I thank the Deputy. There is an audit going on into equity of access on waiting list management. I expect to have that audit at the end of November. I will have to wait until then to confirm any figures. At the end of August this year, there were 135 patients on the CHI spinal active waiting list, compared with 150 in August 2024. That is a reduction of 10%. Outpatient lists are also down, with a 45% reduction in the number of new spinal outpatients waiting on an appointment. While I recognise this progress, there is an awful lot more work to do to drive improvements in spinal services. I have met with families and advocacy groups, and it is important to listen to them. The Deputy is more than aware that €30 million was allocated to reduce waiting lists in different areas. There is a ringfenced theatre providing dedicated capacity. There are additional outpatient clinics, in particular this year on Saturdays, which have seen over 800 additional patients, and which has reduced the waiting list for initial assessments. We are trying to maximise capacity through national and international outsourcing. As I said earlier, which I appreciate the Deputy was not here for, there is an awful lot more work to do there. I am trying to explore additional options. Activity has increased with 342 spinal procedures completed so far this year, compared with 304 for the same period last year. This is a 13% increase, but at the same time we are seeing a growing need for those services. There are 370 spinal patients who have been added to the CHI active waiting list, which is a 10% increase compared with last year. While some of this reflects faster outpatient access and better referral pathways, we are also trying to do further analysis to understand some of the source of that demand, which is really important. The services remain an absolutely top priority and I will do everything I can to actively drive progress to address the challenges children face.
Sentiment score: 0.22
No.
Sentiment score: -0.30
I do not believe so. There is a separate portion of money to do that, so I do not believe that. I will check, but it is certainly not my understanding. I remain concerned about the number of children referred, or not referred, for international surgery. As I said earlier it is a source of deep frustration to me that those services are not being utilised. Part of the audit is an analysis of equity of access on the waiting lists, which is something we have not done previously. This qualitative assessment involves talking to parents and patients and asking them how they ended up in Blackrock, for example, and what the pathway was. I have spoken to parents who told me that the international option was not provided to them or was provided to them too late in the process. I am not clear on it, but I asked for an audit into spinal services, neurological surgery and another medical area in CHI precisely to try to determine that, such was my concern.
Sentiment score: -0.01
I updated the House earlier. They should be fully in sympathy. I also recognise that whoever is leading the inquiry will need to clarify the terms and make a final decision on what they need to be. I anticipate a comprehensive and transparent inquiry where the terms of reference are developed in partnership. The Government is one piece. The advocates are another piece, as is the person leading from both a legal and a clinical perspective on how that is best done. I updated the House on some of my thinking about this. I am conscious that I spoke with regard to other forms of inquiry, where the public nature or the particular model of statutory inquiry precludes the information in that inquiry being used for any other purposes. We look in particular at Limerick, where for the first time ever in the health system, there are a number of serious disciplinary proceedings happening there, particularly in relation to the Aoife Johnston case and the circumstances of that. There was review done by Frank Clarke, which had significant powers. I have spoken with Mr. Justice Clarke since to ask if powers of compellability would have made a difference to him. He was satisfied with the model he had. It is my responsibility to scope out the different models and express the pros and cons of the different models. We will ultimately have to agree the nature of it in partnership, but I am conscious of the need for whoever is leading it to be able to do a good job and have their appropriate powers, the requisite timeframe, support and all of those different things. We just need to work out what model is going to work best for that.
Sentiment score: 0.27
I thank the Deputy for allowing me to update the house on the new primary care centre in Graiguenamanagh, County Kilkenny. The need for that primary care centre was identified as part of the HSE’s overall primary care centre development programme. It is to be delivered via the HSE operational lease mechanism. As the Deputy is aware, the HSE has advertised for and identified a preferred developer for this new centre. I am pleased to advise that an application for planning permission was lodged by the preferred developer in July 2025. In response to this application, Kilkenny County Council requested further information on 1 September 2025. The HSE has advised me that the developer is in the process of preparing a response to that request. The preferred developer will issue a construction programme once approvals of the relevant statutory procedures have been secured. Once that programme is available, the HSE will be able to provide further updates on the timeline of the project, including the date of commencement of construction works on the site. When it is opened, it is envisaged that a wide range of primary care therapy services, community nursing services and GP services will be delivered from the centre. It is welcome news that the development of the new primary care centre in Graiguenamanagh is progressing and nationally we are trying to make progress in developing primary care centre infrastructure. There is a total of 180 primary care centres operational across the country with 51 of those opening since 2020. I assure the Deputy that the Department is engaging with the HSE to progress the further development of PCCs throughout the country, including specifically in the Deputy's good county of Kilkenny.
