2026-04-21

123. Deputy Willie O'Dea asked the Minister for Health the targets in place for inpatient waiting times in 2026; and if she will make a statement on the matter. [28345/26]

136. Deputy Willie O'Dea asked the Minister for Health the targets in place for outpatient waiting times in 2026; and if she will make a statement on the matter. [28346/26]

Tá muid ag dul ar aghaidh go dtí Ceist Uimh. 123. Tá sé in ainm an Teachta O'Dea, ach tá an Teachta Daly á ghlacadh ar a shon.

This fits in with the rest of the debate going on here. It is to ask the Minister about the targets for the inpatient waiting times. I acknowledge her focus on productivity and reform within the health service. Deputy Neville has pointed out that with all these things it is an ecosystem and they are interconnected. If you cannot have an efficient admission and discharge policy for both elective and acute, you will end up with long waiting lists.

I propose to take Questions Nos. 123 and 136 together. Improving access to healthcare in our hospitals is an absolute priority for me. As the Deputy knows, we have very good outcomes in our healthcare system. Our challenge is making sure we have access as quickly as possible. That is the focus, on making sure we are using our resources in the best way possible. We are focusing on a public healthcare system in which everybody has timely access to high-quality scheduled care where and when they need it. I refer to the waiting time action plan for 2026. This used to be the waiting list action plan, until we all realised together that the length of time spent waiting is more important than the number of people on the list, obviously. This builds on the progress to date. It includes significant reductions achieved in the length of time patients are waiting. The plan takes a multifaceted approach in achieving it, setting out six overarching and interconnected targets focused on patients waiting the longest. The plan aligns with the national service plan, NSP, targets for planned care, including targeting increases in the proportion of patients waiting within Sláintecare maximum waiting times and outpatient and inpatient day-case waiting lists. Those targets represent steps towards our ultimate shared goal of all patients being seen or treated within the Sláintecare target times, namely, ten weeks for outpatient appointments and 12 weeks for inpatient and day-case procedures. The devolution of responsibility to the regional executive officers is an important part of this reform. The REOs have complete visibility over what is happening with their acute hospitals, their model 4, model 3 and model 2 hospitals and everything that is happening in the community and in their primary care centres. There has to be a complete synergy between the different model hospitals and primary care to use this. We now have tools that we did not have before. We have the outpatient toolkit, which is showing what the actual room utilisation is in every hospital. There should be no resistance to the application of the outpatient toolkit. It is not tenable that some hospitals have room vacancy rates of between 4% and 9% during the week and 24% on a Friday afternoon. I have not yet seen what the room vacancy rates are on Tuesday evening or Sunday morning, but we do not need to build more capacity and more rooms until those rooms are filled and being used. They are being heated and insured. All of these things are there and available. The utilisation of the outpatient toolkit is, therefore, enormously important. It means that we are scheduling according to the most efficient use of time. We are not asking people to change the length of their consultations or change the nature of their medical practice. We are simply taking the length of time they normally use and reorganising so that things are done differently and delivered differently, including in primary care centres. This really matters because we have opportunities between the outpatient toolkit and now the surgical hubs in respect of inpatient day-case procedures - or a certain proportion of those - and also freeing up the corresponding activity in the home hospital. The first real application of that, of course, will be with the Dublin north-east surgical hub. This is a huge opportunity to test how the public-only consultant contract is being used or not used, rostered or not rostered, how the five over seven roster is complementing that and how that is being used by all the different hospitals in the Dublin north-east region. We have these different opportunities but it is important that they are delivered. I want to highlight the importance of clinical leadership in this. Every single person in this House is calling for and looking for the same thing. It has to be implemented and there is a responsibility on clinical leadership to stand up and make sure the clinical community is doing everything it can to adapt and change its ways of working within the contractual parameters its members have signed and that have been set in agreements to make sure we are delivering for the patients of Ireland.

There are brilliant people working in the public health service who do their work very well but we can acknowledge, and I think the Minister acknowledges, that there are some hospitals in areas of the country where that productivity is not apparent. I will speak about the HSE West and North West region. In the past, at the health committee, the Minister acknowledged there are issues around discharge and management of patient flows. The west and north west is the poorest region of the country, with the highest proportion of the population in receipt of disability payments and the highest proportion of the population in receipt of a full medical card. We have a situation where we cannot discharge patients from a level 4 hospital, namely, UHG because there are not any step-down beds and not enough rehabilitation beds or enough home-help hours. In addition, we have a level 4 hospital that is purporting to carry out all the services of a level 4 hospital without having that capacity. We need a commitment to a new hospital in the west, at UHG in Galway. In addition, we have a situation where there has been an over-reliance on the private developer-delivered primary care centres and also an over-reliance on individual GPs to deliver that infrastructure. If we are completely serious about the interconnectivity of our health service, we need to get some of that investment into primary care. The vast majority of the very considerable investment by the State over the last five years has continued to go into hospital care and acute care and not enough has gone into developing primary care. We have the longest waiting lists for speech therapy, psychology, community physiotherapy and speech and language therapy in the community. Unless we fix that capacity in the community in tandem with the acute service, we will not see the end of these waiting lists.

