The national review of adult specialist cardiac services is finalised. The review provides a detailed, evidence-driven analysis of cardiac services across the country. A wide range of stakeholders - clinical, patient and public - were consulted as part of the review. The review provides recommendations around cardiac health policy, specifically: patient-centred care integrated with Sláintecare; increased cardiac care in community settings; a focus on prevention; capital investment for non-invasive diagnostics and imaging, including ehealth; structural reform to develop regional cardiac networks and national comprehensive cardiac centres; and leadership and governance. Publication of the review, which is very important, will facilitate the development of the new national cardiovascular strategy. That will take time to develop and will require significant reform to ensure effectiveness and sustainability. I am reviewing the report and I hope to meet the authors shortly. Yesterday, at St. Michael's Hospital, we met Professor Ken McDonald, who is one of the people involved, and I hope to have the opportunity to meet with them when I return from my St. Patrick's Day engagements. I would anticipate publishing it shortly thereafter.

Sentiment score: 0.32

I cannot answer why it has not been done to date but I commit to the Deputy that it will be done and, naturally, I would welcome his engagement on it when it is published. I will be meeting the people involved when I come back from the St. Patrick's Day trip. I look forward to getting it published then because, as the Deputy says, it is incredibly important that it is done. Recent trends in the demand for cardiac services reflect the changes in population and the health needs of an ageing population, which considerably changes the profile of need. The demand for emergency cardiac interventions is declining but the demand for non-acute services, such as the management of chronic disease, is increasing and we need a balance in terms of how to deliver the best service. We will need to carefully consider the number, location and resourcing of emergency heart attack centres to ensure that a balance can be achieved between accessibility and the provision of safe, efficient services. Cardiovascular health is a major pillar of the health funding announced in budget 2025, which included over €9 million in full-year costs to support important cardiovascular health initiatives. As the Deputy said, the publication of this review is a precursor of that, which I recognise.

Sentiment score: 0.34

I could not agree more about the need for a dedicated cardiovascular strategy and the multi-annual funding to facilitate that. With regard to Waterford, I have a small update. After an extensive recruitment campaign, we now have two labs open. One of those, from 18 March, will open with extended, albeit not 24-hour, 8 a.m. to 8 p.m.-----

Sentiment score: 0.06

I know the Deputy is aware but I want to inform the House more broadly. The other lab will provide elective services five days a week and the two labs together will protect better against both emergencies and elective issues. That is a major step in what the Deputy correctly acknowledges is a long-standing need. With regard to 24-hour care, I am very open to providing the best care possible. I want to see what is in the cardiac review and to make sure we have the resources there, but I also want to ensure they are doing enough procedures to ensure that patient safety is encompassed within that. I am keen to work with the Deputy on delivering both of those things as we move to that point, while recognising that enough procedures must be happening all of the time to ensure it is a safe place to do that.

Sentiment score: 0.56

Following the Deputy’s question last week, and prior to that, my Department and the HSE have had extensive engagement with the organisation concerned. That engagement has focused on identifying ways the organisation can continue to deliver services, which is what we want, how it can be supported by the Department and the HSE, notwithstanding the tax treatment, and finding what other solutions are possible. Several solutions in line with tax legislation and the provisions of the Health Act have been developed and presented to the organisation concerned, which might have the opportunity to reflect on that. Those solutions identify different business models that are practical and implementable and my Department is confident they would allow the organisation to continue its operation in line with all relevant legislation and the GMS contract. We both want the service to continue. In addition, the HSE provided for a third party to independently advise the organisation on the matter. I understand that this advice built on the solutions presented and further developed the organisation's understanding of what implementation of those solutions would involve, including the identification of any additional costs and resources required. The Department and the HSE remain committed to engagement to ensure it can continue to provide services. That engagement includes working with it to implement the developed solutions and identify any additional supports recognising patient need in that community. Issues relating to tax administration are a matter for the Minister for Finance but I am aware that section 1008A of the Finance Act allows, under certain circumstances, for the GMS income of GPs in medical partnerships to be treated as that of the partnership for income tax purposes rather than income of the individual GP. The introduction of this section did not change how GMS income of GPs who are not in medical partnerships, such as those in the organisation concerned, should be treated under tax law. Tax treatment is a matter for the Minister for Finance. What I am trying to do is ensure that this service remains open, that it has concrete solutions that are implementable and that it gets the resource support it needs to provide the patient care I know the Deputy wants for her constituents.

