I welcome the Minister to the House.
The Future of Healthcare for Longer, Healthier Lives: Statements
I thank an Cathaoirleach Gníomhach for making the time for these statements, which I believe are the first on health in this new Dáil.
The Government and I are fully committed to a vision of a universal health and social care service where people have access to services based on need, and not on their ability to pay. The full implementation of Sláintecare remains one of the most significant reform programmes ever implemented by the State. I am so pleased it is a collective effort in this House that is enabling this. We are doing so against the backdrop of the greatest investment ever in healthcare in Ireland, the largest health and social care workforce, and against the challenge of an increasing and ageing population.
A healthy population is beneficial for society as a whole, and improving the health and well-being of the nation is a major priority for this Government. As a result of the strong continuing investment in our health and social care services and changes in behaviours, our people are living longer, healthier lives. Our life expectancy at birth is now 82.6 years, which is the fifth highest among the EU 27 behind Spain and Italy. Both of those countries have lifestyle and weather advantages we cannot compete with, I am afraid. The aim should not just be to live longer, but also to live healthier for longer, and Ireland’s healthy life years at 65 is the third highest in the EU. Ireland also has the highest self-perceived health status in the EU, with 80% of males and 79% of females rating their health as good or very good. These figures point to a thriving population the members of which in large part are enjoying good health. It is important for us to acknowledge this positive reality and recognise the massive contribution our health and social care workforce makes to the lives of everyone in Ireland.
The Government is committed to further transforming how we deliver health and social care through the implementation of Sláintecare and the programme for Government. Our aim is to ensure that the right care is available, in the right place and at the right time. We are prioritising increasing access to make sure those who need care receive it and that the care they receive is safe and of high quality. We are increasing capacity while expanding eligibility.
The population of Ireland is increasing at an unprecedented rate. In the past decade, the population has grown by 15%. The population of over-65s has grown at more than twice that rate, with an increase of 37%, or just over 220,000 people. By 2044, the number aged between 65 and 84 is projected to increase by more than 65%, while those aged 85 and over will more than double. More people overall and more older people mean more demand for our services, particularly in chronic disease management and long-term care. This is why we have been investing in building our capacity both in infrastructure and workforce.
For many decades, we underinvested in our health and social care infrastructure. We are working hard to address this deficit and increase capacity. Under the new programme for Government, significant public investment in healthcare infrastructure and capacity is continuing. Planning for future capacity requirements ensures that we address longer term challenges and prepare our health and social care service to be fit for the future.
Infrastructure plays a vital role in delivering health services, and we need to ensure that our assets, physical and digital, are fit for purpose and that they help to improve health outcomes and experiences for patients and those who provide their care. In the programme for Government, we have committed to deliver a significant programme of work through our capital programme by: increasing capacity by between 4,000 and 4,500 new and refurbished inpatient hospital beds across the country; increasing ICU bed capacity by at least a further 100 beds; providing more community beds; building four new elective hospitals; establishing six surgical hubs in Cork, two in Dublin, the first of which I was delighted to open in Mount Carmel two weeks ago, and others in Galway, Limerick and Waterford, and exploring the provision of an additional surgical hub for the north west in a timely manner; expanding trauma services, including facilities in Dublin, Cork and Galway; continuing to increase capacity and open more beds at University Hospital Limerick, UHL, and across the mid-west, taking account of the HIQA recommendations, which are yet to come in that regard; protecting diagnostic pathways and investing in infrastructure and equipment to meet target treatment times outlined in the National Cancer Strategy 2017-2026; building the new national maternity hospital, which is a major infrastructural investment on the part of the State for women’s health, providing much-needed facilities for women, girls and babies for generations to come; and the new children’s hospital, which I will be visiting tomorrow, which is going to be an incredible, state-of-the-art facility and Ireland’s first digital public hospital in which there will be 473 beds in total, 380 for inpatients and 93 for day cases.
The construction of the children's hospital is 95% complete against contract value. Once substantial completion is achieved, the hospital will be handed over to Children’s Health Ireland for a post-substantial-completion operational commissioning period of about six to nine months. What we are hoping is to have early access. This is what we are expecting in order for that work to begin in April. To repeat and to be clear, I will be visiting the hospital tomorrow with the Minister for Health for Northern Ireland, Mike Nesbitt. There is good work going on also to develop a children's hospital in Belfast as well so I am excited to speak to him about his project and what is happening Northern Ireland and, of course, to see about the completion of the hospital, which is a priority for everybody in this House.
There has also been an unprecedented level of investment in the health service workforce in recent years. As of December 2024, there were 126,740 whole-time-equivalent staff working in health services funded by the Department of Health. That is an increase of 25% on the numbers for 2020. This represents an increase in our workforce, which is a positive development. It is important that workforce growth is managed in an affordable and sustainable manner and that we get the best productivity we can from everybody who is working in our health service, which is a reasonable expectation of taxpayers and of the people of Ireland.
One of the pressures that we all feel and that we must address is increasing capacity and access to acute hospital services by building infrastructure elsewhere. Of course what we want to do is to reduce waiting times for access to healthcare services. As Minister for Health, ensuring better access to healthcare in Ireland and reducing the time patients are waiting for care in our acute hospitals is one of my highest priorities. Time is what we must focus on. Which would Members rather, 100 people waiting one year for a treatment or 100,000 people waiting for one month? They would of course prefer the latter, and we must focus our emphasis. Our tests and assessments must be based on waiting times, which are coming down but which need to come down further. Our Sláintecare targets are ten and 12 weeks.
The Waiting List Action Plan 2025, which I published earlier this month, is another milestone on that journey. It sets out four key targets that are all focused on reducing hospital waiting times by the end of the year, including further reducing the proportion of longer waiters and average waiting times, as well as having 50% of patients dealt with within the Sláintecare ten- to 12-week waiting time targets. Since the commencement of the approach set out in this plan in 2021, genuine progress has been made in reducing waiting times in acute hospitals. For example, up to the end of 2024, we had achieved an approximately 25% reduction in the number of people on waiting lists waiting longer than the Sláintecare targets. This equates to almost 150,000 fewer people breaching these targets. Over the same time period, we have also reduced the weighted average waiting time for outpatients from 12.8 months to 6.8 months. Through this year’s action plan, we aim to further reduce the average waiting time for outpatients to 5.5 months by the end of this year. Reducing waiting times for care will obviously bring a number of benefits from a patient perspective, including improved outcomes and a genuinely better experience of the health service and of a person's experience of the difficulty they are facing.
The second point of waiting relates to access to urgent and emergency care and, in particular, that most visible element of it, the trolley count we see, with people unacceptably waiting on trolleys to get access to our healthcare services. The number of patients waiting on trolleys in hospitals at 8 a.m. each day in 2024 was down in comparison with 2023 despite increased attendances. However, in the past eight weeks I have seen an drift in the very important and good work that was done between 2023 and 2024. I am determined to arrest that drift and turn it around. Our emergency departments experienced an 8% increase in the volume of attendances, equating to nearly 119,000 presentations and an 11% increase in attendances for 75 years and older patient cohort. In that period, however, we achieved at that time a significant reduction in the cumulative daily 8 a.m. trolley count over 2024, with numbers down 11% and fewer older patients waiting longer times. We intend to try to reduce that further this year. It is important to acknowledge that our emergency departments see over 5,000 patients a day. The vast majority of patients who need a bed get one in a timely manner and do not spend an extended period of time waiting on a trolley. This is happening while our healthcare service is also experiencing a significant increase in our demand for care.
On waiting lists and waiting times, there are two important points. If our population is growing, if people are getting a better service within our healthcare system and if they are getting better diagnostics and are being referred for more procedures, I would like to see, logically, the number of people waiting for treatments increase as a consequence of population growth and as a result of being diagnosed and being correctly referred for treatment. I would like to see, however, the time for all of those things coming down. That is why we must focus on waiting times. We, and I in particular, have to arrest the drift that has happened in respect of trolley numbers into this year. I have obviously placed a particular focus on the weekend spikes we are seeing. I will be updating the House as regularly as I can - the next occasion will be after St. Patrick's Day - on rostering, scheduling and all of the services that are there to support people and ensure they do not have to wait on trolleys. This includes analysis of admissions, discharges and rostering but also broader community supports and the whole-of-region involvement that is necessary to ensure people can be safely discharged as needs to be the case. There is a body of work to be done to improve on the good progress that was made last year and, indeed, to get it back to where it had been.
There is also the issue of access to community care. As people live longer lives, they want to stay healthy and independent. Government policy is to support people living with dignity and independence in their own homes and communities for as long as possible. The enhanced community care, ECC, programme is a transformative initiative under Sláintecare, shifting healthcare delivery from hospitals to community settings, ensuring patients receive tailored treatment closer to home. We want to strengthen primary care, general practice and integrated community services, preventing unnecessary hospital referrals and admissions while enhancing patient outcomes. This is again consistent with Sláintecare; getting the right care as close to home at the right time.
Since its launch in 2020, the ECC has expanded significantly, with 2,000 additional healthcare staff, the establishment of 96 community health networks and 50 of the planned 60 community specialist teams for older people and chronic disease. Last year, community specialist teams for older people had a total of 133,000 patient contacts. This was a 35.1% increase on 2023. The focus of those teams is on prioritising complex and more frail patients and the vast majority of those patients are discharged home as opposed to having to go to an acute hospital.
Linked to the GP chronic disease management programme, the community specialist team for chronic disease management provides services for some of our most chronic diseases: respiratory, cardiology and diabetes. They had more than 354,000 patient contacts in 2024, which is a 128% increase on 2023. Significantly, the overall implementation and roll-out of the chronic disease management programme has resulted in a 16% reduction in chronic disease hospital admissions between 2019 and 2023, significantly lower than the 3% reduction for all medical admissions.
Linked to this also is GP access to community diagnostics, with 280,000 scans completed last year. We have a mobile X-ray service, providing services to those residing in nursing homes, community disability units and those in their own homes for whom an attendance for an X-ray in hospital would prove challenging. In 2024, 7,200 patients were provided with a mobile X-ray diagnosis through that service and 95% of them were treated at home and did not require transfer to hospital, the majority of whom were in nursing homes.
The community intervention team service prevents unnecessary hospital admission or attendance and facilitates early discharge of patients for whom that care is appropriate. It provides access to nursing and home care support, usually from 8 a.m. to 9 p.m., seven days a week. There are 23 of these teams operating nationwide and again, in 2024, their activity continued to go upwards with an approximately 16% increase on 2023. That home support is an absolutely essential service for people to be able to live longer in their own homes and live well in their own homes. At the moment, the State is supporting approximately 58,000 people to receive home support. The overall budget for home support stands at €838 million, which is an increase of 70% on 2020. That allocation meant we could provide more than 24 million home support and complex home support hours in 2024, which is more than we have ever done before.
While we are investing more in our health and social care services, it is really important we see that investment used as productively and efficiently as possible. Since 2016, the budget for health has increased by more than 82% from €14 billion to €25 billion in the budget now for 2025. Expenditure on acute care has increased by more than 80% over seven years from €4.4 billion in 2016 to €8.1 billion in 2023. It is a very significant increase in spending but we must make sure we are getting the best from that.
The productivity and savings task force, established 12 months ago, is driving a programme of work designed to achieve savings and efficiencies across the HSE to optimise the use of health funding by delivering safe health services. I am committed to making sure that task force continues its work and we all see the benefit on behalf of the tax payers and people of Ireland, and that we meet our savings targets and continue to implement a range of productivity measures that maximise access to health.
One of the most important reforms in recent years is the public only consultant contract, which was implemented in March 2023, and more than 2,700 or 60% consultants are now in that contract. We now have 4,5000 consultants, which is a very significant increase, and 60% are on that public-only contract. The primary objective of that is to enable the move towards genuine, universal healthcare with public hospitals exclusively used for the treatment of public patients. A core objective of implementing this contract is to enhance the senior decision-maker presence on-site, out of hours and at weekends, and ensure those senior decision makers are present and delivering patient care when demand is at its highest. It means that more patients are treated by consultants, treated quicker and getting out of hospital quicker, where appropriate.
