The Dublin North and East region, which includes Cavan and Monaghan, has benefited from recent investment, with 12 additional paramedics in 2025 and a further 12 scheduled for this year. Six additional emergency medical technicians are planned for Cavan. This will help to preserve front-line ambulances for emergency calls. I highlight this because the National Ambulance Service is focused on addressing areas where there is a clear need for greater resourcing. A particular emphasis is on targeting potential applicants in areas of need, including the Cavan-Monaghan area, where there have been challenges with recruitment in the past. That is the only reason I set some of that out. I acknowledge that there have been challenges with recruitment, notwithstanding our desire to recruit more people in the area. The HSE has informed me that the National Ambulance Service's response performance in the region between 2023 and 2025 met the key performance indicator, KPI, targets in the HSE service plan. However, it is acknowledged that at times of high demand, some lower acuity patients have waited longer for a response. I also acknowledge that we would like the targets for purple and red calls to be higher in the first instance. I am not saying that KPIs are any sort of panacea; I am simply acknowledging that the performance in the north-east region has been better than the target. That is something, but we have a way to go to build on it. The Government is committed to the continued development of the National Ambulance Service in the context of both capacity and strategic reform. Since 2020, we have increased the budget for the National Ambulance Service by 60%. We have increased the personnel by 30%. This year, as I informed Deputy Cullinane, we really are trying to recruit. We have a targeted recruitment campaign. We have posts available. I will speak more to that, because, as Deputy Bennett is aware, we need to have better response times,
Sentiment score: 0.14
It is difficult to answer in light of some of the circumstances involved. The Deputy raised an individual case where somebody identified a specific reason. While I acknowledge that, in other cases it is not clear whether a patient, for example - it is awful to speak about it in this way - was going to die irrespective. I can understand the clinical constraints in providing broad data when dealing with many individual circumstances. It is because of the increased response times and the availability that we are trying to recruit. The recruitment competition in 2025 brought the highest number of applicants ever with over 1,000 people applying. I take some comfort in that. It will help fill the additional 263 posts that we have in the National Ambulance Service this year. It will provide for 21 additional crewed emergency ambulances for new intermediate care services on a 12-over-seven basis and a range of other investments.
Sentiment score: 0.01
I appreciate that the Deputy may find it difficult to see that we cannot fill posts but I assure her that it is true. Of last year's posts, there were 180, and 134 have been filled. I would like it to be 180 filled. This year we have provision for 263, which is obviously a considerable increase on last year, so the direction of travel in terms of our investment is very clear. This is not unique to the ambulance services; we have this difficulty across home support, we have it across recruiting into the medical profession generally and we have it with GPs. Across the board, we have posts that are unfilled and to which we are trying to recruit. I would welcome these positions being taken. As I said, there were 1,000 applicants. I take great comfort in that, that people want to do this, but it is also important to highlight that we are trying to have alternative care pathways as well. About 40% of patients now do not require, because of that intervention, subsequent conveyance or subsequent transfer to an emergency department, so those pathways are working well and we need to invest more in that as well. There is emergency department in the home, for example and all the different alternative emergency pathways.
Sentiment score: 0.24
I am sorry, that is not-----
Sentiment score: -0.08
I thank the Deputy for his question. He has highlighted this in the context of the difficulty in new GP practices opening in his area. The region has had very significant population growth but not a corresponding rise in the number of GPs available for either GMS or private patients and I acknowledge that. I also acknowledge the efforts the Deputy is trying to highlight as to what we can do to support GPs to expand their existing practices and to open new practices. That is a very fair question because everybody in this House wants more GP practices to be able to be opened. It is important for me to say that the State - I think people forget this sometimes - provides a significant level of financial support to GP practices. We work in partnership with GP practices both within the GMS scheme and more broadly. Among the more notable supports available are practice staff supports and subsidies towards the employment of a practice nurse, an administrator or a practice manager. The 2023 GP agreement increased the rates of those subsidies and introduced further staff supports. Specific supports are available for rural practices and, since 2019, in urban areas of disadvantage. The strategic review of general practice, which is currently under way, is examining the ways in which this can be better and differently supported. We have reached agreements with GPs, for example, on chronic disease management, all of which is really improving people's outcomes. It is a different way of delivering care but it is also a financial partnership with GPs. In relation to the Deputy's specific question about refundable tax for setting up new GP practices, that would be a budgetary matter for the Tánaiste and Minister for Finance, but I assure Deputy Neville that I will raise it with the Minister. I know he would like to see greater GP practices around the country, and this is certainly something I have heard from GPs that would be helpful.
