Vol. 1089 No. 4
91. Deputy Paul Murphy asked the Minister for Health if children who are private patients have been prioritised over public patients for surgery in our public hospitals; and if she will make a statement on the matter. [52178/26]
The Minister has said she believes in equality for every baby born in our public maternity hospitals and I absolutely agree. However, the EY report into CHI shows that children whose parents can afford to go private are being prioritised for essential surgery in our public hospitals. Surely the same equality should apply to children as well.
I was very concerned about this and specifically about the management of waiting lists, particularly for spinal surgeries. Because of that, along with the former HSE CEO, I undertook an audit into equity of access and waiting list management in CHI. Recognising the challenges families have faced regarding paediatric services, we also undertook a separate qualitative piece of work to try to capture their experiences away from the strict terms of the counting audit and to ensure their voices inform the development of services. The audit took much longer than I wanted it to and much longer than anticipated - I was correctly questioned about that in the House - but that time was essential to ensure that the findings, conclusions and overall report were accurate and robust. The report found no clear evidence of inequity between public and private patients, but it did outline important findings in governance, including recurring delays against clinical recommended timeframes and inconsistent documentation in relation to waiting list management, neither of which is acceptable.
Importantly, the patient and family feedback revealed dissatisfaction with waiting list management with significant emotional and health impacts, although it did not need revealing to anybody here as we were already aware. These impacts was not just for the children but also for the parents. Parents and families want to be informed, involved and treated with empathy and respect. Those findings were capable of being anticipated - I would not have initiated the report had we not had shared concerns - but nevertheless they are disappointing. We need to provide a better experience for children and their families. I have met with the HSE and CHI and I am more satisfied than I would have been 12 months ago that there is a different attitude in senior management in CHI in its responsiveness and care around this. I am not saying everything situation is perfect - I certainly would not say that - but I can see a real change in the reaction and response of senior CHI management to this audit and qualitative report, which I think is important.
I thought there was some incredible spin, and some sections of the media absolutely fell for it, suggesting that this report proves there is no evidence of inequity in access. The Minister has echoed that. That is the first finding, but the full sentence states, "No evidence of inequity ... was identified; however, this conclusion is constrained by significant limitations in data availability, classification, and sample size." It is essentially exploiting perhaps deliberately poor record keeping, to claim that preferential access cannot be proved, but it does not change the fact that preferential access was found in the report. It is there in black and white on page 109 in the context of urology. Urology consultant 2 had 20 public patients with an average wait time of 12.4 months and ten private patients with an average wait time of 1.84 months. The other consultants are not as bad but there is a discrepancy between private and public. The same applies when you go into orthopaedics. Consultant 6 has 12 public patients with an average waiting time of 1.7 months and three private patients with average waiting times of zero. There are other examples.
I reject the question of trying to present this in any particular way. I commissioned the audit because of my concerns about this. There is no question but that I was uncomfortable with what was being found overall, but specifically when I drill into those a bit more there is not a systemic problem I can see. What I did see and what I was concerned about was that less complex procedures were being too easily moved to private facilities, resulting in the more complex procedures remaining. I think what the Deputy describes with those figures reflects some of that. There is a bigger complexity than what he has presented.
This is why I initiated it. This was my concern. My concern in particular was that this was more endemic than the report ultimately gives credit for. The Deputy is right that there is a limitation in data, but there is no question but that this audit was done with the best of intent and in good faith. We see more real experiences in the qualitative piece that Lily Collison did. That was an important piece of work that really speaks to the experience children had. It is improving but is not perfect.
There is often an attempt to suggest that discrimination between private and public patients does not have an impact on safety or patient care. That happened in the debate on the Rotunda. The Minister was involved and was on the correct side of that debate. I again quote the report, which states, "For Spinal patients, only 41% (9 out of 22) were treated within the Clinical Recommended Timeframes (CRTs), meaning 59% faced delays, sometimes for several months." In terms of urology, "Of the 73 patients reviewed, 30 (41%) were treated outside the Clinical Recommended Timeframes." The median delay was 152 days. There was one case where a child waited seven years for routine surgery. The report points out that "children may wait longer than clinically recommended for assessment, investigation or treatment, with potential consequences for clinical outcomes, disease progression, and quality of life." Does the Minister agree that just as private healthcare has no place in our public maternity hospitals, it similarly has no place in CHI? We should not be building private suites in the national children’s hospital. We should not be building inequality into our health system.
