Catherine Ardagh
Ceist:81. Deputy Catherine Ardagh asked the Minister for Health if there are any plans to introduce lung cancer screening; and if she will make a statement on the matter. [64099/25]
Ceisteanna Eile - Other Questions
Cancer Services
November is lung cancer awareness month. Lung cancer is the leading cause of cancer-related death in Ireland yet unlike for breast, bowel and cervical cancers, there is no national screening programme in place. The Marie Keating Foundation recently launched the Breathless Collection campaign to highlight key symptoms of lung cancer, including shortness of breath, chest tightness, shoulder pain and a persistent cough. It is a simple message: symptoms cannot be ignored. We also now have the benefit of evidence from the lung health check pilot delivered in partnership with Beaumont Hospital, the RCSI and the ICS using a mobile low-dose CT model that has shown real promise in detecting lung cancer at its very earliest stage. My question today is this: when does the Department intend to progress this programme to a full national lung cancer screening programme?
I am committed to supporting Ireland's population screening programmes which are a valuable part of our health service. The programme for Government commits to evaluate the current lung cancer screening pilot in line with the WHO criteria and to develop recommendations for a way forward. The pilot, which was led by researchers in Beaumont and the RCSI with support from the EU, the Irish Cancer Society and my Department, is under way. It has issued a call for proposals to advance research in this area focusing on outstanding uncertainties.
I have had several meetings with Gillian Ryan who is a leading lung cancer advocate and a leading advocate for a mobile screening service. I have met her in Cork and have hosted her and her daughter here in Leinster House. I met her again last week to unveil Ireland's first White Ribbon for Lung Cancer campaign. I know the Deputy was involved in that and did the breathlessness piece.
Lung cancer is a very serious condition, particularly for those who are not identified as being at high risk. For example, a number of non-smokers are getting lung cancer and they would not necessarily see themselves as being high risk. They deserve to have the opportunity to have themselves tested. I particularly favour the mobile unit but I recognise that we have a screening programme and screening advisory programme that have worked well for us. This is under broader consideration. We need to do a complex set of calculations to get a careful balance to deliver population benefit. I am told lung cancer is particularly challenging due to the very significant budget impact. There are difficulties with risk stratification and high levels of incidental findings that are not necessarily lung cancer that cause their own problems as well. As I am learning, there is a particular complexity to lung cancer screening that was not apparent to me on the first go. Nevertheless, we are continuing to try to assess what may be done through established evidence-driven protocols, as always. I very clearly hear the Deputy and agree with her that there is a particular need to look at this more closely.
It is good to hear that the Minister is well-disposed to putting more research into it and trying to assess whether it is an appropriate screening programme. We know from international evidence, including from the UK, the US and across the EU, that low-dose screening reduces mortality, particularly among high-risk groups such as long-term smokers and those with an extended smoking history. Having said that, I also know that many people who are not traditionally in this high-risk group are presenting with lung cancer and sometimes at quite a late stage. From ongoing work here in Ireland, we also know that there is a stigma around lung cancer and that awareness of the symptoms of lung cancer is quite low, particularly among former smokers. The Beaumont pilot programme has been very successful, especially in identifying lung cancer at a very early stage. We know that drugs exist to treat lung cancer at this early stage. When will the national screening advisory committee, which is scheduled to review the work, issue a report on the possibility of a pilot programme?
I am not in a position to give that date at the moment but I will try to come back to the Deputy as soon as I can. Very few countries have introduced lung cancer screening because of the uncertainty around its effectiveness. That does not mean we should not explore it. As the Deputy has done, I want to commend the pilot programme that has been introduced, instituting a community-based lung health check programme by inviting individuals from north Dublin and the north-east region identified as being at high risk of lung problems to attend for mobile screening, for breath tests and for low-dose CT scans. I have met a number of people who were not high risk who have developed lung cancer. They run marathons and do not smoke, and yet they have lung cancer. As the Deputy has said, in those cases diagnosis often happens at a considerably more advanced stage, which is obviously exceptionally problematic. How do we best capture that group? How do we screen in that group? Under Europe's Beating Cancer plan, in 2022 the recommendation was for further expansion of cervical, breast and bowel cancer screening, and feasibility studies on gastric, prostate and lung cancers. We have to get that balance right around effectiveness. I am so glad to have the opportunity to discuss it in the Dáil today with the Deputy.
I appreciate what the Minister has said. I also congratulate her on expanding the home testing for cervical screening. People who are diagnosed with lung cancer at an early stage have an 80% survival rate. Being diagnosed at a late stage reduces the survival rate by up to 20%. I commend the Marie Keating Foundation and the Irish Cancer Society. The Marie Keating Foundation's Breathless Collection campaign is hugely important in highlighting awareness and also in supporting campaigns for a national screening programme. I ask the Minister to commit to publishing the implementation roadmap and the report from the advisory committee, and to confirm that we will hopefully see a lung cancer screening programme during the lifetime of this Government.
I am not in a position to say that because I do not know what the recommendation will be. Thankfully this is a country driven by science and scientific evidence.
This is a matter of real concern to me.
The Deputy referenced advances in cervical screening. While I have the opportunity, I want to reference that it is expanding and that there are home testing kits, which is a huge advancement for women who do not necessarily feel comfortable presenting for screening or who just want to avail of their sheer convenience. This will help us to make sure those screenings get done. In the same way, we have now extended bowel cancer screening through the community pharmacy agreement. I am so glad to see so many pharmacies sign up to this fantastic opportunity to diagnose common conditions and provide prescriptions to people right around the country from early next year. It also enables pharmacies to identify people within their cohort of patients or customers who should be screening for bowel cancer, register them for the system and give them the kits over the counter that may be used at home and sent back. These are life-changing interventions that can happen in people's homes. I ask anyone who is watching to engage in cervical or bowel screening or any of our screening programmes.
