Vol. 1084 No. 2
120. Deputy Matt Carthy asked the Minister for Health the number of instances in 2023 to 2025, inclusive, when ambulances in Cavan and Monaghan did not arrive within the targeted timeframe; and the longest period that a person waited. [28365/26]
Tá ceist Uimh. 120 in ainm an Teachta Carthy á glacadh ag an Teachta Bennett.
The Dublin North and East region, which includes Cavan and Monaghan, has benefited from recent investment, with 12 additional paramedics in 2025 and a further 12 scheduled for this year. Six additional emergency medical technicians are planned for Cavan. This will help to preserve front-line ambulances for emergency calls. I highlight this because the National Ambulance Service is focused on addressing areas where there is a clear need for greater resourcing. A particular emphasis is on targeting potential applicants in areas of need, including the Cavan-Monaghan area, where there have been challenges with recruitment in the past. That is the only reason I set some of that out. I acknowledge that there have been challenges with recruitment, notwithstanding our desire to recruit more people in the area.
The HSE has informed me that the National Ambulance Service's response performance in the region between 2023 and 2025 met the key performance indicator, KPI, targets in the HSE service plan. However, it is acknowledged that at times of high demand, some lower acuity patients have waited longer for a response. I also acknowledge that we would like the targets for purple and red calls to be higher in the first instance. I am not saying that KPIs are any sort of panacea; I am simply acknowledging that the performance in the north-east region has been better than the target. That is something, but we have a way to go to build on it.
The Government is committed to the continued development of the National Ambulance Service in the context of both capacity and strategic reform. Since 2020, we have increased the budget for the National Ambulance Service by 60%. We have increased the personnel by 30%. This year, as I informed Deputy Cullinane, we really are trying to recruit. We have a targeted recruitment campaign. We have posts available. I will speak more to that, because, as Deputy Bennett is aware, we need to have better response times,
I welcome that additional staff have been employed. It is still not enough, however. More needs to be done. The National Ambulance Service used to make data available to help inform policymakers in coming forward with constructive solutions. Data indicates that the number of people who died by the time an ambulance actually reached their homes was up 70% in the eight years prior to 2024. There were over 95,000 instances in 2022 of people waiting more than one hour. However, when Sinn Féin recently sought updated information, the National Ambulance Service told us that there is no operational imperative to do so and that there is little or no clinical evidence underpinning response-time targets. That is despite coroners having found evidence of ambulance service capacity being the root cause of a person's death. Does the Minister think this information is relevant and important and that it should be made available to Members?
It is difficult to answer in light of some of the circumstances involved. The Deputy raised an individual case where somebody identified a specific reason. While I acknowledge that, in other cases it is not clear whether a patient, for example - it is awful to speak about it in this way - was going to die irrespective. I can understand the clinical constraints in providing broad data when dealing with many individual circumstances.
It is because of the increased response times and the availability that we are trying to recruit. The recruitment competition in 2025 brought the highest number of applicants ever with over 1,000 people applying. I take some comfort in that. It will help fill the additional 263 posts that we have in the National Ambulance Service this year. It will provide for 21 additional crewed emergency ambulances for new intermediate care services on a 12-over-seven basis and a range of other investments.
I find it hard to believe that there are 263 posts that we cannot fill. I do not know if this is down to how we are advertising these posts that they are not being filled. As stated, this information, which I asked for previously, is very important in order that we can inform policy decisions. We cannot fix what is not measured. In terms of what needs to be done in order that the right people across the State have the ambulance service that they deserve and need, however, a few things are apparent. Our dedicated and highly educated newly qualified paramedics need a clear pathway to permanent employment in the National Ambulance Service.
They are well needed because the service, by its own admission, is massively short-staffed by 2,000 workers. In Cavan and Monaghan, we need a 24-7 advanced paramedic. At a time when we have seen an overwhelming vote by National Ambulance Service workers for industrial action, up to strike action, will the Minister intervene on these matters?
I appreciate that the Deputy may find it difficult to see that we cannot fill posts but I assure her that it is true. Of last year's posts, there were 180, and 134 have been filled. I would like it to be 180 filled. This year we have provision for 263, which is obviously a considerable increase on last year, so the direction of travel in terms of our investment is very clear. This is not unique to the ambulance services; we have this difficulty across home support, we have it across recruiting into the medical profession generally and we have it with GPs. Across the board, we have posts that are unfilled and to which we are trying to recruit. I would welcome these positions being taken. As I said, there were 1,000 applicants. I take great comfort in that, that people want to do this, but it is also important to highlight that we are trying to have alternative care pathways as well. About 40% of patients now do not require, because of that intervention, subsequent conveyance or subsequent transfer to an emergency department, so those pathways are working well and we need to invest more in that as well. There is emergency department in the home, for example and all the different alternative emergency pathways.
Could I just ask about the 24-7 advanced paramedic that was taken away from Cavan and Monaghan?
I am sorry, that is not-----
Sorry. That is okay. I will table a parliamentary question to the Minister.