As the House knows, this is an area where I have a particular focus and forgive me for looking at my phone but I want to show the House something that has been important this week and it relates to digital health. Under Sláintecare, funding has significantly increased to expand digital health technologies across the health service, building cyber resilience and progress towards digital health records for patients. The health service has an ambitious forward-looking digital pipeline to deliver on our vision of digital for care 2024-2030 and its accompanying implementation roadmap, coupled with an appetite and momentum for change. This is something for which everybody has been looking for a very long time. It will address a deficit of investment in technology to date and significantly impact on productivity for people working in the system and access for everybody trying to access health and social care services.
This started just yesterday with the launch of the app, which is what I was trying to show the Deputies on my phone. This is my version of the app and if anybody has not downloaded it yet, as health spokespeople and Members of Dáil Éireann, I ask them to download it. A MyGov ID is needed to do that. Not everybody has that to hand, but if they do not have one, they should please get one. It is a fantastic app and provides an opportunity for people to schedule appointments in the public system. It started with a pilot in Cork with maternity patients where they could clearly see their antenatal and other appointments throughout the system, both prior to having a baby and also for some of the follow-up care.
It will enable us to schedule appointments over time. There will be a series of roll-outs relating to this but right now, for example, users can look locally and find a GP wherever they happen to be. If they have an emergency in some other part of the country, they can see where the local urgent emergency care centre or primary care centre is and look up what they need. It will also enable them to track their medication. The idea is this will be a single point of information. If you can do your shopping and your banking on it, you should really be able to look after your own health on your own phone and using the technology everybody in this House has.
For example, I can see on this my flu and Covid-19 vaccination records and I am horrified by the gap between my vaccinations but I can see it. If I had a series of medications or if it was difficult for me to remember, I can track that. How many of our constituents do we know who are tracking their medications on paper? This should make it dramatically easier for them. The reason I pick my phone up is to show Deputies and I ask them to please download the app. They should go to the App Store or Google Play and download the HSE health app. Please do it as it is a big step forward in our electronic health record programme. That is the first step. We will then have a shared care record and ultimately, the electronic healthcare record. I hope this House will put me under great pressure to secure the funding and make sure the electronic health record because, of course, it is in everybody's interest we do so. I want to get lots of PQs about how we are progressing with that so please do put me under as much pressure as possible.
Separately, I want to mention improving patient safety outcomes. My Department leads the direction of patient safety policy and legislation via the work of the national patient safety office. This is something that is important. The office is responsible for notifiable incidents and open disclosure but I am particularly sensitive this is something that is deeply relevant today with Portiuncula Hospital. I met more families this week on Monday in Portiuncula who have been impacted by patient safety.
Members will possibly see an over-indexation in the programme for Government on patient safety. It is very important to the Government that we get on top of responding to patients in a timely and a caring way and making the experience of having a difficulty in hospital easier. One of the families I spoke with in Portiuncula this week identified the experience. Some of the situations in Portiuncula appear to be emergencies that have been responded to by the hospital. Others are different types of cases. I will not pre-empt the investigations and the analysis of the reports but the experience is so important - not just the facts, but the experience.
For example, one family told me about the experience of coming to Dublin with their baby who had been transferred to the Rotunda Hospital for cooling, which was a completely appropriate response in the case. If a mother has just had a baby and her baby has been appropriately taken for cooling and taken away, that is a traumatic experience to go through. The family described the experience of coming to Dublin and while all the care was correct, the experience around the care was different. It would have made their lives easier to know there was discounted parking available in the Spire car park and it would have made their lives easier to know they could get discounted food in the staff canteen downstairs.
It is the little things that would have made their lives easier, for example, knowing people do not wear sleeves in a neonatal intensive care unit. The family would have felt more comfortable had they known that coming up.
Yesterday, I met the Master of the Rotunda, Sean Daly, and I made these points to him and asked him to set up a dedicated liaison for anybody coming from anywhere around the country to make that experience a little easier. This extraordinary family offered to even share pictures of their little baby or of the cooling process itself, just to, as they said, take the edge off that terribly traumatic experience. The Master of the Rotunda has already come back to me to say he will implement those changes and put together a practical care pack for people coming. I will ask the other maternity hospitals to do the same where that sort of cooling process is used. It is the gentle changes that are a bit more compassionate and more understanding of the patient's experience. If any Deputy has any examples of where we can make the patient experience when things go wrong a little gentler, softer, kinder, a little more compassionate and perhaps more thoughtful by all the parts of the State working together, will they please bring those to me and I will do everything I possibly can to make sure they are implemented?
Separately, on patient safety, obviously HIQA are doing an important body of work. I am running out of time. We will be dealing with those issues over time in any event.
If I could summarise our health system more broadly as I come in as Minister for Health for the first time, every time I look at our public policy questions and challenges around health, I am struck by our very long life-expectancy relative to our EU peers and by our extremely good outcomes in care right across the spectrum. Whether it is cardiac care, stroke care or cancer care, our outcomes are extremely good when people are in the health system. That is a good public policy situation to be in. Where we struggle, and we all know this, is access to care such as to diagnostics and treatment. That is why a focus on waiting times and on access to urgent and emergency care is so important. I say to the Members of this House, to whom I am accountable, that my focus is on improving access as much as I possibly can. What that means is making sure we get the funding and the process in place to deliver the remaining surgical hubs, the elective hospitals, the national maternity hospital and our digital health programme, to make what I genuinely hope can be a leap in the infrastructure for our healthcare system to try to keep as many people as possible out of our acute hospitals. We have heard some examples this evening of what we are trying to do in the community whether it is enhanced community care or the community interventions schemes. We try to keep people away from acute hospitals in the first instance and try to keep them at home rather than in hospitals for different types of care. However, we also have this body of people who should be getting surgical treatment in elective hospitals and in surgical hubs and it is my intention to try to get the funding and make sure we manage the delivery to ensure we have those.
The week before last, I opened the Mount Carmel surgical hub facility, which is the first of six such facilities. This will do about 11,000 small surgical procedures every year, whether it is carpal tunnel surgery or a pain relief medication that has to be done in a clinical setting, but it will also have 18,000 outpatient appointments. It is appropriate that people are not going to acute hospitals for outpatient appointments of that kind. However, I also want to see outpatient clinics delivered by consultants in hospitals on Saturdays. That is what our public-only consultant contract enables us to do. That is the expectation we should have for our healthcare system, trying to use not just the infrastructure for better care outside of the acute hospital system but also making sure we are getting the productivity we expect of the people - public servants, as we are - who are employed by our healthcare system to ensure they are delivering for the people of Ireland. I assure the House that as Minister for Health I will work every day to ensure we are fully realising the benefits of the very considerable investment Irish taxpayers have put in to our healthcare system, that we are building on the outcomes we already have and that we are improving access for everybody in Ireland.
Gabhaim buíochas leis an Aire Sláinte. I wish her well with all of that.
Bogaimid ar aghaidh anois leis an gcéad cainteoir ó Pháirtí Shinn Féin. Tá seacht nóiméad ag an Teachta David Cullinane.
I start by wishing the Minister well. I think is the first chance we have had in the Dáil to formally do that. I also acknowledge the contribution that the former Minister for Health, Deputy Stephen Donnelly made as well. It is important to put that on record. We had many exchanges but there are areas of healthcare, particularly women's healthcare, where the former Minister made a lot of positive changes so I want to start with that.
The Minister mentioned bank holidays, and rightly so. We see a spike on bank holidays in terms of the numbers of patients on hospital trolleys or not admitted to a bed in a timely fashion. The difficulty is it is not just on bank holidays; it is every day of every week of every month. According to the Irish Nurses and Midwives Organisation, we have this continuous clash between the figures produced by the HSE and the numbers used by the INMO. However, last year, there were 122,186 patients admitted to a hospital without a bed. In fact, January of this year was the worst-performing month in the history of the State with more than 13,000 people again treated inappropriately without being admitted to a bed in our hospitals right across the State. Most of those people were not there on bank holiday weekends. I got an email from a constituent called Mary. I want to give her example because the Minister asked for examples. This was not a bank holiday. It was today. She said she was waiting since July for an amputation following an infection and complications from a previous surgery. It was causing her great difficulty as she is the main carer for her daughter who has Down's syndrome and she is restricted because of her injury. She turned up today at the hospital only to find out that not only her surgery but that of many others was cancelled because of other problems in the hospital. This is causing her great stress. Her daughter is due for treatment in the hospital next week and now she is worried her daughter's treatment will also be cancelled.
There were 20,000 more hospital cancellations last year than there were the previous year. Therefore, while the Minister can talk about the number of long waiters coming down - and I celebrate the fact that they are - we still have far too many problems in our healthcare system, including cancellations and overcrowding. When we see a surge in emergency departments, one of the few options open to hospital managers is to cancel elective procedures and that then creates havoc with our health services generally.
It is right that we should always aim to ensure that people can live longer and live healthier lives. The first thing we need to do is to make sure that people can be treated and live in their homes. The Minister mentioned that in her speech. She did not mention was the statutory home care scheme that was in the last programme for Government and it seems is in this programme for Government, though the Minister made no mention of whether she would deliver it. We were promised it and promised it and yet no movement was made by the previous Government. As Teachtaí Dála, we all receive representations all the time from people who are looking for intensive home care packages and they are not there. The Minister spoke about having the senior decision-makers, as she put it, working in our hospitals during bank holiday weekends to speed up discharges but if she talks to hospital managers they will tell you that part of the problem is that people cannot be discharged because the step-down beds, the recovery beds, the convalescent beds or the home care options are simply not there. If we only focus on one element of the problem, we will not solve it. It needs a lot of different solutions - not just want is happening in the hospital but what is happening outside of the hospital.
We also have a real crisis in mental health. I know she is not directly responsible for mental health but it was not overtly mentioned in the Minister's speech. We have a real problem with CAMHS, which is under-resourced. There was a promise of 12 dual-diagnosis teams to be established in this State. Only two are up and running and even those two teams are not fully operational. All of these are issues under the Government's control, and now under the Minister's, which need to be dealt with.
I turn to the programme for Government. The Minister outlined a long list of commitments she wants to deliver over the next five years. We will see what progress can be made. She talks about 4,000 to 4,500 new and refurbished beds. What we need are timeframes. How many of them are new? How many of them are refurbished? Is the capital funding there to make all of that happen? She talks about providing more community beds. I raised this publicly a number of times. There is no number. Is it one, 50 or 100? Any of us could come into this Chamber and say we are going to do more, have more beds and more staff. If we did that and produced a plan that just called for more of everything, we would laughed out of it. The Minister has to have specifics in this regard. What does she mean by more community beds? She mentions the four elective hospitals. We have been hearing about these elective hospitals for years and years and they are still at the starting gate. They are crucial. It is reform with a big R. If we separate scheduled from unscheduled care, that is the best way to actually reduce waiting lists, particularly those in the elective space which are the big problem. I refer to orthopaedics and many other areas.
The Minister also spoke about the new national children's hospital. It is interesting that we hear a great deal about this June deadline. That is the completion date given by the contractor. I was a member of the Oireachtas health committee when the members of the National Paediatric Hospital Development Board came before the committee last October and told us they had no confidence that the contractor would meet that date. They told us that none of the 4,000 rooms or spaces in the hospital were finished to the appropriate standard. They told us the contractor was not adequately resourcing the project and they had grave doubts whether any of these issues could be resolved. I do not know what happened over the past few months, but now it seems everybody is saying this June deadline will be met. The question is if it will be met. I wonder because we have had 13 or 14 deadlines, which, as the Minister knows, have come and gone. She will probably have seen a letter that was sent to her as well from a number of paediatric consultants working in Children's Health Ireland. They referred to the lack of consultant posts and, essentially, said that if we do not see more capacity in this space, the hospital will not even be safely staffed from the perspective of the consultants from day one. All these are important issues if people are to have confidence that the national children's hospital will be opened on time and treating children as quickly as possible.
I wish the Minister well. I want to see progress being made. I want to see waiting times reducing. I do not want to see hospital appointment cancellations. I do not want to see children with scoliosis or spina bifida waiting for care.