Dental Services
John Paul O'Shea
Ceist:82. Deputy John Paul O'Shea asked the Minister for Health if there are plans to expand or improve dental facilities in Cork North-West, including the delivery of new or upgraded facilities to meet growing demand in towns such as Macroom, Kanturk, Mallow and Millstreet; and if she will make a statement on the matter. [64083/25]
Are there plans to expand or improve dental facilities, including clinics, in north-west Cork? Are there plans for new or upgraded facilities to meet the growing demands of towns like Macroom, Charleville, Kanturk, Mallow and Millstreet?
I thank Deputy O'Shea. As he is aware, over €230 million is invested in public oral healthcare services annually. The dental treatment services scheme, DTSS, provides oral healthcare free of charge to medical card holders aged 16 and over. Services are provided by private dentists and clinical dental technicians who hold a contract with the HSE.
In the north Cork HSE area, there are currently 33 active DTSS contractors, which is up slightly from the 31 who were active in the same period in 2024, although it is not enough. A package of measures was introduced in 2022 to expand the care available under the DTSS and to significantly increase the fees paid to contractors by approximately 40%, which is a very significant increase. Those measures should improve access to care as indicated by patient and treatment numbers which, to be fair, have increased since 2022.
The Department and the HSE are committed to the reform of services for medical card holders, particularly in the context of the design and development of packages for expanded preventative care. That will require a multi-annual programme of work which is currently being scoped by the Department. We are also trying to improve patient access to oral healthcare in a number of different ways through the implementation of the national oral health policy, which is a complete transformation of oral healthcare services and an expansion to children and adults. I am very focused on the deficits that are there today, particularly for children. There is a three-year implementation plan for the first phase of acceleration of reforms.
When I was in Cork last week, I had the good opportunity to attend the annual conference of the Irish Dental Hygienists Association, the members of which perform enormously good preventative work, cleaning work and identifying work. I commend their work to date. Hygienists can play an important role as part of the Government's priority to improve access to preventative oral healthcare, especially for currently underserved populations including people with disabilities, people in residential homes and children in certain areas. There is a body of work there that is not yet completed but is very possible.
I thank the Minister for that update on dental services, particularly in north-west Cork, north Cork and mid-Cork. Certainly, there seems to be gaps in some areas where the DTSS is not available to many medical card holders. That is a serious issue we must try to alleviate. The number of contractors involved in the scheme has increased, but only slightly. As the Minister said, it is still not enough. I would like to see more people coming into that scheme and I would like it to be available for medical card holders. It is important to recognise the orthodontic team that works within the orthodontic service and not just dentists. The Minister mentioned the role of hygienists as well. I am very grateful that the Minister attended a conference in Cork last weekend to see that we can all work together collectively to ensure there is a robust orthodontic service for the people of Cork and Cork North-West going forward. It is critical that people look after dental health. It is publicly available here. It is important to avail of that service.
I will bring in Deputy Burke on the same question.
I am concerned about the whole dental service. There used to be over 1,200 dentists working privately who offered to provide a public service to medical card holders, but that figure has dropped to under 600. Since 2012 or 2013, the number of dentists employed within the HSE has dropped from over 300 to slightly over 250. Even though there has been a huge increase in our population, the number of dentists publicly employed by the HSE is less than it was ten years ago. We need to deal with this issue. Some people are waiting up to five years for orthodontic treatment. This needs to be dealt with by the Department. We need to get our head out of the sand on this matter. I am contacted every week by a huge number of people who cannot get access to dental care for their children. This really needs to be tackled.
In fact, there are 836 contractors on the scheme as of September 2025, although that is a reduction because there was a major data clear-out. There were 1,490 in 2019, when the number was reducing, and there are now 836. A number of inactive dentists were taken off the list in 2022. I can confirm that the fees paid to private dentists to engage in this scheme have increased by 40% to 60%, depending on the nature of the treatment. It is a matter of some astonishment and some disappointment to me that more of them do not wish to engage in it. Notwithstanding that, an additional 256,000 patients have been treated since 2022. As a result of the expansion of the dental facilities in Cork North-West, for example, an additional 44,208 patients were treated in 2024 compared with 2022. I will give this data to Deputy O'Shea directly. The fees to contractors went up from €49 million to €69 million in the same two-year period. It is a very considerable expansion. Indeed, activity in north Cork has increased this year with an additional 286 treatments provided. I recognise it is not enough, but it is a very considerable expansion within a two-year period.
I thank the Minister for her response. I want to focus on the HSE dental services that are available to children and to adults with significant special care needs. The service provided over the last number of years has been challenged by the Covid-19 pandemic. There have been a number of challenges in terms of providing orthodontics, particularly in ensuring there are enough staff to support clinics right across Cork North-West. We have clinics in Charleville, Newmarket, Mallow and Macroom. We also have St. Finbarr's Hospital and the Cork University Dental School and Hospital in Wilton to support that. However, it has been quite challenging to get the school programmes back up and running. Obviously, there is an opportunity for children in second class and sixth class to avail of dental examinations and appointments. There has been some improvement. I encourage the Minister to see if we can work with the HSE to make more improvements in that regard and make more clinics available more locally. It is a challenge for people in Cork North-West to travel into the city to accommodate clinic appointments in St. Finbarr's Hospital or the dental hospital. More clinics around the vicinity of Cork North-West would be of huge benefit.
