I will answer on HIQA specifically and ask the Minister of State, Deputy O'Donnell, for his perspective as well. HIQA plays a crucial role in ensuring high-quality and safe care for patients using our health and social care services. The Government strongly supports HIQA in maintaining and strengthening its critical regulatory role. While it provides an important role, it also needs improvement. A number of changes to both primary and secondary legislation have been made in recent years to expand and reinforce HIQA’s functions. Under the Patient Safety (Notifiable Incidents and Open Disclosure) Act 2023, HIQA’s remit has been expanded into private health services and hospitals. Other legislative amendments have strengthened the regulatory framework in nursing homes, giving HIQA additional new powers in the areas of enforcement, data collection and compliance notices. My Department has committed significant financial support to HIQA, reflecting its expanded regulatory role. The budget allocation of non-capital expenditure from my Department to HIQA in 2025 is €35 million, which is a considerable increase of more than 60% compared with the €21.4 million allocation in 2022. It is likely HIQA’s regulatory responsibilities will expand further under future developments, such as the patient safety (licensing) Bill, the provisions of which I took to Cabinet this week. I met with HIQA last week. Along with the Minister of State and I, it is considering what is needed to further strengthen its regulatory role and processes, in particular to reflect the changing dynamic of the nursing home market and sector and the ownership structures within those. That is important. I will continue to work closely with HIQA in reviewing its powers and exploring ways to improve and strengthen its inspection and regulatory regime. As I said, that includes exploring how HIQA can best deal with regulating larger corporate entities that operate in the nursing home space. It is important to say - and I know the Minister of State, Deputy O’Donnell, has been strong on this - that there is a need to report in real time, rather than some months later. We must have better visibility over this at an earlier stage. HIQA is an important institution in this State which has done exceptionally good work. I have good confidence in it. Everything, be it this House, HIQA and everything else, needs process and institutional development improvement in response to these events.
Sentiment score: 0.52
It is exceptionally important to acknowledge that our focus here is on HIQA, but HIQA did not do and did not enable what happened in the nursing homes. I want to take a moment to reflect on the fact that the provider and the individuals involved are ultimately responsible. We will also work with HIQA but let us first and foremost direct our ire at the providers of the nursing homes.
Sentiment score: 0.17
I recognise the importance of timely access for patients to medicines, including new medicines. Supported by €128 million of funding, in the past four years the State has delivered access to 194 new medicines. Of these, 74 were for cancer and 49 were for rare diseases. Budget 2025 allocated €30 million for new medicines, to come from efficiencies to be identified by the HSE. The Government has introduced a suite of new measures to enhance capacity in the HSE’s pricing and reimbursement system, including 34 additional staff, which is a 100% increase, and a medicines application tracker to increase the transparency and efficiency of the process. Access to medicines requires industry and the State to work together, through timely assessment, reasonable pricing and fully completed health technology assessments. This partnership has already directly benefited patients, for example those with cystic fibrosis and other rare diseases. In this spirit of co-operation, I continue to encourage pharmaceutical companies to submit timely applications for their products so as to increase access for patients with unmet needs. It is also the responsibility of the HSE to improve its efficiency and it has been enabled to do that with the provision of a 100% increasing in staffing in that area. All medicines are assessed from a clinical, economic and ethical standpoint, with no hierarchy of disease. Upon approval by the European Medicines Agency, applications for reimbursement are assessed by the HSE in the order in which they are received from applicant companies. As outlined in the programme for Government, as the Deputy correctly identified, consideration will be given to various measures to address access to medicines. As part of this, my Department is looking at reimbursement systems across the European Union, including Belgium. We are working closely with our Benelux partners on access to medicines where we have had some previous success.