I do not want to see children with disabilities waiting for dental treatment. These are not the types of cases we want to bring to the floor of the Dáil, but, unfortunately, we have to because of the many challenges we have in the healthcare system.
We are debating an issue that touches every family and community across Ireland, which is the future of healthcare for our ageing population. This is far more than just a policy discussion. It is about ensuring dignity, safety and quality of life for our parents, grandparents and, one day, ourselves. The facts are clear. By 2030, more than 1 million people in Ireland will be aged 65 or older. By 2057, this number could nearly double. This demographic shift is not a surprise. It is a foreseeable challenge, yet for over a decade Fine Gael has failed to prepare. Instead of building a resilient health service, it has allowed hospitals to crumble under the pressure. Last January, a record 13,972 people were left on trolleys or chairs in overcrowded accident and emergency departments. More than 28,000 hospital appointments were cancelled. This was 5,000 more than the same month last year. This is not just a crisis, but the result of political neglect. Fine Gael wants to blame these failures on an ageing population. Let us be clear, however, that the problem is not our older people but a Government that refuses to plan ahead. It underfunded the national cancer strategy, leaving a €180-million hole in vital services. A stroke strategy was published, but then starved it of the resources required, putting lives at risk.
This inaction has turned our hospitals into pressure cookers, with soaring budgets and unsafe conditions. It does not, though, have to be this way. Sinn Féin has a plan to future-proof healthcare. Our vision is simple: prevention, proximity and people-first reform. We must prevent illnesses before they start. Chronic diseases, like cancer, heart disease and respiratory conditions, account for most deaths in Ireland. These are often preventable. Sinn Féin would invest in community health, sporting supports, housing and clean environments to tackle the root causes of poor health. We would expand screening programmes and empower pharmacies to deliver pharmacy-first care, thereby reducing the strain on GPs and hospitals. We will bring care closer to home. Too many older people end up in hospitals because they cannot access basic sports. Those admitted to hospital often see their discharge times greatly delayed as there is a complete and utter lack of space in step-down care facilities. Delayed discharges are adding more and more pressure to services already operating on the edge. Our home first policy will invest in homecare packages, rehabilitation services and local health hubs. We will train more GPs, especially in rural areas, and expand community nursing.
This is not just compassion: this is cost-effective. Keeping people healthy at home eases the pressure on overwhelmed hospitals. Fine Gael's reliance on outsourcing and mismanagement has wasted millions of euro. We will direct this funding into front-line staff, modern equipment and digital systems to cut waiting times and improve accountability. Our safer staffing initiative will ensure hospitals have the nurses and doctors needed to provide safe and timely care. Sinn Féin will take a whole-of-government approach, linking health policy to education, infrastructure and climate action. Healthy lives require more than hospitals. They require thriving communities. Fine Gael and Fianna Fáil pour taxpayers' money into private outsourcing. We will cut this waste and invest in services that deliver. Let us be clear. Every cancelled appointment, every patient on a trolley and every life lost to a treatable illness is an outcome of this Government's failures.
I congratulate the Minister and the Minister of State on their new roles. I wish them well. We all want them to succeed and we all need them to succeed in the area of health.
I wish to concentrate my contribution on eating disorders. Some Members may have attended when Cared Ireland presented in the audiovisual room. The reason I went in there was I am desperately seeking help for a constituent whose BMI is at 14.8 and she weighs 39.9 kg, as it is. I have been looking for help for her for the past six to eight months. I know she is only one person, but every door is being shut in my face. Obviously, she needs a bed for treatment. We do not have the 23 beds that were promised. It really concerns me that the Minister of State, Deputy Butler, says we do not need those beds. We absolutely do need them. In the meantime, however, we have to facilitate people in such bad health to get private help. It will cost €77,200 to have an admission to Lois Bridges centre, where she can be treated. It is not fair that somebody who does not have the money or health insurance is excluded from vital treatment. This is a matter of life and death.
A woman, Paula Crotty, spoke in the presentation today about her own daughter who had died. The way she was treated and the lengths to which she went to try to help her daughter to stay alive would make the hair stand up on your head. She was then told by a Minister's adviser she was lucky to have what she had. The way these families and individuals are being treated is grotesque. It is not right to say they can be treated in the community. As was said in the audiovisual room today, it is eclipsing the issue of the lack of beds to say the community teams are in place. Psychiatrists who do not have an expertise in eating disorders cannot deliver the care needed and that can be delivered in the treatment centres that do exist, like Lois Bridges. Something, then, must be done, and done urgently. Ciara spoke about the mental torment that has led to her physical destruction and may destroy her choice to ever be able to have her own child. We talked about natal care earlier. This is how serious the situation is. We are failing these people. If there is one thing I would ask the Minister to do, it would be to please sort it out so we can have treatment beds to allow us to treat people with eating disorders.
I wish the Minister and the Minister of State well in their new roles. I think I said to them that they have the shortest titles but probably the biggest responsibilities in the Government.
I join others in saying that we need the Minister and the Ministers of State to do well. For our part, we will do everything to try to support the work they are doing to get the positive health outcomes that we need in this country.
The list is endless in terms of what we could say when talking about longer, healthier lives but I am conscious that those advocating on behalf of people who suffer from rare diseases were in Leinster House today. What is critical for them is support for research and, crucially, access to new drugs in the market. Daffodil day is just a month away. The Irish Cancer Society has made a particular call to reinstate the Laura Brennan catch-up scheme for HPV vaccination, which expired at the end of January 2024. I ask the Minister to please try to do that. As she said in her comments, small things can make a big difference and impact on people's lives. The HPV vaccination has proven to have a big impact to people's lives and we must continue with the catch-up programme.
The issue I want to talk a little about this evening concerns primary care. We have a twin issue in Ireland of a growing life expectancy and an ageing population. Perhaps the single greatest challenge for the Minister is ensuring that we have a primary care system of supports that is both fit for purpose and sufficiently equipped to respond. Average life expectancy is now fifth highest in the EU at 82.6 years. We know that the share of over-65 year olds is expected to grow by almost 24% by 2044. We also know that age is not the clear-cut determinant of health need, rather it is the proximity to death and the incidence of morbidities among the population. Therefore, it is not about life expectancy but a healthy life expectancy. As I understand it, the reality is that in this country that is going down rather than up - from 69.6 years in 2019 to 66 years in 2022.
When we throw economic circumstances and the level of deprivation into the picture, we begin to get a much more stark situation. In 2024, Pobal research into disability and deprivation found the people in the most disadvantaged areas are four and half times more likely to report not having good health than those in affluent areas. Furthermore, it goes on to say that people living in disadvantage areas are twice as likely to have a disability compared with those living in affluent areas.
In my constituency in Dublin Central, research conducted by the HSE profiling the north side of Dublin and based on the 2022 census found that the numbers reporting good health was just 38.3% - more than a third of all people. The national average is 53.2%.
How is the State responding? Let us take GP care. This is the first point of contact for almost all persons seeking healthcare in this country. We have a private system of primary care and a public system of hospital care. There are no GP to patient ratios. There is nothing to say we should have GP practices in every community in our country. Instead, the State has outsourced the first point of contact in our health system to a private system of GP carers. That is not to say we do not have brilliant GPs, but the reality is that it is a for-profit model, and there are significant implications in that regard for who gets care.
When we look at certain areas, especially in my constituency in Dublin Central, the reality is that we do not have enough GPs. We do not have enough GPs across the country, but especially in the most deprived areas. In Dublin 1, for instance, we have nine GPs on the GMS scheme. In Dublin 7 there are 17. Finglas, if anybody knows it, is typically divided into two - Finglas east and Finglas west. The west has far higher levels of deprivation. There are 14 GPs in Finglas east but there is not a single GP in Finglas west. How can the Department of Health stand over this? There are significant questions about inequality of access to timely healthcare in certain communities.
I wish to raise the situation of a GP practice in Dublin Central - the Summerhill Family Practice - GP Care For All. I hope the Minister is familiar with the situation. It is in operation since 2016. It is a charity model operating in an area that is crying out for GP care. Since February last year that practice has been put in jeopardy because of a change to the Finance (No. 2) Act 2023, which changed section 1008A of the Taxes Consolidation Act 1997. The change effectively precludes the practice from operating as a charity. This charity practice that provides services has a list of 2,600 patients. It has the funding in the bank to extend the practice list by a further 1,200 to 1,500. It has more funding again to set up a practice in Finglas west, but it cannot do anything at the moment because of the limbo it finds itself in because of the tax changes to the finance Act last year. It is crucial to say that nobody is beating down the door to start a GP practice in the north inner city. Almost all the patients in this practice are on the GP scheme so there is no incentive or profit in this practice.
I ask the Minister to look at the weighting for GMS patients, which prioritises or weights in particular women of childbearing age and older patients. However, when we look at the typical profile of people attending the practice in Summerhill in Dublin 1, the life expectancy is much lower. The practice tells me it does not have patients in their late 60s, 70s or 80s, and there is a reason for that. Twelve months on from discovering the change to the finance Act that is putting this vitally important GP practice in jeopardy, and after many letters going to the HSE, the Department of Health and the Department of Finance, there has yet to be a face-to-face meeting between the Minister for Health and a serving Minister for Finance. I ask the Minister to change that. More crucially, I ask her to personally intervene to ensure that this GP practice survives, because if we were without it, it would make a mockery of our discussion about healthy lives.
To add to the farce, the HSE has had to come in to provide funding to an accountancy practice to try to put forward a solution to how the finance Act might be amended. It is also providing funding to the double PAYE payment that is going to become liable by the end of this year. It is a complete waste of money in the general scheme of things, and that needs to change.
Ultimately, there is a wider question here about the future of GP care in this country. A charity was set up because it is impossible to get GPs to set up a practice. When I talk to trainees they tell me they want to be clinicians; they do not want to set up a business. Cracking the nut of having more GPs in this country must be about direct employment.
If we are serious about primary care, then we must look at home care packages. Deputy Cullinane is correct in what he said about a statutory right to home care. At the moment we have an utterly haphazard system that has grown up in a bizarre way. I remember talking to a woman in her 70s a number of months ago, who spoke about the absolute torture of trying to get help for her husband. She had to speak to five or six different providers in the area. The public health nurse was helpful but could not provide her with all the oversight or detail she needed to try to care for her husband in the home. She is saving the State an enormous amount of money, yet there was no single point of contact. As there is no statutory right to a home care package, the reality is that we have an utterly haphazard system.
In the remaining minute and a half of my time I wish to pick up on what Deputy Conway-Walsh spoke about. I too met the Cared Ireland organisation today, which presented on eating disorders. The expansion of community hubs is very welcome, but anybody who understands eating disorders in this country knows that it is a matter of life or death. It is not a minor health issue that can be just treated in the community. The reality is that this country has outsourced inpatient care to charities and private providers. Some 76 admissions for eating disorders in this country were to charities and private providers. The vast majority have to go to England. A woman talked today about a child, who is now an adult, being an inpatient in Britain for seven years, who cannot leave yet because she is not fully treated. We know from the Health Research Board that those with an eating disorder have the longest inpatient stays of all psychiatric illnesses, yet we have a Minister of State who says there is no need for additional inpatient beds in this country. It is not either of the two Ministers present in the Chamber, it is the other Minister of State. There is a need. I ask the Minister to change that. There is a commitment to 20 beds since 2018.
Tá an t-am caite.
Could the Minister please put them in place?
Healthcare is not just about treating illness; it is also about enabling people to live longer, healthier and more independent lives. The future of healthcare must focus not just on hospitals and emergency care, but on prevention, early intervention and community-based supports. We are living longer than ever before but the challenge now is to ensure that these extra years we spend are in good health. That requires a shift in how we think about healthcare. We need to move from a system that primarily reacts to illness to one that actively promotes wellness.
First, prevention must be at the heart of healthcare. Chronic diseases like heart disease, diabetes and cancer account for the majority of healthcare costs, yet many are preventable with early action. Investment in screening, lifestyle support and mental health services can reduce hospital admissions and improve quality of life. Prevention is not just about medical interventions; it is also about supporting people to make healthier choices in their daily lives. This is why the Government must take a more holistic approach to health, not just stepping in when things go wrong, but actively creating an environment where people can stay healthy in the first place. One example is my proposal to make gym memberships tax deductible. We already recognise the importance of physical activity for mental and physical wellbeing, so why not incentivise it? If we are serious about prevention, we should be treating gyms, sports clubs and exercise facilities as part of the healthcare system, not just as leisure activities. This kind of forward-thinking policy would reduce long-term healthcare costs and help people to live healthier lives.