121. Deputy Joe Neville asked the Minister for Health if her Department has considered introducing initiatives such as a refundable tax for set-up costs on new GP practices to address the current GP shortage and incentivise more GPs to open practices; and if she will make a statement on the matter. [28453/26]
I ask the Minister if her Department has considered introducing initiatives such as refundable tax credits on costs of new GP practices or extensions to GP practices to try to address the current GP shortage and incentivise more GPs to extend their practices; and if she will make a statement on the matter.
I thank the Deputy for his question. He has highlighted this in the context of the difficulty in new GP practices opening in his area. The region has had very significant population growth but not a corresponding rise in the number of GPs available for either GMS or private patients and I acknowledge that. I also acknowledge the efforts the Deputy is trying to highlight as to what we can do to support GPs to expand their existing practices and to open new practices. That is a very fair question because everybody in this House wants more GP practices to be able to be opened.
It is important for me to say that the State - I think people forget this sometimes - provides a significant level of financial support to GP practices. We work in partnership with GP practices both within the GMS scheme and more broadly. Among the more notable supports available are practice staff supports and subsidies towards the employment of a practice nurse, an administrator or a practice manager. The 2023 GP agreement increased the rates of those subsidies and introduced further staff supports. Specific supports are available for rural practices and, since 2019, in urban areas of disadvantage.
The strategic review of general practice, which is currently under way, is examining the ways in which this can be better and differently supported. We have reached agreements with GPs, for example, on chronic disease management, all of which is really improving people's outcomes. It is a different way of delivering care but it is also a financial partnership with GPs.
In relation to the Deputy's specific question about refundable tax for setting up new GP practices, that would be a budgetary matter for the Tánaiste and Minister for Finance, but I assure Deputy Neville that I will raise it with the Minister. I know he would like to see greater GP practices around the country, and this is certainly something I have heard from GPs that would be helpful.
I thank the Minister for her very positive reply. This has an impact especially in my constituency of Kildare North, where we see a huge need for more GPs, but I have also been very aware that it is not just commuter belt areas where we have this issue. There are also areas where there are rural sustainability challenges and indeed urban deprivation strategies. Analysis shows that it is in those three areas that we have the biggest issues. For the rural areas we have put in place a rural practice grant. For the deprived areas we have a deprivation grant. However, the one thing we have not really focused on as much is the need to help the GPs in the commuter belt. I look at the town of Maynooth. It had five GP practices 15 years ago. The population has expanded probably from about 11,000 to closer to 17,000. It now has only four GPs. That is why I am really focused on this for the commuter belt area. Maynooth is just a mirror image of what I see across the constituency.
The supports for newly establishing GPs are an important part of the strategic review of general practice, as surveys by the Irish College of General Practitioners have shown that concerns about the costs and risks of opening new practices are important considerations. Essentially, it is a matter of establishing a business and that is a challenging thing to do.
Whatever about new practices, however, we also have to think about how existing practices, which might make it easier for a new GP rather than having to establish their own practice and their own business, could work more easily within the capacity of an existing practice and how that can be expanded through the addition of better or bigger premises or through the use of satellite surgeries to enable local access.
The exact nature of these supports has not been finalised but it is under consideration. This could include supports with business education and training, provision of subsidies or grants, and potentially through the taxation system, as I have highlighted, subject to consultation with the Minister for Finance. Then there is also the growing network of primary care centres, from which GPs can practice. That is a really important part as well that may be complementary.
There is a lot of information in the Minister's reply and I will take on a couple of the points. I have seen the benefit of the new primary healthcare centre in Celbridge, and we have one in Kilcock. It is about maximising the outputs we can get there. I am very conscious as well that in areas like Maynooth - and this is something we have mirrored all across the country - we might have seen a GP practice in the middle of a housing estate. That would have been very common years ago. Now the new GPs may be unwilling. Will they be able to set up a practice? Will they get planning permission? These are all serious complexities for those people. Extensions, as the Minister said, are really important. If we could get those extensions, that would be phenomenal because we could have more GP services, and it is probably easier. At the same time, I am just offering the opportunity to look across the board because the more GPs we can get back the better. I know that GP services are working really complementarily with the Department and I get that feedback from them, but it is just about that chronic shortage we see in the commuter belt. We are putting in the housing, the wastewater and the roads, and it is just that social infrastructure of the likes of GPs to go with it.
Exactly, and it is a totally practical suggestion. We want to enable GPs to have their practice as quickly as possible. I have no view as to where they should practice necessarily. Of course, we would like to employ them into the HSE, but private practice is also so important. Whatever we can do to enable more GPs, it has come up again and again in this House, correctly, and I can point out all the new GPs that have been registered by the Medical Council, all of that work to clear the backlog of people looking to restore their practices and people looking to come to Ireland. If they do not have a place to work within the community that people can access, it is very challenging. I recall going to a GP practice. There was one or two in every big housing estate. It was a very natural thing and it was often a front room. Now it is a slightly different model, and that is true. There may be an opportunity to extend those premises. Just look at the changes we have made today, for example, in relation to planning permissions and so on and exemptions and what we are trying to do to encourage more and more use of space. This is a hugely important piece for any community.
I thank the Deputy for his suggestion. We will come back to it within the Department of Health but it is also an important budgetary matter for the Minister for Finance.