Sentiment score: 0.39
Absolutely. When it is operational, it is expected that it will have GP, dental, community nursing, occupational therapy, physiotherapy, speech and language therapy, dietetics and psychology services, as well as diabetic breathanyl screening and outreach for chronic disease help, all of which are so very important. The Deputy is right when he says that recruitment is a challenge. We have vacancies in the system, notwithstanding having the funding for it. I hope the primary care centre model will be a welcome addition to counties Kilkenny and Carlow. The Deputy will be aware of the existing facilities at Kilkenny Ayrfield, Kilkenny city east, Callan, Thomastown, Ballyhale, Ferrybank and Shamrock Plaza in Carlow. There is a further primary care centre in the early stages of development or planning for Tullow. These centres are a really important part of our care network. As I said, we have 51 opened since 2020, with five opening in 2024 and others having opened this year, most recently in Dunfanaghy in north Donegal and in Newcastle West. The facility in Roscrea opened in quarter 1 of 2025. Another seven primary care centres are currently in construction, two of which should become operational before the end of this year. They are an enormous support to the community, and we want to continue to see them driven and staffed.
Sentiment score: 0.32
I thank the Deputy. Clearly, we are trying to have a network serving counties Kilkenny and Carlow, and we need the staff. The vacancies are there. We are desperately trying to recruit and make sure the complete suite of services is there for the people of the county.
Sentiment score: 0.17
As the Deputy is aware, the Sláintecare target is 12 weeks for an inpatient procedure. That is how we measure performance across the entire health sector. Some 39% of the children on the active spinal waiting list in CHI were within Sláintecare targets at the end of August 2025, which is an improvement on 28% at the end of August 2024. Additionally, only 7% were waiting over 12 months, which is compared to 24% at the same time last year. There is, therefore, some progress being made in reducing waiting times, especially longer waiting times. It is supported by a couple of different initiatives. The dedicated GP referral pathway supports the appropriate prioritisation of urgent patients. Children requiring non-complex procedures have pathways to Blackrock and Cappagh to maximise the capacity for the complex procedures that are happening in CHI. International outsourcing has supported 19 patients to have surgery abroad. As I said earlier in the House, I am disappointed with the figures this year and I am unclear as to the referral pathways to maximise that. There is a new orthopaedic surgeon adding some capacity since 11 August. Crucially, the Mater hospital is now fulfilling its obligations in the adolescent transition spinal service to support seamless transition of care. I am trying to explore what additional measures can be taken. I have asked for a proposal from the Mater to see what more is possible in that regard. We are making some progress, but I acknowledge that it is too slow, and too many children are still waiting. I have met with the HSE and CHI board and executive several times over the past couple of months. I have made new appointments, in particular the appointment of Mr. Fergus Finlay to the CHI board, who will be an excellent advocate on the board working and seriously engaging with spinal services in particular. I have great confidence in him. I have also commissioned an audit of governance and equity in patient access and waiting list management, which has a very important qualitative element to ensure the patient and staff experience is also captured.
Sentiment score: 0.26
Yes, that is my intention. It is a partnership approach. At the end of the day, some terms of reference are going to have to be settled and it is absolutely our intention to do that in a partnership approach. The person leading it, of course, must have some knowledge of how it is going to be done and some hand in how best it can be delivered as well. That is an important perspective. It should not be coming from me to impose it upon them. We are genuinely trying to deliver a partnership approach. We are some weeks away from trying to get the exact model in relation to that. However, I hear very clearly the Deputy's perspective. Yes, I have a concern in relation to medical devices, which I am referring to HIQA to do an investigation and get its perspective. I have a concern generally in relation to governance, equity in patient access and waiting list management at CHI, which is why in May or possibly June - I would like to confirm that; forgive me, please - I asked the HSE to conduct an internal audit specifically into waiting list management and equity of access. I hope and expect to have that back at the end of November or beginning of December.