Second, access to healthcare must be improved, especially in rural areas. No one should be forced to wait months for essential care or to travel long distances for basic services. Telemedicine, community health hubs and better integration between GPs, hospitals and home care services will be key to ensuring that healthcare is accessible when and where people need it.
Third, we need to support those who care for us - our doctors, nurses and healthcare workers. They work under immense pressure and if we want a system that delivers for patients, we must ensure that our healthcare professionals have the resources, staffing and working conditions they deserve.
Fourth, Innovation and technology must be embraced. Advances in artificial intelligence, personalised medicine and digital health records can transform care, making diagnosis faster, treatments more effective and services more efficient.
The goal of healthcare should not be just to add years to life, but life to years. By prioritising prevention, access, workforce support and innovation, we can create a system that does not just treat illness but helps people to thrive. That is the future we must build together.
I congratulate the Minister on her new role and I wish her the best.
I join with colleagues in marking rare diseases day this week. My colleague, Deputy Pádraig O'Sullivan, has done a lot of work in this area. The Minister was able to meet some of the groups and I hope she will co-operate with those who are advocating on the issue of rare diseases.
This debate is on the future of healthcare and, as Deputy Dolan said, it is important that we use new technology, particularly artificial intelligence, to be able to improve health outcomes. When I posed parliamentary questions to every Department, I was heartened to learn that the Minister's Department was one that had adopted a proactive approach. I congratulate the HSE on being able to do that.
I am concerned about the infrastructure within the HSE and our hospitals generally. A lot of money is being spent on addressing the fallout of the cyberattack, but I am concerned about section 39 organisations, which deal with those who are most vulnerable. If I were to organise a cyberattack on the health service, I would not attack the HSE. Rather, I would target one of the section 39 organisations. There are vulnerabilities there, and I ask that they be addressed.
I agree with Deputy Dolan's point that healthcare is not just about treating the sick, but also health promotion and healthy lifestyles. The State needs to respond far more effectively on this. The concept of tax relief for gym memberships needs to be explored. It was signalled by the then Minister for Finance, Jack Chambers, in budget 2025 that this would be considered by the Department of Finance. It is a commitment in the programme for Government. As part of a healthy living strategy, it should be promoted. In many Canadian provinces, there are a number of examples of measures that are used to promote fitness and general wellness and wellbeing.
Deputy Sherlock mentioned the challenge of the shortage of GPs. While I appreciate that there has been a significant additional investment in places in medicine and on GP training programmes, we still have a problem, not just in rural areas, but in areas of high growth. I represent a constituency that has had significant population growth in north Wexford and south Wicklow. The front page of the Gorey Guardian this week referred to the shortage of GPs and the fact that existing practices were not taking on any new patients. We have been waiting for a primary care centre for 15 years. At a meeting with the HSE that I also attended, the Minister's predecessor, former Deputy Stephen Donnelly, remarked that the national children's hospital, for all its delays and cost overruns, would be delivered quicker than the primary care centre for Gorey.
I wish the Minister well. I encourage her to be proactive and innovative and we will support her in that.
The future of healthcare in Ireland is at a turning point. Demand is increasing, with a growing, ageing and more sophisticated population. We have an opportunity to create a system that is patient centred, community driven and sustainable. Our focus must be on prevention and accessibility and ensuring that care is delivered where and when people need it most. A strong healthcare system relies on robust primary care and community care. Hospitals play a vital role but they cannot be a default option. We must continue to invest in GPs, primary care centres and home-based care to ensure that treatment is available locally. This would reduce pressure on emergency departments and improve patient outcomes.
Technology is vital for meeting the increased demand that lies ahead. Telemedicine and remote monitoring can improve care, especially in rural areas, by providing medical advice without unnecessary travel. Wearable health devices and digital diagnostics will increasingly help early detection of conditions and monitor existing ones. However, none of this will be possible without investment in our healthcare workforce: GPs; consultants; nurses; allied health professionals and carers. We must improve recruitment and retention by offering better working conditions and career pathways.
Prevention is key. One in four adults and one in five children in Ireland are living with obesity, leading to increased rates of diabetes, heart disease, cancer and other chronic conditions. The national strategy must be enhanced to promote healthier lifestyles through education, community initiatives and improved access to affordable, nutritious food. We need simple, visible and transparent food labelling and regulation. We are what we eat.
We must also protect our regional healthcare services. In my constituency, Portiuncula hospital and Roscommon hospital are critical parts of our local healthcare infrastructure, providing a span of accessible services that ensure timely diagnosis and treatment. These services must be maintained and expanded.
There will be increasing use of healthcare data to plan our healthcare services, AI and brain-computer interface devices, and a growth in personalised medicine. However, this will only happen in an ecosystem of innovation, security and human expertise. The future of healthcare is about ensuring that every person, no matter where he or she lives, has access to timely, high-quality care. By investing in community services, embracing technology and prioritising prevention, we can build a system that truly supports longer, healthier lives.
I wish the Minister and the Minister of State well in their new roles. I hope they can change healthcare in this country. I have been listening to and taking part in Dáil debates over the past few weeks and it seems easy for the Government to portray that the increased demand for public services has just come out of the ether.
Population modelling seems to be only considered as an excuse as to why services are strained or broken altogether today. Explaining away the failures of today by stating they will be resolved tomorrow will not work. Nowhere is the case made regarding healthcare services. It has been a complete failure but I hope the Minister can improve it.
Consistent modelling by the CSO and others over a long period has pointed to a growing and ageing population. The Irish Longitudinal Study on Ageing, TILDA, in Trinity College estimated that in 2021 the number of those over the age of 65 would stand at approximately 250,000 people and it was spot on. Circumstances or models may change but there are two consistencies. These are that we should expect a significantly increased older population in decades to come and Fianna Fáil and Fine Gael, while failing to deliver these services today, also fail to prepare for tomorrow. I would welcome more forward thinking and planning from the Government on the elderly of 2040, 2050 and beyond. What of our people today? The previous Government provided a new stroke strategy. This is welcome but it failed to provide the funding necessary to implement it.
Last month saw a record of almost 14,000 people on trolleys and more than 28,000 hospital appointments were cancelled. Even though the Government says it has doubled the budget to almost €25.8 million this is not working. Something needs to change. Our growing and ageing population is not unforeseen. References to unprecedented population growth or an ageing population from Fine Gael are simply a distraction from its failure to tackle a crisis in our health service today.
Sinn Féin has outlined our planned to future proof care for all of our people. We need to train more GPs. We need to invest in our hospitals. We also need to deliver more care at home. In Monaghan, where I come from, people cannot get a GP and cannot get all of the services we should have in the hospital in Monaghan. They also cannot get care for our elderly. Sinn Féin would invest in our communities to improve lifelong health and well-being-----
Go raibh maith agat.
-----including more pharmacies, rehab care and sport, housing and the environment.
Go raibh maith agat.
I ask the Minister-----
Tá an t-am caite.
-----as a starting point that if she will not implement Sinn Féin's plan, will she please-----
Go raibh maith agat, a Theachta.
-----do her very best to cause no further harm?
I congratulate the Minister and Minister of State on their new roles. I will begin by flagging a general concern I have. This is the second week in a row we have had general statements on healthcare. Last week we spent two and a half hours on statements on mental health. As a new TD I found it a very frustrating experience. Not a single question posed during the session was addressed in the closing statement by the Minister of State. I asked whether the new Government would commit to providing 10% of the overall health budget to mental health as provided for in Sláintecare. We got no answer to the question. Perhaps we will get an answer to it today. When there were no answers to the questions, I was left wondering what was the point of the debate and why we spent time researching and preparing. Instead of general statements I wonder whether parliamentary time would be better spent on questions and answers with the Minister, through which we could have real engagement on the issues faced by people. Better still, we could progress the backlog of legislation, including the mental health Bill and legislation on adult safeguarding. Safeguarding Ireland has been calling for legislation for ten years. There is also the issue of a statutory right to home care, vaping legislation, dental legislation, the Health Information Bill and amendments to the assisted human reproduction Act. I will be interested to hear the Minister's thoughts on how best we can use this parliamentary time together to improve health outcomes for people. If we expect improved productivity from the health services we should expect improved productivity from Parliament also.
The app is the minimum we can expect. It is 12 years since we had the first strategy on e-health. In 2023 Ireland was ranked one of the worst countries in the OECD for digital health. The majority of EU countries have e-health records. We are far behind our peers and we need to make progress.
I asked for examples where we could have more gentle care. I went to the briefing earlier from CARED Ireland on eating disorders and the experiences of the families were harrowing. There was particularly powerful testimony from Paula Crotty. If the Minister has not done so already, I encourage her to meet with these families and engage with them. Some of the testimony was very moving and they need specialist care.
On the topic to hand, on longer lives, the census in 2022 revealed that our population increased by 8% in 2016, with the highest increase in the over 70s by 26%. Undoubtedly this is a success story first and foremost but it should also put policymakers on notice. After all, this trajectory will not change and it is only going to accelerate. According to the ESRI, the number of people aged over 70 is projected to increase by 94% between 2015 and 2030, and by 2051 the population of those aged over 80 could increase by 270%. More of the same is not going to cut it. We need to completely rethink the way in which we deliver services to older people to ensure they can live fuller lives and more independent lives.
As I mentioned, the key to this is the statutory right to home care. Staying at home with supports is associated with better health outcomes and it is what most people want. However, successive Governments have failed to provide for this right. On paper the State's policy is to keep people in their homes but in practice the State is funding people to go into nursing homes, 80% of which are in private hands. The overreliance on nursing home care does not serve the interests of most older people. Instead, it serves commercial interests in a sector that is increasingly financed by international investors, while smaller community-based nursing homes, which should be protected, are on the verge of extinction. The problem with this model of care was brought into sharp focus during the pandemic but the financialisation of elder care continues. Contracting out public services is often thought to result in efficiencies but the argument does not stand up to scrutiny. This is because most of those supposed efficiencies have costs and they are largely borne by service users and workers.
Related to this is the urgent need for robust safeguarding legislation. Shockingly, it is still the case that HSE social workers do not have the right to enter private nursing homes, which account for 80% of the nursing homes. Three years ago Safeguarding Ireland warned the Government that HSE safeguarding and protection teams were operating in a legal vacuum but nothing changed. This is inexcusable. A country with a history of institutionalisation and abuse should know better.
Another issue that is often overlooked is that of loneliness. The WHO tells us it is a pressing health threat. The situation in Ireland is particularly bad. In 2022 a European Commission study found that 20% of Irish people felt lonely most of the time compared with 13% of other Europeans. While loneliness is a problem for all age groups it particularly impacts on older people. Just this week the chief executive of ALONE called for a loneliness action plan. This is notably absent from the programme for Government despite previous commitments that were not delivered by the previous Government.
It is disappointing that the programme for Government does not commit to reappointing a commissioner for ageing and older people. The Minister of State, Deputy Butler, said the proposal would be considered by the commission on care for older people. I must say this response misses the point. In referring this proposal to the commission the implication is that older people are purely receivers of care and do not have rights beyond the Department of Health. A commissioner on ageing and older people would have a much broader remit that would recognise the full capacity and potential of older people. I am speaking about the full spectrum of needs and rights in terms of health.
I accept this debate is primarily concerned with health care and ageing but the focus should be wider. The Dáil should be more concerned with delivering a rights-based approach to ageing policy and services. This would include not just health but housing, transport, income, connectivity and education. Ultimately, I fear this rights-based approach to ageing policy and services will remain purely notional. We need to get down to work and pass some of the legislation I mentioned at the beginning of my contribution, which would have a real and meaningful impact on people's lives, provide the rights-based approach that is so badly needed and, ultimately, provide general universal healthcare for everybody.
