Dáil Éireann Debate, Tuesday - 28 April 2026
1225. Deputy Michael Collins asked the Minister for Health her views on whether repeated reliance on antibiotics, prolonged ENT waiting lists and the absence of clear emergency referral pathways represent a failure of joined up care within the public health system; if she will provide a timeline for reform to ensure patient safety is prioritised over administrative barriers; and if she will make a statement on the matter. [30375/26]
Amharc ar fhreagraAn over-reliance on antibiotics, ENT waiting lists and the question of optimal emergency referral pathways all represent challenges for the public health system in Ireland. I will set out below the manner in which each of these issues is dealt with in the public health system in Ireland.
The concern regarding over-reliance on certain antibiotics is the danger of Antimicrobial Resistance (AMR), which has become recognised as one of the greatest potential threats to human health over the last decade. The World Health Organization has declared that antimicrobial resistance is one of the top 10 global public health threats facing humanity. AMR challenges the delivery of modern medicine as antimicrobials, in particular antibiotics, save lives, and add on an average 20 years to life expectancy worldwide. Antimicrobials protect patients receiving many treatments including cancer treatment (chemotherapy), enable safe surgery such as organ transplants and orthopaedic procedures and treat many bacterial illnesses.
Following on from the World Health Organization (WHO) Global Action Plan (GAP) on AMR (2015) and the European Action Plan on AMR (2017), Ireland published its first National Action Plan on Antimicrobial Resistance 2017 – 2020, known as iNAP1. In 2021, on European Antibiotic Awareness Day (EAAD), Ireland published its second One Health National Action Plan on Antimicrobial Resistance 2021 – 2025, known as iNAP2.
Ireland's third One Health National Action Plan on Antimicrobial Resistance 2026-2030 (iNAP3) was launched in 2025 and is now being implemented.
iNAP3 (2026-2030) aligns to the WHO’s Global updated Action Plan on Antimicrobial Resistance. The plan contains a range of strategic interventions, like its predecessors, with activities across the human health, animal health and environmental sectors grouped under six strategic objectives designed to:
1.Strengthen awareness and promote appropriate social and behavioural change to reduce antimicrobial resistance risks across all sectors.
2.Strengthen surveillance systems and laboratory networks to inform effective, evidence-driven antimicrobial resistance policies and actions across all sectors.
3.Intensify infection prevention across all sectors to reduce the burden of infectious diseases and the need for antimicrobials.
4.Ensure equitable access, appropriate use and safe disposal of antimicrobials, diagnostics and other health products across sectors.
5.Ensure sustainable investment in antimicrobial resistance research and innovation across all sectors.
6.Strengthen multisectoral governance, sustainable financing and accountability for a coordinated antimicrobial resistance response across all sectors and at all levels.
The establishment of the HSE Antimicrobial Resistance and Infection Control (AMRIC) Division in 2019 was a key milestone in combatting AMR, streamlining governance and providing national leadership for IPC and Antimicrobial Stewardship.
Arising from engagements with the Department of Health and cross-sectoral partners on the development of iNAP3, HSE AMRIC has developed plan its own Action Plan (2026-2030) in response to the health actions set out in iNAP3. This plan sets out the actions that the Health Service Executive (HSE) will take across the health service over the next 5 years to combat AMR.
The HSE plays a pivotal role in operationalising the human health components of iNAP3 and its key focus is on patients and service users, health and care workers, and the general public.
To date, Ireland has made significant progress under its previous National Action Plans, including:
• A 50% reduction in the sales of highest priority critically important antimicrobials (HPCIAs) for use in food-producing animals between 2018 and 2023, and a 25% overall reduction in antimicrobial sales for food-producing animals in the same period.
• The website www.antibioticprescribing.ie has been developed as a comprehensive resource for General Practitioners (GPs), dentists, nurses, and community pharmacists treating common infections in the community.
• Sustained improvement has been demonstrated in the prescribing of green (preferred antibiotics) in community settings, aligning to one of Ireland’s targets under the EU Council Recommendation on ‘Stepping up actions to combat AMR’.