I commit to trying to expand access to oral health and preventative oral health in every way. We need to look at the role of dental hygienists within the dental profession. In every other aspect of workforce planning in healthcare, we recognise that we do not have enough healthcare workers to meet our need. As I mentioned earlier, we are trying to have pharmacists work at the top of their expertise in their profession in order that they can diagnose basic common conditions. We now have an agreement with them that they will do that, but they should be working at the top of their expertise. We will try to have pharmacist technicians there to support them. In the same way, there is a much bigger opportunity for dental hygienists. We have advanced nurse practitioners and clinical nurse specialists. We have all of these advances in practice. Dental hygienists can play a particularly important preventative role and community support role. I am not saying they can provide all of the treatments - of course that is not the case - but I do not think we have come to the end of workforce planning in this respect. I know the people of Deputy O'Shea's constituency would welcome the opportunity to see a dental hygienist at a much earlier stage than has been possible to date. I have some work to do to try to support that.
Departmental Data
Edward Timmins
Ceist:84. Deputy Edward Timmins asked the Minister for Health the number of operations completed for complex laparoscopy for severe endometriosis to date; and if she will make a statement on the matter. [64607/25]
One in ten women in this country is affected by endometriosis, a condition that inflicts immense pain and suffering and is often unspoken about and misunderstood. Can the Minister advise how many operations have been completed for complex laparoscopy for severe endometriosis to date?
I thank Deputy Timmins. I think it may be closer to one in seven - possibly one in six - women who are affected by endometriosis, rather than one in ten. We are learning more about it together. Our specialist endometriosis services are monitored by the HSE's national women and infants health programme.
At the end of September 2025, 719 specialist endometriosis surgeries had been carried out. The most complex endometriosis surgeries are performed by multidisciplinary teams. Some 263 of the reported 719 surgeries took place in our complex centres in Tallaght and Cork. Surgeries for less complex endometriosis may also be performed in our acute gynaecology services.
I am committed to expanding the scope and standard of our endometriosis services and improving supports for women. In recent weeks, I approved a plan to expedite access to care for women with endometriosis. The HSE will, as a consequence, carry out more than 100 additional surgeries by the end of this year. We expected 1,200 but will instead have 1,300 by the end of this year, an important addition. I have provided an additional €0.5 million directly for this purpose. By way of progress update, in October, 34 additional surgeries had been completed against a target of 33. The majority of these were excision surgeries. Complex and severe cases were prioritised. An additional colorectal surgeon is also being actively recruited to try to facilitate more complex surgical treatments.
On 18 October, I launched the national framework for the management of endometriosis. It is a necessary expansion of services. The HSE’s budget will help to enable expansion and improve all of our services, including endometriosis. We have to increase awareness. I have written directly to all GPs to try to drive awareness where it is not already there and try to drive a better opportunity for women to have referral pathways much more quickly and a presumptive diagnosis, recognising that women are, of course, the most reliable narrators of their own experience and pain.
I thank the Minister for the information. I welcome the launch of the first national endometriosis framework and the recognition of the women and girls who have suffered for many years from this condition. I recently met a constituent in my office who has suffered for over 20 years. She has experienced bottlenecks regarding diagnostics. It is very clear that we must acknowledge the pain and impact this condition has brought to the lives of so many women and girls. We need to ensure the framework is actioned without delay. I understand Cork and Tallaght are super hubs. Is this correct? Do all of the surgeries take place in those hospitals? When is it expected that the additional colorectal surgeon will be in place?
Not all of the surgeries take place in Cork and Tallaght but the most complex ones do. I have expanded a scheme to treat women who require complex surgery abroad. It was the case that they would go abroad and get the funding back via the cross-border directive. We very quickly put in place a scheme whereby people could get funding upfront for such surgery in many clinics in the UK and Europe. I have actively asked clinicians in the HSE to visit two clinics in Athens and Bucharest that women report to me as being very good but which did not meet the criteria in the first instance. We are trying to expand services.
On 1 September this year, I held a patient voice forum in the Department of Health. The Chief Medical Officer, the CEO of the HSE and the chief nursing officer listened to the voices of 60 or 70 women with very complex and painful endometriosis. On 5 September, I put in place a new action plan, drawn up based on the needs of the women at that forum. From 1 October, we had a new plan for additional surgeries in Ireland to be carried out over three months. On 18 October, I launched a framework and plan to support women who are not able to get the scale of intervention they need here, so that they can get that help internationally while we collectively scale up our complexity on imaging and surgeries in Ireland.
I thank the Minister. It is obvious that she is making great progress and is giving this the priority it deserves. We must commit to increasing capacity and implementing the visiting consultant model. Bringing internationally recognised experts to operate alongside Irish surgeons would rapidly and affordably expand skills and capacity, which would be far more effective than relying on an overstretched endometriosis surgery abroad interim scheme, ESAIS. This is especially important if the quota of over 100 extra complex surgeries per month is to be met. Over 30,000 women are on waiting lists for complex endo surgeries. To send each abroad at an approximate cost of €20,000 would result in a total cost in the order of €600 million. For operations and treatment to be provided in Ireland under the visiting consultant model would be more cost-effective and have more long-term benefits. This would demonstrate real commitment to the care of women.
There are not 35,000 people with endometriosis on outpatient gynaecology lists. Approximately 700 are waiting for endometriosis surgeries. An additional colorectal post has been prioritised and advertised for recruitment in Cork University Hospital. The time it will take will depend on the interest generated but I very much hope it will be done as soon as possible.