Yes, I am a firm supporter of the public system. There is no question about that. Some 71% of our consultants in CHI are on the public-only consultant contract. However, there is also a contractual requirement to continue to provide private space for those old, type B contract holders. It is anticipated that fewer than half of the eight planned consultancy rooms will have any private clinics. The rest of the rooms are dedicated for public clinics. More important, they will be private clinics winding down over time and that will all move to public because only be public consultants will be hired in. We are still committed to the rule of law and to upholding contracts. If I say contracts have to be upheld, I have to uphold them on the other side and we have to make that space, as the Deputy is aware. We have a very strong commitment to public service. I do not believe there is space for private work in the same way. I am in agreement with the Deputy, but there are still contract holders who have a contractual entitlement to a certain number of private rooms. I see in the new hospital that will be wound down and down, as we get from 71% to 80% and 85%. That will happen over time.
92. Deputy Paula Butterly asked the Minister for Health the number of patients awaiting elective surgery at Our Lady of Lourdes Hospital, broken down by specialty and waiting time bands; the measures being taken to reduce these waiting lists; and if she will make a statement on the matter. [52249/26]
At a time when many waiting lists have been impacted by the ongoing trend of higher demand and increased referrals, it is wonderful to be able to report some positive progress. In Our Lady of Lourdes, at the end of May, 939 patients were waiting for an inpatient day case procedure, which is a decrease of 17% when compared with May 2025 and a 14% decrease from the start of January.
More importantly again, 90% of those patients were waiting twelve months or less and the number waiting over 12 months has decreased by 46% since May last year. That is a sign of real activity in the hospital. I am very pleased with it and congratulate the manager, Priya, for her excellent work on that and in managing urgent and emergency care as well. Some 47% of patients in Our Lady of Lourdes are waiting within the Sláintecare target of 12 weeks. The interim target in the national service plan and waiting time action plan is 50%, so we really are getting there in Drogheda.
Significant improvements can also be seen in individual specialities. Gynaecology inpatient day cases are down 25% on May last year and 18% since January of this year. Ear, nose and throat lists have decreased by 48% since last year and 14% since January. Against a trend of rising referrals and increased demands, waiting list reductions of that kind are very significant. Overall elective surgery increased by 19% to the end of May 2026, which is positive. I have to sit that against continued good management of its emergency department and patient demand overall. You cannot bring patients into an unsafe hospitals. Drogheda is not doing that and it is still getting the lists down. With two slots per fortnight in the new surgical hub in Swords, I expect those figures to further improve in Our Lady of Lourdes and across the Dublin and north-east region as the hub gets up to speed. I intend to monitor the activity in the surgical hub and the corresponding activity in the theatres in the original hospital to make sure activity is being increased everywhere.
I thank the Minister for that information and join her in congratulating the Lourdes hospital for getting on top of the issue of waiting lists and for the good work all the staff are doing, led by the new general manager. It goes to show that when there is good management, will and the ability to reduce waiting lists, we can make progress. As the Minister pointed out, they are doing nearly 20% more elective surgeries than last year but the level of staffing is the same. While this is a great success story, I wonder if it is sustainable in the long term. It shows two things clearly. First, they are very efficient but, second, the need in the region is significantly higher than the current model accounts for. Lourdes hospital is a model 3, yet it is performing as if it were a model 4 hospital.
Yes, I know. It really is excellent. I am not saying everything and every experience are perfect but it is doing enormously well. It is not just in terms of elective surgery; it has also increased its outpatient capacity by 23% and is at 100% of its endoscopy priority 1 target. That is significant activity, good management of a hospital and an enormous progression for that hospital on 18 months ago, or maybe slightly more, when it was in a different situation.
More staff have gone into the surgical hub for the region and that benefits everybody. About half of the staff in the surgical hub will be dedicated to the hub and different hospitals will move in with their own teams. We have organised it such that, over a two-week period, access to the hub will be shared between Beaumont, the Mater, Our Lady of Lourdes, Cavan-Monaghan, Connolly - all of the hospitals in the region - to ensure equity of access for everybody there. The increase in staff for the hub is an increase in staff for everybody because it can take scheduled activity away from Drogheda.
Our Lady of Lourdes serves about 360,000 people in its catchment area at the moment and I believe that is growing rapidly. Going back to the idea that it is effectively a model 4 hospital while being classed as model 3, there is a case for looking at and expanding the services in Our Lady of Lourdes and making it a model 4 hospital. Looking at a map of where model 4 hospitals are in the country, we have them in Dublin, Cork, Galway, Limerick, Waterford, and Kilkenny for some services. There is a gap in the north east, considering the catchment of 360,000 people and growing. We are in a position to expand on those services. Staff and management are proving they are up to the task. Will the Minister consider this?