I agree. That is what we are trying to do. On the primary care centres, we have 181 at the moment, with eight under construction and 21 more in early planning stages. However, if people do not use them and if they are not used for outpatient procedures to relieve pressures on hospitals, we are going to keep having the same conversation. There is an excellent outpatient centre in Merlin Park right beside UHG. It is one of the few that is being used on a three-session per day basis. Good work has been done in that primary care centre but a lot more can be done. This is as much about how people are working as about where they are working. I have talked about the physical capacity increases that we have but we cannot keep building more physical capacity if people are not going to use it differently. There is no point in concentrating consultant work between 9 a.m. and 5 p.m. Monday to Friday with all of this additional capacity. I would rather spend money hiring more people to fill the spare space. However, how can we be sure that will happen if the clinical leadership does not make sure we are implementing the contract such as it is? We have to see evidence of that and the trajectory in relation to it. I agree with the Deputy on all the fantastic people doing fantastic work but we cannot keep saying that in the knowledge that many of them also have to work differently to make sure we are using the space that we have all paid for by making it available for the benefit of patients. We cannot have primary care centres closing at 5 p.m. They have to be open and serving the community until 8 p.m. or 10 p.m. That is what they are for. This is about building capacity, as it always will be with a growing population, but at some point we will reach a juncture where we have built so much capacity and if we have all of this evidence of it not being used or not being used in the most balanced way across the week, we will have to start asking ourselves decent questions about it.

I have a case involving a patient who has critical ischemia of her leg. She is a hard-working woman in her 60s. Twice she has had to be admitted to hospital and twice she has been sent out. She needs a procedure done. She has now been sitting for two weeks in a bed in UHG because they cannot get theatre time to do the procedure she requires. That is simply not a productive system. We have people who have given up on certain specialties, such as dermatology, rheumatology and others, in the west because they cannot get access. I completely agree with the Minister and she has my full support for any productivity reforms. We also need to deal with the fact that our health service has not been digitalised. We are off the record. The EU 2030 Digital Compass requires that patients will have fully digitalised records in every country in the European Union. Ireland is so far off that chart. Countries like Estonia, Malta and Lithuania can do this, and we cannot. We need to focus on enabling productivity. The Minister is right that we should be using our physical resources insofar as we can. However, there is an issue with UHG, and we need a new hospital there over the next ten years in order to make sure it functions properly as a level 4 hospital. That is the type of specialty treatment that some people need but they are competing with people who go through the emergency room, elderly people who need care in the hospital setting and people who might be better cared for in a community setting. We have to deal with primary care. We need to get over the culture that because it is a contract-led service by GPs, the infrastructure should be borne only by GPs. If we are completely serious, we should be building State-led primary care centres and have five-year, rent-free zones to attract young GPs into those centres.

I agree. As I said, we have 181 primary care centres, with eight under construction and 20 more at early planning stages for precisely that. Regarding the Deputy's constituent who could not get surgery, let us count up the different things we have said here. It was said that they cannot get theatre time for her. There is a theatre utilisation project. I would very much like to know the nature of her procedure and to test this case against theatre utilisation across the hospital. The Deputy says that we need a new hospital. I remind him that we are building both a surgical hub and an elective hospital precisely to provide additional theatre time. Let us stay aligned to exactly what is going on, which is the delivery of full utilisation of all of the theatres in University Hospital Galway, a surgical hub and an elective hospital. Can the Deputy imagine the number of surgeons it takes to run those all of the time? If we are to run them seven days a week, how many surgeons would it take? How many surgeons does it take to run a surgical hub all of the time, recognising that they will not all be working all of the time and that there will be two or three shifts? How many are required to run an elective hospital and all of the theatres that are already in UHG? How many surgeons does all of that take? I strongly recommend to the members of the Committee on Health who are here that they should invite the team that has done the theatre utilisation project and the OPD toolkit before the committee and interrogate them as to their findings and the use of theatres so that they can see this for themselves. We can then come back and seriously look at the number of surgeons it takes to fill six surgical hubs, four elective hospitals and every theatre in the country. When we were doing the urgent project to deliver more endometriosis surgeries, I was looking for an additional 100 surgeries in the final quarter of 2025. One of the responses I got from a surgeon, who really is invested in this and who really is working hard, is that one of the barriers was that he had been told elective work could not be done after 5 p.m. in the theatres in the maternity hospital he was working in. I said "I am sorry, what? Says who?" These are some of the barriers we have to overcome. We have a lot of space. We have to use it.