• IV-line teams have been established in 8 hospitals to date in collaboration with the Health Service Executive (HSE) Antimicrobial Resistance and Infection Control (AMRIC) team
• The development and implementation of a National Veterinary Prescription System (NVPS) to facilitate enhanced monitoring and reporting of antimicrobial use in animals, thereby promoting improved antimicrobial stewardship.
• Harmonised surveillance has identified a trend of reducing bacterial resistance in food-producing animals.
Over €30m has been allocated in new development funding for IPC and AMR since 2018 across the iNAP National Action Plans, including the recruitment and approval of over 345 additional full-time posts to support activities in the human health sector across a range of IPC and AMR roles.
With regard to ENT waiting lists, It is acknowledged that many patients are still waiting too long for hospital appointments and treatments. I am conscious of the burden that this places on patients and their families.
I published the Waiting Time Action Plan (WTAP) for 2026 on January 30th, as part of this Government’s ongoing commitment to improving access to hospital care and reducing waiting times for patients.
The multi-annual Action Plan approach was implemented in September 2021 to sustainably reduce and reform hospital waiting lists and waiting times. Significant progress has been made under this approach in reducing the length of time patients are waiting.
The most recent published figures, for March 2026, show that since implementation of action plan approach there has been:
•a 32% or c. 23,000 reduction in the total number of patients waiting for an ENT outpatient appointment and
•a reduction of 84% or c. 36,000 in the number of patients waiting over 12 months for an appointment.
With the 2026 plan, we will continue to build upon the progress delivered to date under the multi annual action plan approach, moving towards the ultimate vision of a public healthcare service in which everyone has timely access to high-quality scheduled care, where and when they need it.
The issue of emergency referral pathways is the subject of the HSE’s Urgent and Emergency Care (UEC) Operational plan 2026/27, which is the fourth in-year plan as part of the HSE’s multiannual approach to managing increased UEC demand and pressures.
The Plan is built around four pillars; Hospital Avoidance, ED Operations, In Hospital Flow, and Discharge - all of which are focused on ensuring that patients are directed to the right place, first time, and that and that every patient can move through the system without avoidable delay.
The UEC Plan sets out a series of actions to strengthen those pathways, including:
•expanding hospital avoidance measures, such as Injury Units, community intervention teams, chronic disease hubs and virtual wards
•standardising referral routes between GPs, ambulance services and acute hospitals
•improving access to diagnostics so patients can be managed safely outside the ED
•ensuring senior clinical decision makers are available seven days a week to support timely assessment and discharge
These actions are designed to ensure that patients are not left navigating the system themselves and that care is coordinated across settings.
The UEC Operational Plan sets clear timelines and KPIs for improving patient flow and reducing unnecessary ED attendances. These include:
•Average monthly 8am trolley count 280
•Delayed Transfers of Care 300
•24 hour PET for older adults at 100%
•24 hour PET for all patients at 99%
A key part of strengthening referral pathways is ensuring that patients have safe, fast alternatives to the ED.
•Last year, over 222,000 people attended Injury Units, a 5% increase.
•The median PET in an Injury Unit is just 1.3 hours, demonstrating the value of these services.
. •The 2026 National Service Plan includes new Injury Units in Tallaght, Athlone, Carlow and Ballina.
This expansion is specifically designed to reduce unnecessary ED attendances and provide clearer, safer referral pathways for lower acuity patients.
Joined up care also means ensuring that patients can be treated safely outside the acute hospital when appropriate.
The UEC Plan supports:
•7 day community intervention teams
•ICPOP and frailty pathways
•chronic disease management teams
•mental health crisis supports
•virtual wards
•enhanced GP access to diagnostics
These measures reduce ED attendances, shorten length of stay, and ensure that patients receive care in the most appropriate setting.
The actions in the UEC Operational Plan, combined with the expansion of Injury Units and strengthened community services, are designed to deliver a more integrated, responsive and safer urgent and emergency care system.