I have asked the regional executive officer, Sara Long, and the regional clinical director, Eamon Dolan, to do a piece of work that considers the whole region. The region is performing exceptionally well in the overall management of demand, although there is more in the community that needs to happen. In that region there is Beaumont, which is a neurology specialist centre; the Mater, which is a cardiac specialist centre; Connolly, which is a position for the future for elective work; the hub; and Drogheda. There is an interesting matrix of hospitals and division of work and specialities there. I have asked them to come up with what the future of the region looks like. How do we best allocate resources? How do we think about where services should be delivered and the concentration of specialist centres? It is a region that is already demonstrating that. As we move forward with the elective hospital in Connolly, we have done the preliminary work of putting in the high-dependency unit beds. It is really interesting. I have asked them to think about the region in an ambitious way and come back to me with a plan for the future. Perhaps a model 4 is possible. I do not know. Let us see what Eamon and Sara come back with.
93. Deputy David Cullinane asked the Minister for Health her plans to increase clinical training capacity across health professions in the south east; and if she will make a statement on the matter. [52161/26]
Workforce planning is an important component of planning for health services. This question is about the south east. What additional clinical training capacity is being looked at for the coming years across the south east?
I thank the Deputy. The Government is investing €28.5 million to expand healthcare education and training nationally, supporting over 1,100 additional training places by 2028. That includes 461 additional health and social care professions, HSCP, places across nine priority disciplines. Further expansion opportunities are being considered through the Higher Education Authority's expressions of interest process, informed by workforce needs, regional demand and clinical placement capacity.
Clinical placement opportunities are fundamental to development of the future workforce. We are trying very hard to ensure that happens in community settings as well as acute settings, recognising that is where we want people to be able to work. We are also targeting the recruitment of Irish-trained graduates into permanent roles but, although I raised this with the HSE in September and October, we are not in a place I am comfortable with in relation to that for this year. I expect recruitment to be faster and to be co-ordinated with the terms our HSCPs and other students have. It is very obvious they are about to graduate at this time of year. There is a better way of organising that than is currently happening.
In relation to the Deputy’s region, the HSE Dublin and South East region conducted entry-level HSCP recruitment campaigns in 2026 to support the recruitment of newly qualified graduates. In 2025, 33 HSCP graduates were recruited into the region: six occupational therapy, ten physiotherapy, five speech and language, six social work and six dietetics. Recruitment of the 2026 graduate cohort is progressing. Three occupational therapy graduates have accepted employment offers to date. This is expected to increase as graduates complete the CORU registration process which comes after their graduation. Recruitment for other disciplines is ongoing.
Recruitment is important and every additional staff member recruited in acute primary or community settings in the health service is to be welcomed. My question, though, was on increasing clinical training capacity. I know that also falls under the Minister for higher education.
I think the Minister, Deputy Carroll MacNeill, was in the Chamber this week when I raised issues in relation to South East Technological University, SETU. It has plans for a new pharmaceutical, a new veterinary and a new one health building. All of that, if funded, will be important for more graduates, research and development. I spoke to the manager of the hospital a number of times. The glassworks site in Waterford is iconic because it is the former home of Waterford Crystal in Kilbarry. Now it provides opportunities to enhance SETU. I know from talking to the local hospital manager that they see the potential for a new medical school. I think I raised this with the Minister in the Oireachtas health committee in the past. I know it straddles other Departments but there is an excitement about the site that can be realised. It could be a good opportunity to increase training capacity for doctors and other healthcare professionals if it were supported.
I thank Deputy Cullinane. That does sound like a plan of work but I am afraid it is a plan of work for my excellent colleague, the Minister, Deputy Lawless, and the Department of higher education. I do not wish to step across him but I can say in relation to clinical placements and training that I have met the HSE. The Minister, Deputy Lawless, and I have been working on this together, with some frustration that the placements have been too limited to acute settings and they need to be in community settings . We are trying to work on this, although I am still not satisfied it is happening at the scale that is necessary.
I am glad Deputy Cullinane mentioned the hospital. We had a very good week this week with the commencement of 24-7 cardiac care in Waterford and I thank Ben O'Sullivan for all of the work he has done to get ready for it. I know another two consultants are yet to come into post and everyone else did extra work to make sure we met the deadline we set of 6 July. This is very good news. Of course, we will have our surgical hub by the end of the year. As to the medical school, I do not wish to step across my colleague, Deputy Lawless, on that, if Deputy Cullinane will forgive me.
Obviously, there has to be an element of cross-departmental and cross-ministerial work on workforce planning. The health service cannot recruit quickly enough if we are not training and training capacity is very important. I imagine a lot of collaborative work is being done between the Ministers and the Departments. What I am saying is that I will raise this with the Minister for higher education-----
Yes, and I will too.