The Deputy is correct. I do not necessarily want women to be travelling abroad. I would much rather they get surgery here but it is not an either-or situation. I want them to be able to get the right surgery as soon as possible. As we scale up, we must also facilitate women to be able to get the surgery they need. There will be a major conference in January, which will be driven by the Royal College of Physicians and the college of obstetrics regarding endometriosis and the skills available here.
One surgeon, who will remain nameless, offered to travel with her patient to a clinic in the UK to shadow the surgery and better inform herself in order to learn how to provide a better service to her patients. It is that sort of leaning in that I have seen from consultants in recent months who want to provide a service to women, many of whom have advocated for this and want to do more and better for their patients. I was heartened to hear that story from a patient about her surgeon.
Mental Health Services
Cormac Devlin
Ceist:83. Deputy Cormac Devlin asked the Minister for Health the funding being provided for mental health crisis supports and suicide prevention in 2026; and if she will make a statement on the matter. [64090/25]
The question is in the context of significant additional funding for mental health services over the past five years, resulting in a €1.6 billion investment in mental health services for 2026. For the sixth year in a row, there has been an increase in staffing. I would like the Minister to make a statement on the funding provided for mental health crisis supports and suicide prevention in 2026.
I thank the Deputy. I am taking this question on behalf of the Minister of State, Deputy Mary Butler, who unfortunately cannot be here today. The total allocation for mental health services in 2026 is almost €1.6 billion, the sixth year in a row in which the mental health budget has increased. This increase in funding for mental health services will enable continued policy implementation and service improvements in line with our national mental health policy, Sharing the Vision, and our national suicide and self-harm reduction strategy, Connecting for Life. Across the board, we have seen mental health promotion and early intervention through specialist mental health services.
This record budget will allow for a focus on improving support for people in mental health crises in hospitals and in the community through an additional €15 million for crisis supports and suicide prevention. Significant progress has been made over the past three years to develop alternative crisis mental health pathways. However, emergency departments continue to see high volumes of mental health presentations.
Investment this year will be used to establish specialist nursing teams in all model 4 hospital emergency departments, three new crisis resolution services in Donegal, Kerry and the midlands, 12 additional suicide crisis assessment nurses and several Traveller-specific suicide prevention initiatives, the development of the new crisis response pathway for children and young people, increased funding for suicide prevention community and voluntary organisations and funding to implement the new suicide reduction strategy. As occurs each year following the budget, discussions take place with the HSE on details relating to specific service initiatives in the context of preparing the HSE service plan for 2026, including that for mental health.
I thank the Minister of State. It is extremely important that we continue to progress investment in our mental health services. We still lag behind the internationally accepted norms for spending on mental health as a proportion of our budget. The Minister of State, Deputy Butler, has done some tremendous work in this regard. We have identified the tsunami of mental health issues that have arisen since Covid. As a practising GP, it is important to me that when we refer people who are in crisis that there are adequate pathways for them to achieve treatment. I have dealt with situations where young people in crisis, who are actively suicidal, have sat in emergency rooms for eight or nine hours waiting for an assessment. Putting specialist nursing teams into all model 4 emergency departments is a good initiative because it will provide an immediate assessment by a specialist nurse.
I absolutely agree. The Minister of State, Deputy Butler, is very passionate about this and has been working very hard on it. There are three new crisis resolution services, that is, crisis cafés, to support people in distress. They are located in Donegal, Kerry and Tullamore in the midlands. An allocation of €4 million has been given for this. Funding of €1 million has been provided for 12 additional suicide services where nurses support people in distress who present to GPs in the community. There is funding of €415,000 for several Traveller-specific suicide prevention initiatives, which have been codesigned with the Traveller community. There is increased funding of €1.7 million for suicide prevention in the community and for voluntary organisations, including Pieta. Funding of €1 million has been given to implement a new suicide reduction strategy. There is €4 million to develop a new crisis response pathway for children and young people, with 19 new CAMHS specialist doctors for out-of-hours emergency liaison, as well as five new adult liaison psychiatrists. There is more but my time is up.
I welcome all those initiatives. It is really important that they are integrated with existing mental health services. Initiatives must be even and consistent throughout the country, with adequate access. In addition, we need to look at acute mental health capacity in its totality in terms of beds. In the acute psychiatric unit in Roscommon University Hospital, up to a third of beds are taken by people who would be better served in supported situations in the community. In County Roscommon, there were many community hospitals and problems were identified with them. However, after the closure of the psychiatric hospital in Castlerea, there has been no replacement capacity in the community to step people down into those beds and create space for acute presentations to the psychiatric unit in Roscommon University Hospital.
I certainly will go back to the Minister of State, Deputy Butler, on those very important points. I absolutely agree we need more beds. The Minister, Deputy Carroll MacNeill, is very much aware of that. It is something the Government is looking at and the Minister definitely will work on it.
There is a challenge in dealing with suicide in extremely complex cases. We have seen cases where a single event is the factor that leads someone to take his or her own life. There are huge issues there. We need to get supports in place for families, individuals and communities. An action the Minister of State is working on is the new suicide reduction strategy. It is being drafted and will include information on beds and so on. Implementation of this new strategy will be developed in quarter 1 of 2026. I will convey the Deputy's concerns about the need for more beds and I thank him for highlighting it.
