Vol. 1067 No. 1
117. Deputy Darren O'Rourke asked the Minister for Health the number of people issued with a home care package but unable to fulfil it due to staffing shortages, or other reasons, in 2024 and to date in 2025; and if she will make a statement on the matter. [23593/25]
I wish to ask the Minister the number of people issued with a home care package but unable to fulfil it due to staffing shortages or other reasons in 2024 and to date in 2025 and if she will make a statement on the matter.
Improving access to home support is a priority for this Government. Home support hours have increased every year since 2020, from 17.8 million hours in 2020 to a funded target of over 24 million hours in 2025, including intensive and complex home support. The HSE has reported that 5,556 people were assessed and waiting on the provision of home support at the end of 2024, including those waiting for a carer to be assigned and those waiting on funding to be allocated. This is a substantial reduction since the start of 2020, when over 9,000 people were waiting across both categories. Of the people assessed and waiting, 3,073 had a home support service in place but required additional hours, while 2,483 people were waiting for a new package.
As at the end of March 2025, the latest preliminary data indicates that 5.97 million hours had been delivered, an increase of approximately 5.5% since March last year. Nationally, the waiting list for home support reduced to 4,888 people at the end of March, with 2,693 people waiting for additional home support hours and 2,195 people waiting for a new package. No one was waiting for funding to be allocated. The waiting list was approximately 17% higher at the same time last year. Priority is given to those in the community with acute needs and those assessed and in hospitals who can return home with supports.
It is significant. It is acknowledged that the figures are always very high. We are talking about millions of hours of home care packages and these are real services and important ones. We must always think about these things, though, in terms of unmet need. The system does not work if these services are not in place. Is there an analysis of whether there are specific geographical challenges and-or challenges with specific service areas? Is it in complex needs, for example? Does it involve people coming out of hospital and going into the community? Are there particular areas where challenges are encountered? Is it in disability services or care of the elderly, for example?
I thank the Deputy. I gave him global figures. I assumed he was going to ask me about CHO 8, his own area.
Yes, I am.
It is across the spectrum and there are different areas. As regards the Deputy's area of CHO 8, the additional hours provided to March 2025 were 434 in terms of people waiting. The total number of people waiting was 791. At the end of December 2024, that number was 932. We have seen a reduction of 141 in the number of people waiting. This is a positive. At the end of December 2024, then, the figure for people waiting was 932, while at the end of March 2025 it was 791. This is an improvement of 141 people, which is a 15% improvement. In terms of the number of people receiving home care support packages in CHO 8, there were 9,113 at the end of March 2025. This was an improvement from March 2024, when the figure was 8,137. This was an increase of 676 people, which equals 8%. We are always seeking to improve the system and deliver. There are two elements here. There are people who have existing hours and need more and there are people who need new services.
Some things are coming through these figures consistently. There is a pattern within them. I expect this would be the case if we were to look at the geographic variation. I know much of the challenge in CHO 8 concerns the fact that it is very difficult to get staff because it is exceptionally expensive to live in Dublin or the greater Dublin area.
There is then a variation across the State in the demographic and the demand on these services. It is incredibly important that these supports are in place when needed because they are so vital to ensuring the overall system functions properly and people have the care as close to home as possible.
On recruitment and retention of staff into these services, I know there were recent announcements about companies opening up in the sector, which are welcome, but it is a question of general recruitment and retention and the recent pay negotiations.
The Minister of State has outlined a lot of figures, but from the human point of view, I know a lady who had her own business and who had to work part time to look after her mother. She was sanctioned, she was passed for the hours and they had hours Monday to Friday, but on Saturday and Sunday and in the evening, she had to go in. This is a woman with her own family, and she is travelling to look after her mother. The situation is that it was sanctioned and the hours were passed, but that is not enough. People need the supports. The Minister of State needs to come up with a plan. I am not here to criticise him. I am saying there are people who have had the hours passed but who need help and support and it is not coming. I have seen families in recent weeks and people are coming out of hospital without care packages and wrap-around services in place. That needs to be worked on. People should not be let home unless the care packages are in place. People want to go home, we want to support them at home, but we need to put it around them.
I tabled a similar parliamentary question a couple of weeks ago regarding Sligo-Leitrim. One thing I noticed was that, in both counties, the number of hours that were sanctioned but unmet in Leitrim had doubled in the 12 months between 2023 and 2024 and in Sligo had trebled, particularly for older people. One thing I discovered is that what normally happens is the district nurse or some professional recommends a specific number of hours for Lily, Mary, John or whoever as the hours they need but they are never given those hours. The hours sanctioned are less than that, probably one third less. In fact, the need is greater than what is sanctioned. That is the first point.
The second point is that people who work in the service tell me the HSE puts out recruitment programmes that are advertised, brings people in and interviews them, but that it is three, six or 12 months later before they get a call back from the HSE offering them a job. They are not going to be sitting at home for six months. They are finding that the HSE, in many people's view, is not serious about recruiting people in a timely manner in order that they can take up the positions.