-----but I am raising it with the Minister for Health also. We could also have more training capacity in the south east and get the benefit from SETU and its plans. The hospital manager, whom the Minister has praised for other matters, sees this as an exciting opportunity.
The 24-7 cardiology care was a big day for Waterford and is a big step forward for health in the south east. I commend the Minister on the fact she ensured this happened. There was a campaign over a long number of years. I also commend people in Waterford and the south east, including in Carlow, Kilkenny, Wexford and Tipperary, who came out in big numbers on a number of occasions to demand equality of access. The fact it is now there is good news for everybody in the south east.
I thank Deputy Cullinane and I acknowledge all of the people involved. The impact of it means people can rest easier knowing they will have the care they need at any time they need it. Of course I will discuss it with the Minister, Deputy Lawless, and of course it is collaborative. The more I think about the co-location of hospitals and medical schools, what we are trying to do in medical devices and pharmaceuticals, and the opportunity for research and innovation, it is driving health not just for the benefit of patients but to make sure it is a driver for the economy as well. We have such an opportunity and we have such a talented workforce. We have such a medical clinical profession that is dedicated to research and innovation. All of these opportunities present and I am so glad Deputy Cullinane has raised SETU in this context as well.
94. Deputy Marie Sherlock asked the Minister for Health the action she is taking to address the dearth of nursing home beds and increase the number of step-down facilities in response to the crisis in delayed transfers of care in our acute hospital system; and if she will make a statement on the matter. [52270/26]
My question relates to delayed transfers of care and nursing home capacity. I understand that yesterday marked the highest number of delayed transfers of care across our acute hospitals in the year to date, with 555 patients who should have been discharged and were not. This marks 86 continuous days of over 500 delayed transfers of care in our hospitals. For the first four months of this year, almost 50% of those waiting to leave hospital were waiting for a nursing home place. What is the response to this crisis?
I thank Deputy Sherlock, who is quite right to highlight delayed transfer of care, DTOC. As she said, it has been well over 500 variously for the last period, which is essentially a hospital. This is why the use of every bed is so very important. Deputy Sherlock is correct to identify nursing home beds, community nursing units and all of the appropriate step-down facilities that are, can and should be in the system to make sure we do not have people staying in acute hospitals longer than is necessary.
In this context, the national service plan commits to the delivery of 352 community beds in residential settings for older people in this period. The community nursing unit capital programme is ongoing and will have 90 public community nursing units and community hospital beds refurbished or replaced so they meet all of the regulatory requirements. It was a big problem for us that we had beds that were closed because of HIQA standards. This is correct because we have to bring them up to standard but it is a body of work to do this. The public-private partnership project will deliver 528 residential care beds on seven sites in 2026. The programme for Government commits to building more public nursing home beds, including dementia-specific provision, which is a huge issue in the delayed transfer of care.
We are developing a new long-term residential care additional capacity plan, which will be published in the later part of this year. There is a complexity to many of the DTOCs. There is an increase in complexity, particularly on the dementia side. There are other cases where there is a clear pathway out of hospital. I have highlighted the south west a number of times because of my frustration with the use and non-use of Mallow. There are patients in hospital today who could be discharged to virtual beds that are not being used. I do not need to conflate these different issues but it speaks to efficiency and the management of every bed and seeing every bed as being so very important.
The average waiting time in DTOC is 24.8 days across all acute hospitals and in the midlands and north-east Dublin it is more than 30 days. This is a huge cause for alarm in terms of risk to the patients themselves and their prospects of recovery but also the cost to the hospital. We know that nursing home demand is the biggest driver of this, with more than 1,500 people waiting for a nursing home space, but I have to ask about the urgency with regard to the Government's response. In 2022, ESRI research identified that we would need somewhere between 54,000 and 60,000 nursing home beds. We had 33,000 beds back in 2022. We have gone backwards and in 2025 we had fewer beds at 32,408. We are not even running to stand still. I am glad to hear a capacity expansion plan will be put in place but, like the acute hospital expansion plan, it has been sitting there for a number of years and I am not hearing urgency with regard to this problem.
Going back a couple of days, on 6 July there were 526 delayed transfers of care. Of these, 68 involved legal complexity, 35 involved basic housing needs, 90 involved very complex clinical needs, 61 were about access to rehab facilities of various kinds, home support packages were involved in 42 cases, residential care in 217 cases and non-compliance in 13 cases. It is not just about nursing home support; it is also about support at home. For example, it is important to mention the expansion of the enhanced community care teams, which are the multidisciplinary teams supporting earlier discharge from hospital closer to home. There is also extended service availability in the evenings and at weekends, including discharge planning, community supports and decision makers addressing avoidable non-clinical delays to discharge where it is possible.