Medicinal Products
Martin Daly
Ceist:85. Deputy Martin Daly asked the Minister for Health the reason the osteoporosis drug Prolia, denosumab, is not routinely available free of charge to men with confirmed debilitating osteoporosis in Ireland in the same manner as it is available to women in equivalent clinical circumstances; and the steps her Department is taking to ensure equitable access for male patients in the Roscommon–Galway constituency who could benefit from this treatment but currently face significant financial or access barriers. [64522/25]
I apologise to the Minister as this question contains incorrect information. I contacted her team to convey that message. I will ask the question and she might get back to me on it. I gave her short notice in respect of it. Romosozumab is a licensed treatment for postmenopausal women with advanced osteoporosis that does not respond to all other therapies. I have had a representation from a young middle-aged man who has a rare form of osteoporosis that has rendered him disabled. He does not have access to this drug by virtue of being a male.
I thank the Deputy for raising this case. He is right that this drug is reimbursed for postmenopausal women with osteoporosis. I would like an opportunity to check this but, as I understand it, the European Medicines Agency, EMA, originally assessed the drug for use in both women and men. However, the company withdrew the male indication during the process following concern over the benefit-risk profile. It has been added to the HSE reimbursement list for postmenopausal women at high risk of fracture but it is not licensed for use in men for that reason. As prescribing it for men would be off-label, the HSE does not extend reimbursement to male patients. There is no licence to use it to treat osteoporosis in men. The company marketing the medicine withdrew the licence application for that use. I am sorry to tell the Deputy there is nothing I can do about that.
I appreciate the Minister's answer, which is given at short notice. I am glad I raised the question on the floor of the House. The young man I mentioned is in difficulty. He is a self-employed businessman and is now disabled with multiple non-traumatic fractures. He asked whether there was a possibility he might be reimbursed for this medicine. However, it is down to the company to apply for a licence, as the Minister said. I accept that completely. We will have to revert to the company. I appreciate her reply.
Ambulance Service
Brian Brennan
Ceist:86. Deputy Brian Brennan asked the Minister for Health for an update on developments with the ambulance service in the south east; and if she will make a statement on the matter. [64352/25]
It would be remiss of me not to take this opportunity to mention that people from north Wexford have experienced a number of serious medical emergencies abroad. I thank the Minister and her staff for their prompt response and service in these sensitive matters for the families concerned. The responses by the Departments of Health and Foreign Affairs and Trade and the HSE have been really appreciated by the families. One case is still ongoing and I am working closely with the family on it. I must mention one of the Minister's staff, Bríd, who has been more than helpful.
My question asks for an update on developments with the ambulance service in the south east.
The Government remains committed to investing in and developing the National Ambulance Service, NAS, including in the south east. The allocation in 2025 includes an additional €28 million of new service development funding for up to 180 additional posts. Those posts will focus on strengthening front-line emergency services, expanding alternative care pathways and developing specialist services, including critical care retrieval.
Government investment in NAS has increased by 64% since 2020. The HSE Dublin and South East region is served by 14 NAS ambulance bases. Two NAS pathfinder teams aimed at older persons operate from Waterford and St. Luke's hospital in Kilkenny. Four NAS community paramedics also operate in the region. The south-east region has benefited from two additional 24-7 emergency ambulances based in Tipperary and Arklow. Additionally, it is served by the NAS national clinical hub, which offers alternative pathway options for low-acuity patients.
The Deputy will be aware of ongoing NAS capital projects in the region, including new ambulance bases for New Ross and Gorey, which are scheduled to proceed to detailed design phase shortly. In addition, a new ambulance base regional training facility and business support hub project is planned for Carlow town and is proceeding towards detailed design phase.
I welcome the strong investment. The Gorey and Arklow area is one of the fastest-growing areas in Ireland. When we add in the coastal area between Castletown and Cahore, there are an extra 40,000 people every summer. The capacity really is stretched. I ask for continued investment in specialised advanced paramedics and community paramedics, who provide a vital service in communities. Second, what is the status of the promised national ambulance training college in the area? The model in Limerick was rolled out very successfully. I understand we are looking at the nursing residential triage tool that allows patients in nursing homes to be treated in situ.
We continue to invest at pace. There are an additional 500 NAS staff since 2020, with the total going from approximately 2,000 to 2,500, which is a very considerable increase of 26%. That increase is needed to ensure the distribution of staff and the different ways in which they can try to keep people close to home, particularly older people whom we do not want having to present at acute hospitals. The south-east region currently has 14 ambulance bases, with 277 whole-time equivalent staff, including paramedics, advanced paramedics and advanced emergency medical technicians. We have new development funding in 2025 for two additional 24-7 ambulances. There is the new rapid response vehicle operating from Newcastle, County Wicklow. The south-east region is served also by 50 active community first responder groups, which play an enormous role. Further aeromedical support is provided to the region by the NAS helicopter emergency service and the Irish Coast Guard. These are the different ways in which we are trying to provide support and divert lower-acuity patients.
I ask the Minister to give a further commitment of funding for non-emergency patient services. In my constituency, Arklow Cancer Support is an example of a charity doing incredible work providing a wonderful transport service for vulnerable cancer patients to and from appointments. It operates on a shoestring and spends a huge amount of time and effort on fundraising. All the measures we have discussed will put less pressure on Wexford hospital, which provides an excellent service in the south east but is stretched. Although this issue is under the remit of the Minister of State, Deputy Butler, I must point out that the lack of acute mental health services is a real issue in the south east.
The measures I outlined will put less pressure on Wexford hospital.
