It is a devastating thing to happen to a parent who is only trying to be a good parent and take the right decisions. They need support as much as their children do. I totally recognise that.
Disease Management
Naoise Ó Muirí
Question:9. Deputy Naoise Ó Muirí asked the Minister for Health the status of the chronic disease Mmnagement programme; the number of patients now enrolled; and if she will make a statement on the matter. [34666/25]
The GP chronic disease management programme commenced in 2020 and has been rolled out on a phased basis over four years to adults with either a medical card or, for GMS patients, a GP visit card. The aim of the programme is to prevent and manage chronic diseases. Since 2020, over 680,000 patients have been registered on the programme, including those who have exited the programme. Some 91% of patients now receive routine care in community settings, reducing their reliance on hospitals. An ICGP study found that for patients enrolled in the treatment programme, there were 30% fewer emergency department attendances, 26% fewer hospital admissions and 33% fewer GP out-of-hours attendances compared with their pre-enrolment rates.
The majority of patients manage their conditions through the GP chronic disease management programme. In addition, the 26 operational community specialist teams for chronic disease management, linking the care pathways between acute and community services, are delivering services from integrated care hubs located in or adjacent to primary care centres. They are fantastic. In 2024, over 354,000 patient contacts were provided by community specialist teams for chronic disease management, about 55% ahead of target, and this year to the end of quarter 1, 108,000 patient contacts had already been provided by these teams, which is about 30% ahead of target.
The conditions covered by the programme are type 2 diabetes; asthma; chronic obstructive pulmonary disease, COPD; and cardiovascular disease. The treatment programme supports patients in managing their chronic conditions. Patients receive two reviews in a 12-month period, with each review including a practice nurse and a GP visit. GMS patients over 45 years of age found to be at high risk of cardiovascular disease or diabetes are enrolled in the prevention programme and receive one annual review. The prevention programme was expanded from 30 November 2023 to include adult GMS patients with hypertension and all women who have had a diagnosis of gestational diabetes or pre-eclampsia since 1 January 2023.
I am looking at this programme and it seems to be a quiet success story for the HSE. We hear very little about it. The Minister mentioned statistics regarding fewer presentations at emergency departments. That is a very good measure of success. The Minister mentioned some additional conditions that will be brought into it. I think she mentioned hypertension. It would be useful to have that list.
I see from the HSE's report that the overall uptake is pretty good but it is probably behind for younger sufferers, mainly because it has not been open to them for as long. Are there plans to promote it or make those patients aware they have this option? It is a very good option for those patients.
That is right. It impacts early detection as well. As populations age - which ours is doing - the prevalence of chronic conditions, including multimorbidity, rises. Early protection through the chronic disease management programme prevents the need for more intensive hospital-based treatments. Since 2020, 51% of the new chronic disease diagnoses have been made through elements of this programme. It is not just treating more effectively; it is diagnosing more effectively and being able to divert attention to prevention and early intervention.
As regards expansion of the scheme, a further expansion of the programme to include chronic kidney disease is planned for the end of the year, and further expansion would include rigorous clinical assessment and engagement with stakeholders. Not all chronic conditions can be managed in that way and it is important to recognise the capacity of general practice and how we are trying to grow general practice at the same time. I have listed a number of conditions but I also want to flag that, for example, the Benbulbin hub in Sligo treats a range of different illnesses and it is separate from the hospital, and again and again, prevents hospital attendances.
Dental Services
Ruairí Ó Murchú
Question:12. Deputy Ruairí Ó Murchú asked the Minister for Health the progress made by the orthodontic services waiting list initiative for grade 5 patients; the location and number of successful tenderers; the number of patients it is anticipated will be seen in 2025; and if she will make a statement on the matter. [33748/25]
This is a particular issue and there is huge cohort, in particular in the Louth hospital in Dundalk. Those with grade 4 issues were dealt with but those with grade 5 issues, which were more serious, were not. Obviously, the longer we leave this the greater an issue it is. It needs to be dealt with.
