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Dáil Éireann debate -
Tuesday, 21 May 2019

Vol. 982 No. 9

Saincheisteanna Tráthúla - Topical Issue Debate

Road Traffic Legislation

We have discussed the issue of electric scooters in this House several times. Since then several things have changed. In the area covering the Dublin 2 and Dublin 1 postcodes, An Garda Síochána has started impounding and detaining these vehicles and taking them away. In recent times, the Road Safety Authority, RSA, has decided to update the advice on its website in respect of these vehicles. The website was not clear. Perhaps this reflects the lack of clarity in the law.

One year ago, I raised this issue with the Minister in a parliamentary question as a member of the Joint Committee on Transport, Tourism and Sport. I forewarned of this issue. At the time, the Minister said it was not envisaged that the position with regard to the need for regulation or legislation in respect of these vehicles would change in the immediate future. Does he now accept that the position has changed and that there is a need to clarify in law and regulation the status of these vehicles?

In the past hour, the Fianna Fáil Party has belatedly agreed with this position and is launching its proposed legislation on the plinth at 2.30 p.m. tomorrow. This is to be welcomed, as is further focus on this issue. I wish we had foresight in respect of the problems that have so predictably arisen with this new technology. We must now nevertheless legislate for it in hindsight. Fianna Fáil's move in this regard is welcome.

Last week, I met representatives of several institutions and companies that are interested in this area. Many of them are setting up in this country and many others have started operating here. I met representatives of several companies on the DCU Alpha campus in Glasnevin. They are world leaders in creating technology in this sector. It is impressive stuff. Ireland could become a leader in this area but to do so requires foresight to allow the sector to grow and develop.

In the absence of law, there are now far in excess of 2,000 users of these vehicles in the city. Lest we forget, they are also used in many European cities where they are effective. They are a reflection of many of the values the Government espouses, including many of the aspirations of the Department of Transport, Tourism and Sport. They are green and environmental. They reduce congestion and increase the onus on us to improve cycle lane investment. I am at a loss to understand why the Department has been stonewalling on this issue for so long and why responsibility for it has been handed to the Road Safety Authority one full year after I first raised it in the House. I am also at a loss as to why we have been reactive instead of proactive on this issue.

In reply to my most recent of many parliamentary questions, the Minister cited several international experiences that were negative. Much of what was put to me on the record in reply to my parliamentary questions about the international experience was not correct and was, in fact, erroneous. There are many positive international experiences and lessons that could be brought to bear in light of the first wave of these vehicles that occurred some years ago. We can now do things with technology that we could not do three or four years ago to safeguard pedestrians and other road users as well as allow for the effective and safe use of these vehicles.

I was surprised and alarmed by the conservative approach taken in the most recent reply to my parliamentary question. I would welcome it if the Minister clarified his remarks. I would welcome some clarity in respect of the overall issue. Is the Road Safety Authority report available? Do we know when it will be available? What is the Minister's position on this issue?

I thank Deputy Rock for raising the issue of electric scooters and providing us with the opportunity to discuss it.

I am of course aware of the increasing number of electric scooters, electrically powered skateboards and similar small vehicles on our footpaths and roads. I will start by advising the Deputy of the current legal position in respect of such vehicles. It is important that we get such clarity on the matter before we go any further or make any statement about it. The Road Traffic Act 1961 defines a mechanically propelled vehicle as a vehicle intended or adapted for propulsion by mechanical means, including a bicycle or tricycle with an attachment for propelling it by mechanical power, whether or not the attachment is being used. It also includes a vehicle, the means of propulsion of which is electrical or partly electrical and partly mechanical. Electric scooters and powered skateboards fall into this category and are, therefore, considered to be mechanically propelled vehicles. Any users of such vehicles in a public place, as defined in the Road Traffic Act 1961, must have insurance, road tax and a driving licence. There are penalties under road traffic laws, including fixed charge notices, penalty points, fines and possible seizure of the vehicle, for not being in compliance with these requirements.