I thank the Minister and Minister of State for listening to our concerns today. I will take up the theme of loneliness from my colleague because as a society it is crucial for us to reckon with it, in particular with regard to older adults. Large-scale studies by TILDA have presented us with stark findings regarding the impact of loneliness on a person's health, quality of life and emotional well-being. According to Professor Rose Anne Kenny, who is a consultant geriatrician and the principal investigator with TILDA, loneliness and social isolation are rising among older adults in Ireland, loneliness is detrimental to health as it accelerates biological ageing and disease, and addressing this problem is urgent. TILDA studies linked higher levels of loneliness with poor self-rated health, functional limitations and chronic health conditions.
Loneliness was associated with a significantly poorer quality of life. More than three quarters of the loneliest one third of older adults had clinically significant depressive symptoms in the TILDA studies.
A study from last year by TILDA showed that loneliness among older adults increased the risk of death ideation, in other words, the wish that one was dead. Conversely, strong social ties have been shown to protect individuals from emotional distress, cognitive decline and physical disability. While loneliness can be felt at any stage of life, as my colleague Deputy Rice said, older adults are particularly at risk. I believe this risk is magnified by a culture in many of our nursing home settings that are detached from communities and often quite devoid of stimulation. This is a huge moral issue that we need to reckon with as a society. Nursing homes do not have to be socially desolate places offering solely functional care. A friend of mine who recently moved to Finland told me that their nursing home is located right in the centre of their town, and there is a remarkable level of integration with the residents in that community. There is no reason we cannot pursue a similar model of care here. We have a duty as a country, particularly one with so much economic prosperity, to ensure that we support our elders to live the fullest, most integrated, most creative and connected lives that they possibly can.
At the outset, I want to congratulate the Minister on her new role and, indeed, the Minister of State. I have full confidence she will do a great job in this Department. It is a tricky Department but it matters to all of us. Everyone goes through life's processes and as we all care for older people and for communities, it is a very important Ministry.
Unfortunately, in my county, far too many older people fear entering the acute healthcare system because University Hospital Limerick, UHL, is the point of access to all of that. In 2009, a woeful political decision was taken to close 24-hour accident and emergency care in Ennis general hospital, Nenagh Hospital and St. John's Hospital in Limerick city. That has haunted that region ever since. To reiterate, people are afraid to present at UHL because they will probably end up on a trolley and many are not even that fortunate. They could be left overnight, sometimes for a 24-hour period in an armchair. It is not right. At the moment, what exists in the mid-west is a healthcare apartheid. It is not fair. It is not comparable to any other region in this country and it is going to need to be fixed.
I am glad that the previous Government of the Thirty-third Dáil commissioned HIQA to look at the UHL scenario to see if the region needed a second accident and emergency department. It does, and in my belief, I have heard this said by many Deputies in the House in recent weeks, there is no need for some in-depth HIQA analysis of this. The proof is in the pudding several times over. There are many good, positive outcomes in UHL every week but there are also very negative outcomes and there have been deaths. If you ask me, those deaths underwrite the need to have a new accident and emergency department in the mid-west region. I am fully supportive of the campaign for that at grassroots level. I commend in particular the friends of Ennis general hospital group, led by Ms Angela Coll, who have been briefing the Minister's officials and HIQA on the need for this to happen.
We all know the mid-west region comprises counties Clare, Limerick and Tipperary, which my colleague, Deputy O'Meara, represents. It is a huge region. That region had five accident and emergency departments until the 1980s. Now, all of that population goes to one accident and emergency department and yet the population has increased. There are half a million people living in the mid-west and they all go through one accident and emergency Department. There are 1 million people living here in the greater Dublin region. They have a choice of eight accident and emergency departments. There is no equality here. We need to grasp the nettle in the coming months.
In the Minister's tenure in this Dáil term and this Government term, there will not be a new hospital built in the mid-west. We could start bricks and mortar but it will not be built or completed. Someone has to throw the ball in, however. I am asking that when this report comes before the Minister's desk and when it comes before Cabinet., she gives it the best possible shot forward. This hospital has to be in the mid-west, and I believe it has to be in County Clare.
I congratulate the Minister and Minister of State on their appointments. It is my first time speaking in the Chamber with them and I wish them every success.
I would like to start by strongly supporting Deputy Cathal Crowe and his statements regarding accident and emergency care in the mid-west region. It is simply not working. We are completely and utterly underserviced by emergency care in the mid-west region. I welcome the review that has been commissioned by HIQA. It is needed. The answer is obvious. I asked the Taoiseach this question yesterday: when will the initial review be expected? We expected it by the end of the month. I also call for a second accident and emergency department in the mid-west region. It is obvious and that report will I hope say that. However, I stand fully united with my colleague, Deputy Crowe, today in that regard.
I wish to briefly acknowledge the fact that Friday is Rare Disease Day. Deputy Pádraig O'Sullivan had representatives from Rare Diseases Ireland in the audiovisual room today. He has been doing incredible work with them and I would like to acknowledge that day. Following on from my colleague to my left, Cared Ireland also gave a presentation in the audiovisual room today. I call on the Minister to meet then as well. As the Deputy said, what we listened to in there today was harrowing and they need the time and attention they deserve.
I wish to raise two issues in the Thurles area in particular that are affecting healthcare in north Tipperary. The first is that there is only one 24-hour Shannondoc service, based in Nenagh, in north Tipperary. Thurles needs a 24-7 Shannondoc service. There is a brand new primary healthcare centre in the town. It is a fantastic facility. An Taoiseach, Micheál Martin, opened it about two and a half years ago. I was there at the time. It is the ideal facility for it. There is no point in telling the people of Thurles that when they need out-of-care service by a GP, they should travel to Nenagh because, first, the service already full, second, it is too far and, third, they then get sent to UHL, which I have already said is not suitable to cater for the accident and emergency needs of the north Tipperary area.
The second issue refers to the National Ambulance Service. There is a base in Thurles. I spoke to paramedics there and met one paramedic in a different town in north Tipperary during the general election campaign. They raised this issue with me and I have had extended conversations on it. The pressure being put on paramedics because of the system not working is ferocious. We are having retention and recruitment issues because of the work conditions. Putting paramedics in ambulances and telling them to spend their entire shift driving around an area, a lot of the time with regard to the Thurles base, which is outside of our HSE region, is unacceptable. They are spending time travelling around counties Kilkenny, Waterford, Wicklow and Wexford without actually getting to help someone. We really need help for paramedics in that area. I will finish there because I am out of time.
I, too, would like to be associated with the good wishes to the Minister. I wish her the very best going forward. I have no doubt her heart is in the right place.
In County Kerry, we are fortunate to have so many opportunities to stay active and look after ourselves. Our beautiful surroundings, from the sea to the mountains, naturally encourage us to get outside, walk, swim and explore. More than just our environment, however, we are also seeing a real shift in how people here approach health and well-being.
Over the past few years, activities like sauna use, sea swimming and fitness have really taken off in our county. Whether it is a swim in the Atlantic or a relaxing sauna session after a brisk walk, people are realising the physical and mental benefits of these simple practices. Sea swimming, in particular, has become something of a local tradition, with many people now swimming all year round, enjoying not just the physical benefits but the sense of community it brings. It is not just about individual activities, however. Our county has also seen an increase in community-based initiatives that support health and well-being for people of all ages. The active ageing initiative, led by Kerry County Council, is one example. This programme encourages older people to stay active and engaged whether through walking groups, fitness classes, or social activities. It is about making sure that people can remain fit and active throughout their lives and that no-one feels isolated or left behind.
When we talk about the future of healthcare, it is important to recognise that it is not just about the medical system we have in place. It is about creating communities where people are encouraged to take care of their physical and mental health. We can look to countries like Finland and Japan to see how others have incorporated wellness practices into daily life. In Finland, the sauna has long been part of the culture, offering not only physical benefits but a space for social connection and relaxation. Similarly, Japan’s approach to healthy ageing is based on staying active, finding purpose and engaging with life at every stage. We can learn a lot from these places, where health is seen not just in terms of treating illness, but in prevention, self-care and community support, and it is clear that in Kerry, we are on the right track. Therefore, what do we need to do moving forward? First, we need to continue supporting the activities and initiatives that encourage people to stay active. We need to make sure that there are more opportunities for people to engage in physical activity no matter their age or ability. Programmes like the active ageing initiative should be expanded, and we should continue to provide support for local sports clubs, fitness classes and wellness initiatives that promote health for everyone.
I echo the sentiments of my colleagues in wishing the Minister and Minister of State well in their new jobs. The story I want to relate was told on Galway Bay FM last Friday by Professor John Carey, a consultant in rheumatology in Galway county. He shared a very poignant and difficult story about a young mum in her 30s with a young child of 18 months. She had a severe arthritic condition called enteropathic arthritis. That debilitating condition has completely wrecked her life. Before the illness she was a vibrant and functioning member of society, a mother and an active contributor to her community. With the right combination of medications, she was able to regain her health, return to work and take back her life. However, when the original treatment plan began to lose its effectiveness, her medical team developed a new dual therapy approach to restore her quality of life. One of these critical medications was subsequently revoked by the HSE because it could not approve the combination, leaving her without the treatment she so desperately needed. Over the course of a few months, her condition deteriorated so drastically that she is now profoundly disabled, unable to manage basic daily tasks or care for her 18-month-old child. Of course, this is not a criticism of the healthcare professionals or the HSE, which has historically been incredibly supportive in providing access to advanced care and expensive treatments. I am genuinely appreciative of that.
It is vital that our policies remain flexible and patient-focused. Exceptional cases need exceptional solutions. As we look to the future of healthcare in Ireland, our goal must be clear. When a treatment exists that can transform a life, we must find a mechanism to make it accessible, balancing budgetary realities with compassion and common sense. Professor Carey's story is not just about one patient. It is about the need for clear pathways that allow clinical experts to advocate for their patients. It is about ensuring our healthcare system is agile enough to respond to unique situations with empathy and urgency.
I want to take this opportunity to wish the Minister and the Minister of State really well in their briefs. There is a belief out there that the health service is broken and cannot be fixed, but I genuinely believe that with the right political will it can be, especially in respect of health reform. If the Minister gets it right, she will get support on this side of the House. It is not about politics or throwing stuff back and forth. It is about getting the right healthcare for our citizens, which they need.
Older people should be valued. They are living fountains of knowledge accumulated through life's experience and education. They help our younger generation to navigate complex professional and emotional challenges. They act as mentors and emotional pillars for many families in need of stability. Older people are an asset and they need to be valued. I have numerous examples of older people who are not being valued or are not getting the service they deserve. I will raise two cases, the first of which I raised only two weeks ago. Maureen is 86 years of age. She has Alzheimer's disease and is at risk of falling. Maureen has already fallen twice. She is waiting for an appointment with an occupational therapist to make her home safe. I made representations to the HSE in June of last year. I only got a response two weeks ago, which stated that the current wait time for occupational therapy for Maureen in 184 weeks. That is three and a half years for an Alzheimer's patient to get an appointment. I also want to talk about Mary. She is 74 years of age and has a tumour on her back. Mary was to have surgery in Beaumont hospital in March last year. This was cancelled. She got another appointment for surgery for May; this was cancelled. She got another appointment for July last year and it was cancelled. Mary is in a lot of pain and is concerned about her tumour. Beaumont have now stated that they believe the tumour may be a slipped disc that is mimicking a tumour and they want to send her for an MRI. She has not received that appointment yet. These are two examples - a 74-year-old woman with a suspected tumour and an 86-year-old Alzheimer's patient - of people who are not getting the services they deserve. The way Maureen's family member put it to me was this: she worked all her life, she paid her taxes and has been a really good citizen in our country, and they believe the social contract was broken with Maureen. I will send the Minister and Minister of State a note about these cases, and would appreciate anything they can do. It is heartbreaking. I could mention many more people as well.
The last thing I want to bring up with the Minister of State, Deputy Murnane O'Connor, is regarding older people who are being forced to move out of nursing homes for whatever reason. We had two in my area last year, one in Cherry Orchard Hospital and one in Lucan Lodge. Both were for different reasons. There is transfer trauma, and residents and their loved ones feel they are not being listened to. I was on the picket line with them. They felt they were not getting a response back from the Government. If there was engagement that involved sitting down with Ministers and the Department, that would really help.
