2025-12-11

I welcome the Minister of State, Deputy O’Donnell. The Government has indicated that it is opposing the Second Reading of the Bill.

I move: “That the Bill be now read a Second Time." I am not surprised the Government has indicated that it will oppose the Bill. The previous Government signed up to Sláintecare a number of years ago. I was always suspicious of Fianna Fáil and Fine Gael signing up to a plan that delivers universal healthcare and seeks to streamline and reduce waiting lists. I contrast that ambition with the evidence of almost 1 million people currently on some form of waiting list, if we include acute, community, diagnostics and so on. In the past, my party put forward clear plans for an integrated waiting list management system. We had some favourable responses at the time from Simon Harris when he was Minister for Health but, of course, they never saw the light of day. It is troubling but not surprising that the Government will oppose this straightforward but very important legislation. The Bill seeks to do things: first, to acknowledge that waiting lists are too long and, second, to bring a degree of transparency to those lists that does not currently exist. Going back to what I said a few moments ago, almost every Member of the Oireachtas at the time Sláintecare was put in place signed up to that plan. We signed up to a roadmap, in essence, to deliver universal healthcare. It also set statutory timeframes for waiting lists that we are absolutely nowhere near meeting. I raised directly with the Minister for Health a number of weeks ago the situation with even very basic daycare procedures in my constituency of Waterford. Patients come into my office almost daily for cataract, hip or hernia operations - very basic procedures. When I contact local hospital management, they say, unfortunately, the person could be waiting 12, 15 or 18 months. For a patient who needs a cataract procedure, that has an impact because it affects their sight and their quality of life. One gentleman I was dealing with needed two cataracts done. Thankfully, after a lot of lobbying of hospital management, we eventually got him seen through the NTPF and he will be seen that bit quicker. If he was left on the waiting list, we were told he would wait at least 15 months for that to be done. That is the reality people are dealing with. I make that point to reinforce what I am talking about here. There was a lot of excitement when Sláintecare was agreed. Deputy O'Reilly was the representative of my party on the committee at the time. A huge amount of work by many people went into ensuring we set out a roadmap that could transform our health service and deliver the type of health service people want. That is one where people do not have to wait years for basic procedures, or for serious operations, which is also the case, or for speech and language therapy, occupational therapy or access to a dietitian. All those community waiting lists have also got very long in recent years. We currently have 250,000 people on community waiting lists. It is staggering. The vast majority of them have been waiting over 12 months and, in some cases, over two years. We have to juxtapose that with the Sláintecare targets, according to which people should be seen within a matter of weeks. Instead, they are waiting years in some cases. What does our Bill seek to do? It requires the Minister to set priorities for the HSE with regard to maximum wait times and to set specific targets. We want those targets to be the Sláintecare targets we agreed to. The Bill specifies 12 types of service for which there should be maximum wait times and allows the Minister to specify any other service. The Minister must have regard to the Sláintecare report, best practice, outcomes and the effect on services of specifying maximum wait times. The maximum wait time targets are not specified in the Bill because we deliberately gave the Minister flexibility and allowed her to set what she might see as more realistic initial targets as we move incrementally towards implementing the Sláintecare targets. Why that is being opposed I have no idea. The Minister and Government will have to explain why they are so far behind their Sláintecare targets and why people are waiting so long. When we in opposition come forward with solutions, which we have done in this area, they get knocked back time and again. It does not make sense to me in relation to some of the proposals we have been calling for for years. They include an integrated waiting list management system to better utilise all resources across all hospitals so a person is not referred to a single doctor and waiting on that doctor's list unable to be seen by a different hospital or even a different doctor within the same hospital. Having that integrated system would mean patients could be offered procedures much quicker, yet that does not happen. We saw recently with the scandal of insourcing the concerns, challenges and difficulties posed by single consultants managing waiting lists rather than their being managed by a hospital or hospital group or being centralised in some way. Having a local list but also a centralised list makes sense. We have been calling for that for so long, yet it has not been implemented. I also seek in this Bill to bring a greater degree of transparency to waiting lists. At the end of every month, the NTPF publishes some waiting lists. It publishes the acute hospital waiting list, which is very welcome, but it does not publish diagnostic waiting lists or community waiting lists. It does not cover mental health waiting lists, CAMHS or any of the other areas of social care and healthcare where people are waiting. We have to put in parliamentary questions to get that response. It is the same with dental treatment. I got a reply to a parliamentary question recently. I had to ask the question three or four times to get the information I was looking for. I eventually got it but that information should be transparent and clear and on the NTPF website with