I thank Deputies Cullinane and Ward for raising this important issue. I welcome the opportunity to discuss the Health (Waiting Lists) Bill 2024, which the Deputies have put forward. I recognise the worthwhile intentions and aims of the Deputies in tabling this Bill. I am taking this matter on behalf of Minister for Health, Deputy Jennifer Carroll MacNeill. Specifically, the Bill seeks to introduce requirements for setting priorities and maximum waiting time performance targets for services across hospital and community sectors, to extend the waiting list reporting role of the National Treatment Purchase Fund and to place additional statutory accountability measures on the National Treatment Purchase Fund in relation to Oireachtas Committees. In principle, the proposals put forward are in line with measures already in place in relation to priority and target setting; with the continual development and improvement of waiting list reporting; and with our shared recognition of the need to ensure the accountability of aegis bodies under Departments. However, notwithstanding the merits of what the Bill aims to achieve, the Government is opposing it on the basis that the specific proposals are not necessary, given the measures already in place or being developed, and in some cases are not possible to implement. Furthermore, the proposals will not address the key issue, which is the length of time people are waiting for treatment. To reiterate, the Government will be opposing the Bill for reasons I will outline in greater detail. On priority and target setting, throughout their proposals, the Deputies acknowledge the importance of having clearly defined priority and target setting in the delivery of health services. This is already in place, with an existing rigorous process underpinned by strong governance arrangements across the Department, the HSE and the National Treatment Purchase Fund. In regard to letters of determination and the national service plan, on foot of the budget announcement, the Minister for Health’s letters of determination to the HSE include the requirements that the HSE’s national service plan for the following year must set out the type and volume of services to be delivered and appropriately reflect the priorities set out by the Minister in the Department. That is set out under the Health Act 2004. On maximum wait times, the targets in the national service plan are set having regard, as the Deputy has already referenced, to the 2017 Sláintecare report, which specifies maximum waiting time targets for scheduled care in our hospitals of ten weeks for a first outpatient appointment and 12 weeks for an inpatient or day case procedure. The range of waiting time targets for scheduled care set out in each year’s national service plan represents progressive steps towards the ultimate goal of the Sláintecare targets. In regard to the performance engagement model, it provides a framework for oversight and engagement on performance issues between the Department and the HSE, and ensures that HSE performance can be measured against the objectives and targets set out in the national service plan. Internally, the HSE implements the performance and accountability framework, which sets out how the HSE’s regions and national services are held to account for their performance. In line with the programme for Government, the Government’s priority for 2026 is to improve healthcare access and quality across all health regions. This requires greater regional and national accountability for performance against national service plan targets. As such, the performance and accountability framework will further strengthen transparency across every level of the health service, with clear lines of authority, responsibility and accountability to ensure delivery on commitments. The multiannual waiting list action plan approach, which commenced in September 2021, facilitates target setting and monitoring for acute hospital waiting list performance and has been highly effective in improving waiting times for our hospital services. While it is acknowledged that further improvements are needed, the effectiveness of the structures in place is evident in the improvements to waiting list performance since the action plan approach was implemented. As of the end of October 2025, these include a 55% reduction, or 155,000 fewer patients, waiting over 12 months, an improvement of 44% in the average waiting time for patients on lists from 12.2 to 6.8 months, and an 11% reduction in the number of patients waiting longer than the ten- and 12-week Sláintecare targets, which equates to 66,000 patients. The Department of Health is currently engaging with the HSE and National Treatment Purchase Fund to develop the plans for 2026, which will build on the progress delivered to date, renewing the focus on further improving waiting times for patients and considering the learnings from the challenges that arose in 2025. On the matter of waiting list reporting, the Bill also seeks to extend the role of the National Treatment Purchase Fund by expanding its reporting function to include non-hospital services such as primary care, disability and mental health, and to provide a greater level of detail about those services than is currently available. In regard to the development of waiting list reporting, there is currently a robust structure in place between the HSE and the National Treatment Purchase Fund for the collection, collation and validation of acute hospital outpatient, inpatient and day case waiting list information. However, it is important to note that this is being continually developed and improved upon to provide access to greater levels of waiting list information. This is evidenced in the significant work currently under way on a best practice reporting project led by the National Treatment Purchase Fund. The scope of the best practice reporting programme is to implement waiting time and waiting list reporting for patients on acute hospital waiting lists. The greater access to meaningful wait time information for patients and practitioners that will be provided through best practice reporting will assist in maximising resources in the effective management of waiting time and waiting list information. Significantly for patients, best practice reporting will provide them with reliable information on how long they can expect to be waiting for their treatment. Over time, the significant programme of work that has been undertaken and data infrastructure that has been developed across acute hospital services have provided greater visibility of these services from several perspectives. It also provides a platform for reform and the development of data-driven interventions to improve productivity and benchmark performance. Looking at primary care waiting lists, to address the long waiting times for primary care, the Department of Health is currently working with the HSE on a focused, programmatic approach to primary care waiting list management, aiming to put in place considerable standardised infrastructure to support systematic responses to primary care waiting lists. Data are a key aspect of the standardised infrastructure that is needed to bring about long-term improvements to how we plan for faster access to those services. However, currently, there are widely acknowledged limitations in the level of data available at a granular level in terms of the primary care therapies and related activity and waiting lists. One of the aims of the programmatic approach is to address these data limitations. While work in this regard has commenced, it would not be possible at this juncture, as proposed in the Bill by the Deputies, for the National Treatment Purchase Fund to support or deliver waiting list reporting for primary care to the standard currently achieved for acute hospital waiting lists. In regard to community and child and adult mental health services, CAMHS, waiting lists, there is a long-standing and well-established reporting and monitoring system between the Department of Health and the HSE in relation to improving access to CAMHS and reducing waiting lists for those services. This process involves regular engagement and detailed data returns, which will continue to be enhanced. It is worth noting that reductions in the waiting list for CAMHS have been achieved despite the continued increasing demand for those services. The Bill also aims to ensure the accountability of the NTPF by placing a requirement on the CEO of the NTPF to appear before Oireachtas committees upon request. The NTPF board is accountable to the Minister for Health and comprehensive governance arrangements are in place to ensure the NTPF meets its requirements under the code of practice for the governance of State bodies. Under its establishment order, the CEO is required to appear before the Committee of Public Accounts. It has also demonstrated its willingness to engage with other Oireachtas committees having appeared before the Joint Committee on Health this year. As I have set out, while the merits of the Bill are acknowledged, the existing processes and governance structures in place are fully adequate to support improved waiting list performance. This is evident in the progress that has been achieved to date. It is also important to recognise that the appropriateness of the structures in place is only one aspect of what is needed to ensure improved waiting list performance. Notwithstanding the progress that has been achieved to date, it is acknowledged that many patients are waiting too long for care and much further work is needed. I again thank the Deputies, particularly Deputies Cullinane and Mark Ward, for raising these important issues. While our methodology and approach may differ, the Government welcomes that there is a shared recognition of what needs to be in place in principle to address the challenge of reducing waiting times. For the reasons I have put forward, the Government and Minister will be opposing this Bill.

