I do not think anybody wants to be involved in strikes of any kind. That is not how we do things, which is why we have the very comprehensive industrial relations architecture we have painstakingly built over some time. The HSE and my Department have engaged extensively, constructively and in good faith, as have the National Ambulance Service representatives, for more than two years to address the issues raised within the National Ambulance Service. That engagement has taken place through the State’s established industrial relations machinery, including the Workplace Relations Commission, WRC, and the Labour Court, and within the framework of the public service agreement. A comprehensive and independently brokered set of proposals emerged from that process. These included significant pay improvements for staff, of between 3% and 14% on top of the 9.25% pay increases already provided for under the public service agreement. Crucially, those pay increases were linked to agreed reforms and I can go through some of the detail of those reforms, which would generate a more comprehensive ambulance response service for everybody and an easier working life. The HSE and my Department accepted the proposals and the subsequent Labour Court recommendation in full, and both SIPTU and Unite recommended them to their members at the time. The difficulty now is that the unions are seeking to secure all the pay increases while there has been a reluctance to deliver the accompanying reforms. Those reforms are essential because they deliver real benefits for patients and service delivery, including faster response times, more ambulances available through modern crewing arrangements, greater flexibility across the service, stronger assurance of ongoing regulatory compliance and the ability to treat more patients safely in the most appropriate setting.
Sentiment score: 0.48
It is important to acknowledge that there has been 30% growth in the staff of the National Ambulance Service, which is a larger proportional increase than the health service received overall. We have invested an additional €75 million in the service since 2022 and staff members have increased by 761 since 2022. The total workforce is now 2,500. Further investment planned for 2026 will deliver 21 extra crewed ambulances at peak demand. I understand that 134 of 168 posts have been recruited, so recruitment is progressing reasonably well so far this year. My overriding priority, of course, like the Deputy's, is the safety of patients and the continuity of the emergency services. It is important to discuss the reforms that have been suggested and agreed in the industrial relations architecture, and I can do that. However, we cannot just increase capacity anywhere without introducing reform as well.
Sentiment score: 0.25
I am very invested in resolving disputes, and that is why we put so much effort into the industrial relations architecture that we have. It is important to highlight some of the models of the proposed reforms under the agreement reached between union representatives and State representatives in those structures, for example, a modernised pay and allowance structure, which replaces a complex pay arrangement dating back to the late 1970s with a simpler, transparent structure aligned to wider HSE norms. It standardises overtime arrangements to HSE rates and incorporates rostered working requirements, including weekends and night working, to core pay structures. These are important reforms. It is important that we discuss reform in the health service because while we can set a target of 4,000, if we are at 2,500, the Deputy and I both know that we have to deal with the practicality of today. There are 134 already in place out of the 180 posts that were funded towards the end of last year. We are desperately trying to recruit into all parts of the health service. However, it is not a realistic conversation for the Deputy and I to say that we are going to go from 2,500 to 4,000 within six months. We have to recruit where we can, and implement the reforms to make sure that everybody is working in different ways, including in a much more modernised structure. We cannot stand over one that comes from a pay structure from the 1970s.
Sentiment score: 0.10
I am sorry. I have this question as "not submitted".
Sentiment score: -0.04
I do not have a Priority Question from the Deputy. I will try to get an answer for her, but we have this question as "not submitted".
Sentiment score: 0.00
I will do my best to answer.
Sentiment score: 0.64
My apologies for the mix-up, whatever the source. I will get the Deputy a full and more official answer. Nevertheless, I will speak from my own experience. The focus on delayed transfers of care is an integral part of the focus on trolleys - the whole thing goes together. What we are really talking about is patient flow. Hospitals that experience ongoing delayed transfer of care, DTOC, problems include Letterkenny University Hospital, for example, where the number was in the 40s, but is now down in the 30s and moving towards 25. Directly across the road, there is a 100-bed community nursing unit that will open in 2026 and take some of the pressure off. It is also about the management of this. For example, in Galway, we have gone through a deliberate reset. This speaks to the Deputy's example. The last week in Galway hospital was not good. It lost some of its private capacity for egress or transferring out of the hospital, and because that happened, the trolley numbers built up, and it has had seven very poor days. In the previous 25 days, it had only two red days, 22 green days and one amber day. In the 25 days before that, that was essentially inverted, and it was all red and maybe one green. Patient flow matters, and it matters all the time. It matters because of the impact on people in emergency departments, but it also matters to the hospital's ability to bring in inpatient day cases. As the Deputy highlighted, the use of surge means hospitals cannot do endoscopy investigations and so on. They cannot bring in non-time-critical electives. Of course, they bring in time-critical electives like cancer surgery, but not non-time-critical electives. That is why the focus on urgent and emergency care, UEC, is important. It is a complete piece. There is no point in focusing on UEC without making sure they have a full awareness of what is available in the nursing homes. University Hospital Waterford does that particularly well. It has visibility in its patient control room of all of the passages out of the hospital. There are others that could do it dramatically better, such as Letterkenny University Hospital, and many of those have a DTOC problem, except for St. James's Hospital, which is a weird one that I will come back to.