I have mentioned the virtual wards. I do not suggest that everybody would move onto a virtual ward but there are people for whom it is clinically appropriate to do so. Crucially, the SAFER patient flow bundle and the plan for every patient are now in place across most sites, supported by seven-day and 14-day length-of-stay reviews.
Obviously, there are a whole range of issues as to why people do not leave hospital. Almost 70% of the cases relate to a need for residential care or complex care such as dementia. The big issue is the cost. We know the HSE is running a significant deficit at the moment. It will not even make the savings it is supposed to make at the end of this year. We know the cost of an acute daybed is about €1,300, which is almost five times the cost of a community nursing unit bed. This has a very real financial implication for hospitals. The question being asked of me is about the tolerance and particularly the very long average waiting times across our acute hospitals. We need to see a much greater urgency with regard to a nursing home capacity plan, which would be a public nursing home capacity plan.
I agree with Deputy Sherlock. I recall speaking with one of the hospital managers where this is a most acute issue with regard to what is going on, what the experience is and what conversations are happening. Again, there is a question of dementia and advanced decision-making. Some of these issues are very complex and that is its own bundle. As Deputy Sherlock said, there is also the need to access nursing homes and public nursing home support. Within this, it is important to say we will not be able to facilitate every request for every patient to be in the exact location they need to be. There are some questions. I do not wish to overstate it or amplify it but I am saying we will be able to provide supports but we will not be able to provide the perfect support for every person either. A measure of flexibility will have to come into that too.
There are also cases, and again it is hospital managers describing this to me, where families do not want to have a particular outcome and the hospital needs to move the patient, who is no longer an acute model 4 hospital patient but requires a different type of care.
It is important that everybody understands that model 4 beds are for the most acutely unwell and people cannot stay.
95. Deputy Shay Brennan asked the Minister for Health for an update on the plan to increase capacity by between 4,000 and 4,500 new and refurbished inpatient hospital beds across the country; and if she will make a statement on the matter. [48058/26]
I ask the Minister for an update on the plan to increase the capacity of inpatient beds by 4,000 or 4,500 across the country and if she will make a statement on the matter. We know we currently have 12,000 public beds and 2,500 private beds, which is about 2.9 beds per thousand of the population. We also know that the ESRI has predicted a need for a 40% increase in inpatient beds by 2040 and that the plan in 2024 was to provide 3,352 new beds.
I thank the Deputy. The programme for Government, as the Deputy said, sets out a commitment to increase bed capacity by between 4,000 and 4,500 new and refurbished inpatient hospital beds across the country. This will be achieved through a regionally balanced capacity expansion plan. The substantially enhanced national development plan, NDP, provision for the health sector of €9.25 billion will support the delivery of those beds.
To give the Deputy a much more specific update, 292 new acute inpatient beds have now opened across the country since the programme for Government was agreed, between January 2025 and June 2026, including 128 beds in University Hospital Limerick, 18 beds in Cork University Hospital, 15 beds in Our Lady of Lourdes Hospital, Drogheda, 20 beds in Beaumont Hospital and 24 beds in Mallow General Hospital. The HSE anticipates opening 108 more new beds over the course of quarter 3 and quarter 4 of 2026 and quarter 1 of 2027.
Some 259 inpatient beds are currently under construction, including 97 beds at Wexford General Hospital, 42 beds at Sligo University Hospital and 30 beds in University Hospital Kerry. It is intended to open those beds as soon as possible once constructed. In fact, as the Deputy is aware, we are recruiting ahead of the beds being delivered to make sure the staff are there. A further 185 beds are at tender stage and another 152 beds are now at the detailed design stage. We are now seeing this bed-by-bed, significant pipeline of projects progressing through earlier stages of planning, design and approvals. Rather than giving the Deputy broad figures, I thought I would be very specific as to the progress being achieved.
I thank the Minister very much. We had the excellent Professor Rose Anne Kenny, co-ordinator of The Irish Longitudinal Study on Ageing, TILDA, in recently with the health committee. She pointed out the demographic challenge we are facing in health. We are going to have 1 million people over the age of 65 by 2030 and a doubling of the number of those aged over 65 by 2057, to 1.6 million people. We have already seen this trend happening from 2013, with an increase from 569,000 to 806,000.
I bring these figures up because this challenge is looming. Obviously, beds are not a silver bullet, but they are going to be part of the overall way we manage health in future. We will probably start with proper screening programmes at the age of 50, with the whole population moving into better-resourced primary care, step-down beds and rehabilitation beds. I also support Deputy Seán Kyne’s call for the Minister to press for the 300 additional beds in UHG. This is a level 4 hospital operating with level 3 capacity.