Sentiment score: 0.49

I thank Deputies Cullinane and Ward for tabling this Bill and facilitating a discussion regarding the length of time people are waiting to access care in our health service. As stated previously, I am taking the debate on behalf of the Minister for Health, Jennifer Carroll MacNeill. I thank all the Deputies who contributed to the debate. As already stated, while recognising the worthwhile intentions and aims of the Deputies in tabling this Bill, the Government is opposing it on the basis that the proposed measures are not necessary in light of the effectiveness of the current arrangements and structures that are already in place. There are rigorous and effective structures and processes in place for setting priorities and targets for delivery of health and social care services. These include the letter of determination, the national service plan and performance oversight within the HSE and between the HSE and the Department, including the waiting list action plan. In terms of the proposed measures to expand upon waiting list reporting set out in the Bill, significant work is already under way to improve and build upon the information available at present. However, the current limitations in relation to the availability of waiting lists to deliver the specific enhancements set out in the Bill would prevent the proposal from being implemented and would thereby undermine the intentional impact of the legislative change being proposed. With regard to the proposal that the NTPF be made accountable to a committee of the Houses of the Oireachtas, I set out the thorough and extensive measures for oversight and governance of the fund that are in place between the Department and that organisation. In addition, the NTPF is required to appear before the public accounts committee, as specified in the legislation under which it was established. The NTPF has demonstrated willingness to engage with the Oireachtas upon request, including on a number of occasions this year. Obviously, at meetings of the public accounts committee, its representatives are questioned by Deputies on the basis of work done by the Comptroller and Auditor General. As already outlined, the Government is satisfied the structures already in place are appropriate to ensure effective priorities and target setting as well as the live and extensive reporting of waiting list information. In addition, access to accurate data about patients waiting for service across the system is recognised as being crucial to how we can facilitate access to those services. However, it is important to remember that these are only aspects of the solution to address the key issue of the length of time people are waiting for treatment. The improvements achieved in terms of acute hospital waiting lists and waiting times are being driven by specific actions aimed at increasing capacity and embedding reform by means of the waiting list action plan approach. Examples of this include the ongoing establishment of the surgical hubs around the country and the further roll-out of modernised care pathways. Embedding reform actions in our system will ensure the most efficient use of available resources in a patient-centred way, including initiative seeking to optimise the patient pathway from referral to discharge. The implementation and progression of the multi-annual action plan approach is not happening in isolation. The longer term reform of scheduled care and reduction in waiting times is interconnected with and influenced by a number of developments across the health service. This includes the continued focus on productivity and efficiency improvements and the shift of more care into community settings and alternative care pathways. These interdependencies underline the complexity of the system of the system and how an integrated and holistic approach is needed to ensure waiting times are improved across the health service to ensure people have access to the care they need when they need it.

Sentiment score: 0.41