I can update the Deputy on the orthodontic waiting lists. As of April 2025, the HSE employs 14 consultant orthodontists and 36 specialist orthodontists nationally. There are almost 35 oral healthcare vacancies at the moment which the HSE is working to fill, including three specialist orthodontist whole-time equivalents, and a further 2.22 dental nurse whole-time equivalents. There are staffing challenges within orthodontic services in the Dublin and north-east region.
At present, both specialist orthodontists posts in Dundalk, which also serve counties Cavan and Monaghan, are vacant. The HSE is sanctioned to fill those posts and is actively pursuing both temporary and permanent recruitment options. A locum consultant orthodontist post is also being considered. The region also has orthodontic units in Navan and Ashtown, which have a combined total of two consultant orthodontists and five specialist orthodontist whole-time equivalents, currently filled and providing care in the Dublin and north-east region. The HSE is engaged to address the best use of existing funded private procurement options to support delivery of orthodontic care in the region.
Gabhaim buíochas leis an Aire. Could the Minister come back to me regarding the waiting list initiative? We have submitted multiple parliamentary questions on this. This was one of the solutions. There had been a huge number of vacancies. It is positive that attempts are being made to fill these positions but we need to make sure it happens as soon as possible. I saw movement on those who were seen as grade 4 patients and who needed that orthodontic dental work done, but my fear is that those who fall into the grade 5 bracket have a greater medical need and the longer they are left, the greater the issues there may be. I accept the Minister might not have the answer in front of her, but I would appreciate it if she could come back to me with the specifics of this initiative to deal with the waiting lists. We need to make sure there is no hold up and slow down in filling these vacancies related to orthodontic services because the impact this could have could be serious.
I totally recognise that and I commit today to writing to the Deputy with a full answer on these points. However, as regards the waiting list initiative, there is €8.4 million for this year, provided on an ongoing basis this year to address the primary care waiting lists for children, including in orthodontics. The funding is ongoing rather than one-off and is provided to try to reduce the waiting lists and address increased demand for those services. In the area of orthodontics in 2025, €1.35 million is to be invested in the jaw surgery initiative, while €1.5 million is to be invested in the community-based treatment initiative. Up to the end of May, 128 patients had been transferred to private orthodontic treatment, with 33 receiving jaw surgery under that initiative. A higher number of grade 5 patients are commencing, progressing and completing treatment than grade 4, and I recognise the very serious impact that has, particularly on young people, and the need for timely surgery. I will come back to the Deputy with a complete and full answer.
I appreciate the Minister's response. We need information on timelines and tenders so that we can see light at the end of the tunnel in terms of delivering for those patients. The Minister accepts that we are talking about those with the most serious orthodontic need. The sooner that happens, the better. Otherwise we could be talking about people who need far more acute care, which will be a cost to them and their families and to the State. We need to ensure these initiatives, which have been promised, are up and running and work as soon as possible, while ensuring that those vacancies that exist in respect of orthodontic services, particularly in the Dublin and north-east region, are dealt with. This is an issue constantly raised in my constituency office. There is even communication from time to time from those who work in the services who see the stress parents are under as well as the pain and anguish children go through in these circumstances.
General Practitioner Services
Naoise Ó Muirí
Question:16. Deputy Naoise Ó Muirí asked the Minister for Health the progress on increasing the number of GPs and GP practices across the country; and if she will make a statement on the matter. [34667/25]
General practice plays a vital role in our health service but we need more GPs to improve access to services in some areas. To meet that need, the programme for Government has committed to increasing the number of practising GPs through a combination of increased training places and international recruitment. In part, to attract doctors to practice as GPs here, the Government has significantly increased expenditure on general practice, primarily through the 2019 and 2023 GP agreements. The agreements provide for increased fees for GPs, increased and new practice supports, and new services for patients, including the GP chronic disease management programme we spoke about.