I recognise the work done by volunteer groups like Arklow Cancer Support and the support they give to cancer patients travelling for blood tests, infusion services and so on. The HSE is not a land development or transport company. I recognise there are many different groups providing an enormous service to cancer patients, some with some measure of State support and others not. While the HSE will never be a transport company, I have met Volunteer Ireland to ask it to compile a list of all the different volunteer groups who provide transport services for health patients, cancer patients or in the disability space - many overlap and intercept. When I have that complete list, I will sit with the Minister for rural affairs, Deputy Calleary, and, in particular, the Minister of State, Deputy Buttimer, who sits in both the Department of rural affairs and the Department of Transport. There is something we have not yet imagined in terms of rural support services and transport services. It is not the responsibility of the HSE. It should not really be. We cannot do high-quality cancer care and transport. That is not the role but there is something better, more imaginative and more co-ordinated that can be done. I am grateful for the opportunity to discuss it today.
Health Services
Erin McGreehan
Ceist:87. Deputy Erin McGreehan asked the Minister for Health for an overview of the recently launched national endometriosis framework; and if she will make a statement on the matter. [63981/25]
I thank the Deputy for giving me the opportunity to raise this matter again. It is fantastic to see the amplification and awareness of endometriosis in Ireland. That is part of what the framework is trying to do. We launched the framework on 18 October. I will set out the timeline again. This was in gestation for some period but it was becoming very clear that we were not meeting the needs or responding or perhaps hearing the acuity of what women were describing in terms of their pain, suffering and the impact on their lives. I also have to recognise the very many women in Ireland - I have met and discussed it with them - who received treatment that was absolutely satisfactory for them but perhaps they are at a different level of acuity. For the most complex and severe cases of endometriosis, it was not the case that we were meeting that need. We were not recognising it either in our public awareness of the impact on a person's life in terms of sport, attendance at work, opportunity to look for promotion and to participate in life in a normal way and how that impacts women and girls and can do so for a very long period of their lives. It is also not recognised that many women got surgeries that were successful here but at the more complex end were travelling abroad, paying considerable sums. In many respects they got all or much of that back through the cross-border directive or the treatment abroad scheme but after the fact.
It is not satisfactory to me that women should have had to do that and that the surgeries were not available to them here. Part of what we are trying to do is upskill what we are doing here and the complexity of surgeries. We are recruiting additional colorectal surgeons in Tallaght and Cork to try to enable more complex surgeries. We need to improve our understanding of the diagnostics and imaging. Endometriosis is very difficult to see sometimes. Different types can be very difficult to see. We need to do a lot better on that and upskill more broadly our capacity to do complex surgeries. In the meantime, I want to try to provide women with upfront support for those who need to travel abroad.
I am an endometriosis sufferer. It is physically, mentally and emotionally draining. Some days I come into this House and I am in absolute agony. I negotiate how I sit down and I am afraid I am not fit to finish the day. As the Minister knows, our job is demanding. It is people-facing. It feels like a knife fight is going on inside you quite often. Many women and girls have to tolerate that pain and agony day in, day out. It is chronic and absolutely exhausting. I am grateful for the Minister's work and that it is recognised and that we have a national framework. I feel emotional about it because it is so important. I was diagnosed and I was absolutely alone. There was no space. I am grateful to the Government for recognising women's health is specific and deserves specific frameworks.
I did not know that. I am sorry I did not. I am so glad the Deputy and I have the opportunity to describe the pain women face every day. As she said, it is like a knife fight inside you and yet she comes to the Dáil, working an extraordinarily demanding job, as everybody here knows. It is exceptionally physically and emotionally difficult and that is just the job. That is on top of all the things we bring to work with us. It has not been understood. The Deputy knows that better than me. She does not need me to explain that to her. I am glad we have a different understanding. I attended a fundraising last night for a local rugby club and a gentleman came up to me to talk about his 28-year-old who had been in precisely the same situation for a very long time. The impact on women's participation in normal life has to be understood. Teenage girls cannot participate in sport and perhaps cannot sit their exams. There are women who have gone through university, doing phenomenal jobs in the workplace, taking significant periods off and are not able to explain or have that understood by their employer. This impacts women's lives. It is important that it be broadly understood and named. It is a series of cells that can move through the body with exceptional pain right through from pelvis, through the diaphragm up to their shoulders, thoracic region and into women's brains and eyes. It is exceptionally painful. The more we try to explain that pain women have been going through, it will be better understood. It helps me to generate urgency around improvement in services.
The Minister is absolutely correct. I ask for mental health supports alongside the framework and fertility education and counselling for women who are not ready to have children. I am blessed that I have four children. I bucked the odds. I am eternally grateful my body was able to do that for me. We need that GP training and dedicated research funding. This is an autoimmune disease. In Ireland, we have quite a lot. Women are more inclined to have autoimmune diseases. We probably do not have a test bed because of the island that we are. We could be doing clinical trials and looking at research funding for endometriosis and autoimmune conditions in women. I cannot tell the House how important it is to move forward - go big or go home. The Minister is improving women's health and families. When a woman is sick in their home, it impacts the family. When we improve their health, we improve families and communities.
I will do everything I can do try to drive clinical trials and research. I am launching the clinical trials oversight group this evening. This is an obvious space. It is under-researched more broadly though there is an opportunity for us in France that I might to talk to the Deputy about separately. It is really important that she mentioned fertility. Fertility is inextricably linked to the experience of endometriosis. Many women have not been able to have children, have had to postpone fertility to try to receive endometriosis treatment and there are women trying to work out that intersection. This is why awareness is so important. I have met teenage girls who have had it suggested to them by professionals in the medical system that they have a baby because that would release the symptoms of endometriosis. If it was a once-off case, I would not say it in the Dáil. I have listened to women of different ages, including teenagers, who have been told, go and have a baby; that will fix it. Of course, it will not. I have spoken to women who have had children and it does not necessarily fix it-----
I have had four. It does not fix it.
