I thank the Deputy for raising this matter. It is my view and his view that care in our public hospitals must be based on clinical need, not ability to pay. He will also be aware of - and shares - our commitment to ensuring full compliance with the terms of the public only consultant contract, POCC. The position regarding consultants on the POCC is unequivocal: they are not permitted to engage in private practice within public hospitals. There can be no local discretion, exemptions or deviation from the terms of the contract without express written permission from both me and the HSE, which is imagined in certain circumstances of great emergency to give us that flexibility. Where issues have arisen, such as in the Rotunda Hospital, I have been very clear that immediate action must be taken to ensure full compliance. There has been clear instruction from my Department and the HSE since early 2025, setting out the requirement for compliance. This includes HSE CEO circulars of 14 February, 21 July and 25 September 2025, which required implementation of the POCC rostering provisions, extended consultant-led services and the completion of consultant work schedules. I also established regular workshops with regional and hospital senior management teams to monitor implementation of the contract and rollout of extended working. I met with each region in September 2025 and again in early 2026, as well as online in April 2026. While progress has been made, it has not moved quick enough. However, that is on the implementation of the contract. The HSE CEO wrote again to all regional executive officers on 15 June 2026, making clear that regions must ensure compliance and address any additional issues. This was then followed by letters from the HSE chief clinical officer, Dr. Colm Henry, on 24 and 30 June, to all regional executive officers and regional clinical directors, stating that POCC consultants could not carry out private work in public facilities, and we have asked for formal assurance on its implementation. Crucially, we have also asked for formal assurances on the implementation of the type B contracts to ensure that does not exceed 20% of workload, as per their contract, and that extended-hours rostering is being fully implemented. Responses are due by 10 July, with a further rostering return due by 31 July. I have more to say but I have run out of time.
Sentiment score: 0.30
As I said to the Deputy privately and am happy to say to him on the floor of the House, we did a productivity analysis in the Department of the actual activity being carried out in each of the four big maternity hospitals to try to determine what the level of private and public activity was. It certainly showed instances of type B contract holders going way beyond the 20% that would be implied in their contract, but it is not information that I felt was of a sufficient standard to be able to publish, share and stand over with the committee. On that basis, I have been a little reticent. However, it is certainly more than enough for me to have done the following. I have written to all the hospitals, asking that the clinical directors confirm compliance with the type B contracts. It is my intention, once I know there is compliance or issues to work on, to initiate a broader audit of how that is done. I have also cross-referenced the admitting rights of public-only consultant contract holders with private hospitals. None of this is enough for me to be able to publish and stand over, but I want the Deputy to be aware that I am doing this work and am trying to do it in a way that is verifiable and robust. It will lead to a much more significant analysis of what is happening in different hospitals.
Sentiment score: 0.25
I could not agree more. I thank the health committee for its robust engagement. This is a shared project, making sure that this contract and structure that we have all agreed are implemented. I have concerns about the operation on a hospital by hospital basis, for example, how intensive care facilities might be used between private and public and what the reimbursement structure is. I do not have robust answers to questions about the use of diagnostics, for example, if I am in a private hospital in a region and suddenly need intensive care facilities, and how that transfers. I do not believe those things have ever really been delineated or tested in different ways. It will be quite the challenge to do that. The first step in that is that it is the responsibility of clinical directors, both hospitals and in regions, to make sure that if work is being done outside the public-only consultant contract in a private hospital, it does not impact the public and it does not create and disincentives and that, crucially from a patient safety perspective, not too much of it is being done. It is crucial that a type B contract holder has a maximum of 20%. I do not want to see any instance where a type B contract holder has been doing more than that in a public hospital.
Sentiment score: 0.26
I agree that too many people are waiting too long to access primary care and community services. A total of 1.3 million patients were seen by primary care therapists in 2025, which is significant. There is no question, however, that there is rising demand and increasing complexity, particularly for children's services. This is placing sustained pressure on services nationally. As the Deputy has referenced, that is why my Department and the HSE are driving forward a joint programme to reduce these waiting lists. This includes detailed analysis of therapy activity, productivity and workforce capacity to identify opportunities to improve service delivery and develop a much better therapy waiting list management protocol. As the Deputy is aware, last year I approved a national waiting list initiative across physiotherapy, occupational therapy and speech and language therapy, targeting the removal or treatment of over 80,000 people by year end. To date, over 21,000 removals have been recorded, of which 13,000 were by validation and 8,000 by treatment. While this work is advancing across several integrated healthcare areas, IHAs, we are not where we want it to be at this point. A number of discrete industrial action issues are holding up implementation, but they are, I hope, nearly resolved. The HSE is engaging with unions to address these issues, and we are determined that progress must now accelerate. Where the initiative is being fully implemented, it is showing results, including reductions of 80% to 90% in long waiters. We can see the beginnings of real system reform, including much better scheduling and much better use of digital supports, as appropriate. Obviously, those improvements benefit patients, but they also benefit therapists and primary care teams delivering these services by easing some of the burden in managing the different lists and enabling them to focus on timely, patient-centred care. We want to see that progress replicated nationally. Furthermore, alongside that, we are building capacity through the recruitment of 200 additional primary care posts this year. We are increasing the student training places for health to ensure the pipeline going forward.