Sentiment score: 0.47

The Deputy set out the different options that were proposed. They were proposed in good faith with a view to keeping the service open and working. At some point, there is a finite number of options that can be proposed and try to be supported. They are really trying to work to find a solution. The Department and the HSE are ready to continue to engage with the charity regarding the proposed structural solutions. It will require some adjustment as to how GP Care For All operates or is structured but the HSE has also made a commitment to cover any funding shortfall arising from a change in the charity's operating model and to work through the implementation of the viable solutions that can be developed. More broadly, I am concerned to ensure that north-east inner-city Dublin is well served and better served by GP services. It is an area that needs GP services and support, as the Deputy and I discussed previously. We are very committed to trying to keep this service open but it will require some adjustment on both sides and we are working to find a solution. The current model will have to change a bit and be flexible in that way.

Sentiment score: 0.49

I do not accept that no solution has been attempted. I know it is not quite what Deputy Sherlock is saying but for the benefit of the House, proposals have been presented to GP Care For All. One is a partnership model, which is a traditional model of service delivery within general practice and also works in other areas. Another proposal is a hybrid model where the HSE contracts individual GPs to provide services to specific patients and a model around that. Another proposal is a more direct subsidy model. A few different options have been on the table. I appreciate that we have 29 seconds to work out the details and I do not wish to read it all into the record of the House but I am certainly happy to try to understand why not one of these models can work. I am also interested to see what flexibility GP Care For All can facilitate as well. The offer here involves structural solutions not just from the Department and the HSE but with an independent third party to try to find a solution, offer of additional resources and offer of direct subsidy. I am certainly not saying, "How much more can we offer?" but I do want to know what we can do to get this resolved because that is our intention. It cannot be that only one side is trying to work it out, however. There must be a certain measure of flexibility.

Sentiment score: 0.38

There is a significant ongoing programme of work to prepare for the opening of the new hospital, including integration of the three hospitals and operational commissioning. This operational commissioning includes the clinical fit-out for the entire hospital, total digital integration and staff training to ensure the hospital can open and accept patients safely and also that the workforces and cultures of the three hospitals come together. There are approximately 4,500 staff working across Children's Health Ireland. This is an increase of 26% since 2019. An extensive training plan is under development to support the transition of current staff to the new hospital. Since the definitive business case was finalised in 2017, the workforce plan for the hospital has been revised multiple times to take account of service developments. I am advised that there is active engagement between the HSE and CHI to revise this plan to take account of further service developments and ensure the right workforce is in place to staff the new hospital. This is something that will need to be revised continually as the population grows and as we build capacity, so I anticipate that the workforce plan will continue to evolve and grow. I understand that there is broad agreement on overall numbers required and every effort is being made to bring this process to a conclusion as soon as possible. Any additional staff needed will be sought as part of the annual Estimates process in the context of overall prioritisation of available funding. Over the next number of years as the population grows, that must grow with it and that is our intention in an appropriate way but, for the moment, the workforce plan is there. Regarding the opening of the hospital, I am assured by the builder that we will have the building at the end of June. I received that assurance verbally when I was there last week with the Northern Ireland Minister of Health, Mike Nesbitt. I am assured by BAM that we will have the hospital at the end of June, which is what it committed to publicly in January. The hospital has advanced very considerably - even since I was there last October. We have agreed early access for CHI. I might pick that up in my supplementary reply.