Sentiment score: 0.28
I want to put a little bit of context on this. The State spent more than €3 billion in 2023 providing medicines to patients. We sometimes forget that €3 billion of the health spend goes to providing medicines. That is appropriate but it is a major budgetary consideration as well. With the early access programmes, we have to get the balance right between being able to get access to the drugs and also being able to work out how that programme intersects with the State's ability to negotiate the right price for the drugs. Regarding Duchenne muscular dystrophy, which the Deputy mentioned, I do not see how the State could be more proactive in trying to support this. On approval from the European Medicines Agency, I asked the CEO of the HSE and the Secretary General of my Department to find ways to support this. The HSE has proactively reached out to the company to ask it to submit an application. I made it my business to speak with the Italian Minister of Health at the EPSCO Council in Luxembourg to ask him to encourage the company to submit an application to Ireland. We will do everything we can because we recognise the life-changing implications of some of these drugs. However, as Minister, I must also point out that we have to get an early access programme right in a way that enables the State to get the best negotiating price for the delivery of drugs for everybody.
Sentiment score: 0.29
I will do so, Deputy.
Sentiment score: 0.00
I agree completely with the Deputy. However, my immediate priority is to ensure that there is clinical follow-up and care for patients who have undergone pelvic osteotomy surgery in accordance with the recommendations of the Thomas audit report. I am very aware that there are families around Ireland who are receiving letters and follow-up to say that surgery was not necessary on their child. I cannot imagine the distress that those families experience when they receive that sort of communication. I have spoken to families who are having that experience and it is so utterly distressing for them. Clinical follow-up to skeletal maturity for children in CHI Crumlin, CHI Temple Street and the National Orthopaedic Hospital Cappagh, NOHC, is already under way for patients. These children have been identified and categorised by age, with a proportion of them being close to skeletal maturity and likely to need just one appointment. The clinic is structured as a one-stop multidisciplinary team model for assessment, and that includes consultation with a doctor, a physiotherapy assessment, an X-ray, if clinically indicated, and immediate documentation of findings. After this, patients enter the recommended normal follow-up process. As of Monday, 23 June 2025, 115 appointments have been offered to CHI and NOHC patients. A total of 86 patients have been booked and 71 patients have been seen so far. Patients who request attendance at another hospital or with another consultant will have their request facilitated by CHI. It is important to say that the consultant who did the surgery is not the one who is doing the review, in the clinical follow-up. I will get to the expert review as well. I just want to make sure that this is on the record. In relation to the retrospective reviews of cases, which is the second process, to determine the indications for surgery and whether they were warranted, the HSE is establishing a separate process, involving external experts. Professor Deborah McNamara, the president of RCSI, has agreed to assist the HSE in establishing the expert panel and terms of reference. I have more information for the Deputy on that.
Sentiment score: 0.11
My practice, as much as I possibly can, is to meet people. Like Deputy Clarke, I have met parents and seen the distress. I have parents in my constituency in this situation. There is no difference between our experiences of this. I cannot believe the distress being experienced by the parents of the 71 children. We are already identifying children. Parents are being told through this initial clinical follow-up that their child did not need this. I will now update the Deputies on the expert review process to follow. We are in the process of establishing that panel. It is not complete but there are a number of experts from Canada and the United Kingdom. It is not surgeons within the system; it is very different. The clinical review follow-up, the first process, is expected to take about six months and for the secondary review panel, the independent expert one, it will take until September for the establishment of the team. We have four at the moment and there are a number of others to come. They need to agree the terms of reference; it is not for us to impose the terms of reference on them. They can assess each case as appropriate once they have begun.
Sentiment score: 0.05
I do not know the exact details of the Deputy's constituent's case but for any child now indicated for surgery, the assessment is done in a very different way from how it happened before. Any such assessment is done by a multidisciplinary team, including a doctor. It is a cross-site piece of work including a physiotherapist assessment. It is not, as had been the case, that an individual consultant makes decisions in his or her own bubble. This is a multidisciplinary team. The Deputy's constituent or any Deputy's constituent who has a child indicated for surgery can, depending on the timing, get the assessment through the multidisciplinary team. It is very different from what was there before. I hope that will give her more confidence where she has questions relating to her child. I agree with Deputy Clarke on counselling and psychological supports. Parents who take the advice of clinicians do so in the best interests of their child and now feel they have done something wrong in following that advice. It is a devastating thing to happen to a parent who is only trying to be a good parent and take the right decisions. They need support as much as their children do. I totally recognise that.
