2026-04-21

117. Deputy David Cullinane asked the Minister for Health the model that the Sláintecare programme board will operate on following the appointment of a new HSE CEO and a new Secretary General at her Department; the reason her Sláintecare implementation plan for 2025-plus does not have year-to-year measurable actions for 2026 onwards; and if she will make a statement on the matter. [28518/26]

I am seeking an update, if I can, on the Sláintecare programme board and how that will operate, given that we have a new CEO of the HSE and, indeed, a new Secretary General in the Minister's Department. I wish to take the opportunity to thank Mr. Bernard Gloster and Mr. Robert Watt for their many years of service, two people I have worked closely with and have a very high regard for. I also want to wish Ms Anne O'Connor and Mr. Derek Tierney the very best as well. We obviously want them to succeed. They are two highly professional people who I have a lot of faith in and I know they will do lots of good things. During the previous Dáil, the leaders of the Sláintecare programme board were the heads of the Department and the HSE. Will that continue? I also refer to the implementation plan, which I think ended in 2025. We need an updated implementation plan with clear timeframes and targets so that the new CEO and the Department head actually have a plan to work to.

I thank the Deputy, and I join him in thanking the Secretary General, Mr. Robert Watt, and the previous CEO of the HSE, Mr. Bernard Gloster, who both did outstanding work in the Department of Health and the HSE in different ways. They have really stabilised and improved the service more broadly since 2022 in particular and I thank them for that. I also wish both the new Secretary General, Mr. Derek Tierney, and the new CEO, Ms Anne O'Connor, well in their new roles, which are very significant roles for everybody. Notwithstanding those changes in personnel, there is no change to the programme of work. That needs to continue. We remain fully committed to the Sláintecare vision. The next meeting of the Sláintecare programme board will take place on 28 April. At that meeting, progress across all of the Sláintecare projects will be reviewed in respect of the action plan for 2026, the second of three action plans under Path to Universal Healthcare: Sláintecare & Programme for Government 2025+. The Deputy knows what they are. For quarter 1 alone, this includes 90 actions across 12 Sláintecare projects. In total, the programme board oversees 23 projects with approximately 400 actions. What does that mean? It relates to reforms being driven through, for example, with the enhanced community care programme, the public-only consultant contract, POCC, and, crucially, the implementation of the POCC, the digital health transformation and women's health. It is envisaged that the same structure will be co-chaired by the new Secretary General and the HSE chair, so there will not be a change there, which I think is very welcome. That is really the answer to the Deputy's question.

I welcome some of what the Minister said but the problem is there are not clear deliverables and timeframes in the current Sláintecare action plan. That is something that has to change. I want to see, for example, changes to the medical card and GP card thresholds. There have not really been any substantial changes to medical card eligibility in a long time. The big reform that the health service needs, from an acute hospital perspective, is delivering the elective hospitals. If you really want to deal with waiting lists, then build the four elective hospitals as quickly as possible. I guarantee that that will give us capacity to deal with lots of the planned procedures that need to be done, separating scheduled from unscheduled care. I am big believer in a seven-day-week health service.

I know.

I know the Minister is. When she is pushing forward those reforms, I will be supporting them, as I did with the public-only consultant contract because we needed it. We have to get bang for our buck. I agree that we need reforms and efficiencies but we also need capacity. If we do not have the diagnostic capacity, the bed capacity and the staff in our hospitals, then it is more difficult to reach our targets and actually get the reforms. It is a combination of all of that, and all of that is obviously part of Sláintecare.

I agree and I thank the Deputy for his support on these reform programmes. He is right about the elective hospitals but before then, we have the opportunity with the surgical hubs, which will be delivered in 2026. The delivery of the surgical hubs is going to create all sorts of different waves. We are looking at what procedures need to go there immediately and what that will free up in the hospitals where they would otherwise have been done. How is that going to be staffed and when? I am looking at the National Treatment Purchase Fund, NTPF, buying capacity in our own hospitals but I am also looking at underutilised capacity in our own hospitals, like the endoscopy suite in Bantry. There are two of them. One of them is used a half a day per week. We have appointed additional people specifically to Bantry but how can that be, and why are we buying any endoscopy action in that area? Why is there endoscopy happening in Roscommon when there is a very good suite there that does not operate after a certain part of the day? How are we using our own resources and how are we going to collectively, as the political leadership in health here, make sure that we are using the assets we have as we build? The elective hospitals are entirely necessary but we have capacity that is not being used. There is room after room in different hospitals and we are not using them.

I could not agree more. I have been saying this for a long time. I am a big supporter of the surgical hubs. There is one coming in my own constituency adjacent to University Hospital Waterford, so I know the difference that will make. I fully agree that we have to look at how to take pressure away from our acute and major hospitals, for example, more off-site rooms for outpatient activity where we can free up clinical space. I am in favour of all of that. I am fully on board with a seven-day-week health service. I want all of that to happen, but for the efficiencies to happen, there also have to be the resources. While the surgical hubs will be a game-changer, I can tell the Minister for a fact that the elective hospitals will be an even bigger game-changer. I am saying that to her because there will be push-back from consultants. I have got it in relation to the elective hospitals. They want the low-lying fruit still in public hospitals. It is why insourcing was so profitable and something they were trying to protect. We have to protect public patients, get value for money and efficiencies but also reduce waiting times. I guarantee that if the elective hospitals are built, the Minister will see some of those wait times in orthopaedics and other areas come down rapidly. It will be the biggest reform that could be made in the health service.

I totally agree with the Deputy and I think we will get there with Galway and Cork much more quickly. I would like to discuss with all Deputies options around Dublin because clearly we have the option in relation to Connolly hospital. The Deputy may have noticed that we put in some high-dependency unit, HDU, beds in advance because that is really going to be an important enabler. We did that in the past number of weeks. We put the staff in to have significantly expanded HDU capacity in Connolly hospital with a view to where that goes for the elective. It is well worth us considering constructively the best other use of brownfield space that is available within other Dublin hospitals, how we might consider that as alternative elective capacity and what we do with Crumlin. It is a useful open conversation that we should have. More than anything else, I need Deputies' help with the implementation of the public-only consultant contract and five over seven. I cannot have the NTPF buying activity in hospitals from 5 p.m. to 8 p.m. and not have consultants rostered at those times. That intersection is going to be really important between surgical hubs, the NTPF and the actual rostering. I am going to need Deputies' help.