the other waiting lists for acute hospitals. It beggars belief that with all the new technologies in the healthcare system, we still do not publish all the waiting lists with wait times. They should be broken down by region, county and area. That would give all of us a chance to see which areas are performing and which are not, where pressures exist and where pressures do not exist. We can then praise those efforts which are achieving better results. An example is in my constituency of Waterford, where the hospital is one of the better performing hospitals. Wait times are down. People are not waiting on trolleys in emergency departments in the same way they are in other hospitals. It is good for all of us to see what is and is not good practice. Transparency around waiting lists shows up that there are sometimes regional differences, not because management or staff in those areas are not doing their best but because we do not have the staff. We might not have the equipment, resources, capacity or whatever it might be. That is mostly the reason we have those types of regional disparities. If we do not have the waiting lists and cannot measure or compare, obviously that is not good. I have always said data is really important in the healthcare system. If we have very good data, we can do so much more. I was at a meeting of the Oireachtas health committee a number of weeks ago. I am not sure if the Minister of State, Deputy O'Donnell, was at that session on digital transformation and the roll-out of the unique health identifiers and electronic health records, EHRs, all of which we are told will happen over the coming years. It will take six or seven years for the full bells and whistles of the EHRs to be in place and for this State to have digital hospitals. While that is being done, it is the perfect time for the State to get its act together on waiting lists. I have seen so many waiting list initiatives from Governments. We could paper the walls of this place with all the winter plans and waiting list initiatives - money thrown at the system, money for insourcing, money for outsourcing. Yet when we look at the waiting list, we see people are still waiting far too long and we are nowhere near the Sláintecare targets. We have to start looking at outputs and asking why, with record investment in healthcare, we are still not getting the results we need or seeing waiting lists come down to the extent required. It is partly resources and capacity. If we do not have the staff, beds, physical space or equipment, we cannot provide the surgeries or procedures or make appointments as quickly as they need to be made. Equally, if the processes are not working or are cumbersome or protective and create little fiefdoms where people control waiting lists and there is not freedom to move from one waiting list to another, that does not make sense. It does not make sense to me or to a patient waiting for a hip procedure in Waterford when there may well be an opportunity to be seen in Kilkenny, Wexford or somewhere else quicker. Why are those opportunities not being made available? Why are we not harnessing that potential and using the full resources of the health service we have? Again, there is evidence of good practice in this area. I go back to my constituency. I was part of a group of Oireachtas Members who met monthly with hospital management and the regional hospital group. We forced them to have better engagement with the local private hospital, UPMC Whitfield, doing a lot of elective procedures and diagnostic work. They bought up beds in private nursing homes and contracted beds to ensure speedier discharges. They also put better systems in place to manage waiting lists and for better collaboration between consultants and staff for discharges and so on. Processes do work. Flow in a hospital is important. Flow in the healthcare system is important if you get it right. What is frustrating is we see evidence in other countries of the solutions we are proposing to fix the problem and to integrate and manage waiting lists in a much more productive way, yet we have a Government that simply will not accept them. It says all the right things and offers nice words when we raise this but then it does not happen. I will be interested to hear the Minister of State's speech and to hear exactly why the Bill is being opposed. There may be some good reason for it. This is a Bill we got a lot of help with putting together to ensure it was as fit for purpose as it possibly could be. I am sure the Minister of State may have been in opposition himself at some point. We do not have the resources a Department has or an army of civil servants to do a Bill, so we do our best, as the Opposition, to craft Bills that are as fit for purpose as possible. Even if they were not ideal or perfect, the reason we have Committee Stage in Bills is so that, if there are any issues, they can be discussed, amended and got to a point where we have more fit-for-purpose Bills. I will finish on this. I have not spoken to the Minister of State and I do not know why the Bill is being amended but for whatever reason it is being amended, I hope he is coming with an alternative and not just coming again to say "No" to the solutions we are putting forward. I do not want to be here in five years' time again still talking about problems with managing waiting lists or about people waiting too long; still waiting for the elective hospitals to be built or the 3,000 beds that Stephen Donnelly promised, which we will not see delivered over the next five years; and still looking for transparency around mental health waiting lists, community waiting lists and so on, where I have to put in parliamentary questions again and again and ask them in a dozen different ways to try to get the information I want. Surely the Minister of State is going to respond by setting out a plan in relation to greater transparency with waiting lists, and a better way to manage them as well.

We are about to find out. I call the Minister of State, Deputy O'Donnell.