I congratulate the Minister and the Minister of State on their appointments and wish them well. Fundamental to longer and healthier living is the provision of wraparound home care supports. Our population is ageing, as the Minister has said, and the HSE accepts that the demand for home care increases by at least 4% per year. Funding for home care must increase by a minimum of 4%; anything less is a cut in real terms. It is extremely beneficial for people to continue to live in their homes and in their own environment and community. It gives people great benefit and a quality of life which cannot be provided in nursing homes or hospitals. Of course, it is of financial benefit and provides savings to the State as well vis-à-vis the cost of nursing homes and hospitals.
There are about 5,000 people on waiting lists for home care supports. The provision of home care is, unfortunately, a postcode lottery. There is a significant division between Dublin and the rest of the country. Thankfully there is little or no waiting list in Dublin, but seven counties in the mid-west and the south east, including north and south Tipperary, make up almost half of the waiting list. We must clear the waiting list and ensure equality of access to home care supports for everyone, right throughout the country. We need an additional 2 million hours of home care delivered to meet unmet needs. We need home care workers paid properly and a career structure for them. These measures must be underpinned by a statutory home care support scheme. This scheme has been in development since 2016. It was targeted for implementation in 2021 but has been repeatedly delayed. This statutory scheme must be implemented immediately.
I wish the Minister and the Minister of State success in their time going forward. We may be making progress in terms of healthcare outcomes in Ireland overall, but there is no doubt that there is an enormous disparity between the north west and the rest of the country when it comes to access to healthcare and healthcare outcomes. In Donegal we are years behind the rest of the country in terms of healthcare that we are able to provide. Letterkenny University Hospital is in dire need of an upgrade to equal funding that reflects the needs of my constituents. The service and capacity of the hospital have required significant improvement for years now but this call has been ignored time and time again. Earlier this month, a report published by the European Commission showed that Ireland has the second highest rate of new cancer diagnoses in the EU. The report stated that people in the most deprived areas, such as the north west, faced an average of 43% higher risk of mortality within five years following a cancer diagnosis, due to limited healthcare resources. It has emerged this week that Letterkenny University Hospital has the worst cancer treatment wait times in the west and north west. It is an absolute disgrace that only 31% of newly diagnosed cancer patients in Letterkenny University Hospital begin their cancer treatment within the recommended time of 15 working days. This is compared to 62% in Galway, 76% in Sligo and 100% in Mayo who begin their treatment within the recommended timeframe. It is outrageous that patients waiting on their first chemotherapy appointments in Letterkenny wait on average 22 days before they can begin.
Last month patients in the accident and emergency department in Letterkenny University Hospital were forced to wait for 24 hours before they were seen. On many occasions appointments have been cancelled due to overcrowding in the hospital. More than 2,000 appointments were cancelled in 2024 and 800 have been cancelled this year alone, which is unacceptable. The people in Donegal deserve equal access to healthcare. Living in Donegal should not be a health risk, as it currently is. We must address the wait times in Letterkenny as a matter of urgency and improve our cancer care under the Minister's watch in this term.
The intensive care unit in Letterkenny also needs a major upgrade to ensure it is safe and working effectively. It is in serious need of a minor injuries unit to relieve the accident and emergency unit. If that comes to pass, we will see it change. Before being elected I was a healthcare worker and so I know what is going on on the ground. I am asking the Minister to prioritise this, come up to Donegal and look at it. During her term she can change this and she can turn Letterkenny around, which would probably be her greatest achievement.
I wish the Minister the best of luck with her new brief. It is important she succeeds for the sake of hundreds of thousands of people who rely on the health service every year and indeed for the workers who provide the healthcare. I apologise in advance that I will need to leave because I am simultaneously participating in the Dáil reform committee and therefore I will not be here for any response the Minister might make, but I will look at the transcript.
I believe the State has an obligation to provide cradle-to-grave healthcare. When we have a two-tier system, there is a fundamental problem in providing that for everybody as a matter of right, which they should have. That needs to be addressed. It is obscene, frankly. The quality of healthcare and the speed at which people get it is dependent on whether they have private health insurance. I hope we have a commitment that that will change and change soon. There has been a long-standing commitment that we should change it but nothing actually happens. The truth is those who can afford to go to the Blackrock Clinic, the Mater Private or a very expensive nursing home are in a different category from the people who cannot afford those things. That is fundamentally wrong and has to change.
Regarding the section 39 issue, with people living longer and so on, the fact that huge numbers of our elderly, vulnerable and people with disabilities are in many cases dependent on workers where the State has outsourced its responsibility to charity organisations or companies makes it impossible to actually deliver on a sustained, fair and consistent basis the sort of service they need. I cite our constituency as an example. Dún Laoghaire Home Care Services announced recently that it was ceasing to function. During the election campaign, I met workers who worked for it for years. They were absolutely distraught as to what was going to happen to them and their clients. Their clients were up the walls about it too. That should not happen. There is no way the services or the employment of the workers working in those services should be dependent on whether a charity or company decides it can trade. That is absolutely crazy. Those workers should be in the same position as other people directly employed by the HSE. They should be employed by the HSE in a single universal healthcare system - from the cradle to the grave. The people for whom they care should not have to worry and be anxious as to whether the service will be there next week or next month, but that is what is actually happening. That needs to be addressed as a matter of urgency.
Virtually every healthcare worker in this country has been balloted for industrial action because of the pay and numbers strategy. The first people to raise that with me were workers at St. Michael's Hospital in our constituency. Then people from Loughlinstown contacted me and then people from multiple other hospitals, all saying the same thing. They cannot recruit, replace and cover the work that needs to be done because of pay and numbers. It has to be scrapped.
I thank the Minister for attending the rare disease event we had today in the audiovisual room. She is the first Minister for Health who attended one of our meetings and it was greatly appreciated. As I said to her afterwards, there is a degree of optimism among the community that things might improve in the coming years under her stewardship. We are looking forward to working with her. I remind Members that Rare Disease Day is on Friday, the last day of the month. We talk about many constituency matters in here. There is a large community of rare disease sufferers, nearly half a million people in this country. They represent a large electorate in their own right. It is important to acknowledge and speak about the difficulties they face.
One of the first things the Minister did when she was appointed was to publish the genomic strategy or she certainly attended an event to launch it. I view something like that as part of the building blocks about how we get our health system right. The creation of a register not just for people who suffer from rare diseases but in terms of developing our ehealth strategy is part of the fundamental building blocks that need to be in place before doing anything else. I urge the Minister to get those fundamental building blocks right.
In the rare diseases briefing today, we were given submissions indicating that, on average, it takes up to six years for somebody suffering from a rare disease to actually be diagnosed. That is six years of appointments and different examinations with consultants and GPs. All that type of stuff contributes to expanding waiting lists because people are on the journey to try to find out what is wrong with them in many cases. If extra resources are devoted to the identification and the diagnosis of rare disease in the first place, we will be able to unclog parts of that system which is full of people seeking answers as to what is wrong with them.
Fundamental to this is access to orphan drugs. I spoke to the Minister two weeks ago about how in Ireland on average it takes anywhere from 500 to 1,000 days to get some of these drugs approved. We are talking about health and people being healthy into the future. Early identification and diagnosis of disease is crucial, as is the treatment. In many cases, if these people get treated early with the necessary medicines and treatments, we can make sure they are productive members of society, they can continue to work, they will not require care and the number of times they have to attend hospital can be reduced. I would like the Minister to look at that piece in its totality. I know it is in the programme for Government and she has said she will. I urge her to give it the attention it deserves.
My contribution will be short. I thank the Minister and I wish her all the very best in her new role. I have no doubt she will perform very well. I raise the specific issue of pharmacies and the receipts they give to customers. This is an issue I raised many years ago and brought a successful motion to Wicklow County Council on the matter. I request that all pharmacy receipts give a detailed breakdown of the medicines and any other costs. This should be the norm, as it is in any other retail purchase. It is in the interest of fair competition and in the interest of consumers who should see the detail of what they are paying. It is a simple request for transparency.
I thank the Minister and wish her well in her role in the Department of Health.
It is appropriate that I thank the former Minister, Stephen Donnelly, who I served for a brief period of time in the Department. I liked working with him. He achieved a great deal in the time in which he was in the Department.
Tonight, it is important to welcome the roll-out of the health app. It is hugely important. There is a need for the computerisation of the healthcare sector. In 2009 I was in Gaza and within half an hour of using my bank card, I got a call from AIB saying that it appeared someone had stolen my card. To think in Ireland we can go from one hospital to another in the same city or the same area and there is no connection as regards the transfer of records. There is a lot of catching up to do. In 1996 the Danish system started the patient card, which has all a person's medical information on one file, no matter what hospital the person is admitted to.
I was speaking to a junior doctor recently who advised me that he spends 50% of his time each day chasing records, X-rays and MRI scans because they are not put on the file. He has to get them from the relevant department to make sure they are put on the file. This goes to show the huge waste of trained professionals' time within the healthcare sector. They are not able to provide the necessary support to patients but are instead chasing records. It is important we do as much as we can over the next three to four years to computerise the entire healthcare sector.
An interesting point on healthcare is how it has been put into a five-day-week operation. We should change the whole thinking in regard to healthcare about five-day operation in many areas. All the hospitals are open seven days a week. They provide care seven days a week but many services are not available during some of those seven days. I spoke to Professor Rónán Collins today who had an interesting article in thejournal.ie about the issue of lack of access to services at weekends such as MRI scans and in certain cases, X-rays are not available. It is not possible to get professional diagnostics and social care people are not available at weekends. If one wishes to discharge an elderly patient on a Friday evening or a Saturday there is nobody there to put in place the back-up supports they need if they are being sent home. Even if they are going to a step-down facility, in many cases such facilities do not take in new patients or new residents at weekends. We need to look at that area to make the health service more efficient. It needs to have a full seven-day turnaround. I agree with the Minister about consultants being available at weekends. However, other personnel also need to be available so that if the consultant decides to discharge someone, there is backup support and a mechanism for moving the patient into a step-down facility.
The other issue relates to primary care. Primary care is very much a five-day-week operation. We need to look long term about how we can develop it into at least a six-day operation. If an elderly patient is discharged home, someone is needed to keep in contact with that patient but there is no support out there for medical support. The only way to follow up is for the person to come back into the hospital. We need to look at developing either a six- or seven-day primary care system.
In regard the issue of transferring people out of nursing homes into hospitals, some of the hospitals in Cork and Dublin have teams that can go to a nursing home and assess the patient in order that instead of the patient being transferred into hospital, the team prescribes the course of treatment for that patient in the nursing home. The nursing home is now covered. There are no concerns that the family might be unhappy with the level of care. They know that they have the support of the medical team from the hospital. We need to roll that out across the entire country so that every nursing home has access to a hospital team rather than having people admitted. In one case in Dublin more than 300 people were assessed and only 20 had to be admitted to hospital. We need to work with both public and private nursing homes on that.
In relation to the roll-out of services within the HSE, one community hospital, namely, the Millstreet community unit, has been finished for some time with an additional ten beds. My understanding is that those ten beds are still not occupied. The building work has been completed but it has not received HIQA approval. HIQA approval was only applied for in January. It could have been applied for a lifetime ago. I ask the Minister to look at those issues.
I congratulate both the Minister for Health and the Minister of State. They are aware that the healthcare system is in crisis. That is no surprise to anyone, certainly not the 800,000 people who are anxiously awaiting treatment or the short-staffed doctors and nurses, many of whom have contacted us because they have University Hospital Kerry, the people of Kerry and the good of the area foremost in their minds. Under the helm of successive Fianna Fáil and Fine Gael Governments, it has become almost impossible to get a GP or a dental appointment. Access to mental health treatment is a shambles. A pilot scheme for crisis mental health interventions commenced last October in Limerick. It was a long time coming. Under that pilot scheme a trained nurse travels around the area in an ambulance to people who have crises in their lives. Perhaps that scheme can be looked at and expanded. We know about the hundreds of people languishing on trolleys. In fact, 2025 set new records in all the ways we want to avoid. For example, for University Hospital Kerry 2025 has been a record year in terms of the number of patients on trolleys and emergency department waiting times. Since the start of this year, at least 650 people have been forced into this situation, some waiting over 19 hours. What are the solutions?