We can say we are always looking to increase the level of funding that has gone into home care, but it has increased to €838 million from a base of just over €400 million in 2020. It is such that between 58,000 and 60,000 people are receiving the service. The key thing is that, since last December, we have seen a significant reduction in the numbers. Deputy Gould might want to bring me the particular human case he spoke about because there is a huge human factor here. I am obviously engaging with the officials and with the HSE. Furthermore, I will meet again with the HSE on the particular matter to see what we can do to make further improvements to reduce the numbers on the waiting lists. It is fair to say there has been significant investment in the area, certainly over the past five years. It is my role to see if we can improve delivery of the service for people who have existing hours and are looking for additional hours and for people who need a new service. There is a key focus on people coming out of hospitals who have that acute need.
118. Deputy Pádraig Rice asked the Minister for Health the date on which she will publish the new national sexual health strategy; the reason for the continued delay in doing so; and if she will make a statement on the matter. [24091/25]
It is ten years since the first sexual health strategy was published. That strategy expired three years ago and has still not been replaced. I raised this issue two months ago in the Dáil and was told it would be launched quite soon. Is the strategy still at design stage or has it been submitted to the Government for approval?
I thank the Deputy for his question and congratulate him on his new appointment as Chair of the health committee. I look forward to working with him and the team.
Sexual health is a priority for the Department of Health. The drafting process for the national sexual health strategy commenced in 2023 following a review of the previous strategy. The drafting committee included policy, service delivery and clinical leads working within the Department and the HSE. However, the strategy underwent an additional round of stakeholder consultation and feedback completed in mid-2024. It was decided that the strategy would be launched under the new Government to incorporate priorities from the new programme for Government. The strategy is supported by an action plan that maps out implementation plans for the first three years. It is currently at advanced design stage and will be submitted for departmental and ministerial approval shortly.
Within the remit of the strategy will be support for positive mental health and well-being across the life course of the strategy, testing, diagnosis and treatment of HIV and STIs, prevention of adverse sexual health outcomes, information, education and research. Subject to departmental, ministerial and Government approval, the launch is planned for two weeks' time, Tuesday, 27 May. We have the launch ready, all going well, for this day two weeks. To keep the Deputy updated, service improvements are ongoing in the meantime. An additional €1.35 million has been allocated to free home STI testing, HIV PrEP and the free contraception scheme in 2025. A lot of work has been done through the Department.
It is great news that the strategy will be launched. I am looking forward to engaging with it and seeing the detail. When I raised this issue last time, the Minister of State talked about how stigma is a big issue and I agree with her on that. Services are also really important, however, and I think we can reduce stigma by having better services and supports for people. We need to make sexual health services everyday, normal and accessible throughout the country. There are currently ten countries in Ireland with no sexual health services. I am surprised this issue is not raised by Deputies across the Dáil, demanding services in their communities. Many of us need access to better sexual health services and it should be an important issue for people. We can also reduce stigma by having public awareness campaigns and challenging negative stereotypes, similar to mental health. We also need better sexual education. This needs leadership, investment and support because this issue has been neglected for far too long.
I thank the Deputy. I agree with him, and it is important the stigma is not there. Additional funding of €550,000 was allocated through the budget for 2025 to improve access to HIV PrEP, bringing a total allocation for PrEP to €6.45 million this year. An additional €600,000 has been allocated to support wider access to home STI testing, given increasing demand for the services. This brings funding for STI testing to €4.82 million in 2025. More than 126,000 kits were ordered in 2024, with a return rate of 71% and just under 10% of returned kits indicating a reactive result. Work to make some forms of contraception more easily available through the community pharmacies is under way and additional measures to increase capacity for sexual health care will be outlined in the new strategy.
We have huge innovations in the area of HIV - on PrEP, PEP and rapid testing - but I think we are not seizing the moment here. We could potentially end HIV transmissions in this country if we massively invested in this. People are waiting far too long to get access to PrEP clinics. There is a real chance here to have a game-changing moment, and I urge the Minister of State to seize that and increase the investment and access to services.
On the online testing, it is fine if people do not have symptoms, but people with symptoms need to go to clinics and need to have clinics in their communities they can access. It is all well and good having access to online tests you can order and do at home, but that does not work for everybody, especially those who have infections. That is why we need those better services in the communities, and we need to spend more money than we are currently.
We are putting a lot of funding into health and well-being and sexual health, which is very important. The strategy in two weeks' time will be really positive. We all know that we need to do more. Supports for the prevention of domestic, sexual and gender-based violence and treatment of victims in collaboration with Cuan and the justice sector are part of it too. It also includes further expansion of the free contraception scheme; women's, men's and LGBT health supports; additional measures for sexual health in third level education; funding to support improved access to HIV prep and for people living with HIV; and expanding sexual health services available throughout the primary care system. It is, therefore, a priority for us. I thank the Deputy again for raising this question. As I said, our strategy launch will be this day two weeks.
120. Deputy Catherine Connolly asked the Minister for Health further to Parliamentary Question No. 137 of 6 March 2025, if the development control plan and the options appraisal process for the master plan for University Hospital Galway has now been completed; and if she will make a statement on the matter. [23679/25]
I am not sure which Minister is answering, but I am asking about the regional university hospital in Galway, a master plan we have been waiting on for a long time and a control development plan. I have in my hand the HIQA report from its last unannounced visit. There is a shortage of 232 beds and a huge difficulty in treating patients with dignity and respect and privacy, notwithstanding the improvements that have been made and good comments from the patients. We are talking about a hospital that is under serious pressure. The Minister might give me an update, please.