As it is currently not possible to tax or insure electric scooters or electric skateboards, they are not considered suitable for use in a public place. As the Deputy knows, I have requested the Road Safety Authority to research how electric scooters and other such vehicles are regulated in other countries, particularly other EU member states. I am keen to understand the road safety implications of the use of such vehicles on public roads, especially when interacting with other vehicles. Road safety is paramount. I am due to receive the outcome of the authority's research within the next few weeks. Until I have received it, I will not make a decision on what actions, if any, to take. I will need to be persuaded that permitting such vehicles on our roads will not give rise to safety concerns for the users themselves and for all other road users, including cyclists, pedestrians and motorists. In this context, I expect the Road Safety Authority to include in its consideration whether there is a potential inability of the scooterist to obey some basic rules of the road; difficulties with lighting electric scooters so that they are easily visible to other road users; the absence of suspension or shock absorption, which places the scooterist in danger on an uneven road surface; and insurance issues in the event of a collision. The Deputy should further note that, should I decide the benefits derived from the use of electric scooters outweigh the risks associated with using this type of transport, an amendment to primary legislation would be required.

I thank the Minister. The genesis of this issue, and of the different perspectives from which we are coming at it, arises from the definition of a mechanically propelled vehicle in law. There is an ambiguity in this regard. For instance, the Minister referred in his answer to a vehicle being powered by mechanical means. He needs to clarify his answer in that regard because it raises a question as to whether he meant a vehicle that can solely be powered by mechanical means. The Minister left out the crucial word "solely". He has effectively dragged electric bicycles into this grey area along with electric scooters on account of the vagueness of his answer. He gave a similar answer to a previous parliamentary question.

As anyone who uses an electric scooter or who has watched the RTÉ "Prime Time" report on them knows, it is impossible to achieve 100% of any journey on an electric scooter without manually intervening. One needs a manual intervention to start up these vehicles, and must reach 5 km/h via manual propulsion to start them. It is only then that an electric motor kicks in, and one continues the journey from there. The journey is, therefore, not 100% mechanically propelled and, accordingly, it is commensurate under the current law with electric bicycles. There is no threshold for which a mechanically propelled vehicle can be defined in law currently. The vagueness of the law needs urgent clarification. The incomplete understanding of various State agencies is exactly why there is ambiguity right now. That ambiguity is precisely what will end up being challenged in court and it, therefore, needs to be clarified in law urgently.

The Deputy is asking me to take a position on this before the RSA completes its report. I am not going to do that. We have people who have made a detailed study of what happens both here and abroad, and for me to make a decision in advance of that would be absurd. I may have a disposition, but the RSA is an agency with some authority and interest in safety, which I notice is absent from the Deputy's representations. Safety is paramount. The most important thing is that passengers, travellers, and people in other vehicles should be safe, and that is the most important element of these particular e-scooters, which the Deputy is seeking to have introduced. If they are introduced, it is important to me that the RSA gives a judgment on whether they are safe for the people affected by them, and I am not just talking about those who are on them.

It is also very important that the Deputy does not make statements without backing them up. He said there were events which were being quoted of incidents overseas, which did not happen. He said they were erroneous. Let us get the detail on that. I have quoted facts and figures about what has happened in other European cities to him. They are well known, and those details, as far as I know, are open to correction but have not been corrected.

I will correct them.

If they should be corrected, let us have them corrected. The Deputy also said, without any basis whatsoever, that to allow these scooters will reduce congestion. The evidence, as far as I know, shows the opposite of that. Those who are proposing to use and are using these particular e-scooters are swapping from bicycles, buses and other means of public transport. They are possibly taking up space. Let us not have some un-backed up, unsupported evidence here. My position is open. I am prepared to take authoritative advice, not populist advice from the Deputy.

The Minister advising on populism is an Alanis Morissette level of irony.

Alcohol Pricing

I would like to thank the Office of the Ceann Comhairle for the opportunity to raise this Topical Issue matter. The purpose of seeking it is to get clarity from the Minister of State on the timelines for the implementation of the section of the Public Health (Alcohol) Act 2018 that relates to minimum unit pricing. I emphasise once again the futility of enacting this Part of the Act in the absence of any similar minimum pricing in the North of Ireland. The rumour has been doing the rounds in the trade, from the chambers of commerce to Retail Excellence Ireland members and some members of the Vintner's Federation of Ireland, that the Department may be on the verge of enacting or implementing this Part. Every Member will be aware of the importance of minimum unit pricing and a majority of this House, including myself, saw, and still see, fit that this Part be enacted. When we debated this issue, the necessity that this legislation would have to operate simultaneously on the island of Ireland was flagged, otherwise there would be an outflow of shoppers to the North of Ireland, not just to buy alcohol, but to do their weekly shopping as well, thus inflicting problems on the retail industry, be they pubs, bars, off-licence trade, or the livelihoods of small shopkeepers who lose out to the larger supermarket outlets, particularly in the Border region. In 2015, when he was Minister for Health, the Taoiseach stated in the Seanad:

While we are not writing it into the Bill, it is our intention to go ahead with minimum pricing at the same time as Northern Ireland. We have an agreement with the Northern Ireland Executive that it will also introduce minimum unit pricing. We intend to do it at the same time for all the obvious reasons. It would be totally counterproductive if people just went north of the Border. While it is not written into the legislation, as we do not want to totally tie our hands, it is certainly the intention.

The Minister for Health, Deputy Harris, when addressing the issue in the Seanad in 2017 stated:

I take the point about Northern Ireland and acknowledge Senators from the Border area, including Senators O'Reilly, Wilson, Gallagher and any I have missed, who raised this issue. I understand that we always have to be conscious on the island of Ireland of the impact of what we do in one area on the other.

He went on to state:

There is a Government decision on trying to do this alongside Northern Ireland. We need a government to talk to in Northern Ireland but that is for another day. Northern Ireland was moving in this direction but the Government will commence this at an appropriate time. The purpose of the Bill is to put the legislative framework in place to enable the Government do that.

I support the Taoiseach and the Minister of Health's stances on that and the need to continue with it, once we have similarity in approach both north and south of the Border. The activities of some supermarkets in using alcohol as a loss leader, especially last Christmas, were probably the most extreme abuse of alcohol as a product to date. In one outlet, a bottle of Captain Morgan rum was on sale at €10, when the combined excise and VAT on that product was €12.30. Another outlet was selling six bottles of wine with a 25% discount and a £10 voucher. This offer, again, was below the combined excise and VAT for the product. I could go on, but I would not want to blame the Minister of State for being tempted to introduce minimum unit pricing on account of this activity, as what is often missed is that the State is subsidising this activity of below-cost selling through the VAT system. I urge him not to be influenced by that greed

I am stepping in for the Minister for Health, Deputy Harris. I thank Deputy Breathnach for raising this important issue. The Public Health (Alcohol) Act 2018 was enacted on 17 October 2018. Its primary policy objectives are to reduce alcohol consumption to 9.1 litres of pure alcohol per person per annum by 2020; delay the initiation of alcohol consumption by children and young people; reduce the harms caused by the misuse of alcohol; and regulate the supply and price of alcohol in order to minimise the possibility and incidence of alcohol-related harm. These objectives were developed in recognition that alcohol causes harms to health and significant costs to the Exchequer, and that alcohol consumption in Ireland remains very high.

Section 11 of the Act provides for a minimum price of alcohol products of 10 cent per gram of alcohol. Government approval was originally given in 2013 for the introduction of minimum unit pricing of alcohol on the basis that it would be introduced simultaneously in the North of Ireland. As the Executive in the North of Ireland is not currently operating, minimum unit pricing cannot be introduced there and, therefore, the Minister for Health is constrained from implementing this measure due to a circumstance that was not foreseen in the original decision. As he outlined in the Seanad last October, he intends to return to the Government to seek approval for this measure and will do so shortly. Minimum unit pricing will target cheaper alcohol relative to its strength because the price is determined by and is directly proportionate to the volume of pure alcohol in the drink. This means that the price of individual products will depend on their strength. It sets a floor price beneath which alcohol cannot legally be sold and targets products that are currently very cheap relative to their strength.

A sample application of a 10 cent minimum price per gram shows that it will affect only the cheapest of products sold in off-licences. The prices of products sold in the licensed trade are unlikely to be impacted by a minimum price of 10 cent per gram. A pub measure of whiskey would cost €1.12, a measure of vodka would be €1.05 and a pint of Heineken lager, Guinness stout and Bulmers cider would be €2.25, €1.89 and €2.02, respectively. The aim of minimum unit pricing is to target harmful drinkers - those who drink so much that they are putting their health in danger. The measure is targeted and it attempts to minimise the impact on moderate drinkers and the minimum price will make little difference to those who only drink low or moderate volumes of alcohol.