I hope the Minister will travel to Kerry to look at the hospital. A number of issues need to be sorted out there. The Minister is aware of the new community hospital. However, it will not give one extra bed to the county because the old hospital is closing down. What that will be used for in the future we do not know. I presume there will be a primary care centre, which is badly needed, in Killarney. One is also needed in Cahersiveen.
Kerry also needs a minor injuries clinic. The location is a matter of some controversy but 70% of the people who use the current emergency department in University Hospital Kerry come from the west, the north, the Castleisland area and Tralee. It makes sense to have a minor injuries clinic. We have seen the success of such clinics around the country, such as the one in Gurranebraher, where patients are seen within the hour. That should be looked at. The priority should be to use the backup staff, the consultants that are there and to take into account the people who use it. I ask the Minister to commit to open one of these and a modular day unit. Every year for the past few years the day treatments and elective surgeries are cancelled. The last time I checked, there had not been an elective surgery since 19 December. I ask the Minister to look at that.
One final point relates to dental surgery. In Kerry the wait time for oral surgery is two-and-a-half years. I spoke to the parent of a five-year-old boy who was in serious pain, suffering from abscesses.
I congratulate the Minister on her new position. I wish her every success in it.
A society is rated on how it treats its elderly people.
How we treat our elderly people in this country beggars belief. We have people on waiting lists continuously. People are waiting two and a half years to see an eye specialist in Cork city. In my constituency of Cork North-Central, we have the Blackpool SouthDoc debacle that has been going on for the last two and a half years where we have a doctor in place who is on call. The building is meant to be open, but is continuously closed. An awful lot of the elderly people in my constituency, and around this country, cannot afford to take taxis and do not have family or friends to bring them to the other side of the city to be seen in SouthDoc out of hours.
We have a situation in Mallow where we have no dentist who will take a medical card for OAPs. That is wrong. There is something seriously wrong in the dental system when an OAP cannot get on a dental list or be seen anywhere, that he or she has to travel all the way to Cork city, up to Limerick or possibly to Kerry.
The cross-Border system has worked very well for us but last year, the Minister's predecessor cut the budget for eye cataract surgeries by 50%. Deputy Collins, other Deputies from Independent Ireland and I have worked continuously with cross-Border hospitals in Northern Ireland, bringing more than 2,500 people to Northern Ireland. We are glad to have that facility in Northern Ireland, but they should be able to have the operation in the Cork and Kerry region. To add more insult to injury, the Department, the Minister's predecessor and the previous Government cut the budget by 50%. An awful lot of people who were dependent on that said it was Belfast or blind for them. People cannot afford to go to Belfast now and as a result are going blind waiting four, five or six years for cataract operations. People are waiting for appointments for knee and hip surgery. It is unbelievable. This is how we are judged as a society; how we treat our elderly people. History will judge the Minister, her Department, her predecessors and this Government in a very poor light.
I also want to bring to the Minister's attention how we are treating our elderly when it comes to downsizing for housing. We are talking a lot about elderly people downsizing and the fuel poverty that is there. What are we doing about retirement villages? What are we doing about keeping people in their communities, who could, with a small bit of assisted living, still live in their communities but do not have the opportunity to downsize because there are no funds available for assisted living in the community? People are ending up in retirement homes for no reason. People are ending up having to get a huge amount of care from care services. People in large houses are having to depend on families. We are always talking about changing the housing situation and allowing people to downsize but we are not investing in small catered communities for the elderly in their own community.
I wish the Minister and the Ministers of State very well in their new roles.
On my first day in the Dáil, the first thing I spoke about was the health system in Limerick. The Ceann Comhairle at the time was Deputy Seán Ó Fearghaíl. I am asking for the Minister's and the Ministers of State's help in Limerick but I am asking for them to use a different approach. I am asking for a breath of fresh air. I am asking them to turn up in Limerick uninvited rather than invited. The Minister's predecessor turned up two or three times in Limerick and I knew about it. He said people had not been notified but they were. I was told by the staff that he was coming. To help the Minister fix the problem, I will help her. I will do whatever I can to help the Minister fix the problem in UHL. We have made a start with a change of management. It is a start, but there is a lot more that can be done. I can help. I do not have to be here all the time criticising from across the floor of the House. I can help, but I want to make sure the Minister goes in there and looks for accountability. If somebody cannot deliver in his or her job, she has to move him or her out of that position.
I believe the biggest problem in UHL was when the hospital became a centre of excellence. It did not allow for a population increase. I refer to the management system there. If a nurse was under pressure and a senior nurse or senior management came around, what they were doing in Limerick was finding fault but what they should have been doing was pulling up their sleeves and saying they would help the nurse and fix the fault the next day by addressing the situation. The staff would see they had help, they were not being criticised and that something was going to be in place to rectify it. I am willing to help the Minister with that. For the Minister to get a full grasp of it, she will have to go there unannounced, and I believe she will. If I have to go in there to be the eyes and ears for the Minister, I will do so. I do not mind doing that because, at the end of the day, we are going to get the best healthcare for people. UHL will become what it once was. At one time it was the number one hospital in Ireland for training.
An issue in UHL, and it is probably happening in other hospitals at the moment, is the integration of different nationalities. We have a language barrier. It is nothing to do with the healthcare, but we have a barrier because of people not understanding each other. That needs to be addressed for the healthcare workers themselves and for the patients. It also needs to be addressed so we can help. If somebody is sick in a hospital, he or she does not want somebody speaking a different language because he or she might not be able to understand the person.
I wish the Minister well in her position. I will do whatever I can to help her make sure that she makes the most out of this going forward.
We should also focus on preventative healthcare from the earliest stages, from children upwards. Sport is of critical importance. One in five children stops participating in sport in the transition from primary school to first year. There is another massive drop off in terms of participation in third year among those who are 15 and 16 years of age. It is important that the Minister addresses it. There are serious issues in the changing of curriculum and additional bureaucracy. It is going to hamper extracurricular activities in schools, which will have a massive impact on them during their adult life as well.
Volunteerism is also in decline. One in four volunteers never returned after Covid. There is a major difficulty around Garda vetting and the fact it is required for each and every organisation that a volunteer may engage in. We should consider having one Garda vetting certificate that would allow the volunteer to engage across the different groups, etc.
I want to bring to the Minister's attention the Icelandic model to ensure that children stay in sport and extracurricular activities from early childhood to adulthood. They introduced a card that allows for children to use the card for various sporting activities, etc.. That would have a massive impact and help young people stay involved in sports and activity. If we lose them in early childhood, it is very difficult to get back into good habits in later life.
I want the Minister to consider the introduction of a tax break for gym membership. We have a tax break for people who have medical insurance, yet there is no tax break for people who take proactive steps in their own lives to stay healthy. I urge the Minister to please introduce a tax break in that regard.
I thank the Minister for being here this evening for this debate. Dublin Bay North is the area that I represent and it has a very mature population, so this topic is directly relevant to us on the northside in that constituency. During the election campaign, we campaigned on this issue in terms of positive ageing and it got good traction with those mature communities. People in Ireland are proactive. Our older citizens are very proactive and they really want to be positive and take an active role in making their own decisions in terms of health living, living longer and those lifestyle choices. This is a really good area to be involved in.
I want to mention two examples. Right-sizing accommodation for older people has been mentioned earlier on the floor of the House.
I spoke yesterday to a constituent in Kilbarrack. He is a man in his late 50s or early 60s. He lives in a three-bedroom council house and he is looking to downsize to a one-bedroom council accommodation, ideally an apartment. It is not directly related to health, but it is indirectly related in that if we can facilitate such an individual, it is better for his physical and mental health. It is the same for people in private housing in Dublin Bay North. During the general election, a lot of people such as parents whose children are gone, have flown the nest, were in large houses and looking for ways to go. I see Deputy O'Donnell nodding his head. It is an important issue in Dublin Bay North and I look forward to the Government making progress on that as a key element of housing.
The other area I will mention is the Go for Life programme. I welcome the commitment to it in the programme for Government. It is a roll-out of activity for older people and people with chronic illnesses by the HSE with sports partnerships with bodies such as Dublin City Council, which is a good local partnership with a lot of reach into the community. That has huge potential to partner with social enterprises, such as ExWell Medical, that have expertise.
The last thing I will mention is Beaumont Hospital, which covers a huge northside catchment area with mature communities and it is also a national centre for a whole range of specialties. It has been underinvested in for as long as I have been in politics, more than 20 years, in terms of capital, but a huge amount of work is done there. To support people living longer, three key projects, namely, the new emergency department, the 100-bed tower and the new intensive care unit, are all vital for the northside, for all those specialties and the people who come from around the country to use Beaumont Hospital. I hope the Government will allocate that capital and that we can work with Beaumont Hospital and the Government-----
Go raibh maith agat a Theachta. Anois leanfaidh muid ar aghaidh go dtí an Teachta John Connolly.
I am grateful for the opportunity to participate in the debate. It was not my intention to mention the briefing that we received today from the care group but, such was the moving personal testimony from people who have suffered from eating disorders and their family members, it would be unbecoming not to mention it. Those who attended became much more aware of the issue today. Many there were already familiar with the issue of eating disorders. There is a specific request. That is for specific treatment and therapies to be provided outside the standard acute mental health facilities for those who suffer from eating disorders. It would be remiss of me having attended that briefing not to raise it here.
I note an issue mentioned by my colleague across the floor, namely, the objective in the programme for Government to introduce tax credits for those who join gyms. We should not be so narrowly focused in that. If we are to look at it - it would have a lot of public health benefits - we should also look at extending such a break to people and families who enlist their children in their local GAA club, soccer club, rugby club or whatever promotes physical activity. We should not have the narrow focus on gym membership and the credit only applying to that area. That is important.
At the outset of her contribution this evening, I heard the Minister speak about a lot of capital investment in healthcare. She used such terms as outpatient departments, primary care centres, trauma centres, surgical hubs, elective hospitals and increased bed capacity. They are terms we are all familiar with. I have been a member of the regional health forum in the north-west region for the past five years and have heard a lot about this, specifically as they relate to my constituency of Galway West and the development of such facilities. They are all welcome. I welcome the Minister's initiative and her determination to see them through. It can be very frustrating following the processes and bringing these projects to fruition.
I saw an example in my constituency when the Government decided to develop an elective hospital in Galway. There is a site in Galway where there is currently a hospital in Merlin Park. I am sure many people are familiar with it. It is 60 acres. When the decision was made to develop an elective hospital in Galway, the local officials were obliged, I understand, to put out a call to the general public to see what site could be used to develop the hospital. That was a three-to-six month unnecessary process. The State, through the Department of Health, held land. It could have been facilitated. The decision was eventually made that the elective hospital would proceed on the site of Merlin Park University Hospital, which is welcome, but that decision did not need that process and the six-month delay. That is the type of bureaucracy I hope the Minister will challenge. I am confident she will. She will have our support should she proceed to do so.
The second topic I will touch on is staffing. We have had statements in the House in the past week on mental health and disability and tonight's statements on health. In each of those debates and statements there is a recurring theme, which is the challenge of recruiting and retaining staff in the healthcare sector. We hear about the lack of therapists, GPs and other such positions. The Minister for Enterprise, Trade and Employment has advised me that last year, 17,168 critical skills work permits were issued across the employment sector. Some 35% of them, or almost 6,000, were in the health and social work sectors. There is a challenge in us training people to work in our public health sector in Ireland. That must be challenged as well.
Anois an Páirtí Sinn Féin. Does Deputy Cullinane wish to speak again? Deputy Mitchell is listed.
I cannot speak again.
No problem. Bear with me. We move to the non-party group and Deputy Toole. Dhá nóiméad, le do thoil.
Since time is tight for our group I will come forward with three solutions. Prevention is better than cure, so the first is healthy eating and exercise from the youngest to the oldest commensurate with their abilities. The second is the value of the wisdom of older persons councils and the Age Friendly Ireland programmes. We must listen to the wisdom and cost-effective suggestions of our older citizens, especially in the area of falls, which are high-cost from a hospitalisation point of view. We should increase resourcing of the healthy age friendly homes programme. Third, from the pharmacy task force, the common condition service should be funded and resourced as soon as possible. That would help with older people managing their medicines and with the proper disposal of unwanted medicines. It is the dump campaign. They are some simple interventions that are low-cost with healthcare professionals who are ready to move on them.