Sentiment score: 0.43
The supports for newly establishing GPs are an important part of the strategic review of general practice, as surveys by the Irish College of General Practitioners have shown that concerns about the costs and risks of opening new practices are important considerations. Essentially, it is a matter of establishing a business and that is a challenging thing to do. Whatever about new practices, however, we also have to think about how existing practices, which might make it easier for a new GP rather than having to establish their own practice and their own business, could work more easily within the capacity of an existing practice and how that can be expanded through the addition of better or bigger premises or through the use of satellite surgeries to enable local access. The exact nature of these supports has not been finalised but it is under consideration. This could include supports with business education and training, provision of subsidies or grants, and potentially through the taxation system, as I have highlighted, subject to consultation with the Minister for Finance. Then there is also the growing network of primary care centres, from which GPs can practice. That is a really important part as well that may be complementary.
Sentiment score: 0.47
Exactly, and it is a totally practical suggestion. We want to enable GPs to have their practice as quickly as possible. I have no view as to where they should practice necessarily. Of course, we would like to employ them into the HSE, but private practice is also so important. Whatever we can do to enable more GPs, it has come up again and again in this House, correctly, and I can point out all the new GPs that have been registered by the Medical Council, all of that work to clear the backlog of people looking to restore their practices and people looking to come to Ireland. If they do not have a place to work within the community that people can access, it is very challenging. I recall going to a GP practice. There was one or two in every big housing estate. It was a very natural thing and it was often a front room. Now it is a slightly different model, and that is true. There may be an opportunity to extend those premises. Just look at the changes we have made today, for example, in relation to planning permissions and so on and exemptions and what we are trying to do to encourage more and more use of space. This is a hugely important piece for any community. I thank the Deputy for his suggestion. We will come back to it within the Department of Health but it is also an important budgetary matter for the Minister for Finance.
Sentiment score: 0.27
I propose to take Questions Nos. 123 and 136 together. Improving access to healthcare in our hospitals is an absolute priority for me. As the Deputy knows, we have very good outcomes in our healthcare system. Our challenge is making sure we have access as quickly as possible. That is the focus, on making sure we are using our resources in the best way possible. We are focusing on a public healthcare system in which everybody has timely access to high-quality scheduled care where and when they need it. I refer to the waiting time action plan for 2026. This used to be the waiting list action plan, until we all realised together that the length of time spent waiting is more important than the number of people on the list, obviously. This builds on the progress to date. It includes significant reductions achieved in the length of time patients are waiting. The plan takes a multifaceted approach in achieving it, setting out six overarching and interconnected targets focused on patients waiting the longest. The plan aligns with the national service plan, NSP, targets for planned care, including targeting increases in the proportion of patients waiting within Sláintecare maximum waiting times and outpatient and inpatient day-case waiting lists. Those targets represent steps towards our ultimate shared goal of all patients being seen or treated within the Sláintecare target times, namely, ten weeks for outpatient appointments and 12 weeks for inpatient and day-case procedures. The devolution of responsibility to the regional executive officers is an important part of this reform. The REOs have complete visibility over what is happening with their acute hospitals, their model 4, model 3 and model 2 hospitals and everything that is happening in the