I thank Deputies Cullinane and Ward for raising this important issue. I welcome the opportunity to discuss the Health (Waiting Lists) Bill 2024, which the Deputies have put forward. I recognise the worthwhile intentions and aims of the Deputies in tabling this Bill. I am taking this matter on behalf of Minister for Health, Deputy Jennifer Carroll MacNeill. Specifically, the Bill seeks to introduce requirements for setting priorities and maximum waiting time performance targets for services across hospital and community sectors, to extend the waiting list reporting role of the National Treatment Purchase Fund and to place additional statutory accountability measures on the National Treatment Purchase Fund in relation to Oireachtas Committees. In principle, the proposals put forward are in line with measures already in place in relation to priority and target setting; with the continual development and improvement of waiting list reporting; and with our shared recognition of the need to ensure the accountability of aegis bodies under Departments. However, notwithstanding the merits of what the Bill aims to achieve, the Government is opposing it on the basis that the specific proposals are not necessary, given the measures already in place or being developed, and in some cases are not possible to implement. Furthermore, the proposals will not address the key issue, which is the length of time people are waiting for treatment. To reiterate, the Government will be opposing the Bill for reasons I will outline in greater detail. On priority and target setting, throughout their proposals, the Deputies acknowledge the importance of having clearly defined priority and target setting in the delivery of health services. This is already in place, with an existing rigorous process underpinned by strong governance arrangements across the Department, the HSE and the National Treatment Purchase Fund. In regard to letters of determination and the national service plan, on foot of the budget announcement, the Minister for Health’s letters of determination to the HSE include the requirements that the HSE’s national service plan for the following year must set out the type and volume of services to be delivered and appropriately reflect the priorities set out by the Minister in the Department. That is set out under the Health Act 2004. On maximum wait times, the targets in the national service plan are set having regard, as the Deputy has already referenced, to the 2017 Sláintecare report, which specifies maximum waiting time targets for scheduled care in our hospitals of ten weeks for a first outpatient appointment and 12 weeks for an inpatient or day case procedure. The range of waiting time targets for scheduled care set out in each year’s national service plan represents progressive steps towards the ultimate goal of the Sláintecare targets. In regard to the performance engagement model, it provides a framework for oversight and engagement on performance issues between the Department and the HSE, and ensures that HSE performance can be measured against the objectives and targets set out in the national service plan. Internally, the HSE implements the performance and accountability framework, which sets out how the HSE’s regions and national services are held to account for their performance. In line with the programme for Government, the Government’s priority for 2026 is to improve healthcare access and quality across all health regions. This requires greater regional and national accountability for performance against national service plan targets. As such, the performance and accountability framework will further strengthen transparency across every level of the health service, with clear lines of authority, responsibility and accountability to ensure delivery on commitments. The multiannual waiting list action plan approach, which commenced in September 2021, facilitates target setting and monitoring for acute hospital waiting list performance and has been highly effective in improving waiting times for our hospital services. While it is acknowledged that further improvements are needed, the effectiveness of the structures in place is evident in the improvements to waiting list performance since the action plan approach was implemented. As of the end of October 2025, these include a 55% reduction, or 155,000 fewer patients, waiting over 12 months, an improvement of 44% in the average waiting time for patients on lists from 12.2 to 6.8 months, and an 11% reduction in the number of patients waiting longer than the ten- and 12-week Sláintecare targets, which equates to 66,000 patients. The Department of Health is currently engaging with the HSE and National Treatment Purchase Fund to develop the plans for 2026, which will build on the progress delivered to date, renewing the focus on further improving waiting times for patients and considering the learnings from the challenges that arose in 2025. On the matter of waiting list reporting, the Bill also seeks to extend the role of the National Treatment Purchase Fund by expanding its reporting function to include non-hospital services such as primary care, disability and mental health, and to provide a greater level of detail about those services than is currently available. In regard to the development of waiting list reporting, there is currently a robust structure in place between the HSE and the National Treatment Purchase Fund for the collection, collation and validation of acute hospital outpatient, inpatient and day case waiting list information. However, it is important to note that this is being continually developed and improved upon to provide access to greater levels of waiting list information. This is evidenced in the significant work currently under way on a best practice reporting project led by the National Treatment Purchase Fund. The scope of the best practice reporting programme is to implement waiting time and waiting list reporting for patients on acute hospital waiting lists. The greater access to meaningful wait time information for patients and practitioners that will be provided through best practice reporting will assist in maximising resources in the effective management of waiting time and waiting list information. Significantly for patients, best practice reporting will provide them with reliable information on how long they can expect to be waiting for their treatment. Over time, the significant programme of work that has been undertaken and data infrastructure that has been developed across acute hospital services have provided greater visibility of these services from several perspectives. It also provides a platform for reform and the development of