Vol. 1064 No. 3
64. Deputy David Cullinane asked the Minister for Health when she will publish the review of specialist cardiac services; when she will publish a comprehensive cardiovascular health strategy; and if she will make a statement on the matter. [10077/25]
Will the Minister outline when the national review of cardiac services conducted by Professor Nolan and his team will be published? I sat in a meeting in 2019, when Deputy Simon Harris was the Minister for Health, with Oireachtas Members from across the south-east and at that point, that review had been commissioned. Here we are, in 2025, and it still has not been published. It was sitting on the previous Minister’s desk for at least nine months. I got a commitment last year that this would be published very quickly - within a matter of weeks - yet it still has not been published. When will it be published?
The national review of adult specialist cardiac services is finalised. The review provides a detailed, evidence-driven analysis of cardiac services across the country. A wide range of stakeholders - clinical, patient and public - were consulted as part of the review. The review provides recommendations around cardiac health policy, specifically: patient-centred care integrated with Sláintecare; increased cardiac care in community settings; a focus on prevention; capital investment for non-invasive diagnostics and imaging, including ehealth; structural reform to develop regional cardiac networks and national comprehensive cardiac centres; and leadership and governance.
Publication of the review, which is very important, will facilitate the development of the new national cardiovascular strategy. That will take time to develop and will require significant reform to ensure effectiveness and sustainability. I am reviewing the report and I hope to meet the authors shortly. Yesterday, at St. Michael's Hospital, we met Professor Ken McDonald, who is one of the people involved, and I hope to have the opportunity to meet with them when I return from my St. Patrick's Day engagements. I would anticipate publishing it shortly thereafter.
The problem is that I have been told that on at least three occasions. I know the report was with the previous Minister for Health for most of last year. Deputy Carroll MacNeill is a new Minister coming in but there is continuity in that this report has been sitting on the Department's desk. It is not going to be the new national cardiovascular strategy because that strategy has to look at prevention, diagnosis and rehabilitation care, whereas this report was specifically set up to look at acute services and, as the Minister said, the regional cardiac networks. As the Minister knows, part of that is relevant to my constituency in the south east. We still do not have 24-7 emergency cardiac services. If people are unfortunate enough to have a heart attack at 9 p.m. or 10 p.m. on any day of the week or at the weekend in Waterford, their only option is to be sent by ambulance to Cork or Dublin. Obviously, and rightly so, there is a campaign for a full 24-7 cardiac service.
This needs to be published as quickly as possible. The Minister has not answered the question as to why it has taken so long. The review was commissioned in 2019 and it is now 2025. It has been sitting on the Minister’s desk and we are now told again that it will be a number of weeks.
I cannot answer why it has not been done to date but I commit to the Deputy that it will be done and, naturally, I would welcome his engagement on it when it is published. I will be meeting the people involved when I come back from the St. Patrick's Day trip. I look forward to getting it published then because, as the Deputy says, it is incredibly important that it is done.
Recent trends in the demand for cardiac services reflect the changes in population and the health needs of an ageing population, which considerably changes the profile of need. The demand for emergency cardiac interventions is declining but the demand for non-acute services, such as the management of chronic disease, is increasing and we need a balance in terms of how to deliver the best service. We will need to carefully consider the number, location and resourcing of emergency heart attack centres to ensure that a balance can be achieved between accessibility and the provision of safe, efficient services. Cardiovascular health is a major pillar of the health funding announced in budget 2025, which included over €9 million in full-year costs to support important cardiovascular health initiatives. As the Deputy said, the publication of this review is a precursor of that, which I recognise.
Both the Taoiseach and the Tánaiste previously said several times in this House that, in principle, they support 24-7 cardiac services for the south east. In fact, the current Taoiseach stood behind a banner essentially saying that his party would deliver the 24-7 cardiac service. I know that is going to require additional resources and additional consultants but we need a policy decision. I am asking Deputy Carroll MacNeill a straight question. She is now the Minister for Health. Is she committed in principle to a full, 24-7 cardiac service in the south-east? That is the first question.