123. Deputy Willie O'Dea asked the Minister for Health the targets in place for inpatient waiting times in 2026; and if she will make a statement on the matter. [28345/26]
136. Deputy Willie O'Dea asked the Minister for Health the targets in place for outpatient waiting times in 2026; and if she will make a statement on the matter. [28346/26]
Tá muid ag dul ar aghaidh go dtí Ceist Uimh. 123. Tá sé in ainm an Teachta O'Dea, ach tá an Teachta Daly á ghlacadh ar a shon.
This fits in with the rest of the debate going on here. It is to ask the Minister about the targets for the inpatient waiting times. I acknowledge her focus on productivity and reform within the health service. Deputy Neville has pointed out that with all these things it is an ecosystem and they are interconnected. If you cannot have an efficient admission and discharge policy for both elective and acute, you will end up with long waiting lists.
I propose to take Questions Nos. 123 and 136 together.
Improving access to healthcare in our hospitals is an absolute priority for me. As the Deputy knows, we have very good outcomes in our healthcare system. Our challenge is making sure we have access as quickly as possible. That is the focus, on making sure we are using our resources in the best way possible. We are focusing on a public healthcare system in which everybody has timely access to high-quality scheduled care where and when they need it.
I refer to the waiting time action plan for 2026.
This used to be the waiting list action plan, until we all realised together that the length of time spent waiting is more important than the number of people on the list, obviously. This builds on the progress to date. It includes significant reductions achieved in the length of time patients are waiting. The plan takes a multifaceted approach in achieving it, setting out six overarching and interconnected targets focused on patients waiting the longest. The plan aligns with the national service plan, NSP, targets for planned care, including targeting increases in the proportion of patients waiting within Sláintecare maximum waiting times and outpatient and inpatient day-case waiting lists. Those targets represent steps towards our ultimate shared goal of all patients being seen or treated within the Sláintecare target times, namely, ten weeks for outpatient appointments and 12 weeks for inpatient and day-case procedures.
The devolution of responsibility to the regional executive officers is an important part of this reform. The REOs have complete visibility over what is happening with their acute hospitals, their model 4, model 3 and model 2 hospitals and everything that is happening in the community and in their primary care centres. There has to be a complete synergy between the different model hospitals and primary care to use this. We now have tools that we did not have before. We have the outpatient toolkit, which is showing what the actual room utilisation is in every hospital. There should be no resistance to the application of the outpatient toolkit. It is not tenable that some hospitals have room vacancy rates of between 4% and 9% during the week and 24% on a Friday afternoon. I have not yet seen what the room vacancy rates are on Tuesday evening or Sunday morning, but we do not need to build more capacity and more rooms until those rooms are filled and being used. They are being heated and insured. All of these things are there and available. The utilisation of the outpatient toolkit is, therefore, enormously important. It means that we are scheduling according to the most efficient use of time. We are not asking people to change the length of their consultations or change the nature of their medical practice. We are simply taking the length of time they normally use and reorganising so that things are done differently and delivered differently, including in primary care centres.
This really matters because we have opportunities between the outpatient toolkit and now the surgical hubs in respect of inpatient day-case procedures - or a certain proportion of those - and also freeing up the corresponding activity in the home hospital. The first real application of that, of course, will be with the Dublin north-east surgical hub. This is a huge opportunity to test how the public-only consultant contract is being used or not used, rostered or not rostered, how the five over seven roster is complementing that and how that is being used by all the different hospitals in the Dublin north-east region.
We have these different opportunities but it is important that they are delivered. I want to highlight the importance of clinical leadership in this. Every single person in this House is calling for and looking for the same thing. It has to be implemented and there is a responsibility on clinical leadership to stand up and make sure the clinical community is doing everything it can to adapt and change its ways of working within the contractual parameters its members have signed and that have been set in agreements to make sure we are delivering for the patients of Ireland.
There are brilliant people working in the public health service who do their work very well but we can acknowledge, and I think the Minister acknowledges, that there are some hospitals in areas of the country where that productivity is not apparent. I will speak about the HSE West and North West region. In the past, at the health committee, the Minister acknowledged there are issues around discharge and management of patient flows. The west and north west is the poorest region of the country, with the highest proportion of the population in receipt of disability payments and the highest proportion of the population in receipt of a full medical card. We have a situation where we cannot discharge patients from a level 4 hospital, namely, UHG because there are not any step-down beds and not enough rehabilitation beds or enough home-help hours. In addition, we have a level 4 hospital that is purporting to carry out all the services of a level 4 hospital without having that capacity. We need a commitment to a new hospital in the west, at UHG in Galway.
In addition, we have a situation where there has been an over-reliance on the private developer-delivered primary care centres and also an over-reliance on individual GPs to deliver that infrastructure. If we are completely serious about the interconnectivity of our health service, we need to get some of that investment into primary care. The vast majority of the very considerable investment by the State over the last five years has continued to go into hospital care and acute care and not enough has gone into developing primary care. We have the longest waiting lists for speech therapy, psychology, community physiotherapy and speech and language therapy in the community. Unless we fix that capacity in the community in tandem with the acute service, we will not see the end of these waiting lists.
