2026-04-29

I am raising this Topical Issue again because children across south Tipperary are being left without access to critical basic community ophthalmology services due to repeated recruitment failures following the planned retirement of the previous consultant, Dr. Hillery, in August 2024. This is not a new issue. It has now escalated into a full-blown failure of ophthalmology service delivery across south Tipperary. What should be a core community service simply has not existed for the past two years. More than 2,000 children are on the waiting list, 1,500 of whom are under the age of four. As we all know, vision development in early childhood is time-sensitive. Delays in assessment and treatment can have lasting consequences for speech and language development, educational progress, social interaction and general confidence and well-being. Very young children are waiting two, three or four years. In some cases my office has been made aware of, children have been waiting for an appointment since 2023. This can mean missing critical developmental windows. In the interim, families are being advised to contact the emergency clinic at University Hospital Waterford if concerns become urgent. Families who have engaged with me tell me that the reality is that, more often than not, the phone in Waterford is not being answered. Waterford is already under huge pressure with its own waiting list. What we really need is a structured contingency plan. I have raised this matter repeatedly throughout 2025, in February, April, July, October and December, and I had a Topical Issue debate on it with the Minister of State on 18 February this year. What immediate actions are being taken to secure a permanent consultant ophthalmologist for south Tipperary? We have now had three campaigns. Following the first campaign, the successful candidate declined the position. The second campaign found no eligible candidates. I do not think there were even any applications. None of the candidates who applied during the most recent campaign were deemed eligible. We also need to know what changes are going to be made. We are now entering into a fourth recruitment campaign. We need to ensure it is successful. How will the Minister for Health ensure that patients in south Tipperary receive timely and equitable access to this critical ophthalmology service? I wish to refer to the response that I received on 18 February last delivered by the Minister of State. The HSE said that it was engaging with the Royal Victoria Ear and Eye Hospital in Dublin with a view to supporting Tipperary South. Is there any update? The HSE also confirmed that it was entering into discussions with a private agency with a view of a scoping exercise being conducted. I previously spoke about availing of capacity within the private sector. There are 2,000 children waiting, with 1,500 under the age of four. As if the crisis in orthodontic services was not enough across the south east, this is another full-blown crisis with regard to ophthalmology.

I thank the Deputy for raising this again and for his continued advocacy in relation to this situation. It is one that I am very familiar with, as our two constituencies align along a border. I have met one of the nurses who works in the service and who has advocated strongly as well. I just happened to meet her one day. On behalf of my colleague, the Minister for Health, I thank the Deputy for raising this important issue, which he has highlighted a number of times. As the Deputy is aware from previous replies, every effort has been made to recruit staff to this service, but these efforts have not been successful to date. The HSE provides free optical services to preschool and national school children who are referred through child health and school health examinations and are identified as having sight problems. These services continue until a child reaches 16 years of age. In addition, the community ophthalmic services scheme, which has been in place since 1979, allows medical card holders aged 16 and over to access care from contracted ophthalmologists, community ophthalmic physicians, optometrists or dispensing opticians. The HSE has confirmed that the community ophthalmic post in south Tipperary - University Hospital Waterford - became vacant in October 2024 following a planned retirement. In 2025, the post was regraded to that of consultant in medical ophthalmology to align with the national clinical programme for ophthalmology. Permanent consultant posts are advertised through the Public Appointments Service, PAS. This process can take time, and the HSE ran two temporary recruitment campaigns in May and September 2025 to maintain services in the interim. Unfortunately, no appointment was made following these campaigns. The permanent post was advertised by the PAS in November 2025. As there were no applicants, the closing date was extended to January 2026. One application was received but following shortlisting, the candidate did not progress to interview. The post was advertised in the British Medical Journal. In parallel, the HSE has advertised clinical optometrist and orthoptist posts, a process that closed in January. Filling these roles will help support the resumption of optical services in south Tipperary. While recruitment to the consultant post remains ongoing, a multidisciplinary working group has been established involving consultants from University Hospital Waterford and the national clinical lead for ophthalmology. In addition, a targeted blitz clinic initiative is being processed to urgently address the significant waiting list backlog for patients in south Tipperary. I take on board every word that the Deputy said in relation to over 2,000 children waiting, with many of them under four years of age. That early intervention is absolutely crucial. We accept that. Sometimes, it is difficult for different reasons to get the specialist consultant into a particular area. That is what is proving difficult in this case. As Minister for State with responsibility for mental health, I have similar challenges in various areas. I was delighted to see a vacancy in south Kerry child and adolescent mental health services, CAMHS, that had been vacant since 2014 being filled only recently. It had been supported by locums up until that. The HSE has tried everything to try to get this post filled. It went out to the British Medical Journey. However, I am pleased to see that this targeted blitz clinic initiative is being progressed to urgently address the significant waiting list backlog for patients in south Tipperary. Hopefully, that will have an impact while the recruitment process is under way in parallel.

I thank the Minister of State for her reply. It is very unfortunate. What I find most frustrating is that Dr. Hillery's retirement was a planned retirement. The recruitment processes that we have been going through for the past 15 months should have commenced before Dr. Hillery's planned retirement. I am a small bit alarmed about what was not mentioned in the reply, namely, the HSE's engagement with the Royal Victoria Ear and Eye Hospital in Dublin. What was the outcome of that engagement? There was also no reference to engaging with the private agency, as was suggested in the reply to me on 18 February. There is no detail on the scoping exercise or, indeed, any plan to avail of capacity within the private sector. I welcome that a multidisciplinary working group has been established involving consultants from University Hospital Waterford and the national clinical lead for ophthalmology. This is a matter concern for all the elected representatives in south Tipperary. Perhaps a meeting could be set up with Deputies Healy and McGrath and myself. It is important that we be kept updated. What are the contingency measures in the meantime? My understanding is that there is no additional capacity. Everybody is working hard down in University Hospital Waterford. I do not like to put on the record of this Chamber that parents are telling me that the phone is going unanswered, but parents are unfortunately being forced into accessing private ophthalmology. It is a crisis. I would like to organise a meeting with the Minister.

It is disappointing that a post that has been advertised for almost two years has still not been able to be filled for various reasons. It is important to note that recruitment to the consultant post remains ongoing. In parallel, a multidisciplinary working group has been established involving consultants from University Hospital Waterford. The national clinical lead for ophthalmology is that piece of the jigsaw that the Deputy mentioned as regards the Royal Victoria Eye and Ear Hospital. That would be the person. Across all definitions in health, we have a national clinical lead. To have the national clinical lead involved at this level is important. The targeted blitz clinic initiative is being progressed. We do not have the details here, but I would expect that would include public and private to try to get the waiting lists down. That would be normal. I will look for more information in relation to the blitz clinic initiative because I am a very conscious of the growing waiting list. I will revert to the Deputy. I will talk to the Minister.