Sentiment score: 0.26
I did not make any comment on that. I said there was an audit-----
Sentiment score: 0.00
-----so please do not put words with me because I did not say anything in relation to that.
Sentiment score: 0.32
Yes, I would also like to do that, but we have to recognise that there are some children for whom it is suitable and who have had good outcomes. I answered the Deputy's question in relation to medical devices. I said I was referring a concern that I had to HIQA. In relation to the clinical lead, I said that I have commissioned an audit, which is a really important process. I do not wish to step across that. I am very happy to discuss the outcome of the audit with the House once I have it, but I cannot step ahead of that.
Sentiment score: 0.18
I thank the Deputy. I know he has been a very strong advocate for the Gorey primary care centre, the need for which has been well identified. A tender process has been undertaken. As he is aware, a preferred provider had been selected, with a letter of intent issued in 2019. Unfortunately, that selected preferred provider encountered difficulties regarding economic viability resulting in the collapse of the process in 2024. To facilitate the readvertisement of this primary care centre, a full review was taken with relevant stakeholders. A number of stakeholders require accommodation in that centre and a scope has been established. That review is now complete and a tender process is under way. The stage 1 tender advertisement was published on 24 June 2025. Stage 1 expressions of interest were received and evaluated and letters have now issued to all parties. It is anticipated that stage 2 priced offers will be advertised on the eTenders procurement platform in the final quarter of this year. The readvertisement and retender process for the project are necessary under the procurement rules. On the ambulance service, HSE capital and estates, in collaboration with the National Ambulance Service, has identified and agreed a suitable facility for use as an NAS ambulance base and is in the process of securing approval to purchase same, subject to planning approval being obtained. The facility will require capital investment to fit it out as a purpose-built ambulance base. The NAS and HSE capital and estates have completed the necessary documentation to facilitate the progression of the project in quarter 4 of 2025, which I hope is a good update for the Deputy. The HSE is working to appoint a design team in this quarter, with the aim of developing and submitting a planning application in early 2026 to progress the project. Those are two important updates for Gorey.
Sentiment score: 0.25
My immediate priority following the publication of the Thomas audit on 23 May 2025 was to ensure there was clinical follow-up and care for patients who had undergone pelvic osteotomy surgery. This is a once-off review to assess any complications that may exist and to determine the current clinical state. After this, patients then enter the recommended normal follow-up process. These multidisciplinary team, MDT, clinics have been under way since 6 June for clinical reviews of patients who had osteotomy surgery in CHI at Temple Street and Cappagh. As of Tuesday, 21 September, a total of 196 patients have had clinical reviews as part of the MDT clinics in both CHI and Cappagh. In relation to retrospective reviews of cases to determine the indications for surgery, as the Deputy is aware, the HSE is establishing a separate process involving external experts. Work to establish that external expert panel is advancing. It is expected that panel will be established this month and the review of individual cases will commence in January 2026. These are international clinical experts. We are trying to establish them to have the availability to do the work here - it takes a little time simply to have their availability - and for them to agree a robust and scientific methodological framework for conducting the review, which will be designed by them between September and December this year, by which everything can be measured. The HSE has also committed to the involvement of parents and patient advocates in the terms of reference for the review. We had a workshop to discuss the external expert panel with them on 14 August. A further workshop took place on 13 September, with a further workshop planned for today. Separately, it is my intention to communicate with all of the parents who are not necessarily part of the advocacy group representing parents, recognising that they may not wish to be part of it but also to make sure they have the opportunity to feed into perspectives, should they wish.
Sentiment score: 0.16
We are imminently close to appointing a lead. I would have preferred to be in a position to do that today, but I am not. It is imminent, essentially. I appreciate what the Deputy said about January. It is for this group of experts to determine their process and not for me to step across that. I expect and hope it would be done within six months but, again, if independent clinical experts tell me differently, then I will take their clinical perspective on it, as I am sure the Deputy would. I remain committed to updating the House, when I have the information, at any stage. I am sorry that I do not have a timeline for the complete group of patients, but I will look into that to see what is possible and come back to the Deputy. Again, it will be an estimated timeframe. I am somewhat pleased that close to 200 patients have had that clinical review. Of course, that has been prioritised for those who might be expected to have complications, as I understand it, but I will look at that further.