Sentiment score: 0.15
The GP chronic disease management programme commenced in 2020 and has been rolled out on a phased basis over four years to adults with either a medical card or, for GMS patients, a GP visit card. The aim of the programme is to prevent and manage chronic diseases. Since 2020, over 680,000 patients have been registered on the programme, including those who have exited the programme. Some 91% of patients now receive routine care in community settings, reducing their reliance on hospitals. An ICGP study found that for patients enrolled in the treatment programme, there were 30% fewer emergency department attendances, 26% fewer hospital admissions and 33% fewer GP out-of-hours attendances compared with their pre-enrolment rates. The majority of patients manage their conditions through the GP chronic disease management programme. In addition, the 26 operational community specialist teams for chronic disease management, linking the care pathways between acute and community services, are delivering services from integrated care hubs located in or adjacent to primary care centres. They are fantastic. In 2024, over 354,000 patient contacts were provided by community specialist teams for chronic disease management, about 55% ahead of target, and this year to the end of quarter 1, 108,000 patient contacts had already been provided by these teams, which is about 30% ahead of target. The conditions covered by the programme are type 2 diabetes; asthma; chronic obstructive pulmonary disease, COPD; and cardiovascular disease. The treatment programme supports patients in managing their chronic conditions. Patients receive two reviews in a 12-month period, with each review including a practice nurse and a GP visit. GMS patients over 45 years of age found to be at high risk of cardiovascular disease or diabetes are enrolled in the prevention programme and receive one annual review. The prevention programme was expanded from 30 November 2023 to include adult GMS patients with hypertension and all women who have had a diagnosis of gestational diabetes or pre-eclampsia since 1 January 2023.
Sentiment score: 0.12
That is right. It impacts early detection as well. As populations age - which ours is doing - the prevalence of chronic conditions, including multimorbidity, rises. Early protection through the chronic disease management programme prevents the need for more intensive hospital-based treatments. Since 2020, 51% of the new chronic disease diagnoses have been made through elements of this programme. It is not just treating more effectively; it is diagnosing more effectively and being able to divert attention to prevention and early intervention. As regards expansion of the scheme, a further expansion of the programme to include chronic kidney disease is planned for the end of the year, and further expansion would include rigorous clinical assessment and engagement with stakeholders. Not all chronic conditions can be managed in that way and it is important to recognise the capacity of general practice and how we are trying to grow general practice at the same time. I have listed a number of conditions but I also want to flag that, for example, the Benbulbin hub in Sligo treats a range of different illnesses and it is separate from the hospital, and again and again, prevents hospital attendances.
Sentiment score: 0.11
I can update the Deputy on the orthodontic waiting lists. As of April 2025, the HSE employs 14 consultant orthodontists and 36 specialist orthodontists nationally. There are almost 35 oral healthcare vacancies at the moment which the HSE is working to fill, including three specialist orthodontist whole-time equivalents, and a further 2.22 dental nurse whole-time equivalents. There are staffing challenges within orthodontic services in the Dublin and north-east region. At present, both specialist orthodontists posts in Dundalk, which also serve Counties Cavan and Monaghan, are vacant. The HSE is sanctioned to fill those posts and is actively pursuing both temporary and permanent recruitment options. A locum consultant orthodontist post is also being considered. The region also has orthodontic units in Navan and Ashtown, which have a combined total of two consultant orthodontists and five specialist orthodontist whole-time equivalents, currently filled and providing care in the Dublin and north-east region. The HSE is engaged to address the best use of existing funded private procurement options to support delivery of orthodontic care in the region.
Sentiment score: 0.20
I totally recognise that and I commit today to writing to the Deputy with a full answer on these points. However, as regards the waiting list initiative, there is €8.4 million for this year, provided on an ongoing basis this year to address the primary care waiting lists for children, including in orthodontics. The funding is ongoing rather than one-off and is provided to try to reduce the waiting lists and address increased demand for those services. In the area of orthodontics in 2025, €1.35 million is to be invested in the jaw surgery initiative, while €1.5 million is to be invested in the community-based treatment initiative. Up to the end of May, 128 patients had been transferred to private orthodontic treatment, with 33 receiving jaw surgery under that initiative. A higher number of grade 5 patients are commencing, progressing and completing treatment than grade 4, and I recognise the very serious impact that has, particularly on young people, and the need for timely surgery. I will come back to the Deputy with a complete and full answer.