I thank the Deputy for her question. It is timely, as I will visit University Hospital Galway, UHG, on Thursday as it happens.
The Deputy will be aware of proposals for further significant capital investment there. That includes additional bed capacity, a new emergency department, new paediatric and maternity facilities, a new helipad, replacement laboratories and a cancer centre at UHG. A surgical hub is under construction at Merlin Park and plans for the new elective hospital are progressing.
Due to the scale and complexity of these projects, a programmatic approach is necessary to ensure the continued delivery of care on the congested hospital campus. We could not deliver it all at once on one site, so that master plan to move around is important.
A UHG capital programme oversight board has developed an integrated, strategic master plan for UHG by way of a campus development control plan, DCP. That master-planning process, informed by population health needs and regional clinical demand will, as the Deputy will be aware, provide a clear plan for the sequencing and delivery of the new capacity and facilities. Both the DCP and the programme strategic assessment report are currently being finalised by the HSE. I understand that it is to be presented to the HSE board for approval at the end of this month. We expect that it will then be submitted to the Department next month for review in line with the infrastructure guidelines. The HSE has advised that initial enabling works to support this programme of works have begun as I imagine the Deputy will be aware.
Unfortunately, I will not be there for that photo opportunity on Thursday because the Dáil will still be sitting.
Deputy-----
I welcome that the Minister is going to Galway. The reason I put my hands up is that we had the former Taoiseach back in 2017 tell us it was not fit for purpose. It is now 2025. I am looking at a HIQA report from last year that states that a strategic assessment preliminary business case had been completed, approved by the Health Service Executive board and submitted to the Department of Health, so forgive me if I am little frustrated. I was born, bred and reared in Galway. I have been in and out of that hospital for many reasons. I know it on every level, professionally and personally. It has not been fit for purpose for a very long time. I heard what the Minister read out to me; I appreciate they are her answers. I have all of those answers I am getting. Hopefully, when she is there on Thursday, she will find out which plan has been completed and why I have been told that this one was done last year by HIQA; that was its answer to HIQA.
I will not go over time; I will go under time actually.
I appreciate the Deputy's frustration. I appreciate that there needs to be a major plan. I also appreciate that this has to be done in a sequencing way so that the hospital can continue to function. The information I have for her is that it will be presented to the HSE board for approval at the end of this month. I cannot put it further than that.
I am attending the hospital, as I attend many hospitals, not to take photographs but to visit and speak with management to understand better the hospitals and how they work, the local nuances that impact them and the fact that Galway has been in difficulties over the bank holiday weekends. I want to understand the scheduling and roster, quite apart from capacity issues, and what is happening with the rosters and with the public-only consultant contracts and whether there are local issues that explain the particular difficulties they have had over the weekends. I am not interested in photographs, but I have to do my work. It is not the first time I have heard it. I appreciate the Deputy's perspective on it, but I do plan to go anyway.
I welcome that the Minister is going there-----
I welcome it, but she should listen to what I am saying. Back in 2015, it was not fit for purpose. We had Leo Varadkar down there telling us it was not fit for purpose, then we had Deputy Micheál Martin as Taoiseach, and here we are in 2025 and we are getting more and more plans. I welcome that there is something at the end of this month.
I know.
We have 31 people in there with nowhere to go due to delayed discharges. We have a serious problem with privacy and dignity. We have a problem with lack of staff and lack of clinical leads, notwithstanding the progress. I pay tribute to the staff. Let us go back to Savita Halappanavar in 2012, and forward. This is a hospital seriously under pressure, a congested site with not enough staff and not enough beds. They are short 232 beds according to their own press release. I pay tribute to the staff. What I do not pay tribute to is all of the Governments that have let this happen. There was an options appraisal way back where the hospital was to move to Merlin Park, and I foolishly relaxed thinking we were getting a brand new hospital. For the past five years we have been given a jigsaw approach to this and finally we are hearing now with a master plan, but there is no sign of it.
I appreciate that the Deputy has been raising this for many years. I appreciate the reasons for that, and I have huge respect for that. This is the approach that has been taken. From my perspective as Minister, I will be keen to see this move forward as quickly as possible with what sits within my control. I am concerned about the interaction with the infrastructure guidelines and the revision process that is ongoing with the Department of public expenditure and reform to make sure the delivery of these projects is done as quickly as possible. The question about whether, for example, we need four business cases or two businesses cases, as the Deputy said, when so much work has gone into it already to be further delayed by infrastructure guidelines such as they are would not be acceptable. That is a body of work I can take responsibility for by interacting with the Department of public expenditure and reform, and also the speed with which it moves with regard to my own Department. However, I do have very strong respect for the background work the Deputy has done and the way in which she has advocated for this month after month in this House when she has been a Member, and I understand the reasons for that. I look forward to going on Thursday to see for myself.
121. Deputy Martin Kenny asked the Minister for Health if she is aware of the issues of water leaking in the orthopaedic surgical theatre is Sligo University Hospital, causing surgeries to be cancelled; and if she will make a statement on the matter. [23221/25]
Sligo University Hospital has the worst-resourced orthopaedic Department with the worst orthopaedic infrastructure in the country. This is an unfortunate reality. It is a consistent struggle for surgeons to get work done there. The current issue is that the theatre roof leaked last week during intense rain showers. Water enters what is supposed to be a sterile area and compromises sterility. This increases the chances of surgical patients getting infections, which is a major patient safety issue. I know the Minister is aware of this issue. It is not just about getting the roof fixed; it is about getting a new surgical block. That is what is needed in that regard to resolve this problem long term.