Second, it was stated in the programme for Government and also during the course of the election campaign that the Government is in favour of multi-annual funding for the health service. If we are in favour of multi-annual funding, then I hope the Minister will set out a very clear five-year strategy of ring-fenced funding for cardiovascular care and the many other national strategies that are needed to ensure that consistency and certainty of funding are there. Cardiac problems are the second biggest killer so this is very important. We have not had a strategy since 2019 and this report has been held up. The Minister said she will look at it. I accept that she is new in the role but there is an urgency here. I hope that when she comes back from the St. Patrick's Day visit, she will publish that report and move to the next stage of developing new strategies as quickly as possible.
I could not agree more about the need for a dedicated cardiovascular strategy and the multi-annual funding to facilitate that. With regard to Waterford, I have a small update. After an extensive recruitment campaign, we now have two labs open. One of those, from 18 March, will open with extended, albeit not 24-hour, 8 a.m. to 8 p.m.-----
I am aware of that.
I know the Deputy is aware but I want to inform the House more broadly. The other lab will provide elective services five days a week and the two labs together will protect better against both emergencies and elective issues. That is a major step in what the Deputy correctly acknowledges is a long-standing need.
With regard to 24-hour care, I am very open to providing the best care possible. I want to see what is in the cardiac review and to make sure we have the resources there, but I also want to ensure they are doing enough procedures to ensure that patient safety is encompassed within that. I am keen to work with the Deputy on delivering both of those things as we move to that point, while recognising that enough procedures must be happening all of the time to ensure it is a safe place to do that.
65. Deputy Marie Sherlock asked the Minister for Health the actions taken by her Department to ensure the continued existence of a practice (details supplied) in Dublin 1 which is currently facing closure due to provisions introduced in the Finance (No. 2) Act 2003 amending section 1008A of the Taxes Consolidation Act 1997; her plans to support the existence of medical charities operating GP practices in socially disadvantaged areas; and if she will make a statement on the matter. [10130/25]
Last week, I raised with the Minister the issue of the GP Care For All practice in Summerhill, Dublin 1. In the Visitors Gallery today, we have the chair and the practice manager of that GP practice. It is a very serious situation because, by June of this year, this practice will be facing closure unless there is direct intervention by both the Department of Health and the Department of Finance. In particular, I want to ask about the plans of the Department of Health for the continued existence of medical charities in providing GP practices across the country.
Following the Deputy’s question last week, and prior to that, my Department and the HSE have had extensive engagement with the organisation concerned. That engagement has focused on identifying ways the organisation can continue to deliver services, which is what we want, how it can be supported by the Department and the HSE, notwithstanding the tax treatment, and finding what other solutions are possible. Several solutions in line with tax legislation and the provisions of the Health Act have been developed and presented to the organisation concerned, which might have the opportunity to reflect on that. Those solutions identify different business models that are practical and implementable and my Department is confident they would allow the organisation to continue its operation in line with all relevant legislation and the GMS contract. We both want the service to continue.
In addition, the HSE provided for a third party to independently advise the organisation on the matter. I understand that this advice built on the solutions presented and further developed the organisation's understanding of what implementation of those solutions would involve, including the identification of any additional costs and resources required. The Department and the HSE remain committed to engagement to ensure it can continue to provide services. That engagement includes working with it to implement the developed solutions and identify any additional supports recognising patient need in that community.
Issues relating to tax administration are a matter for the Minister for Finance but I am aware that section 1008A of the Finance Act allows, under certain circumstances, for the GMS income of GPs in medical partnerships to be treated as that of the partnership for income tax purposes rather than income of the individual GP. The introduction of this section did not change how GMS income of GPs who are not in medical partnerships, such as those in the organisation concerned, should be treated under tax law. Tax treatment is a matter for the Minister for Finance. What I am trying to do is ensure that this service remains open, that it has concrete solutions that are implementable and that it gets the resource support it needs to provide the patient care I know the Deputy wants for her constituents.
I wish to put on record that three options were offered to GP Care For All, none of which are operable. Option one was the partnership model, which is simply not viable because of the risk GPs would have to take on. Almost 97% or 98% of this practice is GMS-reliant. The second option, which was the hybrid model, and the third option, which was direct subsidy, were not acceptable to the HSE. The options put forward by the Department of Health are not workable and the HSE has paid for Western Urgent Care to come up with proposals to send to the Department of Finance and we have heard nothing back. The onus is on the Department of Health to ensure that the Department of Finance actually acts to ensure that medical charities can continue providing these services because nobody else is providing these services in some of the most disadvantaged areas in the country.