I agree. That is what we are trying to do. On the primary care centres, we have 181 at the moment, with eight under construction and 21 more in early planning stages. However, if people do not use them and if they are not used for outpatient procedures to relieve pressures on hospitals, we are going to keep having the same conversation. There is an excellent outpatient centre in Merlin Park right beside UHG. It is one of the few that is being used on a three-session per day basis. Good work has been done in that primary care centre but a lot more can be done.
This is as much about how people are working as about where they are working. I have talked about the physical capacity increases that we have but we cannot keep building more physical capacity if people are not going to use it differently. There is no point in concentrating consultant work between 9 a.m. and 5 p.m. Monday to Friday with all of this additional capacity. I would rather spend money hiring more people to fill the spare space. However, how can we be sure that will happen if the clinical leadership does not make sure we are implementing the contract such as it is? We have to see evidence of that and the trajectory in relation to it.
I agree with the Deputy on all the fantastic people doing fantastic work but we cannot keep saying that in the knowledge that many of them also have to work differently to make sure we are using the space that we have all paid for by making it available for the benefit of patients. We cannot have primary care centres closing at 5 p.m. They have to be open and serving the community until 8 p.m. or 10 p.m. That is what they are for. This is about building capacity, as it always will be with a growing population, but at some point we will reach a juncture where we have built so much capacity and if we have all of this evidence of it not being used or not being used in the most balanced way across the week, we will have to start asking ourselves decent questions about it.
I have a case involving a patient who has critical ischemia of her leg. She is a hard-working woman in her 60s. Twice she has had to be admitted to hospital and twice she has been sent out. She needs a procedure done. She has now been sitting for two weeks in a bed in UHG because they cannot get theatre time to do the procedure she requires. That is simply not a productive system. We have people who have given up on certain specialties, such as dermatology, rheumatology and others, in the west because they cannot get access. I completely agree with the Minister and she has my full support for any productivity reforms.
We also need to deal with the fact that our health service has not been digitalised. We are off the record. The EU 2030 Digital Compass requires that patients will have fully digitalised records in every country in the European Union. Ireland is so far off that chart. Countries like Estonia, Malta and Lithuania can do this, and we cannot. We need to focus on enabling productivity.
The Minister is right that we should be using our physical resources insofar as we can. However, there is an issue with UHG, and we need a new hospital there over the next ten years in order to make sure it functions properly as a level 4 hospital. That is the type of specialty treatment that some people need but they are competing with people who go through the emergency room, elderly people who need care in the hospital setting and people who might be better cared for in a community setting. We have to deal with primary care. We need to get over the culture that because it is a contract-led service by GPs, the infrastructure should be borne only by GPs. If we are completely serious, we should be building State-led primary care centres and have five-year, rent-free zones to attract young GPs into those centres.
I agree. As I said, we have 181 primary care centres, with eight under construction and 20 more at early planning stages for precisely that.
Regarding the Deputy's constituent who could not get surgery, let us count up the different things we have said here.
It was said that they cannot get theatre time for her. There is a theatre utilisation project. I would very much like to know the nature of her procedure and to test this case against theatre utilisation across the hospital. The Deputy says that we need a new hospital. I remind him that we are building both a surgical hub and an elective hospital precisely to provide additional theatre time. Let us stay aligned to exactly what is going on, which is the delivery of full utilisation of all of the theatres in University Hospital Galway, a surgical hub and an elective hospital. Can the Deputy imagine the number of surgeons it takes to run those all of the time? If we are to run them seven days a week, how many surgeons would it take? How many surgeons does it take to run a surgical hub all of the time, recognising that they will not all be working all of the time and that there will be two or three shifts? How many are required to run an elective hospital and all of the theatres that are already in UHG? How many surgeons does all of that take? I strongly recommend to the members of the Committee on Health who are here that they should invite the team that has done the theatre utilisation project and the OPD toolkit before the committee and interrogate them as to their findings and the use of theatres so that they can see this for themselves. We can then come back and seriously look at the number of surgeons it takes to fill six surgical hubs, four elective hospitals and every theatre in the country.
When we were doing the urgent project to deliver more endometriosis surgeries, I was looking for an additional 100 surgeries in the final quarter of 2025. One of the responses I got from a surgeon, who really is invested in this and who really is working hard, is that one of the barriers was that he had been told elective work could not be done after 5 p.m. in the theatres in the maternity hospital he was working in. I said "I am sorry, what? Says who?" These are some of the barriers we have to overcome. We have a lot of space. We have to use it.
124. Deputy Aindrias Moynihan asked the Minister for Health the up-to-date position on enhancing the position of community pharmacies as health promotion and wellness hubs; and if she will make a statement on the matter. [28384/26]
Pharmacies have a very strong position in their communities. They have close relationships with their customers and are very much trusted. They are the first point of contact for many people who want to discuss a health issue. There is a large network right across the country. They are found in almost every community. They are open long hours and are very much available. They are ideally situated for the delivery of health and wellness hubs. Will the Minister outline the efforts being made to expand the role of pharmacies into the area of health and wellness hubs?
I completely agree with the Deputy. They are a phenomenal asset and support and a major part of our health infrastructure. We need to think about them more as a fundamental part of our health infrastructure. Community pharmacies are right where people live. Some 85% of the population is within 5 km of a pharmacy. They are embedded in their communities. They are the first, and often easiest, place to go for trusted advice and practical support for patients.