community and in their primary care centres. There has to be a complete synergy between the different model hospitals and primary care to use this. We now have tools that we did not have before. We have the outpatient toolkit, which is showing what the actual room utilisation is in every hospital. There should be no resistance to the application of the outpatient toolkit. It is not tenable that some hospitals have room vacancy rates of between 4% and 9% during the week and 24% on a Friday afternoon. I have not yet seen what the room vacancy rates are on Tuesday evening or Sunday morning, but we do not need to build more capacity and more rooms until those rooms are filled and being used. They are being heated and insured. All of these things are there and available. The utilisation of the outpatient toolkit is, therefore, enormously important. It means that we are scheduling according to the most efficient use of time. We are not asking people to change the length of their consultations or change the nature of their medical practice. We are simply taking the length of time they normally use and reorganising so that things are done differently and delivered differently, including in primary care centres. This really matters because we have opportunities between the outpatient toolkit and now the surgical hubs in respect of inpatient day-case procedures - or a certain proportion of those - and also freeing up the corresponding activity in the home hospital. The first real application of that, of course, will be with the Dublin north-east surgical hub. This is a huge opportunity to test how the public-only consultant contract is being used or not used, rostered or not rostered, how the five over seven roster is complementing that and how that is being used by all the different hospitals in the Dublin north-east region. We have these different opportunities but it is important that they are delivered. I want to highlight the importance of clinical leadership in this. Every single person in this House is calling for and looking for the same thing. It has to be implemented and there is a responsibility on clinical leadership to stand up and make sure the clinical community is doing everything it can to adapt and change its ways of working within the contractual parameters its members have signed and that have been set in agreements to make sure we are delivering for the patients of Ireland.
Sentiment score: 0.29
I agree. That is what we are trying to do. On the primary care centres, we have 181 at the moment, with eight under construction and 21 more in early planning stages. However, if people do not use them and if they are not used for outpatient procedures to relieve pressures on hospitals, we are going to keep having the same conversation. There is an excellent outpatient centre in Merlin Park right beside UHG. It is one of the few that is being used on a three-session per day basis. Good work has been done in that primary care centre but a lot more can be done. This is as much about how people are working as about where they are working. I have talked about the physical capacity increases that we have but we cannot keep building more physical capacity if people are not going to use it differently. There is no point in concentrating consultant work between 9 a.m. and 5 p.m. Monday to Friday with all of this additional capacity. I would rather spend money hiring more people to fill the spare space. However, how can we be sure that will happen if the clinical leadership does not make sure we are implementing the contract such as it is? We have to see evidence of that and the trajectory in relation to it. I agree with the Deputy on all the fantastic people doing fantastic work but we cannot keep saying that in the knowledge that many of them also have to work differently to make sure we are using the space that we have all paid for by making it available for the benefit of patients. We cannot have primary care centres closing at 5 p.m. They have to be open and serving the community until 8 p.m. or 10 p.m. That is what they are for. This is about building capacity, as it always will be with a growing population, but at some point we will reach a juncture where we have built so much capacity and if we have all of this evidence of it not being used or not being used in the most balanced way across the week, we will have to start asking ourselves decent questions about it.