data-driven interventions to improve productivity and benchmark performance. Looking at primary care waiting lists, to address the long waiting times for primary care, the Department of Health is currently working with the HSE on a focused, programmatic approach to primary care waiting list management, aiming to put in place considerable standardised infrastructure to support systematic responses to primary care waiting lists. Data are a key aspect of the standardised infrastructure that is needed to bring about long-term improvements to how we plan for faster access to those services. However, currently, there are widely acknowledged limitations in the level of data available at a granular level in terms of the primary care therapies and related activity and waiting lists. One of the aims of the programmatic approach is to address these data limitations. While work in this regard has commenced, it would not be possible at this juncture, as proposed in the Bill by the Deputies, for the National Treatment Purchase Fund to support or deliver waiting list reporting for primary care to the standard currently achieved for acute hospital waiting lists. In regard to community and child and adult mental health services, CAMHS, waiting lists, there is a long-standing and well-established reporting and monitoring system between the Department of Health and the HSE in relation to improving access to CAMHS and reducing waiting lists for those services. This process involves regular engagement and detailed data returns, which will continue to be enhanced. It is worth noting that reductions in the waiting list for CAMHS have been achieved despite the continued increasing demand for those services. The Bill also aims to ensure the accountability of the NTPF by placing a requirement on the CEO of the NTPF to appear before Oireachtas committees upon request. The NTPF board is accountable to the Minister for Health and comprehensive governance arrangements are in place to ensure the NTPF meets its requirements under the code of practice for the governance of State bodies. Under its establishment order, the CEO is required to appear before the Committee of Public Accounts. It has also demonstrated its willingness to engage with other Oireachtas committees having appeared before the Joint Committee on Health this year. As I have set out, while the merits of the Bill are acknowledged, the existing processes and governance structures in place are fully adequate to support improved waiting list performance. This is evident in the progress that has been achieved to date. It is also important to recognise that the appropriateness of the structures in place is only one aspect of what is needed to ensure improved waiting list performance. Notwithstanding the progress that has been achieved to date, it is acknowledged that many patients are waiting too long for care and much further work is needed. I again thank the Deputies, particularly Deputies Cullinane and Mark Ward, for raising these important issues. While our methodology and approach may differ, the Government welcomes that there is a shared recognition of what needs to be in place in principle to address the challenge of reducing waiting times. For the reasons I have put forward, the Government and Minister will be opposing this Bill.

Having listened to what the Minister of State said here today, it seems quite clear to me that there is no will from Government to change this. The reality is that this is affecting real people's lives as it does day and day out and as it does today while people are waiting to have procedures and consultations. We are talking about people waiting in the emergency department in Galway University Hospital for the care they so desperately need. It also affects those people who want to provide that care. If we take Galway as an example, we can see that 6,000 people are waiting over six months for procedures. There are 20,000 people waiting over six months for a consultation. This is a huge number of people in Galway who are waiting to get the basic healthcare they need. A key issue coming into my office involves people coming in who have been waiting for the pain clinic. Imagine having to wait to get this help for pain. You are getting older, you are in massive pain and you have to come into an office to speak to someone like me because you are trying to get help for that pain. That is wrong. It should not be like that. It should be that if you need healthcare, you get that healthcare but instead so many people are coming into our offices who are not getting this care. Then there is the issue of people waiting for dental care. We always get a mother ringing us desperately saying her child needs some type of dental care, it is urgent and it is affecting the child going to school or being able to eat but she is being told that her child cannot get the dental care they need. One of the things I really wanted to raise involves emergency departments. As somebody who has visited people in the emergency department of late, I know that the overcrowding is unbelievable and outrageous. We have had many campaigns, including a strong campaign relating to people presenting with mental health issues going to accident and emergency and not being in an appropriate setting. I do not think it is an appropriate setting either for people receiving chemotherapy who are advised that if they go into their local shop, they need to wear a face mask, yet they are spending hours overnight on a trolley in accident and emergency. That does not make sense. I do not know if anybody can make that make sense but that is wrong. I have contacted Galway University Hospital about this. It told me that it is under huge pressure and its staff are under huge pressure. If it does not seem to be able to come to me with a satisfactory answer, I will bring it to the Minister of State. I would like him to raise that issue with the HSE because that is wrong. I will contact the Minister of State directly. Given the impact of overcrowding, we need to look at rural areas and how they can assist. I raised the nine beds in Áras Mhic Dara with the Minister of State and I know he hoped to meet with the HSE about that. Perhaps he has an update. I thank Deputy Cullinane for bringing forward this Bill, particularly during the winter and at Christmas time when so many people have the flu and other bugs and end up in our hospitals, are in hospital over Christmas or are waiting for a pain clinic. Christmas is always a time when there is a focus. It is deeply unfortunate that the Minister of State is not supporting this Bill. I hope he reconsiders that but I hope he can follow up on those key issues I mentioned.