Sentiment score: 0.12
General practice plays a vital role in our health service but we need more GPs to improve access to services in some areas. To meet that need, the programme for Government has committed to increasing the number of practising GPs through a combination of increased training places and international recruitment. In part, to attract doctors to practice as GPs here, the Government has significantly increased expenditure on general practice, primarily through the 2019 and 2023 GP agreements. The agreements provide for increased fees for GPs, increased and new practice supports, and new services for patients, including the GP chronic disease management programme we spoke about. The number of doctors entering GP training increased by 80% from 2019 to 2024. As a result, the number of GPs graduating has also increased and will increase more in the next few years. Evidence of strong interest in GP training and high-retention among GP graduates shows the positive impact of the Government's increased investment in general practice. In addition, recruitment from abroad continues under the HSE and ICGP international medical graduate rural GP programme. Under the programme, doctors work in general practice while undergoing a two-year training programme. Currently, there are 118 such GPs in placement, while a further 18 have completed the course. The number of HSE-contracted GPs has increased by approximately 7% since 2020, although this is a key-target area for growth. The recent ESRI publication on the future capacity requirements for GP services confirms the need to continue to increase our GP workforce in light of our growing and ageing population. The strategic review of general practice will be completed this year and will provide further recommendations to improve GP capacity and the sustainability of our general practice service.
Sentiment score: 0.47
What we are talking about is the continued need to expand GP services, as we have pushed more and more services into the community and that is where we want services, such as the chronic disease management programme we discussed, to be delivered. It is the case that the number of GPs is increasing, albeit at different rates in different regions, but we have a particular challenge in rural Ireland. That is one of the reasons there is now a dedicated programme in the University of Galway. It is a specific rural GP programme to address some of the different slightly specialised issues. That is why I met the Medical Council recently. It was to address such cases as those of Irish people who trained in this system and got three or four years' experience abroad, who come back to Ireland and wish to work as a GP immediately. We need to make sure those people's registration process is triaged and expedited by the Medical Council, there being no reason those people should not be activated to work, as they wish to do and their communities need them to do, as quickly as possible. I have a good detailed list of the number of HSE contracted GPs. It is increasing. It is an option that was clearly identified in the programme for Government. Not everyone wants to set up a business. Some people want to work in a different structure and we are trying to enable more and more of that.
Sentiment score: 0.23
I agree on the delivery of primary care centres. It is difficult for me to speak in general terms about GPs or other medical staff leaving because there will always be a case of someone who has done that. It is not the general trend of what we are seeing. There is clearly work here. There is the opportunity to set up a business and work in one's own practice. There is the opportunity to work in HSE primary care centres and other more directly employed opportunities, that is to work in different ways and there is clearly a need for that. Notwithstanding that, the contracts in 2019 and 2023 were favourable and there is an opportunity to continue to expand practice. There are now direct diagnostic referrals from GPs to try to get GPs operating at the absolute top of their practice and experience. It is very attractive. On the recent dialogue in the Dáil about the cost of living and some of the challenges in the price of groceries and other things, it is a source of great frustration to me that we have expanded eligibility for GP access cards to 430,000 people and only 72,000 of them have taken it up. We have tried to communicate. We will do more to try to communicate, but I ask every Deputy to communicate to their constituents as there are people who are entitled to free GP access cards. We are delighted to pay for them and it would be wonderful if they would take it up.