Effectively, the price of alcohol products will depend on their strength. Minimum pricing is considered effective because international evidence shows that those who consume alcohol at harmful levels tend to purchase cheaper alcohol relative to moderate drinkers and, therefore, the policy impacts harmful drinkers the most. In addition, a minimum price will mean that strong alcohol products are not cheaply available for children and young people.

Will the Minister confirm that the Department will introduce this portion of the Bill shortly? That is contrary to what the Minister said in the Seanad. I have lived my life on the Border and witnessed the sharp movements and volatility of vast currency fluctuations. I have witnessed unsequenced budgets, not to mention the vulnerability we currently have with Brexit. I am going to speak for the small businesses that will be seriously affected by the introduction of this. Unless there is a reciprocal arrangement on an all-island basis, we will go back to the days of smuggling, illicit trade and losses to both businesses and Revenue. If the Minister is intent on forging ahead with this, as he appears to be, he will do damage to our economy and our trade. He mentioned 10 cent per gram on alcohol but without a reciprocal commitment by the Northern Executive, there will not be a bottle of wine for less that €8, a standard bottle of spirits will be at least €24 and a standard 500 ml can of beer will be at least €2.

Without co-ordination North and South, this will drive people to shop abroad. The sugar tax was co-ordinated when Deputy Michael Noonan was Minister, with the tax being introduced North and South, and if the Minister of State attempts to do otherwise, which he suggested will happen shortly, we will go back to unregulated sales into the South, including to minors and the vulnerable people he is purporting to help. My party and I support this section of the Bill but I represent the people who will be affected the most, whether they are in Donegal, Cavan, Monaghan, Louth or Sligo. The Minister is dealing with an issue that is connected to Brexit and will do harm to the trade of small retailers along the Border region. I urge him to desist.

I thank the Deputy for raising this issue on behalf of businesses along the Border and I will take his points back to the Minister for Health. A minimum price unit of 10 cent is likely to affect the price of only a small proportion of products in any off-licence. The aim of minimum unit pricing is to target harmful drinkers - those who drink so much that they are putting their health in danger. The measure is targeted and attempts to minimise the impact on moderate drinkers. The minimum price will make little difference to those who only drink low or moderate amounts of alcohol.

Minimum unit pricing will target cheaper alcohol relative to strength because the price is determined by, and is directly proportional to, the volume of pure alcohol in a drink. Effectively, the price of alcohol products will depend on their strength. In view of this, it is the Minister's intention to seek a revised Government decision to implement minimum unit pricing of alcohol as soon as possible to address the significant health harms and financial costs of alcohol consumption.

Hospital Services

Diabetes is a condition that affects a large proportion of the population, numbering some 190,000. It is a condition that involves a great deal of management and it can involve a great deal of hardship. It involves invasive finger-prick tests and so on. I attended a protest at Cork University Hospital, CUH, yesterday morning, led by the parents and families of children and teenagers who have type 1 diabetes. Their frustration has been building up over some time at the lack of services and the difficulty they have in seeing a consultant at CUH. They were full of praise for the support they got from nurses in the hospital and for the consultant, Dr. Stephen O'Riordan, who is alone responsible for some 400 children and teenagers with type 1 diabetes, as well as for all sorts of other endocrinology disciplines such as Addison's disease, thyroid disease and coeliac conditions. More than 200 children are currently waiting to be seen in CUH, of whom almost 30 have been waiting for more than a year, with many more waiting between six and eight months. International best practice recommends that children and teenagers with type 1 diabetes be seen every three to four months but the HSE is falling far short of that in respect of these children in Cork and the surrounding areas.

One of the parents told The Evening Echo in Cork that her son, who suffers from type 1 diabetes, had not seen a consultant endocrinologist for almost two years, since one of the consultants retired. That is not good enough. These parents feel let down and they are worried. There is evidence that suggests the better care one receives when young, the less likely one's condition will deteriorate or that there will be further complications later in life so it is vitally important that these children and teenagers get a quality service when they are young. They are not getting that at the moment and this is causing a great deal of anxiety and worry for their parents, as well as discomfort for the children and teenagers themselves.

