I thank the Deputy. Just to clarify and for accuracy, I did not bring a memo to Government. That is only a technical point. The Deputy is quite right. What we have decided to do is reflect on the judgment and on the needs of women going forward. The needs of women going forward are for critical care capacity for neonates. I am sure the Deputy has been in the unit in the Rotunda Hospital. They do exceptionally good work but it is not in a suitable place for neonatal intensive care. The idea is to go back in with a new application. All of our options were considered in relation to whether to take a judicial review. That would mean going through an extensive legal process, potentially for two years, to go back into the same body. I am not sure that really meets the needs in any event. What we have decided to do is enhance the application, to go bigger. We need critical care capacity onsite. From the perspective of patient safety, that enables me to say I am satisfied that the patient safety needs of women on that site are being yet better met. Already, of course, the Rotunda is practically beside the Mater and there are very good bluelight channels, as the Mater has said. No woman has died in the Rotunda in 20 years. It is a safe pathway already but it does need enhancement. That is why that critical care capacity for women as well as for neonates will form part of the new application. That enables us to delineate the Rotunda from the otherwise important colocation policy of having that critical care capacity for women closer, the case being Holles Street and the National Maternity Hospital. It enables us to remove that from the equation of a new planning application. The colocation question cannot be in the minds of anyone because it is delineated from that in that way. We are intending to go back with a bigger application directly to An Coimisiún Pleanála with critical care capacity for women and an enhanced sexual assault treatment unit. I want everybody here, which I know they will do, to make a statement that the Rotunda is for women in the city centre in every possible way. The Ministers, Deputies O'Callaghan and Chambers and myself will be backing that application and I am sure the Deputy will too.
Sentiment score: 0.14
I agree. Of course, the heritage consideration was the dominant one in that third round for the decision-making. It still remains of importance to that area. However, balancing the public interest is something we do all the time. Dublin City Council and the inspector took the view that in the previous application, the public interest was overwhelmingly served by progressing with it. The deciding body in the end decided in the opposite direction. In many ways, what we say here informs the public interest. We are the representatives of the public in what we say in relation to the importance of the care of women. Successfully and correctly delineating the Rotunda from the colocation policy, which is important for other hospitals, is a significant step in that. I do expect the application to be well supported in the broader public interest. The Deputy is correct that very little money was spent on the colocation of the Rotunda. However, an enormous amount of money has been spent on colocation policy generally in respect of Holles Street. That reflects the hierarchy of need. The need to move Holles Street was much greater because the patient safety need was much greater, the distance being greater between Holles Street and St. Vincent's than between the Rotunda and the Mater. That speaks to the priority placed on it.
Sentiment score: 0.36
The Deputy is exactly right. Holles Street and Elm Park is settled. The question on Limerick forms part of what we are trying to do generally in Limerick and I would be happy to update the Deputy but our policy is very much the same in respect of colocation there. The Deputy is right to identify the Coombe, which is quite close to St. James's Hospital, where we are investing significant additional capacity at present. It is something I am now going to reflect on. I do not want to separate that yet but it is important that we do a detailed analysis of the needs of the Coombe, the adjacency of St. James's and what we have learned in relation to that. Back in 2013, 2014 and 2015, there were discussions about the necessity for trilocation and all those different efforts to try to put those pieces together. Of course, we are learning more and more. We are seeing the different pathways now. The Deputy is right to identify that and I cannot answer that today. It needs more reflection. We can do that collectively over time. There is not the same imperative because we are driving ahead with investment in the Coombe as it is.
Sentiment score: 0.09
There is no question but that the regulatory framework requires updating and modernisation. It is closely linked to the wider implementation of the national oral health policy. Ahead of comprehensive reform, several priority interim amendments have been identified particularly to strengthen the powers of the Dental Council of Ireland. The first amendment addresses the lack of a statutory basis for continuing professional development, as the Deputy highlighted. While dentists are currently required to meet ethical CPD standards of course, that is not enough and they must be underpinned by legislation. A policy has been developed to introduce CPD on a statutory footing, which will enhance the Dental Council of Ireland’s ability to ensure dentists undertake adequate and appropriate ongoing professional development. I have received Government approval for that policy along with consent to draft the general scheme of the Bill. My Department is now preparing the heads and associated regulatory assessments. We will deal with that in the Oireachtas in due course. With regard to unregistered dentists, powers to address the illegal practice of dentistry by unregistered individuals exist under the Dentists Act 1985 and other legislation. Under the Dentists Act it is an offence for unregistered persons to use the title of dentist to provide dental treatment or present themselves as dentists and the council may prosecute such cases. In addition, under the Consumer Protection Act 2007, the council can also seek court orders to stop dental practices from operating if they enable unregistered individuals to practice illegally. All suspected cases of illegal dental practice should be reported to An Garda Síochána. Unregistered individuals who treat patients while masquerading as dentists may also have committed assault under the Non-Fatal Offences Against the Person Act 1997 or have breached the Criminal Justice (Theft and Fraud Offences) Act 2001. Those offences carry significant penalties including imprisonment.