Sentiment score: 0.37
I agree with the Deputy. As I look at the actual numbers on the lists, not only is there regional variation but there is variation by specialty as well. To be very transparent, if I look at the waiting lists from May 2025 to 2026, for example, there has been a reduction of nearly 7,000 people on the audiology list. There has been, however, an increase of nearly 3,000 people on the occupational therapy list. There is an inconsistency there. There has been some progress is some areas, which is great, but none in others. If I look at the number of people waiting more than 39 weeks for audiology compared with May 2025, there has been a considerable reduction. In occupational therapy and psychology, there have been significant increases, while in physiotherapy, there has been a decrease. It is not just the postcode that matters but the specialism as well. That speaks, in some way, to the number of professionals who are available and trying to get them into place. As the Deputy knows, we are trying to make it easier for physiotherapists across Europe to work here. The profession has been too restricted. Similarly, with psychology, it should be the case that people with master's degrees are able to do much more than they have been able to do thus far. We are trying to expand the workforce, but we are also trying to expand the range of qualifications where people can deliver services.
Sentiment score: 0.21
Of course the Deputy does.
Sentiment score: 0.00
We are trying to end the practice of the money moving from community to acute care and make sure that this does not happen. I will name some additional waiting list initiatives that are important. In budget 2025, we had base funding of €8 million for community-based waiting lists, particularly for psychology and audiology which had previously only received once-off funding. That is more embedded now. I totally agree with the Deputy in relation to the number of people waiting. We will have a dedicated programme over two years to address orthodontic waiting lists. We are just not quite there yet in terms of the negotiations with the Irish Dental Association. Nevertheless, €20 million has been invested in that initiative, resulting in more than 5,500 removals from waiting lists. The Deputy and I are not in any sort of disagreement here. We need to invest more in the community. We need these services to be available in the community. That also means applying the outpatient toolkit, once we are finished with the acute hospitals, to the community lists and the management and scheduling of those. It also means extended hours for all of those therapeutic services in primary care centres, as much as it will mean in the acute. The Deputy can understand why we focus on the acute services first. Nevertheless, that is where we need to get to.
Sentiment score: 0.13
I agree this is a very serious issue for paediatric trauma cases and potentially acquired brain injuries. In light of the recent series of cases and the position paper published by the faculty of paediatrics, the deputy chief medical officer has formally written to the HSE’s national director of public health seeking an initial public health report on e-scooter related injuries in children and young people. That report is intended to clarify the scale of the issue, the impact on health services and whether any recent public health assessment has been undertaken. The deputy chief medical officer has requested that initial report be provided by the end of July or in a proposed timeline if additional data is required in relation to it. I can also confirm my Department is in ongoing engagement with the Minister, Deputy Darragh O’Brien, and his officials in the Department of Transport to ensure that health, transport and road safety policy remain aligned as micro mobility usage continues to grow. The Deputy’s question asked about the number of people who present to emergency departments with injuries arising from e-scooters. Emergency departments do not track that data. They certainly do not track the location of an incident outside the hospital. Their job is to treat the child that has come in with a severe trauma. Nevertheless, the Road Safety Authority, RSA, has statutory responsibility for the promotion of public awareness, including the advancement of education and the safe use of roads. Therefore, I have referred the Deputy's question to the RSA for direct response as best it can. However, as to the Deputy’s question on the numbers presenting with injuries arising from incidents with e-scooters, whether as riders or pedestrians, emergency departments are in the business of treating people and not recording the nature or source of the injury or the location. Nevertheless, the public health assessment is an extremely important part of this and while I do not want to pre-empt it, I imagine it will give weight to any further actions to be taken by the Department of Transport.
Sentiment score: 0.06
As the Deputy and I are in broad agreement on this issue, I will simply use this opportunity to reiterate the potential impact of an acquired brain injury on a child or a teenager. Acquiring a brain injury is a lifelong and potentially life-limiting condition. It can impact their ability to walk, to think, to speak, to eat. It is important that we say these things in the Dáil. The impact of an acquired brain injury can be devastating, not just for the individual but for everybody around them. To acquire a brain injury, whether as a rider, a pedestrian or any person, as a consequence of the misuse of these micro-mobility scooters, or whatever we want to call them, is such a tragedy and such a catastrophe. The Deputy is right that we need data. That public health assessment that is being done between the deputy chief medical officer, who was a clinician in Temple Street and who is very well linked into the paediatric system, and the HSE is the sort of basis on which we need to take other steps in other Departments to try to regulate and restrict usage.