The number of doctors entering GP training increased by 80% from 2019 to 2024. As a result, the number of GPs graduating has also increased and will increase more in the next few years. Evidence of strong interest in GP training and high-retention among GP graduates shows the positive impact of the Government's increased investment in general practice.
In addition, recruitment from abroad continues under the HSE and ICGP international medical graduate rural GP programme. Under the programme, doctors work in general practice while undergoing a two-year training programme. Currently, there are 118 such GPs in placement, while a further 18 have completed the course. The number of HSE-contracted GPs has increased by approximately 7% since 2020, although this is a key-target area for growth.
The recent ESRI publication on the future capacity requirements for GP services confirms the need to continue to increase our GP workforce in light of our growing and ageing population. The strategic review of general practice will be completed this year and will provide further recommendations to improve GP capacity and the sustainability of our general practice service.
I thank the Minister for her response. There is an assertion out there that GPs are being trained and are then leaving the country. My colleague, Deputy Colm Burke, tells me that is not the case. The turnover of GPs is typically 5% to 6%, which is very low. The Minister has laid out the potential GPs entering the system through the various channels which is really positive. Perhaps the Minister could deal with the assertion they leave as fast as they come in and that they go abroad the minute they qualify.
My own Dáilcheantar, Dublin Bay North, is quite mature. We have a particularly difficult issue, in that I am contacted a lot by constituents looking to register with a GP, in particular younger people moving into the area and looking to register with a GP practice but who cannot do so.
What we are talking about is the continued need to expand GP services, as we have pushed more and more services into the community and that is where we want services, such as the chronic disease management programme we discussed, to be delivered. It is the case that the number of GPs is increasing, albeit at different rates in different regions, but we have a particular challenge in rural Ireland. That is one of the reasons there is now a dedicated programme in the University of Galway. It is a specific rural GP programme to address some of the different slightly specialised issues. That is why I met the Medical Council recently. It was to address such cases as those of Irish people who trained in this system and got three or four years' experience abroad, who come back to Ireland and wish to work as a GP immediately. We need to make sure those people's registration process is triaged and expedited by the Medical Council, there being no reason those people should not be activated to work, as they wish to do and their communities need them to do, as quickly as possible. I have a good detailed list of the number of HSE contracted GPs. It is increasing. It is an option that was clearly identified in the programme for Government. Not everyone wants to set up a business. Some people want to work in a different structure and we are trying to enable more and more of that.
I support that, given that there are different models clinicians will want to work under. As the Minister said, not all of them will want to take the risk of setting up a GP practice with everything it entails. The Minister mentioned the chronic disease management programme. That is a classic example of where GPs have helped to make a big difference and it is clear from the HSE's assessment that they have been key in all the outcomes the Minister mentioned earlier.
Will the Minister comment on the issue of GPs leaving and whether it is a factor? She may not have that information today. It would be useful if she could share it at some stage so that we can deal with the issue that GPs seem to be leaving. I do not believe it because I know many of them and they are still here.
In fairness to the Irish College of General Practitioners, it has done a huge amount of work as regards having more GPs trained and putting in place a programme for people who have worked abroad and now want to work in Ireland. It has a two year programme whereas for the normal training, people would have to produce evidence of having worked abroad.
One of the things we need to fast-track in a lot of areas, especially growing urban areas, is the provision of primary care centres so a whole range of services are available. One of the things that is happening with GPs is that they are specialising. Therefore, it is important that a primary care centre is in place to provide a whole range of services and it allows GPs to deliver a far more comprehensive service in an area. The Department should work further on and encourage the HSE to deal with the issue of delivery primary care centres in a timely manner.