I also welcome the Bill and commend Deputies Cullinane and Mark Ward and Sinn Féin on bringing it forward. I have to say that it is disappointing that the Government is once again opposing a Bill from the Opposition. This morning, I attended the working group of committee Chairs with the Taoiseach, who spoke very openly about how he is open to taking amendments from the Opposition, listening to different groups and engaging with people in a productive way to have a productive Parliament. I was surprised because it is not my experience. I have been here a year and not a single amendment put forward from the Opposition benches has been accepted by the Minister for Health - not one. Not a single Bill we have put forward has been accepted in a year. At the same time, Ministers and the Taoiseach in particular, especially at Leaders' Questions, come in and say the Opposition has no ideas, solutions or proposals. When serious proposals are put forward, they are just dismissed out of hand and given no serious consideration. It is deeply frustrating. We saw it yesterday when my party put forward a Bill on animal welfare. It was similar with our votes at 16 Bill and our Bill in the Seanad on domestic violence. Time and time again, there is a timed amendment, our legislation is dismissed and we are told we have no ideas. When a very well-constructed and serious Bill like the one put forward by Deputy Cullinane is put forward, again it is opposed. I am only here a year and I find it deeply frustrating. I am sure others who are here longer find it even worse. People outside the Houses, including the citizens watching this debate, do not have trust in our democratic system and process because we have a system that is two-faced in many regards. On the one hand, the Taoiseach says he is very open to accepting amendments, listening to the Opposition and engaging. On the other hand, the Government just dismisses proposals and suggestions out of hand. I ask the Government and the Department of Health, which has not accepted a single amendment to any legislation in a year, to think again about the strategy and approach, to engage meaningfully with the constructive proposals put before them and to stop dismissing things out of hand because it is bad for our democracy, our Republic and our governance and we can do better. I welcome the Bill. The main provisions about putting waiting list targets on a statutory footing, publishing all waiting lists across the health service and making the NTPF more accountable to the Dáil are things all parties here should accept and progress. Sláintecare set out the core wait times of ten weeks for outpatients and 12 weeks for inpatient day cases. These wait times were to be underpinned by legislation and implemented on a phased basis by 2023, but that did not happen. Is the Government now opposed to the idea of legislating for wait times because that is what I heard from the Minister of State's speech? Is he now against that and going against the recommendation from Sláintecare? If so, I would like him to tell us more about that. In February, the Minister published the waiting list action plan for 2025 with the aim that 50% of patients would wait less than the Sláintecare target of ten weeks for their first outpatient appointment and 12 weeks for their day appointment by the end of 2025. In October, which is the last published month, outpatient appointments were 69.4% over the target, while active inpatient and day cases were 62% over the target. Time and again, we are missing those targets and people are waiting far too long to get access to the health services. Supply-side interventions are needed for investment in primary and community care so that our hospitals are not the default but supply-side policies alone will not address the waiting list problems. Sláintecare is clear on the requirement for maximum wait-time guarantees and the need to ensure that people responsible for holding those guarantees are held to account. This is why we need legislation like this. Currently, the NTPF publishes monthly acute hospital waiting lists and some diagnostic waiting lists. However, those for other areas, such as primary care, are not routinely published. Instead, these must be sought via parliamentary questions, as they are not routinely compiled. This makes it very difficult to get a true picture of the total number of people on health and social care waiting lists in the State and, most importantly, to provide a true picture of the wait times across services. Waiting times in primary and community care are the hidden crisis in our health services. In September, figures I compiled showed there are over 300,000 people on some of our primary and community health and social care waiting lists. Over 240 have been waiting for more than three months, while more than 100,000 people have been waiting for over a year. An extraordinary number of people are waiting an extraordinary length of time to get access to health services in this State. Quite shockingly, 42,000 children were found to be waiting for more than a year across eight core primary care services, including occupational therapy, physiotherapy and speech and language therapy. A massive number of children are waiting far too long to get access to these core primary care services. On NTPF accountability, while the NTPF is required to appear before the public accounts committee, as specified under legislation, and potentially other committees, such as the health committee, there is undoubtedly an arm's-length level of accountability, which needs to be rectified. Instead of being a response of last resort, the NTPF has regrettably become an integrated part of the State's healthcare landscape. The health service has become increasingly reliant on the NTPF, which has a €230 million budget this year compared with €55 million in 2018. We have seen this balloon and balloon, with massive expenditure. A HSE examination over a 27-month period revealed the scale of the HSE's dependency on insourcing and outsourcing. A total of €830 million was spent on outsourcing and around €100 million was spent on insourcing. Huge sums of public money are being spent. While greater controls have been put in place until insourcing is phased out in June 2026, little is being done to address the dependency on outsourcing. This is something that needs to be addressed. The reliance comes at a major cost that is not just financial. It is hollowing out public capacity and creating a perverse incentive for staff to move from the public to private sector. It is a vicious cycle. I would like to hear about the Sláintecare commitment around the legislation and what the Government's current position is on that, and what else will be done to reduce waiting lists. Too many people in our State are waiting far too long to get access to core health services they desperately need. People are waiting in pain and anguish. They are getting sicker and, ultimately, dying sooner because they are not getting access to health services. This Government and this State are failing too many people. It needs to change.