Sentiment score: 0.29

I am advised that there is active engagement between the HSE and CHI to further revise the workforce plan. The question of staffing in all the specialisms has to come within the workforce plan. I appreciate that between now and the opening of the hospital, we might get several such letters from different specialists who are, understandably, trying to make the best case they can for the best resources for their area but this can only be delivered within an overall workforce plan and the budget for that. While we might have different instances over time, that workforce plan is absolutely essential and that is what we have to work towards in the first instance. On the broader commissioning of the hospital, early access in April has been agreed. I am currently assessing the CHI plans to move in and what will be done on a month-by-month basis to ensure that we have delivery of the hospital for patients in 2026. At the earliest possible safe time in 2026 patients will be moved. I am assessing that pretty rigorously at the moment.

Sentiment score: 0.37

I am anticipating that report but I have not received it yet. I have not been presented with it yet. Of course, I will look at it immediately. There are a number of different issues that are not the same thing. One is the report, and we will look at the issues that are particular to that. The others are the resources and the increase in the number of consultants, which is quite considerable as the Deputy is aware, and making sure that we have the best workforce plan for the hospital in the first instance and into the future. They are two distinct things and I would not like to conflate them because no matter how many consultants we have, of course, we have to make sure that every consultant and every person working in the health system is working in the correct way. We may need to separate the issues in the review, which we will look at and I am sure the House will look at in great detail, from the overall workforce plan for the hospital for the future.

Sentiment score: 0.18

Yes, but-----

Sentiment score: 0.40

Over €200 million is invested in public oral healthcare services annually. The dental treatment services scheme provides oral healthcare, free of charge, to medical card holders aged 16 and over, as the Deputy is aware. Services are provided by dentists and clinical dental technicians who hold a contract with the HSE. It is not mandatory for a dental practitioner operating in the State to hold a contract to operate the DTSS. However, it is the Government’s continued intention to support and incentivise practitioners who choose to do so, in order that medical card holders can access vital oral healthcare. In May 2022, the care available under the DTSS was expanded and the fees paid to contractors significantly increased by 40% to 60% to incentivise that across most treatment items. Those measures did improve access to care and more than 44,000 extra patients were treated in 2024 compared with 2022. I know well, however, that there are some towns with no or limited DTSS dentists who have sufficient capacity to accept new patients. In those areas local HSE services can assist patients to access a dentist, and in exceptional circumstances where emergency treatment is required, the HSE can directly contact private providers or arrange treatment to be provided by HSE-employed dentists. The Government is committed to reforming oral healthcare services through the implementation of the national oral health policy, which is particularly important for children. I might come back to that on the supplementary question. The programme for Government contains commitments to implement that policy and reform care for medical card holders. The first phase of implementation to end in 2027 is currently being finalised and it includes reform for services of medical card holders as one of several priority actions. Of course, the real differentiation relates to children and a model of prevention. Perhaps we will catch up on that in the supplementary question.

Sentiment score: 0.22

I accept there has been an issue with the DTSS and the contractors numbers, notwithstanding the increase in fees and the increase of 44,000 in the number of patients being treated, which is something. Nevertheless, our figures for contractor numbers have gone down very considerably, from 1,500 in 2019 to 813 in 2024. In Cork and north Cork those numbers have gone from 35 to 26. I accept that. The new policy is designed to try to reflect this and reform that service delivery. The new policy sets out detailed descriptions of envisaged service reforms, which are about prevention, routine and emergency care, and oral health evaluation. That reform of the DTSS will be impacted by this new policy. It sets out for the first time that there will be comprehensive modern and clinical infrastructure supporting oral care. The child oral health examination programme, which is delivered by HSE-employed oral healthcare professionals, is to provide examinations and treatment identified as necessary from the age of seven up to when a child is in sixth class. Emergency care is also available from the HSE for children up to the age of 16.

Sentiment score: 0.22

No, it is not sustainable and that differential in money is not fair. This is why the emergency services are attempted to be covered by the HSE. We really do need to move to that new oral policy which provides fair and open access to people across every community and in a targeted way. That is about prevention as much as about emergency care. I appreciate what the Deputy has said about accidents, which is a slightly different thing, but this is about general oral healthcare. We need to focus on the implementation of that new policy, which is aligned with Sláintecare in providing care where it is needed and when it is needed at the right time.

Sentiment score: 0.02