The Deputy set out the different options that were proposed. They were proposed in good faith with a view to keeping the service open and working. At some point, there is a finite number of options that can be proposed and try to be supported. They are really trying to work to find a solution. The Department and the HSE are ready to continue to engage with the charity regarding the proposed structural solutions. It will require some adjustment as to how GP Care For All operates or is structured but the HSE has also made a commitment to cover any funding shortfall arising from a change in the charity's operating model and to work through the implementation of the viable solutions that can be developed. More broadly, I am concerned to ensure that north-east inner-city Dublin is well served and better served by GP services. It is an area that needs GP services and support, as the Deputy and I discussed previously. We are very committed to trying to keep this service open but it will require some adjustment on both sides and we are working to find a solution. The current model will have to change a bit and be flexible in that way.
I do not doubt the goodwill there is regarding ensuring GP services, particularly to the 2,600 people on the list in GP Care For All, continue but the reality is that the HSE funding is only for the 2024 liabilities, nothing is in place for 2025 liabilities and I am not hearing any solution. We have a private system of GP care in this country with the result that we have significant gaps across this country in some of the most socially deprived areas and this Government is not coming forward with any solution as to how we put in place GP care in those communities. The medical charity model was a solution to the problem but now, it is being upended and facing closure because of those changes in the Finance Act. I am asking the Minister to make sure that this medical charity can survive and that other ones can be set up across the country.
I do not accept that no solution has been attempted. I know it is not quite what Deputy Sherlock is saying but for the benefit of the House, proposals have been presented to GP Care For All. One is a partnership model, which is a traditional model of service delivery within general practice and also works in other areas. Another proposal is a hybrid model where the HSE contracts individual GPs to provide services to specific patients and a model around that. Another proposal is a more direct subsidy model. A few different options have been on the table. I appreciate that we have 29 seconds to work out the details and I do not wish to read it all into the record of the House but I am certainly happy to try to understand why not one of these models can work. I am also interested to see what flexibility GP Care For All can facilitate as well. The offer here involves structural solutions not just from the Department and the HSE but with an independent third party to try to find a solution, offer of additional resources and offer of direct subsidy. I am certainly not saying, "How much more can we offer?" but I do want to know what we can do to get this resolved because that is our intention. It cannot be that only one side is trying to work it out, however. There must be a certain measure of flexibility.
66. Deputy David Cullinane asked the Minister for Health if she has ensured that plans are in place to safely and appropriately staff the new children’s hospital to ensure there are no delays following handover from the contractor and if she will make a statement on the matter. [10078/25]
This question concerns the new national children's hospital and the preparedness of the State, the Government and CHI for what will be a decanting of staff from three hospitals into the new children's hospital. People want to be assured that the June deadline for completion will be met but also that the Minister and the Government are on top of the project, the contractor, the board and the handover because it is really important that we have as smooth a transition as possible from those three hospitals to the new hospital.
There is a significant ongoing programme of work to prepare for the opening of the new hospital, including integration of the three hospitals and operational commissioning. This operational commissioning includes the clinical fit-out for the entire hospital, total digital integration and staff training to ensure the hospital can open and accept patients safely and also that the workforces and cultures of the three hospitals come together.
There are approximately 4,500 staff working across Children's Health Ireland. This is an increase of 26% since 2019. An extensive training plan is under development to support the transition of current staff to the new hospital. Since the definitive business case was finalised in 2017, the workforce plan for the hospital has been revised multiple times to take account of service developments. I am advised that there is active engagement between the HSE and CHI to revise this plan to take account of further service developments and ensure the right workforce is in place to staff the new hospital. This is something that will need to be revised continually as the population grows and as we build capacity, so I anticipate that the workforce plan will continue to evolve and grow.
I understand that there is broad agreement on overall numbers required and every effort is being made to bring this process to a conclusion as soon as possible. Any additional staff needed will be sought as part of the annual Estimates process in the context of overall prioritisation of available funding. Over the next number of years as the population grows, that must grow with it and that is our intention in an appropriate way but, for the moment, the workforce plan is there.