I very much thank Deputy Cullinane and Sinn Féin for bringing forward this very important Bill. I express real disappointment that the Government is opposing this legislation. We have to be honest here. As recently as September, the Secretary General of the Department of Health talked about the Department remaining committed to achieving the Sláintecare targets of ten weeks for outpatient appointments and 12 weeks for inpatient and day-case procedures. We all know, however, that unless someone's feet are held to the fire, it is hardwired into legislation and we have clear legislative targets, this will be a pipe dream within the health service. As was referenced, Sláintecare very clearly set out that there should be legislation, and that there needs to be maximum wait times for both performance targets and accountability with regard to these wait times. The experience of so many across our public healthcare system at the moment is of unacceptably long wait lists. Currently, 625,000 people are on acute hospital outpatient waiting lists and 110,000 are waiting a year or more. While the targets are there, only 30.5% of people are being seen within that ten-week target, which is a deterioration on where things were at last year. Things are actually getting worse rather than better. We then see the Government opposing legislation such as this, which is obviously brought in good faith to try to ensure there is real accountability within the system. I got a letter some days ago from a consultant ophthalmologist in Cork, who talked about a particular patient who will have to wait until 2028 to get her cataract surgery done. This patient is deemed to be semi-urgent, yet she will have to wait well over three and a half years from when she was referred. This ophthalmologist talked about having made protected disclosures and raising concerns to the highest level about the lack of resources, yet little is being done. There is a huge amount of frustration, upset and lack of trust in the public system, which is pushing people into the hands of private health insurance. Nobody should feel they have to have private health insurance in this country. It should be just to get the private room, but instead people feel they have to take it out in order to jump the queue and get faster access because there is that lack of confidence and trust in so many parts of the public system. An important part of the Bill that was referred to in the reporting on the waiting lists is the glaring absence of the NTPF figures because they just relate to acute hospital care. We do not have comprehensive waiting list data with regard to primary care and diagnostics. We all know that in primary care, and we have all asked the parliamentary questions, which we have to ask because it is the only course of action to try to find out the information, just how bad the waiting times are. In recent weeks, we saw that 28,000 children are now on a psychology waiting list. When we asked the question earlier this year, we saw there was a 170% increase in the wait list in three short years. A fundamental problem ultimately is the lack of a periodic publication of the waiting lists in that sector to see whether we are seeing an improvement or, which is of course what is happening, a disimprovement in the children's disability waiting list figures. We have heard from Bernard Gloster that there is now an action plan for physiotherapy, speech and language therapy, SLT, and OT. We very much welcome that. I welcomed it at the committee a few weeks ago but there is a glaring absence with regard to psychology waiting lists. The critical thing here is we do not have systematic data collection on diagnostics in primary care. There is a cost, human and financial, for the failure to have joined-up thinking on the lack of resources in our health system at this point in time. A patient came to me in my constituency in recent weeks. He is a patient at Beaumont who needs to be tested via a Holter device. It is a monitor that effectively detects arrhythmias or heart palpitations. His consultant cannot see him until he has worn that small device to monitor his heart rhythm during the daytime. When we started asking the questions across the various hospitals, we saw that the next available appointment in Beaumont for a Holter monitor is June 2026. In St. James's, the average waiting time is 22 months. It has only ten monitors and 733 patients on the waiting list. In Galway, 600 people are on the waiting list who have been waiting 12 months; some have been waiting four years. Patients have to wear this device before they can see the cardiologist. For urgent patients needing a monitor in CUH, the wait is up to four months. These are patients who are deemed to be urgent. The cost of this monitor is just €2,500. There is much technology, devices and equipment in the health sector that costs hundreds of thousands of euro. This is a very simple, relatively cheap device in the general scheme of things within the health sector. Yet, we are not seeing the investment needed to ensure that the people involved can be properly monitored, get to see their cardiologists and move through the system. There are so many blockages in the system. It is not just about staffing. So much of the conversation in this regard revolves around staffing, and rightly so, and beds. The conversation also needs to be about equipment and devices. We are not talking about CT scanners, MRIs or PET scanners in this instance; we are talking about a device that costs €2,500. In the context of a consultant seeing