Sentiment score: 0.17
I agree. As I said, we have 181 primary care centres, with eight under construction and 20 more at early planning stages for precisely that. Regarding the Deputy's constituent who could not get surgery, let us count up the different things we have said here. It was said that they cannot get theatre time for her. There is a theatre utilisation project. I would very much like to know the nature of her procedure and to test this case against theatre utilisation across the hospital. The Deputy says that we need a new hospital. I remind him that we are building both a surgical hub and an elective hospital precisely to provide additional theatre time. Let us stay aligned to exactly what is going on, which is the delivery of full utilisation of all of the theatres in University Hospital Galway, a surgical hub and an elective hospital. Can the Deputy imagine the number of surgeons it takes to run those all of the time? If we are to run them seven days a week, how many surgeons would it take? How many surgeons does it take to run a surgical hub all of the time, recognising that they will not all be working all of the time and that there will be two or three shifts? How many are required to run an elective hospital and all of the theatres that are already in UHG? How many surgeons does all of that take? I strongly recommend to the members of the Committee on Health who are here that they should invite the team that has done the theatre utilisation project and the OPD toolkit before the committee and interrogate them as to their findings and the use of theatres so that they can see this for themselves. We can then come back and seriously look at the number of surgeons it takes to fill six surgical hubs, four elective hospitals and every theatre in the country. When we were doing the urgent project to deliver more endometriosis surgeries, I was looking for an additional 100 surgeries in the final quarter of 2025. One of the responses I got from a surgeon, who really is invested in this and who really is working hard, is that one of the barriers was that he had been told elective work could not be done after 5 p.m. in the theatres in the maternity hospital he was working in. I said "I am sorry, what? Says who?" These are some of the barriers we have to overcome. We have a lot of space. We have to use it.
Sentiment score: 0.08
I completely agree with the Deputy. They are a phenomenal asset and support and a major part of our health infrastructure. We need to think about them more as a fundamental part of our health infrastructure. Community pharmacies are right where people live. Some 85% of the population is within 5 km of a pharmacy. They are embedded in their communities. They are the first, and often easiest, place to go for trusted advice and practical support for patients. Of course, pharmacists are medicines experts, but their role goes way beyond that now and we would like it to go further. They deliver prevention and public health every day. This extends to flu vaccines, Covid vaccines and school-based programmes. Of the 26% of children who got vaccinated last winter, 56% got their flu vaccine from a pharmacist, which is remarkable. I am delighted to say that, from May, pharmacies will provide pneumococcal vaccination for eligible healthy adults over 65 who have a medical card. Pharmacies deliver services like health checks, blood pressure management, weight management, and smoking and vaping cessation programmes and help people to live with long-term conditions. All of this demonstrates the ability and willingness of community pharmacies to be an essential part of health infrastructure. A big part of the future is the 2025 community pharmacy agreement, which seeks to expand that role. This gives us the opportunity to expand the role of pharmacists in areas such as bowel screening, contraception, prescribing and medicines optimisation. Pharmacies also have an important role in improving access to contraception through the national condom distribution services. Crucially, they also provide a common conditions service, which I will speak about in my next response.
Sentiment score: 0.34
I am sorry but I do not have that figure. I will get it and come back to the Deputy, if he will forgive me. As part of the community pharmacy agreement, the Irish Pharmacy Union has agreed to support the HSE health and well-being campaigns. The Deputy has highlighted three of them. Following a consultation between the pharmacy union and the HSE, three campaigns were agreed for activation across the community pharmacy network. The Deputy has outlined them. Of course, I would like them to be doing even more, recognising how important their role is. One of the biggest changes in health is going to be the common conditions service and where we can go with it. As the Deputy is aware, 95% of pharmacists have signed up to it at this point. Community pharmacists will be able to manage eight common conditions, offering self-care advice and, where appropriate, prescribing prescription-only medications. That is a first for pharmacy in Ireland. I would very much like to see it succeed. I hope people will use it and that we can extend beyond these eight conditions to the next eight, whatever they might be.
Sentiment score: 0.24
As the Deputy highlights, this is done through consultation and agreement between the pharmacy union and the HSE. My own Department engages regularly with the pharmacy union. I will ask my officials and the HSE about the nature of that engagement because I am not party to those detailed discussions. I will get a much better answer and provide it to the Deputy. The important point is that there is a measure of consultation and agreement in relation to it. Pharmacists are very excited about this expanded role and about working to the top of their professional medical training. That is what I want to enable. I want to make them a genuine alternative to a GP, where appropriate, as they will be in many, although not all, cases. I want it to be a really natural place to get a prescription and to expand the use of community pharmacies alongside every other part of our health infrastructure. I hope the Deputy will forgive me for not having a better answer than that for him at the moment but I will get him an appropriate answer.