Of course, pharmacists are medicines experts, but their role goes way beyond that now and we would like it to go further. They deliver prevention and public health every day. This extends to flu vaccines, Covid vaccines and school-based programmes. Of the 26% of children who got vaccinated last winter, 56% got their flu vaccine from a pharmacist, which is remarkable. I am delighted to say that, from May, pharmacies will provide pneumococcal vaccination for eligible healthy adults over 65 who have a medical card. Pharmacies deliver services like health checks, blood pressure management, weight management, and smoking and vaping cessation programmes and help people to live with long-term conditions. All of this demonstrates the ability and willingness of community pharmacies to be an essential part of health infrastructure.
A big part of the future is the 2025 community pharmacy agreement, which seeks to expand that role. This gives us the opportunity to expand the role of pharmacists in areas such as bowel screening, contraception, prescribing and medicines optimisation. Pharmacies also have an important role in improving access to contraception through the national condom distribution services. Crucially, they also provide a common conditions service, which I will speak about in my next response.
I acknowledge last year's community pharmacy agreement, which recognises the role of the pharmacy as primary care. I also acknowledge the commitment to advance the health and wellness hub side. There is a proposal, which is currently being moved on, with regard to three programmes that are to be rolled out as part of advancing these hubs. While I acknowledge these campaigns, they seem fairly limited. There is to be a week on men's health, a month on alcohol in pregnancy and a winter vaccination campaign, which many pharmacies would already be providing. I feel there is greater capacity and that there should be greater ambition. Has the Minister set out targets for the number of different campaigns that should be run or for the participation rate among pharmacists? Will she outline the rate of participation in the campaign running this month, which is on alcohol and pregnancy?
I am sorry but I do not have that figure. I will get it and come back to the Deputy, if he will forgive me. As part of the community pharmacy agreement, the Irish Pharmacy Union has agreed to support the HSE health and well-being campaigns. The Deputy has highlighted three of them. Following a consultation between the pharmacy union and the HSE, three campaigns were agreed for activation across the community pharmacy network. The Deputy has outlined them. Of course, I would like them to be doing even more, recognising how important their role is.
One of the biggest changes in health is going to be the common conditions service and where we can go with it. As the Deputy is aware, 95% of pharmacists have signed up to it at this point. Community pharmacists will be able to manage eight common conditions, offering self-care advice and, where appropriate, prescribing prescription-only medications. That is a first for pharmacy in Ireland. I would very much like to see it succeed. I hope people will use it and that we can extend beyond these eight conditions to the next eight, whatever they might be.
Pharmacists have considerable knowledge and expertise. As the Minister has mentioned, this extends well beyond the pharmacological side of things, for example, into lifestyle. One would expect the wellness hub concept to expand into the area of lifestyle. Will further non-pharmacological campaigns be made available with regard to vaping, mental health, positive ageing, fitness and many other areas?
It is also vital that there be prior engagement with pharmacists to identify the kind of campaigns to be run and to prepare for their roll-out. Will the Minister outline the level of engagement with pharmacies, the IPU and the various different organisations in the preparation, identification and roll-out of campaigns to ensure they are successful and have a meaningful impact in communities?
As the Deputy highlights, this is done through consultation and agreement between the pharmacy union and the HSE. My own Department engages regularly with the pharmacy union. I will ask my officials and the HSE about the nature of that engagement because I am not party to those detailed discussions. I will get a much better answer and provide it to the Deputy. The important point is that there is a measure of consultation and agreement in relation to it. Pharmacists are very excited about this expanded role and about working to the top of their professional medical training. That is what I want to enable. I want to make them a genuine alternative to a GP, where appropriate, as they will be in many, although not all, cases. I want it to be a really natural place to get a prescription and to expand the use of community pharmacies alongside every other part of our health infrastructure. I hope the Deputy will forgive me for not having a better answer than that for him at the moment but I will get him an appropriate answer.
125. Deputy Pádraig Rice asked the Minister for Health if she has considered the Oireachtas Joint Committee on Health's Report on Dental Services in the Healthcare System; if she will commit to implementing its recommendations; and if she will make a statement on the matter. [28361/26]
There is a deepening crisis in dental services. Last week, the Committee on Health produced a report setting out 19 recommendations as to how this crisis can be tackled. Has the Minister had a chance to consider the report? Will she implement the recommendations?
I thank the Deputy and the Committee on Health for their work on oral health and I welcome their report. I have read it and it aligns with many of the frustrations being brought to me. I understand the frustrations of families and individuals who are experiencing this with the current service. To be really clear, the current position on dental services is not good enough. Too many people cannot get timely care and too many of those are children. We have to do two things at the same time. We have to take practical steps to improve access now and we also have to deliver lasting reform. The model of services we operate is largely rooted in the 1990s and it really needs to be modernised to meet today's needs.
While that reform is being progressed, however, I am determined to ease the pressure people are facing now. What that means is improving access through the public system, especially for children and adult medical card holders. My Department and the HSE are finalising a more focused two-year programme to attempt to do just that.