-----or women for whom it has come as a consequence of pregnancy. Can we just put a line under that now that it never happens ever again in an Irish medical facility that a teenage girl is told to go and have a baby and that will sort her endometriosis?
Hospital Facilities
Brian Stanley
Ceist:88. Deputy Brian Stanley asked the Minister for Health to request the management of the HSE to utilise the existing hospital building at St. Vincent's, Mountmellick, when the new wing opens, which would increase the bed capacity in the facility; and if she will make a statement on the matter. [64160/25]
I welcome the framework for endometriosis as well. It is something I have raised with the Minister in the past. I support that work.
It is very important the capacity at the hospital is increased.
St. Vincent's Community Nursing Unit, Mountmellick, County Laois, is a public nursing home that currently provides 56 long-stay beds and one short-stay bed. Phase 1 of the current capital project for St. Vincent's consists of a new two-storey development containing 50 single en suite rooms adjacent and linked to the existing facility.
The project is expected to be construction complete in the next few weeks.
It is currently expected that St. Vincent’s will be operational in quarter 1 of 2026, following the transfer of residents, the reviewing of staff rosters and the application to vary the registration with HIQA. When complete, St. Vincent's will be registered for 58 beds consisting of 57 long-stay beds and one short-stay bed.
The eight-bed dementia unit in the existing building will continue to operate. The HSE has advised that they are reviewing plans in respect of the future use of the existing facility. However, the main kitchen, canteen, laundry and storerooms will continue to be accessed by staff. The church will also continue to be accessed by residents and staff as required, and daycare will remain operational in its current location.
The scale and scope of future additional phasing of capital works at St. Vincent’s are currently being reviewed by the HSE, and once completed, the specific scope for phase 2 of the capital project will be determined.
Specifically on the matter raised, as I said, the HSE is currently reviewing plans in respect of future use of the existing facility. More particularly, the HSE is currently in the initiation phase of project planning for utilisation of the existing building, necessitating complete refurbishment, taking account of the demands for additional rehab and long- and short-stay beds in the community nursing unit, CNU. Any development in the old St. Vincent's building will be subject to capital and revenue funding approval.
I thank the Minister of State for his reply. There are 58 beds there at the moment. The important thing when the new wing is opened, which I welcome as it is a €31 million investment we have been long waiting for, is that we increase that bed capacity of 58 beds. The reality is that 25 of the existing beds are in a ward that was refurbished in recent years at huge expense. There are double-glazed windows and completely refitted en suite rooms. It would be outrageous were those 25 beds to be taken out of use. There is capacity here to get the hospital up to 83 beds. There are brilliant staff there. It is a very well-run facility. As I said, they are totally refurbished rooms. A total of 25 beds could continue. There is a shortage of nursing home beds in the county. The Minister of State knows the situation he dealt with personally with regard to the residence. I thank him for his work on that and on the private ones. We have lost Ballard Lodge, a private nursing home which closed down and which was a good facility. We need extra capacity in the county. I plead with the Ministers of State and the Minister, Deputy Carroll MacNeill, to do everything they can to try to ensure that they increase the capacity to 83.
I put in a parliamentary question and received a reply on 14 October, outlining exactly what the Minister of State has said. Funding of the sum of €23.7 million was allocated for a 130-bed facility in St. Vincent's in 2016. The project is being carried out in phases, including work on a new 50-bed unit. Will the Minister of State give a firm commitment that the overall capacity will be a 130-bed unit when all phases are complete? I refer to the existing facility in St. Vincent's in Mountmellick, which I know very well because my late mother was a nurse there for many years. A special occasion was when we went to look at the Christmas decorations at Christmas and to visit the patients who were there. I want to make sure we can keep the number of beds we have there. As a politician - we are all politicians at the end of the day working on behalf of the people in our communities - the single biggest issue raised in my clinics every day is by people who are trying to get their loved ones into one of the nursing homes. It is very difficult. There is no capacity in any private residential nursing homes. As has been said, the nursing home in Portlaoise is closed at the moment, which puts huge pressure on the situation. I am asking the Ministers of State and the Minister if they can do everything possible for us.
I thank Deputies Stanley and Aird for raising this matter. As I said earlier, the HSE is currently reviewing matters in respect of phase 2 and, more particularly, in respect of the use of the existing building in terms of pure logistics. The person in charge is in contact with HIQA. There was a request for a preliminary visit of the area in respect of the new building and specifically in respect of the existing building. As I said, the eight-bed dementia unit will continue to operate in the existing building. The HSE advises it is currently reviewing plans in respect of the future use of the existing building. More particularly on that, the HSE is currently in the initiation phase of project planning for utilisation of the existing building in terms of complete refurbishment. I take on board the point Deputy Stanley made about the 25 beds and the point Deputy Aird made about the increased capacity. We have taken account of the demand for additional rehab and long-stay and short-stay beds in the CNU. Developments in the old St. Vincent's building will be subject to capital and revenue funding approval. I take the points both Deputies made on board. I commit to working on what they have raised.
The first thing I want to say in reply to the Minister of State is that €31 million is the cost that I have been given for the new 50-bed unit that is being developed there. In response to a previous parliamentary question, the Minister said that "scale and scope of phasing of these works is currently being reviewed with service colleagues, and once completed, the specific scope for Phase 2", which is the next wing of 50, "will be determined." That is a change from the original plan of three phases. I am trying to be practical about this. I know money cannot be pulled out of the sky but we have 25 beds there out of the existing 50. The first thing is to keep them there. The second thing is to move onto phase 2 for the second 50 beds because we need them. There is a growing elderly population. I do not need to tell the Minister of State that the demand is there for it. A lot of families are coming to me about it.