a patient, however, the latter could be waiting four years before they are monitored. It is a reflection of how broken parts of our health system are that we are not even getting the basics right. Ultimately, we need to make sure that we have a much more comprehensive and systematic attitude towards the collection of data in the health service. That is why the Labour Party is happy to support the Bill. The NTPF is charged with a number of responsibilities, one of which is oversight of waiting lists in hospitals. There is a real issue now about where responsibility lies in terms of monitoring how people are allocated onto the in-service or outsourced service provision. Like Deputy Rice, I am less than 12 months in this brief as my party's spokesperson on health. In the context of all the revelations we have seen this year, one of the things which strikes me is that there is not a clear sense of responsibility as to who takes ownership of the transfer of people from waiting lists to the NTPF. The latter makes certain claims. Hospitals in certain areas have taken responsibility themselves, with varying degrees of consistency. We need to get the right level of transparency when it comes to the NTPF. So much money has been put into the fund. We do not want such reliance on the NTPF, but it has become a necessary evil that we have to outsource because there is no other option following a decade of underinvestment in the health service. A key part of the legislation before us relates to ensuring that there is greater transparency in the context of the NTPF. My party very much supports the Bill.

I thank Deputies Cullinane and Ward for tabling this Bill and facilitating a discussion regarding the length of time people are waiting to access care in our health service. As stated previously, I am taking the debate on behalf of the Minister for Health, Jennifer Carroll MacNeill. I thank all the Deputies who contributed to the debate. As already stated, while recognising the worthwhile intentions and aims of the Deputies in tabling this Bill, the Government is opposing it on the basis that the proposed measures are not necessary in light of the effectiveness of the current arrangements and structures that are already in place. There are rigorous and effective structures and processes in place for setting priorities and targets for delivery of health and social care services. These include the letter of determination, the national service plan and performance oversight within the HSE and between the HSE and the Department, including the waiting list action plan. In terms of the proposed measures to expand upon waiting list reporting set out in the Bill, significant work is already under way to improve and build upon the information available at present. However, the current limitations in relation to the availability of waiting lists to deliver the specific enhancements set out in the Bill would prevent the proposal from being implemented and would thereby undermine the intentional impact of the legislative change being proposed. With regard to the proposal that the NTPF be made accountable to a committee of the Houses of the Oireachtas, I set out the thorough and extensive measures for oversight and governance of the fund that are in place between the Department and that organisation. In addition, the NTPF is required to appear before the public accounts committee, as specified in the legislation under which it was established. The NTPF has demonstrated willingness to engage with the Oireachtas upon request, including on a number of occasions this year. Obviously, at meetings of the public accounts committee, its representatives are questioned by Deputies on the basis of work done by the Comptroller and Auditor General. As already outlined, the Government is satisfied the structures already in place are appropriate to ensure effective priorities and target setting as well as the live and extensive reporting of waiting list information. In addition, access to accurate data about patients waiting for service across the system is recognised as being crucial to how we can facilitate access to those services. However, it is important to remember that these are only aspects of the solution to address the key issue of the length of time people are waiting for treatment. The improvements achieved in terms of acute hospital waiting lists and waiting times are being driven by specific actions aimed at increasing capacity and embedding reform by means of the waiting list action plan approach. Examples of this include the ongoing establishment of the surgical hubs around the country and the further roll-out of modernised care pathways. Embedding reform actions in our system will ensure the most efficient use of available resources in a patient-centred way, including initiative seeking to optimise the patient pathway from referral to discharge. The implementation and progression of the multi-annual action plan approach is not happening in isolation. The longer term reform of scheduled care and reduction in waiting times is interconnected with and influenced by a number of developments across the health service. This includes the continued focus on productivity and efficiency improvements and the shift of more care into community settings and alternative care pathways. These interdependencies underline the complexity of the system of the system and how an integrated and holistic approach is needed to ensure waiting times are improved across the health service to ensure people have access to the care they need when they need it.