Sentiment score: 0.15
Yes. We are having the third meeting today. I will meet the hip dysplasia advocacy group on Tuesday, 14 October in Leinster House. I will also make clear to all parents who may not wish to be part of an advocacy group, or be connected to that, I am here to hear from them at any stage as well. It is also important to update the House that a meeting was held with the DDH advocacy group and the HSE on 24 September regarding mental health supports. It has been an enormously traumatic experience for many parents, as well as patients, to learn that surgery on their child may not have been necessary. A business case for funding all of the elements on this issue, including counselling, has been submitted as part of the Estimates process. I do not want to lose sight of that element of it too.
Sentiment score: 0.14
I thank the Deputy. While we have already invested in the University Hospital Galway campuses, there are significant proposals, as the Deputy is aware, for further investments there. The integrated development control plan, DCP, has been informed by population health needs and clinical demand. That has been developed and now provides a clear masterplan for the sequencing and delivery of new facilities. My Department has received a copy of the DCP and a programme strategic assessment report, SAR, which are currently being reviewed against infrastructure guideline requirements. In parallel, the preliminary business case for the first phase of works is under development. The SAR feedback will be returned to the HSE in the coming weeks for inclusion within it. A considerable amount of enabling works will be required to deliver the masterplan. The phased transfer of outpatient services from UHG to Merlin Park continues, with phase 1 of the outpatient department block now operational and phase 2 at design stage, which will unlock a portion of the campus. The initial scoping and site investigative works at UHG for various enabling works was recently completed. Site clearance works have already been undertaken to begin to clear the site for the first of the new 150-bed ward block. These include the removal of all above-ground prefab and solid structures on the footprint of the proposed development site and the diversion of a number of underground services. The old neurology building was recently demolished following the relocation of this service to Merlin Park. Further enabling works are currently at detailed design stage and will proceed to construction in early 2026. Beyond those, there is another tender to appoint an integrated design team for further works, which will conclude by the end of 2025, with further design work starting in early 2026. A tender is under way for construction of a new electrical energy centre to enhance campus resilience and support future developments there.
Sentiment score: 0.07
It is a master plan that is developed sequentially. The Deputy can see the complexity of the work that is going on there with the diversion of underground services. It is incredibly complex work. Deputy Connolly knows the site a great deal better than I do, of course, and it is an old site that requires considerable development work. The last thing I will do is place a timeline on it. I just want to see things progressing and I hope that by the time the Deputy asks me this question on the next occasion, unless of course other matters have taken over, I will have a further update on the business cases. I will make a couple of important points about how Galway hospital is improving in a couple of other areas because it is important. It recently moved the outpatient department to the facility in Merlin Park but it has recently changed its model of delivery to three-hour slots, three sessions a day, from what had been a two-session model, and that is providing an additional 60 clinical sessions every month. That is a really important and significant change for the people of Galway and for the management of the hospital. The Deputy will be better aware than I am that construction of the surgical hub is well under way. It is expected to be completed in quarter 1 of 2026 and to be operational in quarter 2 of 2026.
Sentiment score: 0.28
That seems perfectly reasonable and that is what I would do too. As the Deputy has saved me the background, I will save her reading out all of the trolley figures. I will highlight that unless Galway hospital, and the west and north west generally, start to routinely roster consultants on the public-only consultant contract at the weekends, they will continue to have the trolley difficulties they have had. It is very important. A total of 73% of University Hospital Galway's consultants have taken up the public-only consultant contract but the hospital was not able to confirm to me, at an important meeting on this on 11 September, the percentage of those who are routinely working extended days and at weekends. I will be meeting the team again in January and I expect it will have an update for me on their weekend rostering. To the extent the Deputy can help me maintain that pressure, nothing will change in Galway with trolleys or across the west and north west until consultants are routinely rostered at weekends, as is happening in other hospitals.