The issue of psychological support was also raised. This condition can be traumatic and can cause stress for children but it has been difficult for them to get support in this area too. There is clearly a need to fill additional consultant positions in CUH. Children are not being seen often enough and not getting the support they deserve. What will Minister do to ensure the waiting lists are reduced and a better service is provided?

I thank the Deputy for raising this issue and for the opportunity to provide an update to the House on services for children and teenagers with type 1 diabetes in the Cork area. Regarding paediatric diabetic services generally, the Deputy may be aware that the HSE developed a model of care for paediatrics and neonatology in Ireland to underpin the delivery of healthcare for children, both in the present and into the future. Key steps in its development were wide consultation with all healthcare professionals, involvement with parents and parent groups, a detailed analysis of the current clinical activity of all paediatric medical and surgical subspecialties, including paediatric endocrinology and diabetes, and a study of how paediatric clinical care is distributed with reference to international best standards. The HSE model of care for paediatrics includes the proposed model of care for paediatric diabetes services.

High-quality diabetes care is complex and requires intensive consultant-delivered care. It is recognised that diabetes care provided by a multidisciplinary team, including clinical nurse specialists, dietetics, social work and clinical psychology, results in fewer days in hospital, a higher level of participation in diabetes self-care practices, decreased readmission rates and delayed development of complications. Diabetes technology also provides an opportunity to improve control and quality of life in selected patients and is expanding rapidly, with continuous subcutaneous insulin infusion, or pump therapy, increasingly used in the paediatric population.

The model for service provision proposes that all hospitals providing acute paediatric care will have staff trained in the acute care of newly diagnosed diabetes. Children whose diabetes is diagnosed in level 1 hospitals that do not have access to a paediatrician with endocrinology training will be referred to their nearest diabetes multidisciplinary team once they have been stabilised in accordance with local agreed guidelines. In addition, the HSE has advised that seven clinical guidelines have been published and disseminated to the delivery system to guide and support service delivery to this patient cohort.

Regarding services in the Cork area specifically, CUH is a centre for paediatric diabetes and provides care for patients in the south west. More than 400 paediatric patients attend the diabetes service in CUH, with one to two new cases of insulin-dependent diabetes mellitus, IDDM, diagnoses per week. The paediatric diabetes service in the hospital has provision for two consultants, 2.8 diabetes nurse specialists and one dietician. The second consultant post is currently being recruited for and the candidate is expected to take up the position in January 2020. CUH is working actively to expedite this start date and, in the interim, is seeking to secure a locum consultant endocrinologist. In addition, it has recruited a locum consultant paediatrician to support the paediatric endocrinology service commencing in June.

Approval for recruiting additional posts for paediatric services in Cork was given in this year's national service plan. The posts include a psychologist, social worker and dietician. These posts will support the delivery of the model of care for paediatrics in CUH.

I thank the Minister of State for his response, but more is needed. From speaking to the parents at the protests, they were concerned, frustrated and angry at a situation that had been developing for some time. Many of them pointed to the fact that the number of children and teens presenting with diabetes was increasing rapidly. Is the Minister of State confident that what has been agreed to, but still has not been delivered, will be adequate to clear what is a substantial backlog of 400 children and young adults? They are not just from Cork, but the wider south west. Will the appointment of an additional consultant on a locum basis and the appointment of a consultant on a permanent basis at the start of next year, which is still a ways off, be enough? This issue needs to be examined carefully to ensure that the children in the substantial backlog are seen every four months as required.

I will take this opportunity to draw the Minister of State's attention to another matter that has occurred to me during our discussion on diabetes. He will be aware that Sinn Féin has published legislation on reforming the long-term illness scheme so that it is reviewed more frequently than is currently the case. Some products and medicines would benefit people, including children, with diabetes. FreeStyle Libre has been made available to children under the scheme but, as far as I am aware, it is not available to all patients with diabetes. Our legislation would allow the long-term illness scheme to be reviewed regularly and to be of benefit to many of the patients in question.

There is a substantial backlog of patients. I appreciate that an appointment next January has been approved and that a locum will be in place. I hope that the latter will be dedicated to this service full time. To put it bluntly, if the additional consultant is provided, is the Minister of State confident that children will be seen every four months?