I agree on the delivery of primary care centres. It is difficult for me to speak in general terms about GPs or other medical staff leaving because there will always be a case of someone who has done that. It is not the general trend of what we are seeing. There is clearly work here. There is the opportunity to set up a business and work in one's own practice. There is the opportunity to work in HSE primary care centres and other more directly employed opportunities, that is to work in different ways and there is clearly a need for that. Notwithstanding that, the contracts in 2019 and 2023 were favourable and there is an opportunity to continue to expand practice. There are now direct diagnostic referrals from GPs to try to get GPs operating at the absolute top of their practice and experience. It is very attractive.
On the recent dialogue in the Dáil about the cost of living and some of the challenges in the price of groceries and other things, it is a source of great frustration to me that we have expanded eligibility for GP access cards to 430,000 people and only 72,000 of them have taken it up. We have tried to communicate. We will do more to try to communicate, but I ask every Deputy to communicate to their constituents as there are people who are entitled to free GP access cards. We are delighted to pay for them and it would be wonderful if they would take it up.
I will go back to Question No. 13 and Deputy Carthy.
Hospital Equipment
Matt Carthy
Question:13. Deputy Matt Carthy asked the Minister for Health if she will ensure that a CT scanner and MRI scanner are located within Monaghan Hospital. [34678/25]
I thank the Cathaoirleach Gníomhach for his latitude.
The Minister may be aware there has been a long saga in respect of Monaghan hospital since emergency and other services were removed by a previous Fianna Fáil Government. Will the Minister help with the evolution and redevelopment of Monaghan hospital by ensuring there is a CT and MRI scanner located on the hospital campus?
The Government is fully committed to the ongoing development of regional hospitals, including Cavan and Monaghan which operate as a single hospital entity, with integrated managerial and clinical governance systems, care pathways and support functions. Since July 2020, significant resources have been invested to meet the needs of patients using Cavan and Monaghan hospitals. The total budget for Cavan Monaghan General Hospital has increased by 30% from €115 million in 2020 to €149 million in 2025. Staffing has increased in the Cavan and Monaghan hospital by 295 people since January 2020. That is an increase of 26%. The budget has gone up by 30% and the staffing has gone up by 26%.
Median waiting times for patients attending the emergency department are within 3% of the national average. For those admitted to the hospital through the emergency departments, median waiting times are 10% lower than the national average. Cavan and Monaghan hospital has two CT scanners and one MRI scanner, which are located at the Cavan general hospital site. As with all CT scanners, I will be assessing how and when they are used. Cavan Monaghan General Hospital has made an application to the HSE national equipment replacement programme to replace the existing MRI scanner located at Cavan. This project has been approved and works are expected to be completed by the end of this year.
Cavan and Monaghan hospitals might be put together for operational purposes but it cannot be claimed that a service in one is equal to a service in the other. There are 47 km between the two sites. Perhaps that does not seem like much to some people, but if people are living in an area with no public transport and a poor ambulance service, that matters. When the Minister says that Cavan Monaghan General Hospital has two CT scanners and one MRI scanner, that does not deflect from the fact that Monaghan hospital has neither and that needs to change. There is a medical need. Currently, more than 1,500 people are waiting for an MRI appointment and more than 1,800 people are waiting for a CT appointment. By providing the services in Monaghan hospital, not only would the Minister be providing a service the people of Monaghan deserve, she would also be relieving the pressures that are on Cavan hospital.
Waiting times at Cavan Monaghan are improving a lot. Some 35% of outpatient appointments occurred within Sláintecare wait times compared with 25% in the same period last year, which is an improvement that needs to continue. Some 58% of inpatient day cases occur within the Sláintecare wait times, as do 95% of GI scopes, which is an improvement on 87% last year, and 94% to 100% of those waiting for outpatient, inpatient or day case, and GI scope appointments are waiting 12 months or less. I see progress there.
The application is from Cavan Monaghan General Hospital for the replacement of the MRI scanner located at Cavan. That is the application the hospital has made to the HSE.