Regarding the opening of the hospital, I am assured by the builder that we will have the building at the end of June. I received that assurance verbally when I was there last week with the Northern Ireland Minister of Health, Mike Nesbitt. I am assured by BAM that we will have the hospital at the end of June, which is what it committed to publicly in January. The hospital has advanced very considerably - even since I was there last October. We have agreed early access for CHI. I might pick that up in my supplementary reply.
I very much hope it is a case of 15th time lucky regarding that commitment and we see it handed over in June. I have a letter from 12 surgeons who work in the department of paediatric surgery, which I raised previously with the Government. In it, they talk about how the national model of care for paediatric surgery clearly outlines the need for 17 paediatric surgeons by 2028. It goes on to say, "we are very concerned that the recommended workforce of 17 paediatric surgeons has not been included in either the definitive business case for the new Children's Hospital, nor in any of the estimates over the last few years". It went on to state that, "this repeated lack of engagement and commitment to address the concerns of the department of surgery has left us with no option but to refer the letter to you [and many others in the HSE]". Is that the case? We cannot have a situation where we have a state-of-the-art hospital but we do not have the paediatric surgeons needed. All of us in this House know about all the surgeries for children with scoliosis and spina bifida and many more that urgently need to be carried out so we need to be assured by the Minister that those 17 consultant surgical posts will be in place by 2028.
I am advised that there is active engagement between the HSE and CHI to further revise the workforce plan. The question of staffing in all the specialisms has to come within the workforce plan. I appreciate that between now and the opening of the hospital, we might get several such letters from different specialists who are, understandably, trying to make the best case they can for the best resources for their area but this can only be delivered within an overall workforce plan and the budget for that.
While we might have different instances over time, that workforce plan is absolutely essential and that is what we have to work towards in the first instance.
On the broader commissioning of the hospital, early access in April has been agreed. I am currently assessing the CHI plans to move in and what will be done on a month-by-month basis to ensure that we have delivery of the hospital for patients in 2026. At the earliest possible safe time in 2026 patients will be moved. I am assessing that pretty rigorously at the moment.
If we do not have enough paediatric surgeon consultants, it creates problems. The Minister knows we have the ongoing Nayagam review and the review by HIQA into the use of springs. There was a media report this week of an audit that was commenced in April of last year conducted by an NHS consultant on the back of very serious allegations made by whistleblowers, including that operations on children were being done purely for financial gain, that osteotomies in two of the three children's hospitals have now been suspended and that potentially there could be a recall of up to 561 children. Is that the case? Has she, as Minister for Health, investigated this? It is a very serious issue on top of all the other reviews which are ongoing and it feeds into the need for more consultants, more staff, proper training, proper oversight and proper accountability. I am alarmed that we have this report, which I have not heard Government respond to yet, that potentially operations which were unnecessary have been carried out on children. We need to be assured that this has been properly investigated. Has the Minister seen this audit report which has been published? Has she sought it? What action will the Government take on the back of the allegations which have been made?
I am anticipating that report but I have not received it yet. I have not been presented with it yet. Of course, I will look at it immediately. There are a number of different issues that are not the same thing. One is the report, and we will look at the issues that are particular to that. The others are the resources and the increase in the number of consultants, which is quite considerable as the Deputy is aware, and making sure that we have the best workforce plan for the hospital in the first instance and into the future. They are two distinct things and I would not like to conflate them because no matter how many consultants we have, of course, we have to make sure that every consultant and every person working in the health system is working in the correct way. We may need to separate the issues in the review, which we will look at and I am sure the House will look at in great detail, from the overall workforce plan for the hospital for the future.
If there is a draft report, the Minister should have seen it and she should be asking for it.
Yes, but-----
67. Deputy Pádraig Rice asked the Minister for Health the reason the new national sexual health strategy has still not been published; her plans to address rising rates of sexually transmitted infections and increase capacity in sexual health services; and if she will make a statement on the matter. [10514/25]
There is currently no active sexual health strategy for Ireland. The previous strategy was launched a decade ago by Leo Varadkar when he was Minister for Health. We have long been promised a new strategy but it has not been delivered. For the third year we are lacking a comprehensive strategy or vision for sexual health. The sexual health services are thin on the ground and starved of resources. Will the Minister of State commit to prioritising sexual health? When will this long overdue strategy be published?