Sentiment score: -0.11
I have spoken to the Minister of State, Seán Canney, specifically on this in recent days and gave him a copy of the letter as to what is happening in relation to the public health assessment. I know that he, like the Minister, Deputy O'Brien, is very exercised by this, as is the Minister for justice. Not one of us in this House wants to enable or perpetuate a situation where children are acquiring injuries of this kind. They are devastating. At the same time, not one of us can go around and police every incident either. We therefore have to try to take the policy steps that will be appropriate, including supporting the Garda in making sure that it can pursue these cases and take the steps it needs to take to stop them. I thank the Deputy for raising this very serious issue. If any child were to see the impact of an acquired brain injury on what their life would look like for the future, I wonder if they might reflect on their use of these vehicles.
Sentiment score: 0.16
It is wonderful to have this conversation with Deputy Kyne in the Dáil because I recall visiting this hospital with Senator Kyne, as he was then, now Deputy Kyne, representing Galway and a continual advocate for University Hospital Galway. He and I were there in May 2025, when we launched the completed master plan, setting out a clear vision for a modern model 4 hospital serving Galway and the west and north-west region. I commend University Hospital Galway and the REO, Tony Canavan, on the way in which they got to that master plan because it took them some time and there were different iterations of it. The way they developed a master plan and a sequential plan for delivery is an exemplar for many other hospitals around the country that might take a leaf out of their book as to how to plan for this. I am happy to say that significant progress has been made in advancing phase 1 of this plan. A major milestone has now been reached with the appointment of design teams for two new ward blocks and associated enabling works. Together, those ward blocks will provide 300 additional beds and represent an important step in moving the master plan from being on paper to being in real life for the benefit of patients. The additional beds will help ease pressure generally on the emergency department, reduce waiting times and improve services generally. I thank the management of University Hospital Galway, who at the beginning of March, alongside the region and the excellent Grace Rothwell, initiated a full reset of the hospital because its trolley situation had been so bad for so long, with 50 or 60 people on trolleys every day. The reset of the hospital was difficult for everyone to do, but they did it and they have managed to sustain it. They have had a few blips going backwards, but you can see and feel a different culture around the management of patient flow in University Hospital Galway. That is hugely important for patients and the Deputy's constituents, the people he represents, and I acknowledge the work they have done. Furthermore, enabling works are under way to, among other things, clear the site for ward block A. That will maintain momentum on site while we undertake the necessary designs and statutory approval processes. The planned relocation of the helipad is vital. I might pick that up in my further response.
Sentiment score: 0.29
I certainly will. In the first instance, I will discuss that with HSE estates. The Minister, Jack Chambers, and the Department of public expenditure and reform are as keen to develop health infrastructure as I am. The accelerated infrastructure report and the work in that is a very significant advancement in that regard. Already we are seeing different areas where we are making quicker progress than we otherwise would have done, so it is very important, and I will certainly do that. It is also important that I highlight the relocation of the helipad. This is important for everybody in Galway and is a matter that sits with Galway City Council. The relocation of the helipad is vital to enabling delivery of the master plan. There is no other way of doing that. It is in the mater plan. It is essential. It will ensure there is a clear flight path for emergency landings away from the future development areas while supporting timely transfer of patients to the emergency department. I understand that the transfer of land is due for consideration by Galway City Council in the coming days. I know there are always concerns among local residents - we all understand that as public representatives - but this is critical to the development of proper emergency services for the people of the north west and enabling the development of the hospital master plan more broadly. I understand that further public engagement by the HSE is taking place this week.
Sentiment score: 0.17
Not only was it done in the Mater but it was done successfully in Limerick. As the Deputy says, we have this standardised design that can be replicated and has been in other places. I will take that up with the Department of public expenditure and reform and HSE estates to try to advance it as quickly as humanly possible. There is no question but that the additional beds are necessary for Galway. They still have to manage their demand and do all the other things, but they need more beds. It is an area of rising population, which is a good thing, but no matter how well demand is managed there, that pressure is coming in the future and there is no question but that it is necessary. I take the opportunity to ask all Deputies and political parties in the House to do everything they can to take any step in terms of public persuasion and public support. Without the transfer of land for the helipad, we cannot progress this plan in a major way. I ask that everyone take what steps they can to advance critical infrastructure, which is what we all need and what Deputies will rightly come in here and ask me about a different day. We want to deliver this, and this is a critical for moment for everybody in the west and north west.
Sentiment score: -0.03