I thank the Deputy. The Government is committed to the ongoing development of Sligo and our other regional hospitals. As he said, I am aware that there were issues with water leaks at the hospital and that in particular on 18 April, the leak led to the temporary closure of the orthopaedic theatre for eight days to allow for cleaning and air sampling to be undertaken, and I am told that additional monitoring is ongoing. While the theatre was closed, as the Deputy will be aware, a number of orthopaedic surgeries were unfortunately postponed. The HSE is working to reschedule those surgeries for those patients as quickly as possible.
As the Deputy will also be aware, two weeks ago I was there on site. I met with some of the surgeons. I heard directly from them on their perspective, not just on the theatre but as he said, on the surgical block and surgical issues more generally related to the north west. I thank them for their engagement. I was told at that point that there would be a meeting on 13 May, which is today, between surgeons, HSE estates and HSE management. I received an update this evening on that meeting. The purpose of that meeting was that the clinicians and HSE management would meet together to review the situation and plan the next steps and hopefully enable the full restoration of full orthopaedic surgeries, including elective surgeries. My information this evening from Mr. Tony Canavan is that, as I said on the day of the news report that I expected this to be fixed, HSE estates has outlined the immediate repairs to be done to the roof but more crucially, as the Deputy is more than aware, the plan to replace the roof entirely this year. It is my expectation that the roof will be repaired entirely this year, hopefully by somebody other than the people who did the initial leak repairs because they were clearly ineffective. That is my expectation of HSE estates.
The surgeons will reflect on the situation and a follow-up meeting is planned with them next week, after which there will be a series of follow-up meetings to monitor progress throughout the year. I hope that will resolve the issues in respect of the roof. I will address the other issues in my next contribution.
I appreciate the Minister's update. It is positive that the management is meeting with the surgeons to try to deal with this situation. I spoke to some of the surgeons, who are extremely frustrated. They want to do their job but they cannot do it effectively in the facilities they have. There are only eight elective orthopaedic beds in the ward, which must be shared between the patients of six consultants. The situation is not fit for purpose in the long term. We need to look at how to deal with this. The surgeons pointed out a number of issues to me, including that the ward is too small, the whole theatre complex is too small and there is no storage space for equipment, with boxes and plant kept elsewhere and surgical implements in danger of contamination because they must be moved into and out of the ward. There is a whole range of issues. New doors were put in that were too heavy for the walls, which are very old and are not fit for purpose. We really need to see a plan for how we will replace the surgical theatre for the future. That plan needs to be brought forward with urgency.
The HSE's capital plan for 2025 details the planned infrastructure investments for Sligo University Hospital. We have discussed the roof but there are also plans for a multi-service block development that will encompass a wide range of services, including a theatre department. Plans for that multi-service block are currently at detailed design stage. There has been significant investment in Sligo in recent years, including in the new 26-bed block. As I saw the day I was there, a 42-bed block is due to begin construction this summer. There is also a new CT scanner.
I compliment the staff of Sligo University Hospital, who have been much more effective in the past number of months in the management of their rosters, with the exception of one blip last weekend in regard to infection. They really have made a significant difference since February through their rosters and practices, thereby bringing trolley numbers down very considerably, including by more than 70% on bank holiday weekends. That is a function of their additional time investment and focus on the issues. I acknowledge that and thank them for their work.
That is positive news but we need to put a deadline on this to ensure it happens. While the new complex may be at design stage, it is a long way from being built. As Deputy Connolly mentioned in regard to Galway, people talk about these things for years and years but nothing happens. That is the reality. We do not want that situation to occur in this case.
There are other facilities can be utilised more. For instance, Our Lady's Hospital in Manorhamilton could be utilised for some of the orthopaedic treatment day services, including for people who come in for injections or small day surgeries. Places like that can be used. Manorhamilton is only up the road and could deal with some of the overcrowding and other issues at Sligo University Hospital. Mr. Gaine has spoken to me about that and I hope he has also spoken to the Minister about it. A number of the other surgeons have innovative ideas as to how we can deal with this situation and try to progress to a position whereby we have a proper service in place for people such that they would not be in danger like they are at the moment. The risk of infection is a real danger on the ward in question. We must all acknowledge that. I welcome any change or movement on this issue. We simply cannot continue just talking about it. The new surgical block has been talked about for 30 years. We need to make it happen.
I agree with the Deputy. It is my intention to do that, along with expanding surgical capacity more broadly in the north west, which we will speak about further. I agree about the need for an innovative approach. Already, some measures have been put in place in that regard. I want to see the immediate issues resolved very quickly in order that the surgeons are not dealing with them going into the autumn this year. There should be no excuse in that regard. I agree with the Deputy about what needs to happen over the medium and longer term.
I go back to the question we are all going to face regarding the infrastructure guidelines, how we deliver major capital projects, the length of time they take and the number of stages involved. It is a question of coming to the best way of proceeding whereby we get multiple bidders for these major infrastructure projects and have a competitive process that will deliver the right outcomes. In my time in the north west ten days to two weeks ago, across Leitrim, Sligo and Donegal, while I saw significant capacity and additional beds through community nursing homes, chronic disease management centres, community virtual wards and so on, there is a substantial body of work to do.