Sentiment score: 0.35
I thank the Deputy and the Committee on Health for their work on oral health and I welcome their report. I have read it and it aligns with many of the frustrations being brought to me. I understand the frustrations of families and individuals who are experiencing this with the current service. To be really clear, the current position on dental services is not good enough. Too many people cannot get timely care and too many of those are children. We have to do two things at the same time. We have to take practical steps to improve access now and we also have to deliver lasting reform. The model of services we operate is largely rooted in the 1990s and it really needs to be modernised to meet today's needs. While that reform is being progressed, however, I am determined to ease the pressure people are facing now. What that means is improving access through the public system, especially for children and adult medical card holders. My Department and the HSE are finalising a more focused two-year programme to attempt to do just that. The plan is going to be delivered by a dedicated governance group with progress monitored closely and aligned to wider HSE and departmental priorities. It will aim to respond to sustained service pressures, workforce constraints and long waiting lists. It will focus on a small number of very clear priorities: cut waiting lists in the school dental programme and orthodontics, strengthen and expand the special access programme, review and improve the dental treatment services scheme, support recruitment, education and training, and then really lean into whatever innovations are appropriate for different ways to deliver care. Over the next two years, our aim is to stabilise services, reduce waiting times and make access measurably better while at the same time laying the groundwork for longer term reform. This will be achieved by initiatives such as utilising the newly available capacity with the new surgical hubs. A small proportion of cases, but not all, will be suitable because some will require general anaesthetic. My Department and HSE officials have already initiated engagements on this with many of the stakeholders, but it is important that they brief the committee as well when the plan is better finalised.
Sentiment score: 0.21
We are committed to updating the Dentists Act 1985, but we have spoken separately about the practicalities of some of those individual cases, some of which relate to legislative reform and some of which relate to completely different things. The Deputy is correct in relation to the need for a new dentists Act, but there is also a lot of policy development needed to underpin that. A recognition of the length of time that it would take in real terms has led to an agreement with the Dental Council to bring forward interim amendments such as continuous professional development, CPD, for dentists so that reforms can commence sooner. However, we need to make measurable and meaningful progress. I would like to have the opportunity to finalise that two-year plan, to present it and to have an implementation plan for it. This is not about planning for something in perpetuity. Rather, this is in recognition of very meaningful problems for a number of individuals who need a very specified intervention.
Sentiment score: 0.27
I will point out that the fees were increased by an order of 40% in that scheme. While I appreciate what the Deputy is saying, the fees were also increased by 40% and there is more complexity. I attended the dental association's conference. There is more complexity to the full range of practice that many dentists are engaged in and the other routes of practice, including aesthetics. I do not just mean aesthetic dentistry, which is important and was well defended at the dental association conference by its president. I just needed to make that point as well. The Deputy highlighted schoolchildren, who are a particular concern of mine. We have engaged with the dental association, the Irish Dental Hygienists' Association and the Dental Council to look at how we are going to deliver near-term improvements in the school programme in particular, how we can use the complete workforce, including hygienists and dental nurses, and how we can broaden the ways in which they are trained. We are engaging with the Department of further and higher education on that so that we can get the best out of our complete dental workforce.