I thank the Deputy. He will not hear any complaint from me about people pressing me to deliver more health infrastructure or to spend more capital moneys. I am doing my very best to spend my entire capital allocation as quickly as possible and I run the risk of spending other people’s capital allocation, if I can be so lucky or so bold. This is because, as the Deputy said, this infrastructure investment is essential for the future.
While I do not wish to be flippant about it and, of course, we must achieve value for money and we must take the correct decisions through the right processes, we really have to aggressively spend on health infrastructure in the right way to make sure we are going to meet the very excellent challenge of having not just a growing population but an ageing population. Some of my European health colleagues do not have that same wonderful situation. Nevertheless, it creates a significant infrastructure challenge for us for the future.
I accept that answer and I thank the Minister very much for that update. It is important because people sometimes equate healthcare with hospital beds, but that is not reality. In isolation, beds cannot provide for the healthcare needs of the public. We will never develop enough capacity in beds unless we change the way we manage healthcare, both in preventative and in primary care. We really do have to step up the number of rehabilitation beds, step-down beds, home care packages, primary care therapies and nursing home beds in the community. We also need to think more strategically about how we manage the health of the population from the age of 50 onwards. Professor Rose Anne Kenny made that very point to the health committee. Deputy Sherlock already pointed out this challenge because we both listened to Professor Kenny's excellent presentation at the health committee last week.
I agree, particularly concerning rehab beds, step-down beds and neurorehab beds. I was in Blarney with Deputy Colm Burke to look at the neurorehab step-down beds in Mercy University Hospital. It was quite creatively done. It was a former hotel on a golf course that was acquired and redesigned for this purpose.
We really are trying to be imaginative and innovative about where we can acquire space to be able to provide beds of every kind. I was in Tallaght University Hospital yesterday, where existing space has been found within the hospital to be repurposed for beds. I have been in hospitals where there are plans to turn records rooms, where patient records have been stored, into beds. Hospital managers are being creative where they can be at the moment, but none of those things are going to equate to the scale of the number of beds we need. We need this significant capital programme, which I hope I have outlined. I do really recognise the challenge.
96. Deputy Shane Moynihan asked the Minister for Health the steps her Department is taking to address delays in processing reimbursement applications submitted under the cross-border directive; and if she will make a statement on the matter. [52045/26]
98. Deputy Shane Moynihan asked the Minister for Health whether reimbursement under the Cross-Border Directive will include interest costs incurred on bank loans or credit facilities used by patients to fund upfront medical treatment abroad, particularly in circumstances where reimbursement delays significantly exceed indicative processing timelines; and if she will make a statement on the matter. [52044/26]
These questions are to ask the Minister for Health what steps her Department is taking to address the delays in processing reimbursement applications submitted under the cross-border directive. Will reimbursement under the cross-border directive include interest costs incurred on bank loans or credit facilities used by patients to fund upfront medical treatment abroad, particularly in those circumstances where the reimbursement delays significantly exceed indicative processing timelines?
I propose to take Questions Nos. 96 and 98 together.
The cross-border directive allows public patients to access healthcare, which they would have been entitled to access in the public healthcare service in Ireland, in another EU or EEA country. As the Deputy is aware, patients pay upfront for the treatment and are reimbursed upon their return to Ireland. We want to support patients in this way and I do not want them to have additional administrative or any form of burden because of the operation of this scheme.
The HSE is responsible for the operation of the cross-border directive and has a dedicated office for that purpose. There has been continued growth in use of the scheme. The HSE tells me that this has placed additional demands on the HSE cross-border directive, CBD, office and given rise to a build-up of applications. The increased activity is evidenced by the number of treatments reimbursed increasing by approximately 75% between 2020 and 2024.
Nevertheless, it is important this service operates in a responsive way and that reimbursement applications are processed within a reasonable timeframe. The HSE advises that it usually aims to repay patients within 30 days of receipt of all completed documents. However, the HSE also advises that it is currently processing applications received in mid-January 2026. A six-month delay for reimbursement is absolutely unacceptable. It is not fair to patients to have an additional financial burden placed on them that is occasioned simply because of administrative delay, notwithstanding the increase in applications.
Accordingly, the HSE has advised my Department that additional resources are being assigned to manage this increase in demand with the aim of restoring processing times back to expected and more acceptable levels. I have, however, set the HSE a very specific target of getting back to the 30-day target by the end of 2026. It will need to sort this issue out between now and then and get back to that 30-day target. It is not reasonable to put administrative stress, financial stress or other burdens on people in addition to their healthcare issues.