122. Deputy Seán Ó Fearghaíl asked the Minister for Health the timeframe for building four new elective hospitals; and if she will make a statement on the matter. [24131/25]
Will the Minister outline the timeframe for the building of the four new elective hospitals?
The Government approved the preliminary business cases for Cork and Galway, and the preferred sites for the two Dublin facilities. Following a public tender competition, the HSE appointed a design team and project controls team at the end of 2024. The design team is progressing design and engagement to inform statutory planning submissions and the regulatory approvals required. I go back again to my infrastructure point.
Surveys and site investigations have been conducted, which are informing the design and planning applications for enabling works that are expected to be submitted shortly. The design team is also progressing detailed design and tender documents to commence procurement for the main works. The granting of full planning permission for the Cork and Galway main works, expected to be submitted next year, will determine when construction works can commence.
The Dublin plans will also be progressed, using the principle of design once, build four times to optimise efficiencies, delivery timelines and value for money. Delivering these new facilities will require significant investment. I am engaging with my colleague, the Minister for Public Expenditure, National Development Plan Delivery and Reform, to secure the necessary funding through the NDP review. In the interim, new surgical hubs have been developed, with south Dublin already operational and those in north Dublin, Waterford, Galway, Cork and Limerick now under construction and expected to open for patients during the course of this year and next.
The elective hospitals are absolutely critical health infrastructure. In the past, acute and emergency cases have had to compete with elective cases, with people who had waited long periods having their elective surgery deferred. We often talk about the emergency room as being the focus point but it is really just a symptom of lack of capacity within our health services. I am very happy with what the Minister has outlined in terms of developing capacity in the health service. We need to alleviate demand and separate out acute care from elective care.
I completely agree. It is important to note that engagement with planning authorities is under way on agreement in regard to the principle of design once, build four times. I really cannot overstate that there is no room for local variation or perspectives. This is about doing something in the most efficient way and also having the ability to move between the different elective hospitals without any difficulty whatsoever. These elective hospitals will alleviate pressure on major hospitals. Precisely as the Deputy said, we should not have elective capacity within an acute hospital, which should be for the treatment of significant illness and trauma. The disruption that can happen for various reasons in acute hospitals delays planned surgeries and takes up capacity that should be there for urgent and emergency care within the acute system. My priority will be to secure the funding to advance these projects and also, working with the House, to revise the infrastructure guidelines to get to a way where we can build more effectively and efficiently, which is what we need for these projects in particular.
I sincerely wish the Minister every success. The elective hospital in Cork is supposed to be ready next year. It is now at design stage and will go to planning next year. It is years behind schedule. We were promised an elective hospital 20 years ago. The Minister is new in her role and I cannot land this on her shoulders, but I can land it on the shoulders of the Fianna Fáil and Fine Gael members who made promises every election year that the new elective hospital would be delivered in Cork. They went missing when the election was over. I will work with the Minister and do everything I can to ensure the new elective hospital in Cork is delivered. The project needs to be fast-tracked. The waiting lists in Cork are absolutely scandalous. The need for this elective hospital and for elective surgeries is absolutely huge. In Sarsfield Court, we have a perfect site of nearly 100 acres on the northside of the city next to Glanmire. I wish the Minister every success but the project must be fast-tacked.
While I agree with the Deputy, local issues that come up, including site selection and other questions like that, all delay the delivery of the different hospitals. We simply need to move forward with all of them in the most efficient way.
In Cork, the HSE is progressing that enabling package in advance of the main construction, including pitch and putt relocation, site clearance and demolition work, site access, roadworks and the planning applications to be submitted on a phased basis from September 2025 while work in Galway includes demolition and site clearance, with the planning application to be submitted in September 2025. That engagement with planning authorities is under way.
123. Deputy Pádraig Rice asked the Minister for Health to provide an update on the programme for Government commitment to design a statutory home care scheme, the timeline she is working towards, and if she will make a statement on the matter. [24093/25]
My question concerns the statutory right to home care. In 2017, the then Minister for Health, Deputy Simon Harris, said home care needed to be placed on a statutory footing. The same year, the then Minister of State with responsibility for older people, Deputy Helen McEntee, said a statutory right to home care and necessary regulations would be delivered in two to three years. Eight years on, they remain underdelivered. We know the regulations are finally progressing but what is happening with the statutory scheme? Will the Minister of State provide me with an update on the programme for Government commitment to design a statutory home care scheme and the timelines he is working towards?
I wish Deputy Rice well in his new role as Chair of the Oireachtas Committee on Health. No doubt, we will be working with him. The programme for Government commits to designing a statutory home care scheme to allow people to stay in their own home for as long as possible. As Minister of State with responsibility for older people and housing, I am fully committed to delivering the design of the scheme and the operational and legislative reform that will be necessary to underpin it. Achieving this commitment requires a focused effort across several work streams, all contributing towards developing the statutory framework and improving experiences of those receiving home support.