The plan is going to be delivered by a dedicated governance group with progress monitored closely and aligned to wider HSE and departmental priorities. It will aim to respond to sustained service pressures, workforce constraints and long waiting lists. It will focus on a small number of very clear priorities: cut waiting lists in the school dental programme and orthodontics, strengthen and expand the special access programme, review and improve the dental treatment services scheme, support recruitment, education and training, and then really lean into whatever innovations are appropriate for different ways to deliver care.
Over the next two years, our aim is to stabilise services, reduce waiting times and make access measurably better while at the same time laying the groundwork for longer term reform. This will be achieved by initiatives such as utilising the newly available capacity with the new surgical hubs. A small proportion of cases, but not all, will be suitable because some will require general anaesthetic. My Department and HSE officials have already initiated engagements on this with many of the stakeholders, but it is important that they brief the committee as well when the plan is better finalised.
I thank the Minister. It is welcome that progress is being made because it is now seven years since the national oral health policy, Smile agus Sláinte, was published and we still do not have that implementation plan. I was not impressed by some of the excuses we received from officials at the committee, one of which was to blame Covid-19 for the failure to do this over the last number of years.
We have been here before. Previous Ministers have promised an implementation plan, but it was never delivered. I hope that the current Minister does so, with clear actions, targets and timelines.
Crucially, we need a new dental Act. The Dental Council is currently toothless. It needs powers to investigate, inspect and regulate. We have heard of cases of an unregistered person convicted of a sexual assault who may be practising as a dentist, as well as an unregistered dentist offering dental treatments, including X-rays, from a sitting room in an apartment in Dublin. We have also heard about three unregistered dentists offering pop-up clinics in Munster. We want to see a new dental Act and for the Dental Council to be given the real powers that it needs and has been calling for since 2008.
We are committed to updating the Dentists Act 1985, but we have spoken separately about the practicalities of some of those individual cases, some of which relate to legislative reform and some of which relate to completely different things. The Deputy is correct in relation to the need for a new dentists Act, but there is also a lot of policy development needed to underpin that.
A recognition of the length of time that it would take in real terms has led to an agreement with the Dental Council to bring forward interim amendments such as continuous professional development, CPD, for dentists so that reforms can commence sooner. However, we need to make measurable and meaningful progress. I would like to have the opportunity to finalise that two-year plan, to present it and to have an implementation plan for it. This is not about planning for something in perpetuity. Rather, this is in recognition of very meaningful problems for a number of individuals who need a very specified intervention.
Children in particular are being failed here. Too many children are leaving primary school without receiving a screening. We know that children should be screened in second, fourth and sixth classes. Some of them are not being screened until fourth year in secondary school or later. We know that, in 2023, only 104,000 out of an eligible 208,000 children were screened, so half of them were not screened that year. There are real issues with workforce planning and having adequate staff in place to do that. It is a real failure by the State that we are not providing those services to children.
Equally, the medical card scheme is not working. Dentists are leaving it. The number of dentists in the scheme has halved over a decade, which is a real signal that there are failures in this scheme. It is too limited, with a limit on the number of fillings but no limit on the number of extractions. There needs to be engagement with the Irish Dental Association to develop a scheme that works for patients, dentists and the public purse.
I will point out that the fees were increased by an order of 40% in that scheme. While I appreciate what the Deputy is saying, the fees were also increased by 40% and there is more complexity. I attended the dental association's conference. There is more complexity to the full range of practice that many dentists are engaged in and the other routes of practice, including aesthetics. I do not just mean aesthetic dentistry, which is important and was well defended at the dental association conference by its president. I just needed to make that point as well.
The Deputy highlighted schoolchildren, who are a particular concern of mine. We have engaged with the dental association, the Irish Dental Hygienists' Association and the Dental Council to look at how we are going to deliver near-term improvements in the school programme in particular, how we can use the complete workforce, including hygienists and dental nurses, and how we can broaden the ways in which they are trained. We are engaging with the Department of further and higher education on that so that we can get the best out of our complete dental workforce.
127. Deputy Catherine Ardagh asked the Minister for Health if there are plans to increase support for the Planet Youth model in light of the insights it provides into adolescent behaviour, physical activity and mental health. [28355/26]
Tá ceist Uimh. 127 in ainm an Teachta Ardagh á glacadh ag an Teachta Daly.
I would like the Minister to reflect on the support for the Planet Youth model, which covers about five different regions in the country and dwells on youth mental health, well-being and the maintenance of that well-being, including through repeated surveys of youth to find out what makes them tick.
I am taking this on behalf of the Minister of State, Deputy Murnane O'Connor. She sends her apologies. I thank Deputies Ardagh and Daly for their interest in the prevention of drug use among young people in Ireland and for the opportunity to provide an update to the House on this very important work.
As Deputy Daly will be aware, the Minister of State published the draft national drugs strategy in early February. The successor strategy will seek to further the progress made under the previous drugs strategy and emphasise the importance of effective and evidence-based drug prevention. Significant support is currently being provided for drug prevention. In 2023, a first-of-its-kind funding programme to support evidence-based drug prevention initiatives was launched, providing €1.5 million to date. This funding has supported five programmes and represents a significant step in developing our approach to drug prevention in Ireland.
