2026-07-09

87. Deputy David Cullinane asked the Minister for Health her plan for tackling primary and community care waiting lists; and if she will make a statement on the matter. [52168/26]

This question is in relation to community care waiting lists, which I have been tracking for some time. There are now 280,000 people, unfortunately, on community waiting lists, with many of them waiting far too long. I know the Minister has talked about new initiatives to reduce community waiting lists, which I respect and want to see implemented, but, unfortunately, the numbers have been going in the wrong direction for some time. This important area of healthcare needs more attention.

I agree that too many people are waiting too long to access primary care and community services. A total of 1.3 million patients were seen by primary care therapists in 2025, which is significant. There is no question, however, that there is rising demand and increasing complexity, particularly for children's services. This is placing sustained pressure on services nationally. As the Deputy has referenced, that is why my Department and the HSE are driving forward a joint programme to reduce these waiting lists. This includes detailed analysis of therapy activity, productivity and workforce capacity to identify opportunities to improve service delivery and develop a much better therapy waiting list management protocol. As the Deputy is aware, last year I approved a national waiting list initiative across physiotherapy, occupational therapy and speech and language therapy, targeting the removal or treatment of over 80,000 people by year end. To date, over 21,000 removals have been recorded, of which 13,000 were by validation and 8,000 by treatment. While this work is advancing across several integrated healthcare areas, IHAs, we are not where we want it to be at this point. A number of discrete industrial action issues are holding up implementation, but they are, I hope, nearly resolved. The HSE is engaging with unions to address these issues, and we are determined that progress must now accelerate. Where the initiative is being fully implemented, it is showing results, including reductions of 80% to 90% in long waiters. We can see the beginnings of real system reform, including much better scheduling and much better use of digital supports, as appropriate. Obviously, those improvements benefit patients, but they also benefit therapists and primary care teams delivering these services by easing some of the burden in managing the different lists and enabling them to focus on timely, patient-centred care. We want to see that progress replicated nationally. Furthermore, alongside that, we are building capacity through the recruitment of 200 additional primary care posts this year. We are increasing the student training places for health to ensure the pipeline going forward.

As I said, 280,000 people are on primary and community care waiting lists. Of those, 86,000 people are waiting for physiotherapy, 60,000 people are waiting for occupational therapy, 34,000 people are waiting for psychology, 32,000 people are waiting for speech and language therapy, 24,000 people are waiting for audiology, 22,000 people are waiting for dietetics, 20,000 people are waiting for ophthalmology and 8,000 people are waiting for podiatry. I submitted a parliamentary question on how long people are waiting because waiting lists are bad enough as it is, but the real test is how long people are waiting. There were some incredible responses. A person in Longford-Westmeath has been on a waiting list for dietetics for 709 weeks. Someone in Louth has been waiting for ophthalmology for 617 weeks. There were several cases in Dublin of people waiting 500 weeks for psychology and a person in Galway has been waiting 534 weeks for occupational therapy. There is a lot to be done in this area. I do not doubt everything the Minister has said in terms of the additional staff and so on, but if Sláintecare is to be delivered and if we are to live up to the potential of the health regions, primary and community care have to be better supported.

I agree with the Deputy. As I look at the actual numbers on the lists, not only is there regional variation but there is variation by specialty as well. To be very transparent, if I look at the waiting lists from May 2025 to 2026, for example, there has been a reduction of nearly 7,000 people on the audiology list. There has been, however, an increase of nearly 3,000 people on the occupational therapy list. There is an inconsistency there. There has been some progress is some areas, which is great, but none in others. If I look at the number of people waiting more than 39 weeks for audiology compared with May 2025, there has been a considerable reduction. In occupational therapy and psychology, there have been significant increases, while in physiotherapy, there has been a decrease. It is not just the postcode that matters but the specialism as well. That speaks, in some way, to the number of professionals who are available and trying to get them into place. As the Deputy knows, we are trying to make it easier for physiotherapists across Europe to work here. The profession has been too restricted. Similarly, with psychology, it should be the case that people with master's degrees are able to do much more than they have been able to do thus far. We are trying to expand the workforce, but we are also trying to expand the range of qualifications where people can deliver services.

I accept all of that. In my constituency of Waterford, I deal with these issues all the time.

Of course the Deputy does.

We receive representations from people who have been waiting far too long for an occupational therapist or a speech and language therapist. The Minister mentioned children. Very often, children are on these waiting lists. A number of weeks ago, we had a debate in the House on dental services. The number of children waiting for orthodontic treatment and dental treatment is shocking. So much more needs to be done in that area. The Minister of State, Deputy Murnane O'Connor, took the debate on that occasion. One of the benefits of Sláintecare, if it is realised, and the health regions is that it will end the silos and, potentially, the bias of investment in the acute system and recognise that if we have alternatives in primary and community care, we can take real pressure away from our acute hospitals, which is also better for prevention and catching ailments earlier. There is lots of positive stuff happening, for example, enhanced community care and the integrated care programme for older persons. I recognise all of that, but there are still far too many people waiting. As the Minister said, in some specialties, they are waiting far too long. We need to keep the focus on it.

We are trying to end the practice of the money moving from community to acute care and make sure that this does not happen. I will name some additional waiting list initiatives that are important. In budget 2025, we had base funding of €8 million for community-based waiting lists, particularly for psychology and audiology which had previously only received once-off funding. That is more embedded now. I totally agree with the Deputy in relation to the number of people waiting. We will have a dedicated programme over two years to address orthodontic waiting lists. We are just not quite there yet in terms of the negotiations with the Irish Dental Association. Nevertheless, €20 million has been invested in that initiative, resulting in more than 5,500 removals from waiting lists. The Deputy and I are not in any sort of disagreement here. We need to invest more in the community. We need these services to be available in the community. That also means applying the outpatient toolkit, once we are finished with the acute hospitals, to the community lists and the management and scheduling of those. It also means extended hours for all of those therapeutic services in primary care centres, as much as it will mean in the acute. The Deputy can understand why we focus on the acute services first. Nevertheless, that is where we need to get to.