Sentiment score: -0.03
The Deputy is 100% right. It does not necessarily lie with the hospital management. For example, in Cork, with the IHA managers, there is no governance element to this. They are not CUH beds or Mercy Hospital beds, and nobody had better tell me that they think they are. They are beds for the south west, and they have to be managed from a single centre, which happens to be in CUH at the moment, but we will see about that. They have to have visibility over what is the situation in Blarney, Bantry, Mallow, South Infirmary and other places. It is their whole responsibility to be able to move people through. As for the hospital managers' responsibility, I do not want to hear from consultants who say they cannot move X patient because they need to be in CUH instead of the very good care in Mallow. There needs to be an understanding that every hospital sits within a region, and patient flow works in that way. That is the only way this can possibly work. I am glad to hear the Deputy highlight that because it is the sort of reinforcement I need, particularly in the south west, to make sure that the patient flow experience is fully understood and that every bed is opened. As regards the Killarney unit, I am told that will be in the next couple of weeks. There was a HIQA registration problem and there is engagement with the union but, frankly, it is not good enough that those beds and other beds have not been opened. Mallow's 24 beds were supposed to be opened in quarter 1. It will now be very shortly but it should have been done.
Sentiment score: 0.10
I understand. For example, I visited a facility very like that. Please forgive me; I do not have the name in front of me but it is in the north of Dublin, an acquired brain injury-----
Sentiment score: 0.24
That is exactly it. Forgive me. It is looking to build the facility adjacent to the primary care centre.
Sentiment score: 0.26
Exactly. What we can do is work with an approved housing body, AHB, to build that residential. The HSE is for delivery of healthcare and we try to make it work as well as we can but here are the things we are not: we are not a transport company and we do not build homes. What we can do is partner with AHBs to make sure we are developing long-term residential that is adjacent and appropriate for needs of that kind. On that site in particular, what we are looking at is what capacity we can have for people who need to come to that facility and that form of residential. We are trying to work with the sites we have adjacent to a primary care centre. I used that example because I happened to be there so recently. The Deputy is right about acquired brain injury and dementia but the HSE has to focus on healthcare and partner with bodies like approved housing bodies that are experts in building housing.
Sentiment score: 0.31
I would rather it did not.
Sentiment score: 0.00
I thank the Deputy, and I join him in thanking the Secretary General, Mr. Robert Watt, and the previous CEO of the HSE, Mr. Bernard Gloster, who both did outstanding work in the Department of Health and the HSE in different ways. They have really stabilised and improved the service more broadly since 2022 in particular and I thank them for that. I also wish both the new Secretary General, Mr. Derek Tierney, and the new CEO, Ms Anne O'Connor, well in their new roles, which are very significant roles for everybody. Notwithstanding those changes in personnel, there is no change to the programme of work. That needs to continue. We remain fully committed to the Sláintecare vision. The next meeting of the Sláintecare programme board will take place on 28 April. At that meeting, progress across all of the Sláintecare projects will be reviewed in respect of the action plan for 2026, the second of three action plans under Path to Universal Healthcare: Sláintecare & Programme for Government 2025+. The Deputy knows what they are. For quarter 1 alone, this includes 90 actions across 12 Sláintecare projects. In total, the programme board oversees 23 projects with approximately 400 actions. What does that mean? It relates to reforms being driven through, for example, with the enhanced community care programme, the public-only consultant contract, POCC, and, crucially, the implementation of the POCC, the digital health transformation and women's health. It is envisaged that the same structure will be co-chaired by the new Secretary General and the HSE chair, so there will not be a change there, which I think is very welcome. That is really the answer to the Deputy's question.
Sentiment score: 0.26
I know.
Sentiment score: 0.00
I agree and I thank the Deputy for his support on these reform programmes. He is right about the elective hospitals but before then, we have the opportunity with the surgical hubs, which will be delivered in 2026. The delivery of the surgical hubs is going to create all sorts of different waves. We are looking at what procedures need to go there immediately and what that will free up in the hospitals where they would otherwise have been done. How is that going to be staffed and when? I am looking at the National Treatment Purchase Fund, NTPF, buying capacity in our own hospitals but I am also looking at underutilised capacity in our own hospitals, like the endoscopy suite in Bantry. There are two of them. One of them is used a half a day per week. We have appointed additional people specifically to Bantry but how can that be, and why are we buying any endoscopy action in that area? Why is there endoscopy happening in Roscommon when there is a very good suite there that does not operate after a certain part of the day? How are we using our own resources and how are we going to collectively, as the political leadership in health here, make sure that we are using the assets we have as we build? The elective hospitals are entirely necessary but we have capacity that is not being used. There is room after room in different hospitals and we are not using them.