Regarding the Deputy's question on whether it is enough, it will never be enough where some services are concerned. I have just come from the Rehab talks, which are moving along nicely.

The Government is committed to developing and strengthening all paediatric services, including diabetic services. I accept the Deputy's points, particularly those concerning teens and children. No one is arguing otherwise. The national paediatric model of care aims to deliver services that are timely, effective, safe, child and family-centred, efficient and equitable. No one disagrees that all children should be able to access high-quality services in an appropriate location within the appropriate timeframe irrespective of their geographical locations and social backgrounds. That is the plan under Sláintecare, which sets out a vision of high-quality, integrated and accessible healthcare services for children from birth to adulthood. The model is based on the principle of good quality care with an emphasis on early detection and prompt treatment.

Regarding the services in Cork, a second permanent post is being recruited for and is due to commence. We are trying to move that process forward and get that person in place. In the interim, CUH is hoping to secure a locum in addition to the locum general paediatrician. The HSE's national service plan also makes provision for the recruitment of additional posts for paediatric services in the Cork area. These include a psychologist, social worker and dietician and are intended to support the delivery of the model of care for paediatrics in CUH. The issues that the Deputy raised are important and I will highlight them to the Minister, Deputy Harris.

Hospital Facilities

This issue concerns the second gynaecology surgical theatre at Cork University Maternity Hospital, CUMH. It is a fact that, since the CUMH opened in 2007, that theatre has remained closed. Last January, Deputy Ó Laoghaire, others and I attended a briefing from Professor John Higgins, the clinical director of the maternity directorate in the South/South West hospital group. He provided an update on the positive and significant progress that had been made in dealing with what had been a lengthy gynaecology outpatient waiting list at CUMH. It was as long as 4,700 women in April 2017, but the latest parliamentary reply that I received from the Minister, which issued just last week, puts the outpatient waiting list at 1,854. That is a reduction of almost 3,000. I acknowledge the work of everyone involved in the maternity directorate in achieving that. The directorate at CUMH also covers University Hospital Kerry, University Hospital Waterford and South Tipperary General Hospital. The initiatives that it has taken to eat into the backlog have proven successful. Many of the consultant gynaecologists at the hospital commenced additional gynaecology outpatient clinics out of hours; a weekly outreach outpatients' clinic was held in the Mallow primary healthcare centre; the number of new patients seen at all clinics was increased; additional daily gynaecology clinics were set up from July 2018; and, in January of this year, a comprehensive drive to see an additional 500 outpatients at out-of-hours clinics was planned. To my knowledge, the consultants achieved that, which contributed to the reduction. While I welcome all of these initiatives, I do not want women simply being transferred from the outpatient list to the inpatient and surgery waiting lists. This concern is shared by the clinicians.

The second operating theatre has lain idle since 2007.

In recent times, however, CUMH has rented theatre space in the Mater Private Hospital in Cork. While I do not have any ideological hang-up about the use of spare capacity in the private system, I believe the operating theatre that is lying idle in the CUMH building should be put into use in the first instance. I understand that the Minister, Deputy Harris, signed off on the gynaecology business case, which involved initiatives for dealing with the outpatient waiting lists, in 2017. We need the funding and the staffing to be provided in order that the second theatre can be opened without any further delay. I am not a medic and nor is the Minister of State, but both of us are well aware of the impact of this delay on the quality of life of many women who are on the waiting list for inpatient and day case surgery procedures. Some of them are continuing to wait long periods. The overall number of women on the waiting list is 421, some 12 of whom have been waiting for over two years, a further 23 of whom have been waiting for between 18 and 24 months and a further 31 of whom have been waiting for between 12 and 18 months. This needs to be dealt with. I hope the Minister of State has some positive news for the women of the region.