Sentiment score: 0.30
I agree with the Deputy. While in 2024, nearly 1.4 million people accessed therapy services across disciplines including physiotherapy, speech and language therapy, occupational therapy, dietetics, psychology, podiatry and all of that, in many cases waiting times are wholly unacceptable. To tackle this, the Department of Health is working closely with the HSE on a targeted, programmatic approach to managing therapy waiting lists in primary care, in particular. As well as looking at the longer term changes that are needed, we are trying to do what is possible right now. I have asked the HSE CEO to now put in place measures to address physiotherapy, occupational therapy and speech and language therapy waiting lists to reduce the waiting times for these three therapies to less than 10 months, which I hope will be achieved. That would be a massive improvement on where we are now. It would remove 60,000 people from the waiting lists across these three therapies and get them therapeutic services. That is a challenge but unless we set a direction and a target, which I have very clearly given to the HSE CEO, I am concerned nothing will change without some direction and the resources and support to do that. I do acknowledge that we have global workforce challenges, the same as everybody else in healthcare. We are trying to advance initiatives to retain and recruit the skilled professionals we need. Recruitment efforts include offering permanent roles to all Irish HSCP graduates, streamlined registration with CORU, which has improved enormously over the last number of months, and the introduction of 320 new training places via the CAO. The Deputy will be aware that since January 2020, 5,019 additional therapists have joined the HSE, a 30% increase. In that time, 40 additional therapists have been recruited in the Cavan and Monaghan area, bringing the total to 177. The Deputy will be aware that includes 12 new occupational therapists, 14 physiotherapists, 7 dietitians and 3 speech and language therapists, demonstrating our commitment to strengthening front-line capacity. I still acknowledge the concerns the Deputy raised and remain committed to targeted reform in the way I have given direction to the HSE CEO.
Sentiment score: 0.29
I thank the Deputy. He might allow me to reflect on that and discuss it with my officials further. What we are trying to do to build capacity in primary care therapy services is this three-part national programme, which I will lay out for the Deputy. Workstream 1 is an analysis of regional productivity to optimise current therapy care to maximise capacity within existing resources. Frankly, there is variation between regions and we need to understand specifically what that variation is and have a national response that prioritises patients who have been waiting over one year for therapy access. We are developing a primary care therapy waiting list management protocol, the purpose of which is to ensure consistency and transparency during referral, waiting list management and discharge across all primary care in the different regions to improve overall patient experience. We have seen this used in other areas to good effect and it is now time this be properly used for primary care therapies.
Sentiment score: 0.49
I thank both Deputies. There are an additional 320 new training places via the CAO in the different colleges. That is a significant expansion. I will speak to my good colleague the Minister for further and higher education, Deputy Lawless. My responsibility is, of course, in respect of the clinical training places that must go alongside the academic piece. We moved from a sort of apprenticeship model of nursing to an academic degree model to try to lift standards and expertise as far as possible, and enable the sort of advanced practice we want across the specialisms. We are now trying to do that with health and social care professionals too. I have met representatives of CORU about its registration processes, which, frankly, were too slow. There has been an enormous improvement to those processes. I have also met the different professions to signal clearly that we will be aligning ourselves with the European standards to enable even greater numbers of people to come from different parts of Europe to work in Ireland. That has not happened in the past at the rate we should have seen. CORU is working hard with the professions to ensure that clinical training places are available not just in acute hospitals but in primary care and other areas as well.
Sentiment score: 0.35
I propose to take Questions Nos. 87, 97 and 101 together. I thank the Deputy. Endometriosis has been under-considered by all of us, including the Department of Health and the HSE, but a significant body of work has happened in recent months. I am pleased to say that the national framework for endometriosis is now ready for publication. I am conscious that the budget is next week and we are trying to find the appropriate moment to publish the framework. It has developed and changed considerably, with significant additional patient voices now included. On 1 September, a patient voice forum was held in the Department of Health with 60 to 70 patients, comprising girls and women who were in difficulty or who had had difficulties and had successful surgeries abroad. I was also in attendance, as were the CEO of the HSE, the chief medical officer, the chief nursing officer, the head of the national women and infants health programme, NWIHP, and all of the senior clinical team. We were not there to participate but simply to listen to the women. We were there for quite a number of hours listening to their experiences. Their voices have directly influenced changes in the completed framework. I am glad we had that interregnum to enable their voices to come into that space and be heard. They have directly changed the language and some of the direction in the framework, as well as the communication of it. I am glad that opportunity arose and I thank each woman who shared her personal experience. Following the forum, I