Sentiment score: -0.07
I agree with the Deputy. While the broad legislative suite is in place and there are existing powers are under the Dentists Act, I have no difficulty with a review and strengthening them where needed. I recognise the suite of legislative powers I outlined so we need to be very specific as to the additional powers necessary. I have no difficulty in strengthening the powers of the Dental Council of Ireland to do just that. We are talking about potentially unremediable assault on a person in their mouth or on their face. It is an appalling thing to happen to any person. We need to make sure the powers are as robust as necessary. There is simply no question on that. I signal a change I want to make to the Act to enable direct access for dental hygienists. That would require an amendment to section 54. Direct access refers to the ability of a dental hygienist to initiate treatment within their scope of practice based on assessments of patients' needs without the specific authorisation of a dentist. That is a change I want to make to enable the workforce but that is for dental hygiene work not necessarily dental work. There is distinction, of course.
Sentiment score: -0.01
I agree with the Deputy. At the moment I am trying to develop a programme with Pat Healy in the HSE, who is doing excellent work on a very targeted programme of intervention to get on top of screening in schools and make sure we can address the backlog, particularly in relation to orthodontic work and specialised orthodontic work. I have given a direction to all of the various regions that I expect our new surgical hubs to have a measure of dental capacity in them, whether it is once a month or whatever it happens to be, so that access to theatres is there equally for dentistry in the community and to ensure we have pathways. I acknowledge there is a considerable work to be done and I will bring forward a plan and proposals on this. I welcome the Deputy's engagement with the dental associations. We do need to hire more public dentists. They have suggested to me that part of the graduation programme could be that qualifying dentists spend a period of time in the public system, something I would greatly welcome. It would give dentists who do not have an opportunity to train in public practice the opportunity to be in public practice. It is too private, too remote and too disconnected from the public health system. If part of the training was that we got the benefit of a graduate spending a year in the public system, I certainly would be very much in favour of that proposal.
Sentiment score: 0.30
I agree with the Deputy. The two strategies have changed the landscape for people who are diagnosed with cancer. Today nearly 250,000 people in Ireland are living with or beyond cancer, 50% more than a decade ago. The evidence is that the chances of survival for more than five years for someone diagnosed with cancer in the 1990s was considerably less than what it is now. This is on foot of the extraordinary work done by clinicians and researchers, and the way in which cancer services are delivered. This has enabled a very considerable shift. Nevertheless, we know we will have more and more people diagnosed with cancer in the years to come. This is because we are living longer and we are diagnosing better, and we need to make sure that the services are available for them, for all of us and for everybody we represent who will face a cancer challenge at some point in their lives, particularly as we live longer. The Deputy is right to identify the strengths in some of the KPIs as well as the slippages in them. I certainly want to highlight both of these things. One of the reasons we are changing to this regional funding model is so we can have better regional transparency. It is correct that public representatives have the ability to see this regional variation and that there is a pressure linked to the performance framework in relation to the regions achieving the best performance and matching the best performance around the country. The cancer strategy had 52 recommendations, 43 of which have been delivered or continue to be in the process of being delivered, as will be the case to the end of the strategy. We want to reflect on and evaluate the strategy and its efficacy as we develop a new strategy. What will be very interesting, and where we are open to every suggestion, is how much the world has changed in terms of research and the role AI can play. Some of the extraordinary research being done in Galway, for example, is where they have learned to manipulate cancer cells against themselves and how this works. Treatment has become so individual and personalised. The next cancer strategy can be genuinely ambitious and different again, and I welcome every suggestion relating to it.