I thank Deputy Michael McGrath for raising this important issue. I welcome the opportunity to address the House on it. The HSE advises that while it has not been possible to provide funding this year for the opening of the second gynaecology theatre, a new commissioning process has been established by the HSE through which all proposals for funding will be considered within the framework of the annual Estimates process. I am advised that the HSE is reviewing all possible ways to achieve a sustainable solution to the challenges being experienced in CUMH in the short and medium terms. It has advised that the possibility of NTPF support is an option that will be considered. It has further advised that a funded and targeted waiting list initiative is under way in Cork specifically to address the gynaecology outpatient waiting list in the region. This has resulted in a decrease in the number of patients on the outpatient waiting list from 5,000 in early 2017 to just over 1,500 patients on 2 May last. The South/South West hospital group is aiming to reduce this number to 1,000 by June 2019. The initiatives being pursued to meet this target include the commencement of additional out-of-hours gynaecology outpatient clinics, the commencement in November 2018 of a weekly outreach outpatient clinic at Mallow primary health centre in conjunction with the GPs in the clinic, an increase in the number of new patients being seen at all clinics and the establishment of additional daily gynaecology clinics from July 2018.

Last year, the support of the South/South West hospital group and funding from the NTPF to the CUMH enabled the treatment of 87 long waiters from the waiting list. This year, funding has been agreed through the NTPF for the treatment of almost 850 patients who are waiting for inpatient day case or outpatient appointments. The total that is due to be received from NTPF in 2019 is over €630,000. The Department of Health recently convened a working group to develop a scheduled care improvement plan. The objective of this working group, which comprises representatives of the HSE and the NTPF as well as departmental officials, is to examine medium to long-term initiatives to improve access to outpatient services, in particular. Gynaecology will be among the specialties examined by the working group. The group is examining the current models of care, the current and projected demand and capacity of services, the short-term, medium-term and long-term initiatives to improve access for patients at community and acute hospital level, the best way to move care to more appropriate settings and the best way to provide care at the lowest level of complexity.

I thank the Minister of State. The bottom line is that the women in Cork and surrounding counties who are on the waiting list for day case procedures and inpatient surgery want to know when the second operating theatre will open. The reality is that it has been lying idle for 12 years while the HSE has been paying for capacity in the private system through the NTPF. In my view, the NTPF should be used primarily where the capacity does not exist in the public system. The capacity exists in this instance. An operating theatre is lying idle. The business case was made by the maternity directorate to get the necessary funding in place to enable the theatre to open. I have acknowledged the significant progress that has been made with the outpatient waiting list. Very dramatic progress has been made. Other areas within the HSE could learn from the initiatives that have been undertaken by the maternity directorate. While the numbers outlined by the Minister of State when he spoke about the reduction from approximately 5,000 patients to approximately 1,500 patients are impressive, we do not want women who have been seen by a gynaecologist, and in respect of whom a referral for surgery has been made, merely to go onto another waiting list for that inpatient or day case surgery to take place. Although I welcome initiatives like the establishment of working groups and the new commissioning process, I did not hear anything in the Minister of State's reply that gives me confidence or, more important, gives the women concerned confidence that the second operating theatre at CUMH will open any time soon. I ask the Minister of State to take up this issue within the Department of Health, the HSE and the South/South West hospital group in order that this project can be accelerated. It should be a priority. The infrastructure is in place. It was paid for by taxpayers 12 years ago. It is a great shame to see it lying idle while women are on waiting lists, in some cases for over two years, for what could be life-changing surgery.

I take the Deputy's point on the capacity issue. I strongly accept the point that the reductions in waiting times are impressive. It is a key priority of the Government to reduce patients' waiting times for hospital operations and procedures. The Minister and I acknowledge that waiting times are often unacceptably long. We are conscious of the burden they place on patients and their families and on hospital staff. We take that point. I will bring the Deputy's message in respect of confidence back to the Minister. The overall outpatient waiting list, which includes those on gynaecology waiting lists, remains a significant challenge. Therefore, I welcome the great co-operation of the CUMH and its continued work to reduce outpatient waiting lists this year. The Minister welcomes the engagement of the South/South West hospital group and CUMH with Sláintecare and the NTPF. I share the Minister's position. I encourage all hospital groups and individual hospitals to engage with the NTPF to develop proposals for waiting list initiatives for inpatient day case procedures and for outpatients. Under the scheduled care access plan, the NTPF will provide funding for 40,000 new outpatient appointments this year. The HSE advises me that a new commissioning process has been established through which all proposals for funding will be considered within the framework of the annual Estimates process. I will bring the Deputy's concerns back to the Minister.