I was not aware that you could come in on the back of a written question at oral question time.
You can.
It is a new procedure in the Dáil. Maybe the Standing Orders have been changed and the Leas-Cheann Comhairle might advise me afterward.
I allowed him in.
It is good to see such strong cross-party representation from the constituency of Laois. On the particular matter Deputy Stanley raised, there are two aspects. They are currently reviewing the scope for additional works under phase 2. More particularly, both Deputies raised the point in respect of the existing building. I followed up with the HSE yesterday in advance of our debate. I got the update the Deputy is looking for, which is that it is currently looking at the use of the existing building. It is looking at it in the context of the refurbishment that was referred to, the 25 beds, which I will bring up with it, and the need for additional rehab long-stay and short-stay beds. The first step is that the HSE completes its work in that area. We then need to look at funding. I will be following up with the HSE on that particular matter.
Hospital Equipment
Matt Carthy
Ceist:89. Deputy Matt Carthy asked the Minister for Health if she will commission a feasibility study into the provision of CT scans in Monaghan hospital. [64412/25]
The decisions by previous Governments to remove all services from Monaghan hospital has proven to be absolutely disastrous for the health services across the region. It has been a battle a day ever since to establish new services at Monaghan hospital. The most recent battle was in relation to an MRI scanner, that eventually we are told will be in place over the next 18 months, which is still far too long. I am asking the Minister that we do not have to go through the same rigmarole and process to get what is blatantly needed, which is a CT scanner in Monaghan hospital. Will she ensure that this is put in place?
Cavan and Monaghan operate as a single entity with integrated managerial and clinical governance systems, care pathways and support functions. They are 46 km apart from each other. Cavan and Monaghan hospitals currently have two CT scanners and one MRI scanner. Two CT scanners is one more than is available to the people in Mayo, where there is only one CT scanner in Mayo University Hospital. There is no business case submitted by Cavan and Monaghan hospital for a CT scanner. The hospital does not have plans to seek additional CT capacity as clear clinical pathways exist to support the region. The replacement to the existing MRI has been approved. Works are expected to be completed by the end of the year. It is clear to me that the number of scans done at Cavan general hospital this year is very considerable and has increased but the opportunity to do more also exists.
Up to 31 May 2025, around 22,000 CT scans took place in Cavan and Monaghan hospital, which is a year to date increase of about 6%. As I look at the operating hours, there are normal working hours of nine to five, two outpatient scanning per week from 5 p.m. to 8 p.m. and 24-hour seven-day-per-week emergency department services provided. There is always a well-acknowledged challenge in respect of radiographers and radiologists but it certainly shows that there is capacity in the existing CT machines with additional staffing and rostering to considerably increase utilisation. A business case has not been submitted by Cavan and Monaghan hospital for a third CT scanner.
I have heard about Monaghan hospital a number of times. It is really important to express how much investment in additional staff has gone in there. The budget has increased by 54% since 2020 and the number of staff in the Monaghan element of the Cavan and Monaghan hospital has increased by 70%, which is an outstandingly large outlier having regard to all of the other hospitals.
I invite the Minister to go back and read her statement and those of her predecessors about an MRI scanner at Monaghan hospital and several other issues. She is right. There have been staff increases in Monaghan hospital and services have increased in terms of provision. Every single one required a sustained campaign to force the Department and the HSE to see logic. When it came to the minor injuries unit when Monaghan hospital was operating at the lowest operating hours anywhere in the State, we had to fight tooth and nail to get the same operating hours as everyone else. The then Minister said the exact same as the Minister is saying today. When it came to the MRI scanner, I put down questions to Ministers countless times and they gave the exact same answer as the Minister is giving with regard to a CT scanner yet eventually the logic has become apparent and an MRI scanner will be provided. That is the result of pressure put on the Department and the HSE. The Government should cut out the middle man, cut out the messing and deliver. It should carry out a feasibility study on a CT scanner for Monaghan hospital because it is what the county deserves.
There is nothing the Deputy likes better than a good campaign and nothing he likes less than a few facts. Staffing has increased by 70%. I am so glad to hear him acknowledge it today because there are so many times when I do not hear that about Monaghan.
The Minister had to be dragged kicking and screaming.
That may be the Deputy's perception of all things but if he had been here he would have heard the dialogue around diagnostics, including from his party spokesperson, and the utilisation of them - he is sitting beside Deputy Conway-Walsh, whose county actually does need a second CT scanner in Mayo University Hospital and the local injury unit. I was there this week.
Deliver it. We have none in Monaghan.
The Deputy does not like answers that do not operate as convenient for him. He is the only Deputy this morning who talked across me as I was trying to give him an answer. He does not like facts.
Because she is not giving an answer.
The Deputy does not like an answer. I am entitled to give him an answer to his question. He asked me about Monaghan hospital. Here is his answer. Cavan and Monaghan have two CT scanners and an MRI scanner. They are the same unit. Staffing has increased by 70%. The budget has increased by 54% for Monaghan alone. What the Deputy does not like is how my colleague, Deputy Maxwell, reminds him of the number of hospitals and services removed in the adjoining area in the North of Ireland that have been closed under Sinn Féin's watch. It is about time Deputy Carthy recognised the totality of services for people in that region as the rest of the country does.
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