As Deputy Ardagh will be aware, the first strategic pillar in the draft strategy prioritises prevention. It will seek to protect individuals, children, families and communities from the harmful effects of drug and alcohol use and will contain several actions aimed at preventing the onset of drug use among our citizens, with a particular focus on young people. Upon publication of the finalised strategy, these actions will provide targeted responses to groups that are faced with high levels of risk, such as children living with parental drug use and experiencing hidden harm. Any new initiatives on drug prevention will be considered in the context of the finalised strategy, which will develop a coherent, co-ordinated and quality-based national drug prevention system.
The health and well-being of all citizens is of vital importance and reducing health risk factors for our young people is a priority for this Government. I will speak about Planet Youth in my next contribution.
I am glad that the Minister of State recognises the value of the Planet Youth project, which is based on the Icelandic model of intervening early to try to identify the reasons young people may fall into lifestyles that will be deleterious to their health.
One of the Planet Youth reports, which came out from Galway, Roscommon and Mayo in 2024, identified the fact that things such as unsupervised time for young people on the street gave them nine times more risk of smoking cannabis. Being unsupervised in a friend's home makes a young person five times more likely to engage in drinking at an early age. Other things that came out included that 18% of young people under the age of 13 had viewed pornography. These are really important pieces of data that allow us to target schemes at those young people to try to prevent them for getting into trouble.
Planet Youth Ireland is an initiative to promote, as Deputy Daly said, well-being among our children and adolescents. It takes a ground-up approach whereby local regions enter into a process that researches local government agencies, the education sector and young people themselves. Planet Youth is not an intervention, though, rather a data collection exercise that provides evidence to inform interventions.
The Icelandic prevention model refers to efforts made in Iceland to address adolescent drugs and alcohol use.
Iceland has also significantly invested in professional parent councils and networks. It has expanded that out. Officials from the drugs policy, tobacco and alcohol control unit and health and well-being unit met representatives of Planet Youth Ireland from across Ireland on 9 March in departmental buildings.
The value of having repeated data collection means you get an evolving picture of how things are on the ground. In the Ballinasloe area, for example, if your parent had an alcohol problem, you are something like five times more likely to have taken alcohol by the age of 14. If your parents were permissive around the use of alcohol, the risk of having a problem with drink in later life is three times higher. These are important parameters that allow us to plan health services based around health and well-being and working upstream so that we avoid the problems that develop in later life. Alcohol, drug abuse and the viewing of pornography lead to unsafe and sometimes dangerous practices for young children and adolescents. Data allows us to intervene earlier with measures that will prevent future problems.
Planet Youth Ireland communicated that it intends to discontinue its links with Planet Youth as it was felt the work done by Planet Youth could be done in Ireland at a lower cost. Planet Youth Ireland is separating from Planet Youth while continuing to do the work. For example, a number of regular surveys capturing information on youth drug and alcohol use patterns, risks and protective factors have been implemented in Ireland. These include European school survey projects on alcohol and drugs every four years, with the last wave of findings being published in 2025, the health behaviour of school-aged children, which monitors the health behaviours, health outcomes, drug and alcohol use and social environment of school-aged children every four years, and the Growing Up in Ireland study, which includes research on drug and alcohol use. The model is still being used, but Planet Youth Ireland has separated from the cost factor and is investing the money saved in drug prevention instead.
128. Deputy Darren O'Rourke asked the Minister for Health her plans to invest in Navan hospital in view of the recent HIQA report, details supplied, and if she will make a statement on the matter. [28366/26]
Will the Minister to outline her plans to invest in Our Lady's Hospital in Navan in view of the recent HIQA report and will she make a statement on the matter?
I thank the Deputy. I reaffirm that the Government is committed to investing in Navan hospital. Since 2020, the number of whole-time equivalent staff has increased by 17.5%. During the same period, the budget increased by 51%. Under the acute hospital bed expansion plan, a total of 46 new and replacement beds will be delivered at Our Lady's Hospital in Navan by 2031, which includes 31 beds delivered between 2021 and 2024 and another 15 beds between 2025 and 2028. A new minor injuries unit is planned for Navan hospital. I am advised by the HSE that this is progressing through the detailed design and procurement phases. Construction is expected to commence in quarter 4 of 2026, with an indicative operational date of 2027, which is good for the area.
As part of its statutory role, HIQA conducted unannounced inspections of Our Lady's Hospital in Navan in June 2024 and November 2025. It is important to note that, at the follow-up inspection, HIQA recognised that the hospital had made progress since 2024, even where the formal compliance ratings did not change. It is important that I state that.
I would also like to outline the suite of service and safety enhancements being implemented in Navan hospital. I am informed by the HSE that additional staffing across primary care and older person services has enhanced the management of chronic conditions. Consultant-led chronic disease teams for respiratory and cardiology services will be developed in 2026. The new Navan patient quality and safety board was established last year to provide enhanced oversight of the safe and effective transition of care between Navan hospital and the HSE Dublin and North East region generally, as is the case for many hospitals. That led to the development of different and robust policies and procedures which will be further improved this year.
Several risk mitigation strategies have also been implemented, including the utilisation of the orthopaedic unit during periods of high activity and the implementation of surge capacity. In addition, acute surgical services are maintained to allow for patient stabilisation prior to transfer, as is the case in many other hospitals, along with integrated bed management solutions which link community and acute bed services. There are also ambulance bypass protocols, to which I will come back.