The difficulty is that the application for scanners at Cavan hospital is made, as the Minister said, by Cavan Monaghan General Hospital, but Monaghan hospital needs these scanners and as I understand it, the staff there want them. The difficulty is that they have to go through this convoluted process Micheál Martin established that put Monaghan and Cavan hospitals together. What happens? Priorities are chosen and the priorities have never been the people, patients or even the staff at Monaghan hospital and that needs to change.
I am appealing to the Minister to engage directly on the ground with elected representatives, the staff of both hospitals and management of the Cavan Monaghan General Hospital and ask them how it is that there is capacity, willingness and eagerness in Monaghan hospital to deliver a service with MRI and CT scanners that is desperately needed by patients, yet there is a reluctance in the management group to ask for them.
I am sure the Deputy has discussed this in detail with the management group already. I wonder what response he got directly.
As I said, staffing at-----
Deputy Carroll MacNeill is the Minister. I am asking her to ask.
Deputy Carthy is the local representative in Monaghan so I assume he has discussed this in detail with hospital management.
Yes, I am not happy with the response so I am asking the Minister to ask.
The Deputy should allow the Minister to answer.
If the Deputy would like me to answer, I will do so.
The reality is that staffing has increased in Cavan Monaghan General Hospital by 26% but the increase in Monaghan has been 70%, so Monaghan is not being left behind. I look forward to going there and discussing all these issues, including the business cases submitted or not submitted by Monaghan hospital, as I am sure the Deputy already has.
Questions Nos. 14 and 15 taken with Written Answers.
Question No. 17 taken with Written Answers.
Pharmacy Services
Aindrias Moynihan
Question:18. Deputy Aindrias Moynihan asked the Minister for Health the up-to-date position on further plans on expansion of the role of community pharmacists; and if she will make a statement on the matter. [34893/25]
Pharmacists have shown time and again their great capacity to expand services and provide more and more services to communities locally, for example, vaccinations, repeat prescriptions and in so many other different ways. Will the Minister outline the next steps in expanding the role of pharmacies in community care?
I thank the Deputy. I am a huge advocate for the reform and expansion of pharmacy services and the Government is committed to ensuring people can access as much care as possible in the community including in pharmacy, which will play a very large and expanded role in this.
The report of the expert task force to support the expansion of the role of pharmacy was published in August 2024. Its findings provide a framework to inform how we are going to do that. My vision for the future includes pharmacists playing a much larger role in the health service. I am happy now to see the progress being made between my Department and the representatives of the Irish Pharmacy Union, IPU, in this regard.
The priority focus is the development and introduction of a common conditions service in community pharmacy. That service will be the first step in enabling full, independent pharmacist prescribing. It will allow pharmacists in Ireland to treat their patients for common conditions such as shingles, urinary tract infections and conjunctivitis. It will also support the development of new revenue streams for pharmacies.
Development of the service is well under way. It is led by the community pharmacy expansion implementation oversight group. That group meets monthly with the aim of developing the necessary enablers required to establish the common conditions programme. That includes clinical protocols along with the pharmaceutical regulator, new education and training for pharmacists and a package of required regulations.
We aim to have all of these in place to facilitate pharmacies to establish this new service before the end of the year. Deputy Ó Muirí asked about GP care. The huge advantage of this is that it will take some of the work from GPs into pharmacies that can be done more easily. From the patient's perspective, I would like a patient to be able to go into a pharmacy, be diagnosed for a simple and common condition of this kind and pay a fee to do so, and get their prescription there and then rather than go to a GP, pay a GP fee, go back to the pharmacy and pay for the prescription. All of that can be taken into one. The intention is that this would be the basis for beginning this, recognising that taking that approach will expand access to healthcare generally, and that patients in the general medical services, GMS, scheme and so on still have that option with GPs but now with, I hope, increased capacity.
I thank the Minister. She has kind of pre-empted my next question on GPs.
I am sorry.
They are under pressure in the complexity and range and the load of the increasing population. GPs in many places are under pressure, especially in rural communities, and medical experts are available beside them with a willingness to expand out and give support.