Tá áthas orm labhairt ar na ráitis sláinte anocht.
The demographics are all pointing one way and that is towards a predominantly older population and decreasing birth rates. It is a phenomenon that we are witnessing across the western world and in dramatic forms in Asia, including China, where population replacement levels are collapsing. Clearly this will present enormous challenges for our healthcare system, especially in the context of an already overburdened nursing home sector where closures in recent years have been rising dramatically under cost conditions that are simply unsustainable for many private operators.
There is also a deeper, more fundamental challenge to us all. It is that in many ways we are becoming an anti-child and anti-family culture. We are now living in a society where an average of 10,000 abortions take place each year . We are also living in a society where it is becoming increasingly difficult for families to survive and thrive. Since 2021, I have repeatedly raised this issue with the Minister for Finance in the context of tax individualisation which may be discriminatory in practice as it penalises single-income married couples by making it necessary for them to pay more tax than two-income married couples.
I heard the Minister's speech when I was in the Chair. I congratulate the Minister and Minister of State on their new roles. I wish them well.
She outlined the massive increase in funding from €14 billion to almost €26 billion. I have a personal story to relate and the heading of tonight's debate is appropriate. It hurts me. My lifelong friend who is 90 years of age, celebrated two weeks ago, was in hospital for a week in Clonmel in St. Joseph's Hospital, south Tipperary general. He was forced out of the hospital by a couple of doctors on Monday evening into a convalescent home many miles away. When he arrived, he was not fit to be there. He did not want to go. His wonderful niece, Mary, who was minding him, was remonstrating all day. I was involved in the case and he was moved because he had no one to advocate for him. He is 90 years of age, a powerful tradesman, a wonderful neighbour and a true friend. It should not have happened. Our elderly people are being mistreated in hospitals. An advocate is meant to be present, but apparently she had not seen him. Two or three doctors came to talk to a 90-year old man to tell him he was fit to go.
He was not fit to go. He was a week in bed. He had only been out of bed once that morning and he has now, unfortunately, gone to his eternal reward. The hospital is apologetic but that is no good.
I perish to think of old people who have no one to advocate for them. They are cast aside. In all the millions and all the bureaucracy, they are cast aside and there is no patient advocacy person. Two doctors should not talk to a man like that who was quite deaf. He had not wanted to go and was in fear but they tell me he said he would go. It is shameful this happened in the modern day in 2025 in that hospital in Clonmel. It is not acceptable. The family are devastated, obviously, as are his extended family, his friends and his neighbours. It was so unfortunate. If he was a bed blocker and was there for a month, I would say something, but he was there for one week. I visited him last Sunday night week and he went to the hospital the morning after because of issues with standing up and getting up. He was fine with a bit of treatment but he was not fit to be discharged to that area. He should not have been. It is very sad.
I wish the new Minister and Ministers of State across the way all the very best in their work. We will try to work the best we can with them. There are a lot of elderly people in Kerry presenting with health issues. This is what we are talking about. A lot of people, young and old are not experiencing the health service they would expect. There is one thing that is driving people absolutely stone mad - I would appreciate it if the Minister and Minister of State would listen to me for one second - and that is elderly people being taken out of their warm beds where maybe they have spent a long time because they got sick for one reason or another and are being taken in an ambulance or by family members and they finish up in corridors for 24 or 48 hours and until the weekend without anybody seeing because doctors are not to be found at evening time or late at night because they have finished up. This is totally and absolutely wrong. Will the Minister do something to ensure there is a bed there for the person who is coming out of their own warm bed? This could be an elderly person in their 70s, 80s or even 90s who is waiting for 48 hours in the corridor to get into a ward in University Hospital Kerry. It is not on.
I am pleased to take part in this debate on the future of healthcare for longer and healthier lives. I will touch on two topics, one of which, the statutory home care scheme, came up in the debate. I will give Members an update on that and then I want to speak about right-sizing, which falls under my brief as positive ageing, and housing options for people to age positively.
The programme for Government has committed to designing a statutory home care scheme to allow people stay in their own homes for as long as possible. Achieving this commitment will require focused efforts across several different elements all working towards developing a statutory framework. The first element being legislated for relates to licensing and registration of home care support providers. The general scheme of the health (amendment)(licensing of professional home support providers) Bill seeks to establish a licensing framework for a professional home support service. This was approved by the Government on 14 May last year. The Oireachtas Joint Committee on Health published its pre-legislative scrutiny report in October of last year. My officials are reviewing the recommendations of the committee's report. The general scheme has now been referred to the Office of the Parliamentary Counsel for final drafting with a view to presenting the Bill to Cabinet as soon as possible. This is something I am actively working on. I want to get this to Cabinet as quickly as possible. It is the first element to it. The Bill would provide for regulation of the sector by HIQA. Final amendments have been made to draft quality standards for home support providers. Following a public consultation engagement with stakeholders groups and partners working closely with HIQA, the prepared draft quality standards went out for public consultation. We are actively working on that with the Office of the Parliamentary Counsel and are looking to bring the Bill to Cabinet as quickly as possible.
The other issue that came up with a number of Members is that of right-sizing for older people. I am a Minister of State in two Departments, health and housing. My remit is to look at housing options for older people, which includes right-sizing. I am actively working on this with the officials in the Department of housing at the moment and I hope to bring it forward. In one sense it is about older people and their social and health aspects and about the housing aspects. That model will cover all aspects of life. I am delighted to contribute to this debate and I look forward to working with all Members into the future.
I, too, am delighted to be here tonight. Like the Minister and Minister of State, we also have been listening to all the concerns. There are very serious concerns here that we are committed to working on over the next few years. Investment in cancer care was one of the concerns that was brought up. I assure Members the Government is committed to improving cancer care, ensuring better prevention, maintaining improvements in cancer survival rates, and timely access to treatments. That is really important. This includes allocating ring-fenced funding to cancer services and investing in further infrastructure. Given the impact of cancer on society, we are committed to funding and implementing the national cancer strategy. Significant funding of €76 million, including the €23 million in 2025, has been invested in the national cancer strategy since 2020. I assure Members that this is a priority for us.
The other issue brought up was GPs. The Government is committed to supporting general practitioners, increasing the number of GPs, and improving access to GP services for patients. A strategy review of general practice is under way, examining issues across five areas: GP training, GP capacity, the ehealth agenda, out-of-hours reform and the supportive model for GPs. The review is led by the Department of Health in partnership with the HSE and relevant stakeholders, including the Irish Medical Organisation and the Irish College of General Practitioners. The review will identify improvements to the current system of GP care as part of the primary care focused health service. The review is to be completed early this year with a report to be presented to our Minister for consideration and the next steps. There is a commitment that we are working on this and we will come back to the House when we have more information.
I thank the Members. I am honoured and delighted to be working with the Minister for Health and the Ministers of State. All of us working together want to improve the system and make sure we have better access for people to services.
It is very much a team here who are here to work with Members as a team. I thank the House for the acknowledgement that, when we all do well together, it is the people who benefit. That is the way we will work here. I say this on behalf of all of the Ministers of State here.
Deputy Rice made a very good point that this is not the most efficient way of using Dáil time. It is most unusual at this time until the legislation comes in and until the committees are structured. At least 37 people have spoken in this debate so allow me to try to respond as much as possible. I recognise that Deputy Rice has been here this whole time.
I thank Deputy Cullinane for highlighting some of the additional issues regarding the pressures on hospitals in January. Of course, where we have additional pressures, either from RSV or other pressures, appointments and surgeries are getting cancelled. The Deputy is right that this is precisely why the new elective hospitals have not happened yet and they must happen. This was linked to what Deputy John Connolly said about some of the procedures around that. I need planning permission to turn a hospital into hospital, so to speak, and the public infrastructure guidelines that go out to public consultation in these ways are not, strictly speaking, the most efficient way of doing that. I would like to try to do that slightly differently. I would ask for Members' help in that.
On Deputy Sherlock's points, I did attend with and met the rare diseases community today. Similarly, I met some from the Cared Ireland group, which was also highlighted by many different groups. I thank Deputies for raising the issue of HPV vaccination. I must highlight how important it is for boys as well as girls and the emphasis on that. The Minister of State, Deputy Murnane O'Connor, has answered on GP access but we can have a conversation about the Summerhill family practice because we do have some solutions to that.
I thank Deputy Rice for raising not just the digital structure but also the subject of digital health. The Deputy is absolutely right about the delay in delivering that and it needs to be done. As the Minister, I am glad my predecessors have done the work on the development of the app, which is at the first stage, but we need to continue to drive on that. Obviously I would like very much to be put under pressure to get the finance for that electronic health record, which is extremely important for everybody.
On Deputy Ó Muirí's point, I believe we have committed to that emergency department and to the additional block. My colleague, the Minister for Finance, Deputy Chambers, launched the Beaumont strategic plan a little while ago, so there is a strong commitment. I highlight to all Deputies that the HSE capital plan is coming and a very significant body of work in this regard is outlined there.
I thank Deputy Burke for raising the complex issues with emergency presentations. Of course consultants are not the only part of that, as Deputy Cullinane also recognised, and there are multiple different factors. One of the things I have highlighted is the bank holiday weekend precisely because that was one of my first weekends there, but this is an every weekend problem.
I would expect to see in the scheduling consultants routinely being there from 8 a.m. until 6 p.m. on a Saturday, not 8 a.m. until 2 p.m., thereby reducing the time when there are no senior decision-makers present. Of course, they have to be supported by the rest of the team in the hospitals and by diagnostics. That is very much an inconsistent experience at the moment. In some hospitals, there is access to diagnostics. In some, there is not. That is not okay. I need to be able to come to the Chamber and confidently say that there is a consistent experience across Ireland.
Deputy Ward recognised the experience in Letterkenny and Deputy Pa Daly recognised the experience in Kerry. It should not be a geographical accident. While I am highlighting these examples as regards the broad trends I am seeing, I recognise that there are local differences and nuances and that this is a broader, whole-of-region responsibility as well as a whole-of-hospital responsibility. I welcome the debate by Professor Collins and others in this space because it highlights some of the issues we need to focus on. At the end of the day, there is a weekly spike that is exacerbated on bank holidays because of the two-day window where there are not enough people, including consultants, working. I have tried to track resources and the scheduling of resources over the past number of weekends.
I thank Deputy O'Donoghue for highlighting Limerick and the substantial body of work to be done there. I compliment Limerick on its response to Mr. Bernard Gloster on the scheduling that it anticipates over the next number of weeks. The hospital's response was one of the best and most proactive. There is a balance to be achieved. I also compliment Limerick on the fact that it progresses its elective surgeries when certain hospitals cancel them.
I will do my best to try to flatten those lines to make the approach across Ireland more consistent and there are not geographical differences.
I thank Deputy Timmins for raising the issue of transparency in terms of pricing and pharmacies. It is a long-standing issue. When we had the energy credit scheme, it appeared on our bills - on my bill, at least - as a credit put towards the charge. Taxpayers understood that it was their taxes, not Government money, contributing towards paying their bills. It should not be a million miles away with pharmacies. If I get a bill, I would like to see what the cost of the medicine was, what the cost of the dispensing fee was and what the State paid towards that, recognising that the State is paying €500 million of taxpayers money to pharmacists every year to support taxpayers in accessing medicines. There is a lot of merit in what the Deputy is describing. Let us have a think about the best ways we might approach that. This issue has also been highlighted in respect of HRT.
I will take ten seconds to pay tribute to my predecessor, Stephen Donnelly, who put enormous work into this position, developed the database and placed a strong emphasis on data, process and productivity that has led to significant improvements.
Cuireadh an Dáil ar athló ar 8.43 p.m. go dtí 9 a.m., Déardaoin, an 27 Feabhra 2025.
The Dáil adjourned at 8.43 p.m. until 9 a.m. on Thursday, 27 February 2025.