2026-01-27

I am thankful for the opportunity to speak this evening. Before I start, I want to reflect on how far we have come as a nation in the last 25 years in relation to health. Our budget in 2000 was €5.6 billion and this year it is €27.4 billion, which is a fivefold increase. We see improved individual outcomes, economic growth with a healthier and more productive workforce, increased life expectancy and greater equity and social well-being across the population. However, multidisciplinary primary care was first discussed here as a concept in the 1980s. The first strategic plan, Primary Care: A New Direction, was introduced in 2001. We saw our first primary care centre nine years later in Mallow, and since then we have seen over 180 new primary care centres delivered nationwide. I firmly believe it is an infrastructural development area that is not recognised half enough when it comes to the delivery we have seen in the area, with many more in the development pipeline. In my county we have seen Tullamore up and running. We officially opened Banagher Primary Care Centre with the Minister, Deputy Carroll MacNeill last year. Birr is nearing completion and I recently visited it. Edenderry is at the planning application stage and I hope, once we get approval on that, the HSE will prioritise it for development. We have the bricks and mortar and now it is a matter of ensuring adequate human resources capacity. I acknowledge Dr. Velma Harkins in relation to the introduction of the international medical graduate rural GP programme, which has made a material difference in relation to providing GPs in rural areas. We heard from many in opposition in this Chamber about how we were never going to see a GP again and services were lost. This has taken the pressure off but we need more. There are problems which remain and I hear about them regularly from my constituents. Occupational therapists, physiotherapists, speech and language therapists, psychologists and chronic disease supports are seriously lacking. There are a number of vacancies in these roles that need to be filled as a matter of priority in my area. There are long waiting times and waits for assessment and intervention. People are literally waiting for years, so I ask the Government to prioritise this, working with the HSE. Elective surgery is a growing problem and the statistics speak for themselves. Midland Regional Hospital, under the stewardship of Louisea Burke, has proven itself to perform at every level, and there are plans for further development of dialysis, an oncology day ward and an extension to the existing emergency department. It proudly boasts one of the lowest emergency department trolley numbers in the country. I visited recently and saw this at first hand. The urgent need for an emergency department is backed by the fact that, in 2025 versus 2024, there was a 3% increase in ED attendees, with 9% of those being over 75 and 11% over 90. This is a bed capacity challenge which brings a significant increase in surge requirements and that is impacting on elective surgery. We have seen insufficient protection of elective beds, underutilised theatres due to staffing and schedule constraints, high cancellation rates because of emergency demand, and elective surgery constantly crowded out, not because the need is not there but because emergency takes priority. We have seen increases as high as 48% and 27% in inpatient and day cases, respectively, as well as in endoscopy year on year. This is something that needs to be addressed by the Government as a matter of priority.