As the Deputy knows, the reimbursement amount is the cost of the treatment in Ireland or the cost of it abroad, whichever is the lesser. Reimbursement is confined to the costs of the care itself and does not include any additional costs incurred by the patient. This is not the Deputy's question, however. His question is about the timeline, and I hope I have given him some confidence that this will be changed by the HSE.
I thank the Minister for that very comprehensive answer. I welcome her support and proactiveness in getting the HSE to commit to that timeline.
I have a few follow-up questions. This is around confidence-building. It is a very useful directive and gives us additional capacity in getting people the treatment they need. From my understanding of how the scheme operates, it centres on a small number of providers and hospitals because of the specific procedures that are there. As the Minister said, waiting six months for reimbursement is onerous, especially if it is an older relative or someone who has been waiting for a long time.
Could the Minister say a bit more about whether any consideration can be given to a situation where a family, not of substantial means, has had to take a loan to pay for the overall cost of the treatment and because they have not been able to repay that loan, or because the reimbursement has been delayed, this has led to interest being accrued on the credit facility they took?
Is the HSE considering providing alleviation for families who find themselves in those circumstances through, as the Minister said, no fault of their own? It is unacceptable they should have to wait that duration of time to receive the reimbursement due to them and they then have to pay an additional interest or credit charge on top of that. There is a question of fairness. I fully appreciate and am grateful to the Minister for driving the HSE to get back to a 30-day target by the end of 2026. How confident is the Minister that it will do that? Is it allocating additional staff? What exactly does additional resource look like? Will the HSE report to the Minister with an interim progress report before the end of the year to see how this is tracking? Has the HSE made any substantial progress in addressing that target in the meantime?
It is a good directive and scheme. From a political point of view, we are very supportive of this but it is also about making sure patients relying on it get the reimbursement they are due. As I am sure the Minister will agree, we do not want to cause more hardship to or place onerous pressure on people who may have been through a procedure or have had a loved one go through a procedure. Will the Minister share her thoughts on the staffing, her confidence that the HSE will reach the target and the refund of interest on credit facilities?
I cannot speak to the specific staff numbers. I generally find it is about process change as much as staff increases, so I think it is a measure of both. I will look for an interim report, probably in October, as to how the work is going. I made the point that it is possible to change processes. For example, this time last year, I gave the Medical Council a significant challenge to sort out its backlog of people applying to be doctors in this country. It was a patient safety issue not to have had them. By September, it had that done. These things can be done with a measure of focus, and I expect it to be done in this case.
In relation to the specific question about interest and bank loans, there is a difficulty with this. The reimbursement is limited to the eligible healthcare costs that would have been met by the public health service. There is no provision for the reimbursement of interest charges, borrowing costs or other consequential financial costs. Reimbursement under the cross-border directive is governed by European and national legislation. Reimbursement of additional costs is not envisaged by the directive because it was never expected people would be waiting in that period. I appreciate the unfairness point the Deputy made. That is why I am saying these delays are absolutely unacceptable and we need to get back but there is not provision in that scheme. We have no flexibility to change a European scheme of that kind in relation to additional costs beyond the healthcare costs.
I thank the Minister for her response, in particular on the process change. If possible, will the Minister tell us if there are particular processes the HSE has identified which it thinks could be changed to speed this up? I am always reluctant to say we need to throw more staff at a problem, especially when it is administrative, because, as the Minister said, more often than not a system change is needed or there are unnecessary barriers in processing which cause delays.
I fully accept the Minister's point that the directive is European legislation but the European legislation did not envisage it would take six months to reimburse an application. In that vein, is there any consideration that can be given internally for the HSE to look at what it might to do remediate and compensate the people who, through no fault of their own, are left to pay large amounts of interest they did not envisage when they took out the loans? That was not an expectation of the scheme when it was set up. It certainly was not the expectation of the patients when they applied for the scheme but, with all due respect to all involved, the HSE is the one at fault for the delay. There should be some indication or signal from it about how it might compensate or at least take account of the fact that the interest accrued or credit facilities people took have given rise to additional bank charges on the fees.
From a human point of view, families who have gone through the stress of having to travel abroad to get a procedure are expecting reimbursement. Six months down the line, they have not been reimbursed and are hit with extra interest or bank charges. This was not envisaged by the European legislation. I fully accept the point on flexibility and the parameters but given that this is a process issue related to the administering of this scheme, will the HSE look at compensating for or taking account of that in the reimbursement process?
I appreciate the point the Deputy is making but I am not going to make any commitments or policy on the floor of the House. I am also operating without information on the specific patients, the duration or the interest costs. I do not have any of that information but if the Deputy wants to speak to me about the matter privately, I will be happy to look at it. However, I will not make promises I cannot deliver as it would not be right for me to do so. I appreciate the Deputy's point and his reasoning.