On the common conditions, it is good to hear that the Minister is aiming to get that done in the months ahead before the end of the year. There is a limited number of conditions the Minister is focusing in on. What is the plan for expanding that out? Have the details on it been discussed yet? Will the Minister give an outline on expanding the conditions for which it could be available?
The first and most important thing is to take the steps forward to get this going. There was an inertia on that, if I may say, until recently. It has now been progressed and there are detailed negotiations to take the necessary steps forward. I would like to see this in place and operational and then be able to expand it appropriately. I have already said, I think, that the list of common conditions should be expanded. It is not going to be enough but it is no harm to get the practice under way as quickly as possible, make sure it is supported by the appropriate regulatory and training environment, and recognise that pharmacists themselves need more support and more pharmacists' assistants and technicians. They are working under pressure in different ways and need to build their own capacity to do this as well.
My vision for it is that it is established, is working well and will be expanded as quickly as possible. Pharmacists are trusted and we need to expand this service as much as possible, recognising that will take that pressure off GPs. For an older woman, in particular, a urinary tract infection can be very dangerous. They need to be seen and diagnosed and get medication early rather than wait for a GP appointment. By moving that into pharmacy, it frees up that slot in a GP practice as well. It is a broader expansion and a good thing generally.
Pharmacists have been raising with me the Veterinary Medicinal Products, Medicated Feed and Fertilisers Regulation Act 2023 and the dispensing of medication for animals. The implementation of the statutory instrument on that is due shortly. They feel very much that this restricts the capacity to make available veterinary medical products, between the cost of getting a prescription and integration with the computer system and in so many different ways. Can we ensure there would be greater integration in, availability of and access to the prescription system? At the moment, a limited number of vets use the online system. Pharmacists are concerned that there is not access to it. Can we also ensure that pharmacists would be enabled to prescribe antiparasitic medicines for food-producing animals?
Deputy Clarke wanted to ask a supplementary question.
I cannot fail to take the opportunity to speak further on the issue I raised with the Minister at committee yesterday around the emergency supply scheme, where somebody from a virtual clinic, or leaving as a previous inpatient of a hospital, has 24 hours to get to their GP if they are a medical card holder and will receive only a seven-day supply of medication. There is a very real opportunity for our pharmacists to be more involved in this scheme. It is absolutely bonkers, to be quite frank, that you would have only 24 hours. It also does not reflect the reality of the prevalence of virtual appointments and the lack of need for forms to be filled in triplicate at this point. There has to be a better way of doing it, and a very important part of that would be our pharmacy network.
I agree completely with the Deputy, and I thank her for that. While I do not have an update for her today - it was yesterday we discussed it - I have instructed my officials to see what can be done, and I will revert to her on it.
I have to say Deputy Moynihan has got me. I do not know, and I am going to have to find out. I can tell him about estradot patches and so many different things but I cannot tell him about vets, agriculture and pharmacy. He has got me, and I am going to have to go back and find a proper answer for him. I commit to writing to the Deputy today to make sure that is done. I ask him to please forgive me; I do not know.
Questions Nos. 19 and 20 taken with Written Answers.
Hospital Services
Pádraig Rice
Question:21. Deputy Pádraig Rice asked the Minister for Health if her Department has received a copy of a 2017 report into paediatric urology services, known as the Dickson report (details supplied); if her Department was made aware of the existence of this report by Children’s Health Ireland, CHI, or anyone from Temple Street or Crumlin hospitals prior to CHI’s establishment; her views on CHI’s decision not to publish the report; and if she will make a statement on the matter. [34815/25]
On 19 June, CHI advised the Joint Committee on Health that neither Temple Street nor Crumlin hospitals accepted the Dickson report when it was completed in 2017. My Department received a copy of the report on Friday, 20 June and my officials are reviewing it. I will be seeking assurance from CHI that the matters raised in the report have been addressed.