The first legislative element is the health (amendment) (licensing of professional home support providers) Bill 2024, which will establish a licensing framework for professional home support services. The general scheme was approved by Government on 14 May 2024 and has been referred to the Office of Parliamentary Counsel for final drafting with a view to presenting the Bill to Cabinet in quarter 2 of 2025. This Bill will provide for the regulation of the sector by HIQA. Final amendments have been made to draft regulations for home support providers following public consultation. Alongside this legislation, the Department is working to address the future financing of home care, the reform of the model of service delivery and the breadth of issues relating to recruitment and retention in this sector, all in the context of a substantial expansion of the State-funded home support service.
It has been a year since the Minister of State, Deputy Butler, told the Oireachtas Committee on Health that the delay was due to the funding model. At the time, the Minister of State said the nut had not been cracked on financing the scheme. In February 2025, the Minister for Health told me no final decision on future funding had been made and that further research was under way to enhance the evidence base. Is this still the case? It has been eight years and the Department should have figured it out by now. Political will is needed to get this over the line. What happened to the promise in the wake of the pandemic that an entirely different model of elder care would be provided? The regulations are important but only a statutory right to home care has the potential to deliver a radically different model. It is the most crucial part of the broader reform programme.
As Minister of State, I have a responsibility to navigate the introduction of a statutory home care scheme. I am utterly committed to it but it must be built on solid foundations and process. The home care sector is unregulated so we have to regulate it.
I know that.
This is a statement of fact. That is the first step. We are looking at the funding model. The ESRI is doing a body of work, which I hope to receive very shortly, looking at capacity in the context of acute, older people and private health services, so it is part of it overall. The first step is to get the legislation passed to regulate the sector. We will look at a funding model to look to introducing a statutory home care scheme that gives people the right to statutory home care.
It is taking far too long. The Social Democrats have concerns about the financialisation of elder care. In 2020, at the height of Covid, Simon Harris and Leo Varadkar said the model of care for older people had to change. Since then, the very large-scale commercial nursing home model has increased despite the fact it was deemed to be no longer fit for purpose. Ireland, alongside England, now has the most privatised nursing home system in Europe, with 81% of all nursing home beds in the State being privately run. Of even greater concern is the fact that very large investment funds now hold one third of all nursing home beds in the State. Eight years ago, those firms had virtually no presence here. While successive Ministers have delayed on the statutory right to home care, private equity providers and real estate investment funds have moved in. How many more of these nursing homes will be allowed before an alternative is put in place? I know the Government accepts that older people should be supported to stay in their homes but this rhetoric must be matched with more action. Expensive private nursing homes cannot be the default option for people. People deserve a right to home care and we need to put the regulations and that statutory right in place.
It is worth setting out the practical side of it. Since 2020, Government has increased the spending on home care packages by €338 million. That is a considerable amount of money that has clearly allowed people to stay in their homes. It is about choice. We must stick with the process. I am new in the role. A lot of work was done by my predecessor. It is now about bringing the legislation forward and bringing it through the Houses of the Oireachtas. I have no doubt we will be working on it in the Oireachtas Committee on Health, more particularly, in plenary session here and in the Seanad. We will then look to put a model in place that enhances the home care provision people have at home. The fair deal scheme took many years to introduce. It is about getting this right. Bringing it forward is a priority for me and the Government.
124. Deputy Naoise Ó Cearúil asked the Minister for Health her plans to improve diagnostic pathways and invest in infrastructure to meet target treatment times outlined in the national cancer strategy and if she will make a statement on the matter. [24135/25]
Each year, more than 44,000 people in Ireland are diagnosed with cancer. It remains one of the leading causes of death, accounting for 30% of all deaths annually. In July 2024, in excess of 172,000 people were waiting more than three months for a diagnostic imaging test, delays that have significant implications for early detection and outcomes. In light of these trends and the commitments made in the programme for Government, will the Minister outline her plans to improve diagnostic pathways and invest in the infrastructure needed to meet target treatment times as set out in the national cancer strategy?
The Government is committed to the implementation of the national cancer strategy and to improving the services patients receive. Infrastructural developments are a key enabler of timely cancer detection and treatment. Since the launch of the strategy in 2017, more than €140 million has been invested in capital infrastructure. This funding has improved cancer facilities throughout the country. It has delivered the new national cervical screening laboratory hospital and two new radiation oncology facilities in Cork and Galway.
This year, the HSE’s capital plan includes a further €20 million for diagnostic facilities. This will improve access to imaging, endoscopy and laboratories. The plan also includes €12 million for radiation oncology projects. These investments will continue to modernise our cancer care and diagnostic infrastructure.
Access to radiology and diagnostics has been recognised as an issue and I thank the Deputy for highlighting it. The productivity and savings task force published an action plan for 2025 to address this. This commits to greater evening and weekend availability of diagnostic equipment. I have spoken to the CEO of the HSE, Bernard Gloster. On foot of that conversation, he is conducting a review of diagnostic equipment utilisation. The findings will be presented to me along with the waiting list task force in June. This is very important to understand the local nuances of how diagnostic equipment is or is not being used and when it is or is not being used. The Deputy can be sure I have a very direct interest in that.
The Government continues to build on our investment and strategic approach to cancer control. Since 2017, funding of €105 million has been invested in the national cancer strategy. This has enabled the extension of population cancer screening, increased access to therapies and services and improved quality of life for people with cancer but, of course, we need to continue that work.