If I was in government and was handed a script like the one the Minister of State was expected to deliver this evening - I assume by officials in the Department, but I do not know who crafted the speech - I hope that I would say, "No thank you, I am not going to read that out." It was embarrassing in the context of the reasons given for opposing this Bill. It is embarrassing for one simple reason, namely it is what the Minister of State and the Government signed up to. It is what we all signed up to when we agreed Sláintecare. An Teachta Rice is right. It is alarming that the Government is clearly stating that it is walking away from a commitment given to put in place statutory waiting list targets and maximum waiting list times. The Minister of State is mixing up policy and policy targets, on the one hand, and statutory targets, on the other. That is the difference between what this Bill seeks to do and what he outlined. What we see routinely from this Government are HSE service plans. These are produced every year but are not worth the paper they are written on because the HSE does not have the capacity to meet any of the targets. Almost every target that is set is broken. The Minister of State cited all of the targets set out even in the most recent waiting list plan to reduce wait times in some areas by 50%. Nobody out there, not even the people who wrote the script for him, believe that is going to happen. All we have are these published fantasy targets. It is a case of "We will see what is going to happen, but we are not going to do anything and do not really care." That is what I hear from Government. Before I get into some of the process issues behind the Bill and the reasons I think the explanations the Minister of State gave are utter nonsense, I highlight the fact that I am also of the view that we will not reduce waiting lists until we put capacity into the system. We have to build the four elective hospitals. We have to deliver on the hospital beds. We have to deliver on the diagnostic capacity. We have to upgrade equipment. We need new equipment in some hospitals, and we need staff. We need to train more healthcare professionals to fill the gaps where there are staff shortages. All of those are obvious ingredients when it comes to reducing waiting lists and providing faster care. In the context of Sláintecare, it is understood that process is important. Setting targets is also important, however. I do not believe we will ever solve the problem in emergency departments and have a situation where people will not be left on trolleys if we do not adopt a zero-tolerance approach. That is precisely what happened in Waterford, where the hospital manager at the time said that one person on a hospital trolley was one too many and adopted a zero-tolerance approach as a result. He did not believe change would happen overnight, or in a week or a month. However, if we set it as a target, the entire system - the staff, consultants, nurses, healthcare assistants, radiographers and everybody working in hospitals and in other parts of the healthcare system which are crucial in the context of reducing crises in emergency departments and identifying what the capacity needs are - will be forced to get us to a point where we do not have patients on trolleys. That is precisely what happened and it would not have happened if a zero-tolerance approach had not been taken. It is the same with the maximum wait time targets. The reason Sláintecare set those targets was that it was believed, on the advice of the Department, the HSE and all the experts who came before the special Oireachtas committee that looked at Sláintecare, it was possible to do it. The purpose of setting a maximum wait time was to force the system to put the capacity in to meeting that objective. The Government is now walking away from that. The Minister of State shook his head earlier when he indicated it was not but clearly it is. The reason he gave for opposing this Bill was that the Government did not have to accept this because it was doing it anyway. It is not doing it. It does not have statutory targets. I do not know if the Minister of State could point to me where on the Statute Book the Government has ever legislated for the Sláintecare targets. I know it has not done so. Coming then to the community waiting lists, I find the Government's response on those even worse, and breathtaking in many ways. It is an acceptance of utter failure by the Government. It is really saying it cannot publish the community waiting list times through the NTPF, in the same way as the acute hospitals, because we are not up to that standard yet. What an appalling response and appalling situation for us to find ourselves in. We have children and adults on those waiting lists waiting for access to dentists, dietitians, speech and language therapists and all the other community waiting lists. We get those responses back through parliamentary questions. They may not be perfect, and I made that point earlier, but at least we get numbers. It is possible for Government to publish those waiting list times. If they are imperfect and need to be improved or brought up to a standard similar to those for the acute hospitals, that can happen over time and evolve. However, simply to say we are not doing it because we do not believe we can do it to the same standard as acute hospital waiting lists is not a satisfactory response. We have an entitlement to the highest levels of transparency. I imagine it frustrates patients that we spend tens of billions every year on health and yet there is basic information we cannot collate or publish. I will finish how I started. If I was in the Minister of State's shoes, I would have handed the speech back and said, "No thanks, I am not going to read that out" because it essentially tells the public the Government is again walking away from one of the key proposals and action points it had in accepting Sláintecare. That is regrettable. My party remains committed to Sláintecare and to the highest levels of transparency in the health service for waiting lists. We also remain committed to people getting timely, fast and rapid access to care, as best we can. This will not happen overnight and there is a lot to be done to get to a point where we can reach those targets. Unless we take targets seriously, however, which the Government is not doing based on the Minister of State's speech, and use those targets to mobilise and marshal the resources of the health service to meet them, patients will continue to wait. I gave the examples of patients waiting for cataract, hip and hernia operations, which are standard day-case procedures in most cases, but there are others, including cancer care, cardiac care and so on. I am disappointed the Minister of State is not accepting this Bill. I will take this up with the Minister for Health.

In accordance with Standing Order 85(2), the division is postponed until the weekly division time next week.