Sexual health is a priority for this Government. Following expert advice, the second national sexual health strategy underwent an additional round of stakeholder consultation and feedback, which is now complete. The good news is that the strategy was approved to progress to design stage at the end of last week. Once design is completed, the strategy will be submitted for ministerial and Government approval, then launched. It will be launched quite soon. The strategy will be supported by an action plan that will map out implementation in more detail for the first three years of its term.
HIV and STI rates have been rising both nationally and internationally. Consequently, we allocated funding of €550,000 for 2025 to support the HIV pre-exposure prophylaxis scheme, bringing the total allocation for HIV PrEP to €6.45 million. This funding includes €200,000 for additional PrEP drugs and €350,000 for additional staffing in public STI clinics providing PrEP from July 2025. These measures will increase capacity for in-person PrEP appointments. Furthermore, an additional €600,000 has been allocated to support the free STI home-testing scheme, bringing funding for STI home-testing to €4.82 million in 2025.
A lot of work has been done on this and I assure the Deputy that this will be done as soon as possible when we get the go-ahead.
It is welcome to hear that this strategy is to be launched but this is not the first time it has been promised. As the Minister of State knows, there was a review in 2023. The Minister of State, Deputy Naughton, promised a strategy in 2024 and the then the Minister of State, Deputy Colm Burke, followed up by promising a strategy in Q1 of 2025. I welcome that progress has been made but it is urgently needed.
As the Minister of State said, sexual health infections have increased by 31% and the incidence of gonorrhoea rose by 60%. Last month the European Centre for Disease Prevention and Control reported that Ireland had the highest rates of gonorrhoea in Europe and among the highest rates of syphilis. At the same time services in the ground are really thin, particularly outside Dublin. Ten counties across the country have no STI clinics - ten counties with no services whatsoever. In the counties where there are services, some of them happen very rarely. In Kerry, for example, there is a clinic every fortnight. There are very poor services on the ground.
The Minister of State mentioned the online services. We know from research that these are not available to many people who are excluded because of literacy, digital exclusion or language barriers. They are not the solution; we need real services on the ground for people.
The rates of gonorrhoea and chlamydia had reduced slightly by the end of 2024 in comparison with the last two years. Better access to testing may be reducing onward infections. The national sexual health strategy supports positive sexual health information. It will have education, research, prevention and information, particularly on stigma. All this will be in the strategy.
In her opening response the Minister of State mentioned PrEP, which could be a game-changer for HIV. The same is true for PEP and rapid testing. It can take 18 months for someone to be seen in a PrEP clinic in this country. In Dublin, over 1,000 people are waiting for an appointment at one of the PrEP clinics. It took a year and a half to replace the nurse specialist in the South Infirmary in Cork. At the same time, the UK has same-day walk-in clinics and screenings. We can talk about increased funding but the services are not there, particularly on PrEP. We have seen that 39% of new HIV infections were late diagnosis. We now know that 50% of the transmissions are among heterosexuals. Both these findings result in poor outcomes and the likelihood of ongoing HIV transmission. With these kinds of results there is a serious risk that we will not reach that target of eliminating new HIV infections by 2030.
Great work is being done by some of the NGOs and some of the people working in sexual health, but the services and funding are not there. We need the new strategy and we need to protect sexual health because it has been neglected for far too long.
The funding includes €200,000 for additional PrEP drugs and €350,000 for additional staffing in public STI clinics providing PrEP from July 2025. I understand the Deputy's concerns. As I said, this strategy is urgent for us. I assure him that hopefully in the next few weeks or maybe two or three months, I will definitely come back to him with this strategy. As he said, education and information are really important. Stigma is a big issue that we need to address. I will be delighted to work with the Deputy and do whatever I can to help and support him.
68. Deputy Ken O'Flynn asked the Minister for Health if there is a mandatory requirement for dental practices to accept patients with medical cards for treatment; and if not, the measures that are in place to ensure access to dental care for medical card holders. [10370/25]
I ask the Minister to clarify if there is a mandatory requirement for dental practices to accept patients with medical cards for treatment. What measures are in place to ensure access to dental care for medical card holders? What are the current procedures for emergency dental treatment for children under the age of 16 when dental clinics, such as the dental clinic in Cork city, are closed at weekends? What plans does she have to improve accessibility to urgent dental care for patients under the age of 16?