I thank the Deputy for raising this really important topic. I am taking this on behalf of the Minister. The Government acknowledges many patients are waiting too long for care, but we are committed to improving access to hospital care and reducing waiting times for patients, including through the multi-annual action plan approach. Building on the progress made to date, we will continue to focus on reducing waiting times for scheduled care in our hospitals through a range of measures, including service reforms and innovation, as well as targeted increases in capacity. The Government is also committed to increasing elective care capacity across Ireland to ensure high-quality and timely scheduled care is available to all. In order to meet medium-term demand, we are delivering the first phase of increased elective capacity through a national network of surgical hubs. The two surgical hubs at Tallaght and Mount Carmel in south Dublin are already open and are having a real impact on day case waiting lists. There are due to be five more surgical hubs opened in 2026 at Cork, Galway, Limerick, Waterford and in north Dublin. Hubs at Sligo and Letterkenny will then follow, with design for both now under way. In the longer term, and to meet the needs of our growing and ageing population - the Deputy is right to note it is ageing - we are also delivering a national network of elective treatment centres in Cork, Dublin and Galway. These new facilities will make a real difference to those who are waiting for access to elective treatments while also freeing up capacity in other hospitals to deal with more complex and emergency cases. Patients in the midlands will have access to these elective treatment centres on an equal basis to everyone else in the country, that is, based on clinical need. This will help to reduce waiting times for elective procedures and ultimately lead to a more efficient and responsive system for everyone. Long waiting times are not unique to the hospital system, however. To address the long waiting times for primary care therapy services, the Department of Health is currently engaging with the HSE on a focused approach to these waiting lists. Under this programme of work, in September last year the Minister asked the HSE to put measures in place to address the long waiting lists for physiotherapy, occupational therapy and speech and language therapy. This is expected to remove over 60,000 people from these three waiting lists throughout the country. In addition, to ensure the necessary resources are available to maintain waiting lists below that target, the HSE is prioritising recruitment of permanent staff to primary care therapy services, with approval of an additional 200 whole-time equivalents in the national service plan for 2026. It is therefore about recruitment too, which the Deputy spoke about, through the different areas. An additional 12 posts have been allocated to the midlands integrated healthcare area, including posts to address vacancies in occupational therapy and physiotherapy for children’s services in Offaly and Laois. I am also very pleased to advise that additional primary care infrastructure is in development in County Offaly following on from the opening of primary care centres in Tullamore and Banagher in recent years. Birr primary care centre is due to open in the first half of this year. It will include an extensive GP practice and allow the HSE to consolidate its primary care and mental health services under one roof, and this will be of real benefit to the people in the area. The Edenderry PCC is in the early planning stage and a planning application was submitted for this development to Offaly County Council this month. All of these measures are showing significant investment in the area and will have a very positive impact on the people of the midlands.

I appreciate the Minister of State's response but the options that will be given to patients in the midlands are in every geographical location around the country except the midlands and that is exactly what needs to change. Sláintecare commits to reducing waiting times, bringing care closer to home and regional delivery. We want to see all three delivered in the midlands. On a basic human level, behind every waiting list number is a person living in pain, struggling to work or watching their quality of life deteriorate. If you are living in the midlands or in Offaly you are expected to commute or get a train in order to avail of those services, and that is simply not acceptable in 2026. In 2018, A Trauma System for Ireland: Report of the Trauma Steering Group recognised Tullamore for its 24-7 emergency department with trauma, orthopaedic and general surgery on call. That is a strategically important location. As recently as July 2024, a report commissioned by the HSE exploring the options for increasing hospital capacities in the midlands identified the need. Yet, in the response this evening, there is no recognition of that. We are seeing population growth. We need to future-proof for it. It took 30 years to deliver the concept of primary care centres. The midlands and Offaly cannot wait 30 years for elective capacity to be brought there. We need to move away from a model under which we are expected to go to Dublin or Galway. We want that capacity to be brought to the midlands and to take the pressure off the other areas. I propose that the Government look strongly now at forming some kind of dedicated stakeholder task force to work on the issue as a matter of urgency to ensure patients in the midlands who want and need elective surgery can get it in the midlands, and do so as a matter of urgency.

I thank the Deputy for raising this important issue. I assure him the Government is committed to providing access to the best care for the people of Ireland. We are clear that no matter where the facilities are located, everyone should have access to adequate and appropriate care based on their needs. Through the delivery of this programme, we are increasing capacity to meet short- and long-term needs, but the surgical hubs and elective treatment centres together will form a national network. These facilities will enable the delivery of care for all patients. Geography will not be a barrier. Instead, consultants and other doctors will be able to refer on the basis of patient need. I see where the Deputy is coming from but the Minister welcomes the news that the development of the primary care infrastructure in County Offaly is progressing, offering a real example of the investment the Government is making in community-based health infrastructure, providing a single point of access to healthcare services for patients. I assure the Deputy that there is currently no barrier to recruitment to primary care services and an additional 200 staff for primary care therapy services have been prioritised in the HSE national service plan. I assure the Deputy that I will be speaking to the Minister, Deputy Carroll MacNeill, tomorrow and I will highlight the concerns Deputy Clendennen raised tonight. I thank him for raising this important issue.