Sentiment score: 0.37
I thank the Deputy. I reaffirm that the Government is committed to investing in Navan hospital. Since 2020, the number of whole-time equivalent staff has increased by 17.5%. During the same period, the budget increased by 51%. Under the acute hospital bed expansion plan, a total of 46 new and replacement beds will be delivered at Our Lady's Hospital in Navan by 2031, which includes 31 beds delivered between 2021 and 2024 and another 15 beds between 2025 and 2028. A new minor injuries unit is planned for Navan hospital. I am advised by the HSE that this is progressing through the detailed design and procurement phases. Construction is expected to commence in quarter 4 of 2026, with an indicative operational date of 2027, which is good for the area. As part of its statutory role, HIQA conducted unannounced inspections of Our Lady's Hospital in Navan in June 2024 and November 2025. It is important to note that, at the follow-up inspection, HIQA recognised that the hospital had made progress since 2024, even where the formal compliance ratings did not change. It is important that I state that. I would also like to outline the suite of service and safety enhancements being implemented in Navan hospital. I am informed by the HSE that additional staffing across primary care and older person services has enhanced the management of chronic conditions. Consultant-led chronic disease teams for respiratory and cardiology services will be developed in 2026. The new Navan patient quality and safety board was established last year to provide enhanced oversight of the safe and effective transition of care between Navan hospital and the HSE Dublin and North East region generally, as is the case for many hospitals. That led to the development of different and robust policies and procedures which will be further improved this year. Several risk mitigation strategies have also been implemented, including the utilisation of the orthopaedic unit during periods of high activity and the implementation of surge capacity. In addition, acute surgical services are maintained to allow for patient stabilisation prior to transfer, as is the case in many other hospitals, along with integrated bed management solutions which link community and acute bed services. There are also ambulance bypass protocols, to which I will come back.
Sentiment score: 0.28
On the HIQA report, of the 43 actions in the compliance plan, I understand 18 have been completed and the rest are under way. It is important to highlight that. I want to look at the region in a very interesting way because it is a region that will have a new surgical hub opening shortly. It is a region where we are planning an elective hospital, in Connolly. It is a region where the hospitals are geographically concentrated. I am not yet convinced what all of the different pathways are and what the different specialisms are and how they intersect. It is a region of particular opportunity and Navan has a strong role to play within that. On the immediate safety issues, ambulance bypass protocols are in place to ensure that patients receive the right care. For example, patients are stabilised and, if necessary, transferred to other hospitals. Patients classified as categories 1 and 2, including cardiac and stroke patients, are not brought to Navan hospital by ambulance. Beaumont and the Mater, which are specialist centres for both of those cohorts, are very close. That is what I mean by looking at the region in a different way.
Sentiment score: 0.19
Of course the HIQA report needs to be implemented. Where there are issues within the control of the hospital, the HSE is required to deliver sustained improvement. Where risks relate to the broader intersection of the region, that is what I am trying to work out at the moment. On 17 February, I met the regional executive officer and regional clinical director for the HSE Dublin and North East region and the integrated area healthcare manager for Louth and Meath to discuss the overall demand profile for the region, the pressures in Navan, the pressures on neighbouring hospitals, the different specialisms and their interoperabilities, and the ideal design of all of those hospitals, recognising the elective hospital, surgical theatre and capacity that that frees up. We have possibly examined this in a way that has been too individualised as regards the different hospitals. I am interested in the best interoperability and how we achieve that while, at the same time, implementing the compliance requirements identified in the HIQA report.
Sentiment score: 0.18
In the short time that I have, I will say that dermal fillers are regulated as medical devices. There are rules to ensure that devices placed on the market are safe and perform as intended. That means a dermal filler must have a CE mark before it can be legally sold anywhere in the EU. It is important to be clear about what current EU legislation does not do. While it regulates the product, it does not regulate who can administer it. The Government recognises there is a need to strengthen regulation in this area. That is why it is in the programme for Government that we will only allow this to be undertaken by trained healthcare professionals. Work is under way in my Department on the options to strengthen controls on the use of dermal fillers. The Health Products Regulatory Authority, HPRA, as the competent authority, previously provided my Department with a policy paper setting out the different options. In addition, we have commissioned research through the Health Research Board to look at the national policy and legislative and regulatory measures used in other countries. We expect that report in the coming period. We will engage with stakeholders to try to bring this piece of work forward. The final regulatory policy determined will be informed but all of those important pieces of evidence. We will progress it as quickly as we can thereafter. I recognise what the Deputy is saying.
Sentiment score: 0.25