I appreciate the work under way across the health service and I know there is a strong focus on delivering improved cancer outcomes, but the data points to real challenges and real opportunities for improvement. I welcome the commitment from Government and the Minister and acknowledge the investment to date. Ireland still has one of the highest cancer mortality rates in western Europe and one of the highest rates of new diagnosis in the EU. Waiting times for access to new cancer medicines remain a concern, with Irish patients waiting an average of 644 days post-EMA approval, which is longer than many of our European counterparts.
Our screening participation rates are encouraging in County Kildare, with bowel screening rates above target. However, HPV uptake has dipped slightly since 2019 and the perception of access remains an issue. In Leinster, outside of Dublin, two in five people report delaying care due to system pressures.
We have made progress, which I acknowledge, but more is needed to ensure timely diagnosis, equitable access and improved outcomes.
The Deputy raised a number of issues, which I will try to take in turn. On medicines, approval for reimbursement by the HSE was given for 74 cancer drugs between 2021 and 2024. The total spend on cancer drugs in that period exceeded €645 million. We have launched an application tracker and have recruited an additional 34 staff, which is a 100% increase. I expect to see that move more quickly. It is also important that applications are made in a timely way. It is a two-stage process, as the Deputy will understand.
We hope the uptake of HPV will increase across all ages.
It is, of course, important to note it is a good thing that the numbers of diagnoses are increasing. It is a bad thing if the numbers are not increasing, considering our expanding population. We are living longer and detecting more cancers. We are treating more cancers successfully. We are identifying and diagnosing more cancers, particularly as we age. We must understand the implications of that marker. It is not necessarily a bad thing. It is about how we treat it. I will come in again.
I acknowledge the work of the Minister and her Department. I encourage the Department to continue prioritising that capital investment. I also encourage the delivery of ring-fenced funding for cancer services, as mentioned by her, which was committed to in the programme for Government. I also encourage the expansion of acute oncology facilities, ensuring patients undergoing treatment are not forced through overburdened emergency departments. We have heard in this House this evening that emergency departments are not the ideal setting for these people.
The national cancer strategy provides a strong roadmap and the commitment is clear. I acknowledge the political will is there. However, as incidence continues to rise and the population grows, as the Minister mentioned, now is the time to match that ambition with pace, particularly in diagnostics where early intervention can change everything. I appreciate, as she said, that as things improve, we will see more diagnoses. That shows the system is working and we are picking up on things, particularly with an ageing population. We must keep the pressure on and continue to work with the Department and the HSE.
I agree with the Deputy. The point about diagnostics is important. It is one of the reasons it is important for me to visit different hospitals and understand the efficiency of their work. Sligo hospital, for example, has two CT machines beside each other, which allows staff to move back and forth between them and thereby increase the number of scans being conducted. Some hospitals use their CT machines between 8 a.m. and 5 p.m. Others use them between 8 a.m. and 8 p.m. This inconsistency can have an impact on diagnostics.
I highlight the increase in the number of radiographers registered with CORU. There was a 10% increase between the end of 2023 and the end of 2024. Numbers are increasing in 2025. It is important that the registration of radiographers who have the capacity to work in Ireland is progressed by CORU efficiently. I would say the same for any other healthcare professionals who want to work in Ireland. If they are entitled to, they should be able to do so quickly. That might be an interesting programme of work for the health committee.
On rapid access clinics, I will be able to give the Deputy more detailed information but I am over time.
125. Deputy Naoise Ó Muirí asked the Minister for Health when the review of the model of care for eating disorders will be completed; and if she will make a statement on the matter. [24140/25]
I will bring the Minister of State back to the completion of the review of the model of care for eating disorders. Will she make a statement on the matter?
I thank the Deputy for this important question. Eating disorders are complex and individual. They are the mental health illness with the highest mortality rate. The first model of care was devised around 2018. At the time, it was expected that approximately 50 people would present with an eating disorder. In 2024, 562 people were treated through HSE services.
The national clinical programme on eating disorders has progressed well, with 14 of the 16 teams envisaged by the model of care now funded. Approximately 100 dedicated eating disorder clinicians are working on the teams across the country. Enhancement of eating disorder services is a key priority for me and the Minister. While there has been great progress under the model of care, we cannot stand still. That is why I am progressing the review of the model of care, which has two distinct phases. Phase 1 focuses on adult inpatient services and a review of adult bed capacity for specialist eating disorders beds is under way. The national clinical programme is developing a bed capacity plan with a geographical spread, which is important, based on this review. I expect to receive the plan from the HSE at the end of June.
Phase 2 will involve evaluating the community-based teams and reviewing service level trends over recent years to inform a plan for the future development and expansion of eating disorder services. Originally, it was envisaged we would need 16 teams, 14 of which have been funded this year. However, the clinical lead has already told me that another team will be potentially needed in the Dublin area, such is the growth in population.
I know this review is of keen interest to people with lived and living experience and advocates, many of whom I have met. I will ensure they have an opportunity to input into this review and have their voices heard as we plan for the future enhancement of eating disorder services.
I thank the Minister of State for the update. As she said, it is a complex area. The disease has been misunderstood for years. It affects girls and young women, in particular, in difficult circumstances. We regularly get the opportunity to attend briefings. I attended the Cared Ireland briefing, which was really powerful. It included testimonies from people who have suffered from eating disorders in the past, ongoing sufferers and family members. Everybody here probably has a family member or friend who is suffering or has suffered from an eating disorder.