99. Deputy Marie Sherlock asked the Minister for Health the reason the national lipoedema working group is proposing to exclude surgical intervention from its guidelines on the management of lipoedema; and if she will make a statement on the matter. [52269/26]
108. Deputy Maeve O'Connell asked the Minister for Health for an update regarding the work her Department has undertaken to improve access to care for people living with lipoedema. [47296/26]
My question concerns lipoedema. It is a condition experienced by an estimated 11% of women in this country. We understand a working group was set up in 2023 and was due to report in the second quarter of this year. We have not seen it yet. When will we see that report? I raise significant concern about the outcome of the report, in that the HSE has indicated it relates only to diagnosis and non-surgical management, when we understand surgery should be an important part of the care of these women.
I propose to take Questions Nos. 98 and 108 together.
I recognise that lipoedema is a chronic and often very painful condition, which can significantly affect physical health, mobility, quality of life and psychological well-being. It is frequently under-recognised or misdiagnosed. I am very aware of the distress many women experience in seeking recognition, diagnosis and appropriate support. Diagnosis remains challenging as there is no specific diagnostic test. It is based on clinical history and examination by an experienced clinician, with investigations used to exclude other conditions or contributing factors. There is currently no medication or cure as such that we are aware of. Management that appears to be the approach, requiring a holistic, multidisciplinary and person-centred approach.
In relation to surgery, the HSE's chief clinical officer has tasked the national clinical programme for plastic surgery with reviewing the evidence. I understand the clinical programme has provided its advice to the chief clinical officer for consideration. I would like to have the opportunity to discuss this with the chief clinical officer in greater detail. I have not had that opportunity in the context of the parliamentary questions and everything else going on. International research continues to evolve, including the LIPLEG trial in Germany examining whether liposuction can provide greater long-term improvements in pain and symptoms compared with complex decongestive therapy alone. That evidence will be important to inform any future updates to the guidance. A working group was established in 2023 to develop a standardised, evidence-based approach for health services but I really want to discuss the matter with the chief clinical officer, recognising the evolving evidence.
Many in the medical community with expertise in this area are of the view that specialised sparing liposuction surgery - there is big distinction from other types of cosmetic liposuction - is the only intervention that can directly address the pathological adipose tissue issues. Many women have to travel to Cyprus and other countries to access those surgical interventions. Serious consideration has to be given to that surgical intervention in Ireland. Some women who believe they have this condition are seeking liposuction in a setting not specific to lipoedema, which is very worrying. We need to make sure we can provide for these women in this country.
I take this opportunity to raise awareness about lipoedema. As Deputy Sherlock said, one in 11 women or girls has it. That is one member of your camogie or football team or two in your leaving certificate class, at least. That is how significant this is. I know the Minister is a huge advocate for women's healthcare. I joined her yesterday in Tallaght hospital for the national women's strategy. We really need to see a strategy and path forward for how we will raise awareness among the public and medical professionals, specifically for early diagnosis, which is so important for early treatment and in preventing this condition from becoming a more severe chronic disease. There are also psychological issues associated with chronic disease, in particular one like lipoedema, which is a physically debilitating and visual disease that women and young girls in particular are very sensitive to.
I thank both Deputies. It is wonderful that so many other Deputies have joined us to hear that lipoedema affects 11% of women. It is a serious chronic disease and, as with many other conditions for women, we have to think carefully about the research available. Yesterday, we launched the third iteration of the women's health action plan. In that we talk about so many conditions that present differently for women. For example, heart failure in women has different symptoms, has been under-researched and under-diagnosed and treatment outcomes have not been as good because of that.
We put €2 million in funding this year specifically into women's health research, precisely to identify areas that have been under-researched. Many colleagues here have talked about endometriosis. Lipoedema is just as important. It affects 10% or 11% of women and the impact on lymphedema - the crossover that can happen - is also a significant risk with serious health implications.
Women's health has been under-researched and under-diagnosed and there has been a bias in research against understanding women's health as something distinct, important and separate from health generally. We have seen that consistently in the research. It is important we take the opportunity to consider the most contemporary research on lipoedema and that it has the opportunity to feed in at every level. I will discuss it with the chief clinical officer to make sure we have all the best evidence about this condition.
Like the Deputies, I know women with lipoedema. There are many of them. Like the Deputies, I want to advocate loudly for women's health generally. I thank them for joining us at the women's health action plan launch yesterday. We must continue to advocate separately and differently against the bias that has existed against women's health and women's health research for so long. I thank Deputies Sherlock and O'Connell for raising the important issue of lipoedema in front of all Deputies today.