Over €200 million is invested in public oral healthcare services annually. The dental treatment services scheme provides oral healthcare, free of charge, to medical card holders aged 16 and over, as the Deputy is aware. Services are provided by dentists and clinical dental technicians who hold a contract with the HSE.
It is not mandatory for a dental practitioner operating in the State to hold a contract to operate the DTSS. However, it is the Government’s continued intention to support and incentivise practitioners who choose to do so, in order that medical card holders can access vital oral healthcare.
In May 2022, the care available under the DTSS was expanded and the fees paid to contractors significantly increased by 40% to 60% to incentivise that across most treatment items.
Those measures did improve access to care and more than 44,000 extra patients were treated in 2024 compared with 2022. I know well, however, that there are some towns with no or limited DTSS dentists who have sufficient capacity to accept new patients. In those areas local HSE services can assist patients to access a dentist, and in exceptional circumstances where emergency treatment is required, the HSE can directly contact private providers or arrange treatment to be provided by HSE-employed dentists.
The Government is committed to reforming oral healthcare services through the implementation of the national oral health policy, which is particularly important for children. I might come back to that on the supplementary question. The programme for Government contains commitments to implement that policy and reform care for medical card holders. The first phase of implementation to end in 2027 is currently being finalised and it includes reform for services of medical card holders as one of several priority actions. Of course, the real differentiation relates to children and a model of prevention. Perhaps we will catch up on that in the supplementary question.
I appreciate the Minister's response and I understand the response but the DTSS programme just is not working. For instance, the working-class town of Mallow that I come from, which has 13,450 adults living there, has no medical card provided dentist practice. Nobody is accepting a medical card in Mallow. You must travel to Cork city or to Charleville, to Limerick or down to Kerry. Many practices have given up because the system is not working. Would the Minister agree that what we need to be doing now as a Government, or what the Minister needs to be doing as part of the Government - I am not in the Government yet-----
Soon.
Some day. Could we not start looking at a programme where medical cards are accepted in the same way as when a person goes to the GP and the dentist would be paid in the same way GPs are paid, so everyone is covered and there would be buy-in from everybody?
The other reality is that there are situations in Cork city where if a young child falls off their bike and breaks their teeth, they have no access to the dental clinic on the weekend and therefore it is either accident and emergency or the mercy of a dentist who might accept a medical card. The reality is that a lot of them do not so children are without teeth or parents are faced with bills of €4,000 or €5,000 to replace them.
I accept there has been an issue with the DTSS and the contractors numbers, notwithstanding the increase in fees and the increase of 44,000 in the number of patients being treated, which is something. Nevertheless, our figures for contractor numbers have gone down very considerably, from 1,500 in 2019 to 813 in 2024. In Cork and north Cork those numbers have gone from 35 to 26. I accept that. The new policy is designed to try to reflect this and reform that service delivery. The new policy sets out detailed descriptions of envisaged service reforms, which are about prevention, routine and emergency care, and oral health evaluation. That reform of the DTSS will be impacted by this new policy. It sets out for the first time that there will be comprehensive modern and clinical infrastructure supporting oral care. The child oral health examination programme, which is delivered by HSE-employed oral healthcare professionals, is to provide examinations and treatment identified as necessary from the age of seven up to when a child is in sixth class. Emergency care is also available from the HSE for children up to the age of 16.
I thank the Minister but, as I pointed out, emergency care is available but is not available all the time. What does a parent do when their child is suffering? Parents have to find the money somewhere and they will beg, borrow and steal to protect or save their children. In my constituency of Cork North-Central many people have come to me and said they had to borrow money from friends or family because they had no access to dental care for a child over the weekend due to an accident. That is €2,000 or €3,000. It is simply not good enough.
No, it is not sustainable and that differential in money is not fair. This is why the emergency services are attempted to be covered by the HSE. We really do need to move to that new oral policy which provides fair and open access to people across every community and in a targeted way. That is about prevention as much as about emergency care. I appreciate what the Deputy has said about accidents, which is a slightly different thing, but this is about general oral healthcare. We need to focus on the implementation of that new policy, which is aligned with Sláintecare in providing care where it is needed and when it is needed at the right time.