Sentiment score: 0.40
The Government is fully committed to the ongoing development of regional hospitals, including Cavan and Monaghan which operate as a single hospital entity, with integrated managerial and clinical governance systems, care pathways and support functions. Since July 2020, significant resources have been invested to meet the needs of patients using Cavan and Monaghan hospitals. The total budget for Cavan Monaghan General Hospital has increased by 30% from €115 million in 2020 to €149 million in 2025. Staffing has increased in the Cavan and Monaghan hospital by 295 people since January 2020. That is an increase of 26%. The budget has gone up by 30% and the staffing has gone up by 26%. Median waiting times for patients attending the emergency department are within 3% of the national average. For those admitted to the hospital through the emergency departments, median waiting times are 10% lower than the national average. Cavan and Monaghan hospital has two CT scanners and one MRI scanner, which are located at the Cavan general hospital site. As with all CT scanners, I will be assessing how and when they are used. Cavan Monaghan General Hospital has made an application to the HSE national equipment replacement programme to replace the existing MRI scanner located at Cavan. This project has been approved and works are expected to be completed by the end of this year.
Sentiment score: 0.12
Waiting times at Cavan Monaghan are improving a lot. Some 35% of outpatient appointments occurred within Sláintecare wait times compared with 25% in the same period last year, which is an improvement that needs to continue. Some 58% of inpatient day cases occur within the Sláintecare wait times, as do 95% of GI scopes, which is an improvement on 87% last year, and 94% to 100% of those waiting for outpatient, inpatient or day case, and GI scope appointments are waiting 12 months or less. I see progress there. The application is from Cavan Monaghan General Hospital for the replacement of the MRI scanner located at Cavan. That is the application the hospital has made to the HSE.
Sentiment score: 0.29
I am sure the Deputy has discussed this in detail with the management group already. I wonder what response he got directly. As I said, staffing at-----
Sentiment score: 0.11
Deputy Carthy is the local representative in Monaghan so I assume he has discussed this in detail with hospital management.
Sentiment score: 0.00
If the Deputy would like me to answer, I will do so. The reality is that staffing has increased in Cavan Monaghan General Hospital by 26% but the increase in Monaghan has been 70%, so Monaghan is not being left behind. I look forward to going there and discussing all these issues, including the business cases submitted or not submitted by Monaghan hospital, as I am sure the Deputy already has.
Sentiment score: 0.41
I thank the Deputy. I am a huge advocate for the reform and expansion of pharmacy services and the Government is committed to ensuring people can access as much care as possible in the community including in pharmacy, which will play a very large and expanded role in this. The report of the expert task force to support the expansion of the role of pharmacy was published in August 2024. Its findings provide a framework to inform how we are going to do that. My vision for the future includes pharmacists playing a much larger role in the health service. I am happy now to see the progress being made between my Department and the representatives of the Irish Pharmacy Union, IPU, in this regard. The priority focus is the development and introduction of a common conditions service in community pharmacy. That service will be the first step in enabling full, independent pharmacist prescribing. It will allow pharmacists in Ireland to treat their patients for common conditions such as shingles, urinary tract infections and conjunctivitis. It will also support the development of new revenue streams for pharmacies. Development of the service is well under way. It is led by the community pharmacy expansion implementation oversight group. That group meets monthly with the aim of developing the necessary enablers for required to establish the common conditions programme. That includes clinical protocols along with the pharmaceutical regulator, new education and training for pharmacists and a package of required regulations. We aim to have all of these in place to facilitate pharmacies to establish this new service before the end of the year. Deputy Ó Muirí asked about GP care. The huge advantage of this is that it will take some of the work from GPs into pharmacies that can be done more easily. From the patient's perspective, I would like a patient to be able to go into a pharmacy, be diagnosed for a simple and common condition of this kind and pay a fee to do so, and get their prescription there and then rather than go to a GP, pay a GP fee, go back to the pharmacy and pay for the prescription. All of that can be taken into one. The intention is that this would be the basis for beginning this, recognising that taking that approach will expand access to healthcare generally, and that patients in the general medical services, GMS, scheme and so on still have that option with GPs but now with, I hope, increased capacity.
Sentiment score: 0.34
I am sorry.