The statistics the Minister of State set out, the 562 people receiving treatment, speak for themselves. That is the volume of cases.
The Minister of State said she hopes to receive a report on the phase 1 review by the end of June. That will probably involve beds with a regional distribution. I will come back in again.
I thank the Deputy. He is right that eating orders are complex and individual. They are the mental health illness with the highest mortality rate. Every case is different. I acknowledge the advocacy groups, including Bodywhys and Cared Ireland. They provide enormous support to people with eating disorders and I acknowledge that.
There are currently only three adult eating disorder beds in St. Vincent's University Hospital in Dublin. As of yesterday, nobody was waiting for a bed, which is unusual. There is normally a waiting list but there was no waiting list yesterday. We are trying to grow the number of beds organically around the country. There are 64 approved centres around the country, including departments of psychiatry. The HSE is considering where we can provide the correct wraparound supports, such as those provided by dieticians, clinicians, social workers and whomever else. We want to know if we can grow beds organically because we believe we have the capacity to do so.
That is probably the best setting. It is best to do it in a community or distributed setting.
The capital plan will require funding for beds. Does the Minister of State envisage that happening in the short term or will that be a three- to five-year part of the capital plan?
I hope, with the support of the Minister and Cabinet, to look for funding in the Estimates process when I have the report at the end of June. These premises exist. We will also consider any new approved centres. Five will be rebuilt and we will potentially look at putting some beds in there. We will have to grow this incrementally. Everything we do is incremental because we need dedicated staff. They are dedicated and precise in the work they do. They work with people who are very ill with eating disorders. As I said, dieticians are important. We have learnt a lot in the past six or seven years about the importance of a clinical programme. It is important that we move forward with the lessons we have learned.
127. Deputy Noel McCarthy asked the Minister for Health to provide an update on the development of a building (details supplied); and if she will make a statement on the matter. [24103/25]
Will the Minister for Health provide an update on the development of the community nursing unit at Midleton Community Hospital and make a statement on the matter?
I thank the Deputy. In 2016 a capital programme for older persons residential centres was developed in response to the introduction of HIQA's national residential care standards for older people and the requirement that all facilities providing long-stay beds be registered with HIQA. This is a programme to replace, upgrade and refurbish community nursing units as appropriate at 89 locations. The new 50-bed community nursing unit in Midleton is part of the programme. At the end of 2024, 51 community nursing units were completed. Seventeen are currently under construction; seven of those, including the unit at Midleton, are being delivered through public-private partnership, PPP. The remaining 21 are at various stages of appraisal, review, design or tender.
The community nursing unit in Midleton is anticipated to complete construction in quarter 3 of 2025. The HSE advised the Deputy in reply to a parliamentary question in February 2025 that it was anticipated that Midleton would be completed by quarter 2 of this year; however, there are a number of outstanding items that need to be addressed prior to completion. It is important to note that these items are essential for HIQA registration. All parties are actively engaging to address the outstanding items and ensure we achieve construction completion for each of the seven PPP sites, including Midleton. Following construction completion and commissioning, the new building must be registered with HIQA as per the Health Act 2007, as amended. Once the community nursing unit is registered, the HSE can admit residents. Workforce planning is progressing across all staff disciplines to ensure the required complement and skill mix of staff is in place to facilitate the operational schedule. It is estimated that, pending successful registration and recruitment, the new community nursing unit will be fully resourced and operational during quarter 4 of 2025.
I thank the Minister for her response. I also thank her Department and the HSE for progressing this development. Midleton Community Hospital supports residents and their families across east Cork and I am delighted, as I am sure the families of residents are, to see that the staff's hard work is being rewarded with a new facility that will accommodate increased numbers. The Minister has outlined the anticipated progression of the project and it is welcome news that it is progressing quickly. What use is planned for the Midleton Community Hospital building when residents have been moved to the new unit?
I will address the delay, such as it is. We want to anticipate the workforce planning is there to ensure it is operational. The delay is one that is essential for HIQA.
On the Deputy's question about the plan, when a HSE-owned property has been vacated by a health service, we have to determine whether it is surplus to health requirements in the area. That involves HSE engagement with other HSE services to establish whether they have a need for the property. I would be very interested in the Deputy's perspective, representing the area as he does. There is a programme of sale of buildings by HSE Estates, which I have been partially updated on. There is also a programme to offer them to the Land Development Agency for housing, if that is suitable, or to other State entities. I would be interested in the Deputy's perspective on the best use of the facility. It is important to hear from public representatives as well as every other stakeholder.
Will the Minister outline the total intended staff numbers and positions within the 50-bed community nursing unit, once it opens?
A scoping exercise with regard to the existing Midleton Community Hospital site is under way to identity possible future uses which align with existing service needs. My view is that we need healthcare capacity and we need to think about that in every way. There are multiple stakeholders. The Deputy's voice and view will be important in relation to that. With a rising population, we are trying to increase capacity in suitable ways. Not every site is suitable. Some are better sold or just moved forward. The HSE is not a property developer as such. We have a pressing housing need as well. Acknowledging all of that, a scoping exercise is under way with regard to the existing hospital. As soon as I have any information on that, I will update the Deputy.