Sentiment score: -0.04
The Deputy is right to highlight the variance. It is very different between hospitals. For example, the time for chemotherapy is within 15 days, which is so important. This information has been provided to him. In Cavan hospital, there were 174 patients and 174 of them were seen within 15 days. It was similar in Connolly hospital with 1,717 patients. Naas hospital is at 98%. I do not want to just highlight the good ones and I will pick at random. Tullamore hospital is at 93%, St. James's Hospital is at 91% and Drogheda hospital is at 83%. Then we get to Waterford hospital, which is at 66%, which is the area the Deputy represents. CUH is at 68%. There is variance. Most of the hospitals are concentrated at way over 85% and then there are hospitals such as Portiuncula hospital in Galway, St. Luke's hospital in Kilkenny, CUH, Waterford hospital and St. Luke's Hospital in Dublin, which are at less than 75% and this is not good enough. This is the sort of visibility and transparency we need, and we need to continue to drive to ensure everybody is at a rate of well over 95%. I recognise the variance in this.
Sentiment score: 0.10
This is very important. We have 58 seconds to have this conversation but it would be good to have a session at the Oireachtas health committee where we can go through all of the various regions and KPIs and recognise the variance. For example, we spoke in December about Galway, where there was a particular challenge. It reported 86% within the target in December, which was up from 68% in November. Local management is so important. Significant additional resources in terms of people and equipment are included in the annual plan and in the capital plan. Sometimes this is the issue and there is a question later on recruitment and replacement when we can deal with this. It is also about local management. Deputy Charles Ward spoke earlier about access to surgery. This is why I am putting in additional oncology chairs and surgical hubs in Letterkenny hospital to make sure there is better access. It is a combination of various things but as long as we are focused on what is different and why it is different, we are all likely to achieve a better and more consistent outcome.
Sentiment score: 0.27
Under the national plan for radiation oncology, an equipment replacement programme is in place in St. Luke's in Rathgar, St. James's Hospital and Beaumont hospital, along with a phased expansion in Beaumont. The replacement programme is being progressed under the national development plan. It is included in the capital plan and the health sectoral plan. There are 23 linear accelerators, ranging in age from three to 18. These are located across five public hospitals: Rathgar, Beaumont, St. James's, Galway and Cork. State-of-the-art radiation oncology centres opened in Cork and Galway in 2019 and 2023 respectively, representing a €120 million capital investment. The linear accelerators in Rathgar, Beaumont and St. James's were installed between 2008 and 2016. The HSE advises that the typical lifespan of a linear accelerator is ten to 15 years, although some can be used for longer. An accelerator's lifespan depends on many factors, including the type, how it is used, how it is maintained and the manufacturer support lifespan, which includes software upgrades. There is a degree of variance. The preliminary design process for linear accelerator replacements within St. Luke's is ongoing. In addition, tenders for the main contract for the Beaumont phase 2 expansion and replacement project are due in the coming weeks. We are committed to improving cancer care and to investing in this way.
Sentiment score: 0.10
I agree with the Deputy. I would like us to be replacing equipment because we have used it so intensively. Part of this issue relates to the number of radiation therapists. There has been a very considerable expansion in that regard. We have 217 radiation therapists in Ireland, an increase of 21% since 2020. In the last six years, the radiation therapy training programme has grown by 32%, with more than 20 additional specialty training posts established in the last three years. We need the people but we also need organisation to allow these machines to be run hard. I will give an example regarding a performance indicator for radiation oncology, that is, the number completing radical treatment and the percentage commencing treatment within 15 working days in the Deputy's own area of Galway. In January 2025, the percentage was 72%, in October it was 98%, in November it was 98% and in December it was 100%. In Cork, there was a fall-off. The figure was 97% in January 2025 but fell to 91%. That is still reasonably strong but nationally we are just not where we need to be. It is about resources, organisation and consistency.
Sentiment score: 0.13
I understand the Deputy's point. We want the machines working hard. There is considerable variance. It should not get to 20 years. We have a programme of replacement. The HSE has a key performance indicator target for 90% of patients to commence treatment within 15 working days. The figure for performance nationally is 79%. The majority are exceeding the target. Unfortunately, St. Luke's is consistently below the key performance indicator target. Is that unfair to say? What are the specific reasons for that? Is it a question of disruption to machines, access to radiation or access to management? As public representatives, the Deputy and I are now able to intelligently interrogate the reasons for that and to challenge or support, as appropriate. Because we have the capacity to tell that story rather than speaking in generalised ways, which unfortunately was our wont some years ago, we are able to have a much more detailed conversation and reflect fairly and honestly on the varying reasons for those things.
Sentiment score: -0.02