mandated an immediate action plan. On 5 September, I received an initial plan from the Department and officials from NWIHP. On 15 September, the HSE CEO advised that a working group had been established to develop the plan. On 18 September, I updated those who attended the patient voice forum. On 22 September, I approved the revised national framework for endometriosis and a letter for GPs to go alongside that framework to help advance awareness. On the details of the plan, the HSE will, crucially, increase the number of surgeries to be done this year. Some 600 surgeries were done in the first part of this year so you would expect 600 to be done in the second half of the year. I have required that an additional 100 surgeries will be made available in quarter 4 of this year and have provided funding for those surgeries. Nevertheless, I am conscious of the quality and nature of surgery, which is an issue we can discuss again, and the need to increase surgical skill everywhere. This condition is misunderstood or too little understood everywhere. The increase to surgical skill must happen internationally and also in Ireland. I have also provided funding for an additional colorectal surgeon. That position has been advertised. The role will be an important part of facilitating more complex surgical treatments. The HSE is also providing additional support for women within the treatment abroad scheme. It has in the past been too difficult for women to access funding to get effective surgeries internationally. I have a little more work to do in that regard to look at the different international programmes that can be supported. I will update the House as soon as I can. The HSE has created a different email address specifically to assist women with that service to try to streamline their experience within the HSE, which is important. An endometriosis group, with patient advocates and women's health task force members, has been set up. International endometriosis experts will now be invited to collaborate and engage with our own clinicians for better learning, diagnostics and surgical expertise. I yesterday approved a letter to all GPs, consultants and other relevant healthcare professionals to go alongside the framework, which is an effort to raise awareness of endometriosis. It is affecting many women, perhaps as many as one in seven. By that, I do not mean one in seven people but one in seven women. It is just as prevalent as other very common conditions, and should be as prominent in GP surgeries and should be understood by GPs. The HSE has also planned a GP practice update and a specific endometriosis awareness campaign.
Sentiment score: 0.19
I thank the Deputy. Our thoughts are with Aisling as she goes through her treatment programme. On endometriosis, I want to acknowledge the many different groups that have engaged with endometriosis sufferers and the importance of all of that advocacy work. It was a step change to invite women to come into the Department when many of them feel that the Irish health system has so badly let them down. It was difficult for many women to come in and do that but we had to bring that experience right into the heart of the Department, for it to be heard very loud, very proud and right at the centre of policymaking, and to have the HSE there as well. I acknowledge how many different people have already said that. Of course, the most important point and what is so important in relation to the GPs is that women are the most reliable narrators of their own experience. I need to say it again: women are the most reliable narrators of their own experience, not just on this but on everything. I am absolutely sick and tired of women not being listened to and not being heard. Part of the change with regard to GPs is to operate on a presumptive diagnosis piece and to really listen to women about the complexity of symptoms that can be there that are not necessarily menstrual. There can be constipation, UTI and a whole range of things that are not necessarily presenting as a menstrual issue. All the Deputies are correct in what they say about the quality of diagnostics and surgery. Many women are getting an inadequate service at present. I recognise that and indeed, they have told me that. For many women, because of the complexity of imaging and diagnostics and the complexity of reading MRIs, we do not have sufficient consistent capacity in this State to that reliably. That is an area that I am trying to develop, both in facilitating international experts coming here to provide additional training and longer-term fellowships and pathways for improvements in diagnostics. I also acknowledge the advances in AI that will facilitate this over time. I have been researching that as well but nevertheless, there is a significant body of work to do. I would say the same regarding surgeries and the complexity of same, including in relation to excision over ablation. I recognise that is a clinical issue but we must move to a model where we are capable of doing very complex surgeries. We do not want women to get to the point where endometriosis is right throughout their bodies. It is important to recognise that it is not simply a gynaecological issue. It can present right through the diaphragm. I have met women who have had endometriosis in their shoulders, eyes, brains, right through their colon and it is a very serious, painful condition. The pain management specialists and supports need to be improved, as does the quality of the surgical capacity. I do not say this to be critical of surgeons but it is just simply not there yet. I know that surgeons have leaned in to wanting to have better collaboration and fellowships with the centres of excellence that exist around the world, although there is not enough of that yet. We are certainly not there yet and we need no congratulations of any kind in relation to this. This is a body of work that has begun and that we will sustain and develop over time. We are trying to seriously improve things but there is a long way to go yet and I fully acknowledge that.
Sentiment score: 0.10