I welcome every euro invested in Navan hospital, as does the entire community in the county. The national standard 3.1 states that service providers protect service users from the risk of harm associated with the design and delivery of healthcare services, and the hospital was non-compliant in that regard in June 2024 and November 2025. Essentially, what management said at a follow-up inspection was that decisions regarding the transformation of the hospital on a national level were still outstanding and the hospital continued to operate as a model 3 hospital without the provision of acute on-site surgical services. That is stating that it is a model 3 hospital in name. In effect, it is a model 2.5 hospital because it does not have on-site surgical services. Is the Minister satisfied that the investment plan she has will address the risks identified in the HIQA report?
On the HIQA report, of the 43 actions in the compliance plan, I understand 18 have been completed and the rest are under way. It is important to highlight that. I want to look at the region in a very interesting way because it is a region that will have a new surgical hub opening shortly. It is a region where we are planning an elective hospital, in Connolly. It is a region where the hospitals are geographically concentrated. I am not yet convinced what all of the different pathways are and what the different specialisms are and how they intersect. It is a region of particular opportunity and Navan has a strong role to play within that.
On the immediate safety issues, ambulance bypass protocols are in place to ensure that patients receive the right care. For example, patients are stabilised and, if necessary, transferred to other hospitals. Patients classified as categories 1 and 2, including cardiac and stroke patients, are not brought to Navan hospital by ambulance. Beaumont and the Mater, which are specialist centres for both of those cohorts, are very close. That is what I mean by looking at the region in a different way.
I am certainly open to that. It would be welcome. It is an argument we have made. The starting point is that we have to protect our emergency department at Navan hospital. There has been a significant increase in population in the region. If there is an opportunity in terms of a surgical hub, the population base, infrastructure and potential are there for enhanced services at Navan hospital. That could work alongside Connolly, Our Lady of Lourdes, Beaumont and the Mater. There is potential there. The HIQA report needs to be the basis of increased investment and addressing the risks that may be present.
Of course the HIQA report needs to be implemented. Where there are issues within the control of the hospital, the HSE is required to deliver sustained improvement. Where risks relate to the broader intersection of the region, that is what I am trying to work out at the moment.
On 17 February, I met the regional executive officer and regional clinical director for the HSE Dublin and North East region and the integrated area healthcare manager for Louth and Meath to discuss the overall demand profile for the region, the pressures in Navan, the pressures on neighbouring hospitals, the different specialisms and their interoperabilities, and the ideal design of all of those hospitals, recognising the elective hospital, surgical theatre and capacity that that frees up. We have possibly examined this in a way that has been too individualised as regards the different hospitals. I am interested in the best interoperability and how we achieve that while, at the same time, implementing the compliance requirements identified in the HIQA report.
129. Deputy Marie Sherlock asked the Minister for Health the steps her Department is taking to urgently regulate the administration of dermal fillers as committed to in the programme for Government; when such regulation or legislation will be introduced; if she and her Department will engage with stakeholders regarding the best way to protect the public; if her Department received research from the Health Research Board on international best practice; if so, when she will publish same and her Department's response; and if she will make a statement on the matter. [28374/26]
My question relates to the regulation of the administration of dermal fillers in this country. Obviously, millions of euro is spent each year on beauty and cosmetic treatments. The vast majority are topical external treatments, but some are medically invasive. Unfortunately, there is something of a wild west out there in terms of who can administer these treatments.
The incorrect administration, particularly of dermal fillers, can literally be the difference between life and death. Certainly, we have a lot of stories coming to us of people developing sepsis, permanent scarring and other impacts. What is the Government doing to regulate and protect people accessing these treatments?
In the short time that I have, I will say that dermal fillers are regulated as medical devices. There are rules to ensure that devices placed on the market are safe and perform as intended. That means a dermal filler must have a CE mark before it can be legally sold anywhere in the EU.
It is important to be clear about what current EU legislation does not do. While it regulates the product, it does not regulate who can administer it. The Government recognises there is a need to strengthen regulation in this area. That is why it is in the programme for Government that we will only allow this to be undertaken by trained healthcare professionals. Work is under way in my Department on the options to strengthen controls on the use of dermal fillers.
The Health Products Regulatory Authority, HPRA, as the competent authority, previously provided my Department with a policy paper setting out the different options. In addition, we have commissioned research through the Health Research Board to look at the national policy and legislative and regulatory measures used in other countries. We expect that report in the coming period. We will engage with stakeholders to try to bring this piece of work forward. The final regulatory policy determined will be informed but all of those important pieces of evidence. We will progress it as quickly as we can thereafter. I recognise what the Deputy is saying.
There seems to be a legal lacuna in this regard. The HPRA does not regulate the administration of clinical practice, and HIQA is obviously not looking at this either. I am conscious there are people out there – many of whom are in my constituency - accessing these treatments for a little as €60, whereas other practices charge in excess of €250. A lot of people are being lured in by the prices. It is a potential question of life or death or of serious injury. We need to see the report. It was commissioned in 2025 and I have been submitting parliamentary questions about it. I ask for a bit of urgency in publishing that report.