Sentiment score: -0.08
The first and most important thing is to take the steps forward to get this going. There was an inertia on that, if I may say, until recently. It has now been progressed and there are detailed negotiations to take the necessary steps forward. I would like to see this in place and operational and then be able to expand it appropriately. I have already said, I think, that the list of common conditions should be expanded. It is not going to be enough but it is no harm to get the practice under way as quickly as possible, make sure it is supported by the appropriate regulatory and training environment, and recognise that pharmacists themselves need more support and more pharmacists' assistants and technicians. They are working under pressure in different ways and need to build their own capacity to do this as well. My vision for it is that is established, is working well and will be expanded as quickly as possible. Pharmacists are trusted and we need to expand this service as much as possible, recognising that will take that pressure off GPs. For an older woman, in particular, a urinary tract infection can be very dangerous. They need to be seen and diagnosed and get medication early rather than wait for a GP appointment. By moving that into pharmacy, it frees up that slot in a GP practice as well. It is a broader expansion and a good thing generally.
Sentiment score: 0.20
I agree completely with the Deputy, and I thank her for that. While I do not have an update for her today - it was yesterday we discussed it - I have instructed my officials to see what can be done, and I will revert to her on it. I have to say Deputy Moynihan has got me. I do not know, and I am going to have to find out. I can tell him about estradot patches and so many different things but I cannot tell him about vets, agriculture and pharmacy. He has got me, and I am going to have to go back and find a proper answer for him. I commit to writing to the Deputy today to make sure that is done. I ask him to please forgive me; I do not know.
Sentiment score: 0.21
On 19 June, CHI advised the Joint Committee on Health that neither Temple Street nor Crumlin hospitals accepted the Dickson report when it was completed in 2017. My Department received a copy of the report on Friday, 20 June and my officials are reviewing it. I will be seeking assurance from CHI that the matters raised in the report have been addressed. In light of concerns raised in relation to corporate and clinical governance concerns at CHI, as the Deputy is aware, I have appointed two HSE board members to the CHI board. We discussed yesterday the changes to the service level agreement, the role of the HSE and the internal audit being conducted by the HSE. I do not wish to disrespect the Deputy by repeating those issues he already knows about, but all of those governance changes are being made with a view to supporting the new CEO as she continues to establish her executive team. She needs to implement the recommendations of a range of different reports and at the same time take CHI forward in a constructive and positive way towards the new hospital but also towards the delivery of better paediatric services across this country. On the Deputy's direct question around the Dickson report, my Department received it on Friday, 20 June and is reviewing it. I can engage with the Deputy further on it.
Sentiment score: 0.26
I could say about the summary that it is CHI's view that this is the best it can do, recognising some of the HR and legal constraints. I want to see the report published in the broader public interest but it is not necessarily the case that in every instance it should be published. In particular, I am concerned that this was a HR report where people who might be constituents of the Deputy, and for whom he might take a protective trade union perspective as well, participated in a process to try to address a significant cultural issue. It would be very difficult for those people to talk about the experiences they had in this HR process and for their comments to be published in the public domain. While we are trying to get to the issues relating to culture and to governance, I understand the difficulty there for those individuals and CHI's perspective on that. In relation to the legal advice, in general that is a matter for CHI and the committee directly.
Sentiment score: 0.13
I very much respect the Deputy's perspective on that and on the culture piece. I had a good meeting with the new CEO, Lucy Nugent, where I was very clear and reiterated that this is a new CHI for the future with a new executive management team, a new approach and a new culture. She needs that team around her to be able to implement that new culture. She is coming from Tallaght, where there has been good success and where she has a very strong track record in relation to that. I take the Deputy's perspective on the response to parliamentary questions and other matters very importantly and seriously. There is never a difficulty in being forthcoming with information to the extent that it is appropriate legally and from that HR perspective but there is a way in which you can lean in and provide better confidence. I would be careful with phrases such as "confidence is on the floor". People are attending Crumlin and Temple Street hospitals today. I was there last week. I have a lot of confidence in the medical team there. I have a lot of confidence in the nurse specialists who listened to my voicemail and rang me back and the service and support I receive. That is the majority experience of Crumlin and Temple Street. There is a very important set of problems that we have to address but the majority experience is positive. I have parents contacting me to continue to make that point about their experience. This is parents and children at very vulnerable moments going in to receive hospital care and they are getting it. We have a body of work together as a Legislature but we just need to be careful about the experience that they are having as well to make sure that we are reflecting it in a universal way.
Sentiment score: 0.42