In light of concerns raised in relation to corporate and clinical governance concerns at CHI, as the Deputy is aware, I have appointed two HSE board members to the CHI board. We discussed yesterday the changes to the service level agreement, the role of the HSE and the internal audit being conducted by the HSE. I do not wish to disrespect the Deputy by repeating those issues he already knows about, but all of those governance changes are being made with a view to supporting the new CEO as she continues to establish her executive team. She needs to implement the recommendations of a range of different reports and at the same time take CHI forward in a constructive and positive way towards the new hospital but also towards the delivery of better paediatric services across this country.
On the Deputy's direct question around the Dickson report, my Department received it on Friday, 20 June and is reviewing it. I can engage with the Deputy further on it.
A number of patient advocacy groups and parents have for a long time been calling for this report to be published. I urge the Minister to consider that and to consider publishing that report along with the others. What we have seen time and again from CHI are issues around transparency, accountability and a reluctance to release information, and we have had to drag that information from the organisation, which is deeply concerning.
It indicates to me that the culture in the organisation is not changing. This is another example of it. Last week we raised the internal investigation with CHI. Its officials told the Joint Committee on Health they would provide us with the legal advice on that internal investigation. We have not received that legal advice from them. CHI did publish a summary, as the Minister mentioned. Is it her view that that summary of the internal investigation is a true reflection of the full report?
I could say about the summary that it is CHI's view that this is the best it can do, recognising some of the HR and legal constraints. I want to see the report published in the broader public interest but it is not necessarily the case that in every instance it should be published. In particular, I am concerned that this was a HR report where people who might be constituents of the Deputy, and for whom he might take a protective trade union perspective as well, participated in a process to try to address a significant cultural issue. It would be very difficult for those people to talk about the experiences they had in this HR process and for their comments to be published in the public domain. While we are trying to get to the issues relating to culture and to governance, I understand the difficulty there for those individuals and CHI's perspective on that.
In relation to the legal advice, in general that is a matter for CHI and the committee directly.
I thank the Minister. There are ways of publishing these reports that anonymise the individuals and redact information that is key but then provide full transparency and accountability because trust in this organisation is now at an all-time low. Families are deeply concerned. We need more information released and more publications. Sunlight is a good disinfectant and CHI has been at every stage reluctant to release information to us.
I also raise concerns about some of the answers to parliamentary questions we are getting from CHI. Its officials are reluctant to answer reasonable questions we are putting to them. I have no doubt they will be before the health committee again. We have a long list of questions to put to CHI. I have concerns around the pace at which the culture is changing. It seems to me that culture change is not happening quickly enough. That reluctance to release information persists and we have seen that time and again with report after report and the one referenced here is another example of that.
I very much respect the Deputy's perspective on that and on the culture piece. I had a good meeting with the new CEO, Lucy Nugent, where I was very clear and reiterated that this is a new CHI for the future with a new executive management team, a new approach and a new culture. She needs that team around her to be able to implement that new culture. She is coming from Tallaght, where there has been good success and where she has a very strong track record in relation to that. I take the Deputy's perspective on the response to parliamentary questions and other matters very importantly and seriously. There is never a difficulty in being forthcoming with information to the extent that it is appropriate legally and from that HR perspective but there is a way in which you can lean in and provide better confidence.
I would be careful with phrases such as "confidence is on the floor". People are attending Crumlin and Temple Street hospitals today. I was there last week. I have a lot of confidence in the medical team there. I have a lot of confidence in the nurse specialists who listened to my voicemail and rang me back and the service and support I receive. That is the majority experience of Crumlin and Temple Street. There is a very important set of problems that we have to address but the majority experience is positive. I have parents contacting me to continue to make that point about their experience. This is parents and children at very vulnerable moments going in to receive hospital care and they are getting it.
We have a body of work together as a Legislature but we just need to be careful about the experience that they are having as well to make sure that we are reflecting it in a universal way.