2026-02-18

I raise this Topical Issue because children across south Tipperary, and children across the south east, are being left without access to basic community ophthalmology services due to repeated recruitment failure following the planned retirement of the previous consultant, Dr. Hillery, in August 2024. This is not a new issue. I have raised it repeatedly throughout 2025, in February, April, July, October and December and, most recently, in January of this year. On every occasion, I sought an update on the recruitment progress and, crucially, what contingency arrangements were put in place or are in place. In January of this year, I again asked what immediate measures were operating, yet here we are in February 2026 and still no change. The latest figures made available to me show that almost 1,500 children under the age of four, and 334 children aged between five and 17, are waiting for basic community ophthalmology services. That is almost 1,800 children in south Tipperary alone waiting for basic ophthalmology care, the majority of whom are under the age of five. As the Minister of State and everybody in this House will know, in early childhood, vision development is time sensitive. Delays in assessment and treatment can have lasting consequences. For every young child, an 18-month wait is not neutral. It can mean missing critical development windows. Parents are being told routine referrals carry waiting times of approximately 18 months. Some children in my constituency whose parents have been in contact with my office were referred in 2023 and remain on the list. In the interim, families are advised to contact the clinic in University Hospital Waterford if concerns become urgent. The reality is that the phone is not being answered. This is not a structured contingency plan. Recruitment failure cannot mean service absence. I again ask the Minister of State very directly about this. Are weekend clinics currently operating? Has private provision been formally contracted? Are children being systematically referred across HSE areas? Is temporary contracting or emergency outsourcing now in place? Crucially, what is the update on the appointment of the permanent ophthalmologist for south Tipperary to be based in Clonmel? We are now looking for concrete proposals. Children across south Tipperary are entitled to the same access to community ophthalmology services as children anywhere else in our State. After raising this issue throughout 2025, I believe families deserve a clear and concrete answer today.

On behalf of the Minister for Health, I thank the Deputy for raising this important matter. I acknowledge the number of times he has raised it. I have answered him several times in relation to this. As I go through the answer, for anyone listening in, it will become very clear that every effort has been made to try to recruit staff, but the HSE just has not been able to do so. As the Deputy knows, the HSE provides optical services free of charge to preschool children and national school children referred from child health service and school health service examinations who are discovered to have sight problems. These children are referred to the appropriate optical care, which will continue to be provided until the child has reached the age of 16 years. The community ophthalmic services scheme, COSS, is a national fee-per-item scheme which was introduced in 1979. Under the COSS, medical card holders aged over 16 years can be seen by local ophthalmologists, community ophthalmic physicians, optometrists or dispensing opticians who have entered into a contract with the HSE to provide services. The HSE has advised that the community ophthalmologist physician post, as the Deputy has referred to many times, became vacant in October 2024 due to a retirement. As he knows, our constituencies border each other and this has been raised with me as well. I met one of the nurses while I was out and about one day in west Waterford, close to Clonmel, and it was raised with me. I just happened to come across the nurse working in the services and she explained to me how difficult it had become. In line with the national clinical programme for ophthalmology model of eye care and the modernised eye care pathway - this is important - the community ophthalmologist physician post has been upgraded to the position of consultant medical ophthalmologist. Following a recruitment process to fill the post in south Tipperary, an interim appointment was made in July 2025. Unfortunately, the successful candidate subsequently declined the post prior to the commencement date. I am telling the Deputy everything he knows, but I want to put it on the record. Unfortunately, a second recruitment campaign in late 2025 resulted in no candidates being shortlisted. The HSE acknowledges the impact on patients, both children and adults, caused by the current vacancy and has further advised that it readvertised this position in the Irish College of Ophthalmologists with a closing date of 21 January 2026 and, positively, several eligible candidates have applied. Shortlistings will commence on 27 February with interviews anticipated in mid-March 2026. The HSE expects to fill the role in the near future. The HSE has also confirmed that a clinical optometrist and orthoptist post were also advertised, with a closing date of 19 January. The recruitment of these positions will ensure the resumption of optical services for those living in the south Tipperary region. The HSE has advised that patients from the Tipperary south area who have been unable to receive eye care due to this vacancy may, for urgent eye care issues, be referred to the eye service via the emergency department in University Hospital Waterford and that all patients have been notified of this additional referral pathway but I acknowledge that is not a suitable pathway for children. It is difficult presenting to a hospital like that. The HSE has also engaged with the Royal Victoria Ear and Eye Hospital in Dublin with a view to supporting Tipperary south. It has undertaken discussions with a private agency and a scoping exercise has been conducted in this regard. Personally, I would much prefer to see the consultant in place and services resume. I know that the Deputy wants that as well. For emergencies, a scoping exercise is under way. I am actually pleased to hear that there were several applications which we did not have previously.

I thank the Minister of State. I welcome confirmation that there has been concrete interest and that a number of applicants have applied after the most recent recruitment drive. It is important that a permanent consultant ophthalmologist is in place at the earliest opportunity. I also support additional contingency measures and the scoping exercise referred to by the Minister of State, linking in with the Dublin hospital because we have waiting lists. I alluded to the fact 1,800 children, mostly under the age of five are on the waiting list, including Rory and Aoife, who were referred to my office. They are both under the age of five and were referred back on 10 October 2023. Today, I cannot give them any indication of when they may be seen. In early childhood, delays in vision care can unfortunately lead to damage. Parents should not have to travel to different counties, seek private care or wait a minimum of 18 months for assessment. As I said, I welcome progress finally being made and I hope that through the latest recruitment process we will have a permanent consultant. I thank the Minister and the Minister of State for upgrading the post to a consultant level. I also acknowledge that the other key appointments are already in place. In essence, children cannot wait. They need appointments and they need them urgently. If we have a permanent ophthalmologist in place, we also need to focus on contingency measures that will assist in bringing down the waiting lists at the earliest opportunity. As I said, the children across Tipperary south need these appointments. It is an emergency.

I can confirm that the post was upgraded to that of consultant medical ophthalmologist and obviously that may be one of the reasons it was not as sought after as it was. Several recruitment campaigns have been run and to date the HSE has been unable to fill the post. The post is funded as well, so it is not a financial issue. Several eligible candidates have applied in the latest recruitment campaign, which closed on 21 January. Shortlisting will commence on 27 February, with interviews anticipated to take place in mid-March 2026. The HSE has also engaged with the Royal Victoria Ear and Eye Hospital in Dublin with a view to supporting Tipperary south. It has undertaken discussions with a private agency and a scoping exercise is being conducted in this regard, acknowledging the long waiting list and the likes of the two kids the Deputy mentioned who have been waiting two years which is simply not good enough. I thank the Deputy and I will follow up on this again.