Sentiment score: 0.26
I totally agree with the Deputy and I think we will get there with Galway and Cork much more quickly. I would like to discuss with all Deputies options around Dublin because clearly we have the option in relation to Connolly hospital. The Deputy may have noticed that we put in some high-dependency unit, HDU, beds in advance because that is really going to be an important enabler. We did that in the past number of weeks. We put the staff in to have significantly expanded HDU capacity in Connolly hospital with a view to where that goes for the elective. It is well worth us considering constructively the best other use of brownfield space that is available within other Dublin hospitals, how we might consider that as alternative elective capacity and what we do with Crumlin. It is a useful open conversation that we should have. More than anything else, I need Deputies' help with the implementation of the public-only consultant contract and five over seven. I cannot have the NTPF buying activity in hospitals from 5 p.m. to 8 p.m. and not have consultants rostered at those times. That intersection is going to be really important between surgical hubs, the NTPF and the actual rostering. I am going to need Deputies' help.
Sentiment score: 0.33
I thank the Deputy for his ongoing engagement on this. As he knows as well as I do, this makes a huge difference to families around the country. Much progress has been made now. The Health (Assisted Human Reproduction) Act 2024 was signed into law by the President in July 2024. I have a difficulty with a definitive timeline as to the complete commencement of the AHR legislation as there are a number of interdependencies and considerations involved, not least the timing that I do not control over a Supreme Court case. On the full commencement of that and the full application of the legislation, there is an interdependency there that is outside of my hands. The others include the second Bill, the AHR amendment Bill being enacted, and the regulatory authority being fully operational. I can give the Deputy an update on what is happening with that, but there is also an important relevant Supreme Court judgment pending. I understand the case is due for mention on Monday, 27 April but it will be very difficult for us to get to Committee Stage without that having been resolved. That is really important. As the Deputy is aware, our formal drafting of the AHR Bill is at an advanced stage. It is very substantive. It is on the priority list for publication. Department officials in my Department are scheduled to meet with the Office of the Parliamentary Counsel tomorrow to discuss what is expected to be one of the final drafts and I expect to be in a position to introduce it to the Dáil this term. Some administrative sections of the 2024 Act have been commenced, specifically to establish the Assisted Human Reproduction Regulatory Authority, as the Deputy knows. The Deputy mentioned that three subsections of section 232 of the 2024 Act have been commenced. It is complex and there are very many slightly competing and multifaceted perspectives to be considered. We are going to have to think about the sequencing of some of it but I hope to advance it as quickly as I can.
Sentiment score: 0.15
The Deputy is a practical person, as am I. If a court case is before the Supreme Court, then there is a court case before the Supreme Court and there is nothing I can do about that. I would be in breach of my own responsibility not to cross over in the separation of powers were I to do anything other that wait for the outcome of that. I do not have any discretion in relation to that. As for people threatening to take legal cases, people are entirely entitled to take legal cases if they wish to do so. That is the essence of being an Irish citizen. There is no quid pro quo in relation to it. I am dealing with what I am trying to get resolved now. The reality is that we are advancing the legislation. We will not be able to take it to Committee Stage until the Supreme Court case is determined. It is not that I wish to be in that situation; I do not wish to be. That is simply the factual reality of that situation. There is nothing I can do about that but I will do everything that I can control as quickly as possible.
Sentiment score: 0.10
I agree with the Deputy. Indeed, this is something I have been involved with in different ways since working in the Department of children and since advancing the Children and Family Relationships Act, as I did when I worked in the Department of justice in 2013. I have been working on this for a really long time and I share the Deputy's frustration. I want to see people having access to families where they can. We need to speak about rights in totality, however. Yes, there is a right to family, a right to procreate and all of those different things. There is also a right, and we have an obligation as an outward-looking country, to make sure we are doing everything we can to protect everyone else. I am not saying this specifically to this but I do remember questions, when I started working here and we were dealing with, for example, adoption, the Hague Convention and the restrictions that were put in place because some of our actions at that stage were, frankly, exploitative or potentially exploitative. That was pulled back and for good reason. It changed the adoption rules for the future and they were very significant changes that were made. There were people who felt that they had a right in a particular way, but those rights always have to be balanced and because we are an outward-looking, humanitarian society, we have to take the rights of everybody into account. I know the Deputy will be at the front of that, having advanced looking at things through a human rights lens. There is more than one human involved in these and we have to be careful and balanced. I am not trying to limit anybody but I just have to say it as well.
Sentiment score: 0.23