David Cullinane (Waterford, Sinn Fein)
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I move:

That Dáil Éireann:

recognises that: —there was an alarming rise in healthcare waiting lists from 461,908 in 2014 to 740,712 in January 2020;

—waiting lists have spiralled out of control since January 2020 to 814,345 in August 2021, rising to 907,648 including planned procedures;

—210,740 people are waiting more than 18 months on inpatient and outpatient waiting lists;

—a further 203,976 people are on radiology diagnostic waiting lists for CT, MRI and ultrasound scans;

—more than 98,000 children are on hospital waiting lists, including 31,216 children waiting more than 18 months; and

—children with additional needs are forced to wait on average 19 months for an assessment of need, despite the legal right of three months; notes that: —in excess of €300 million will likely go unspent on vital community and primary care service expansion to ease the burden on hospitals;

—more than 150 promised acute inpatient and critical care beds are unlikely to be operational by year-end; and

—mental health services are not fit for purpose in the context of the looming pandemic mental health crisis; further notes that: —the recent high profile Sláintecare resignations are a vote of no confidence in this Government’s commitment and ability to deliver major healthcare reform; and

—the latest Sláintecare Implementation Strategy & Action Plan 2021 — 2023 notes major obstacles to the delivery of key Sláintecare measures, including a plan to tackle waiting lists; reaffirms its commitment to: —universal healthcare with universal general practitioner care and universal counselling; and

—the removal of private healthcare from public hospitals to free up public capacity for public patients; and calls on the Government to: —urgently implement a waiting list reduction and management plan;

—commit major funding to the rapid modernisation of healthcare information systems,including individual health identifiers, an integrated waiting list management system and a centralised referral system; and

—deliver major capacity boosting measures including additional inpatient and critical care beds next year, a capital fund for expanding theatre capacity, and the modernisation and expansion of diagnostic capacity with direct community access.

We have just had a very lengthy debate on housing where we talked about public land being used for public housing and having a strategy that is not built around developers, landlord and institutional investors. Truth be known, the same argument should, and can, be made on healthcare, namely, that public moneys should be spent on public healthcare services and private medicine should not come before the public good. Yet that is not happening because we have a deeply two-tier health service, where private medicine and the private sector is embedded in the healthcare system.

First we must appreciate the scale of the problem that faces us. We do that in our motion, which I am proposing today. The figures are so stark that it is hard for people even to comprehend them. More than 900,000 people are on some form of health waiting list, either waiting to see a consultant or waiting for a hospital procedure. The big jump in those figures came before Covid, as we know, but has accelerated due to Covid. Of the more than 900,000 people who are awaiting treatment, 210,000 have been waiting for more than 18 months and 31,000 of them are children. There is a human story behind each and every one of those people who are waiting for treatment.

I conducted a survey a number of weeks ago, which I published, in which I asked those who are on waiting lists, sometimes for years, what their experience is. I heard many stories from parents of children with scoliosis who are waiting years for treatment, often in pain. I heard stories of people who are waiting years for orthopaedic treatment and for other procedures, including ear, nose and throat, ENT, and ophthalmic procedures, in areas where we know waiting times are very high. I also heard of the human consequences of people waiting that long. It has an impact on their mental health, their overall physical well-being and their ability to work. Many of them are out of work for too long. My point is there are human consequences and real consequences for people when we have the kind of waiting lists we have.

I wish to go through the Minister's amendment to the Sinn Féin motion. I must say it is weak, to say the least, and it is lame in terms of the excuses the Minister gives. I will provide some examples of this. In the amendment, the Minister talks up some of what was done last year. I accept that investment was made in healthcare last year. The amendment mentions that 795 acute beds were put into the system this year, with a target of 938 that will be reached by the end of the year. The Government funded 1,150 beds last year. Therefore, 204 of those beds will not be delivered. In respect of ICU beds, we had 600 ICU beds in 2009. Even if the Minister delivers what he has said he will deliver, we will fall way behind on where we were then.

The amendment mentions community intervention teams. What the Minister forgets to mention in his amendment is that of the €150 million he provided for enhanced community services last year, only around half of that money is anticipated to have been spent. The Minister took to his feet last year and said we were going to recruit 14,500 people into the Irish healthcare system. That figure has now been revised down to around 7,500. Only around half of the staff promised by the Minister have been recruited. He cannot hide behind Covid, or anything else for that matter. He was the one who made that promise. Covid was with us when the Minister put those figures out there, provided the funding and made those commitments. He simply has not delivered.

In the remainder of my time, I must say there are huge challenges in healthcare and there are big decisions that have to be made. We have had high-profile resignations in Sláintecare, which I reference in my motion.

That cannot be seen as a vote of confidence in the Government's ability to deliver the big changes.

One of the areas where we must collectively stand our ground concerns public consultant contracts. Consultants who work in the public system have to do public work. The other big changes, involving removing private medicine from public healthcare and moving to universal GP care, also must happen, but they are happening at a snail's pace. They are not happening anywhere near quick enough. If we do not make these big changes, more and more people will become disillusioned and put on waiting lists.

On the Government's promise to have multi-annual waiting list targets and a plan to make this happen, unless there is a centralised referral system it will not work. Unless there is an integrated waiting list management system, it will not work. Unless the capacity is put in place, it will not work. I could wallpaper this room, as could the Minister, with all the waiting list management plans of successive Fianna Fáil and Fine Gael Governments. These plans have not worked because they were not backed up with capacity.

The Minister should think about the victims of long waiting lists. Those children and adults who are waiting years for treatment are the ones for whom we have to deliver. They are the people who are at the front and centre of why we moved this motion.

Pa Daly (Kerry, Sinn Fein)
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Last Friday I met a woman from mid-Kerry in the front room of her house. There was a beautiful view looking out over Castlemaine Harbour. She has been battling and beating cancer for the past ten years. She has a young family, one of whom returned home from school as we spoke. Every three weeks, she receives treatment in University Hospital Kerry for three hours with six or seven others. She knows all the staff by their first names. She had the height of praise for everybody in the unit. The people of Kerry are very proud of all the nurses who work there. The woman is comforted by the backup services in the university hospital, including the physiotherapy and scanning facilities. It seemed strange to me until recently that the unit has been borrowing wards from other departments. The most vulnerable are affected. What awaits the woman with the amazing view are anxiety and concern because it seems that, rather than investing in space to treat those affected, the authorities will outsource treatment to a private hospital. I do not know the financial cost but there will be no ancillary services in that hospital. Nurses say there will be a risk to health and safety and that if people become unwell, they will have to be blue-lighted from one end of the town to the other. Is the Government waiting for a charity to pick up the pieces for the unit?

Recently, in the past couple of days, there has been more depressing news from University Hospital Kerry. Surgeons there sent a letter to GPs stating facilities are not available there anymore. Elective surgeries have been curtailed for four weeks running. Things are falling apart. We in the office are receiving call after call about people having to wait for an hour for an ambulance. The situation is not sustainable. Nurses who have given their heart and soul to the hospital are leaving, and surgeons have written to GPs stating 2,200 patients are waiting to be seen in the surgical outpatients department. They say protected surgical daybeds have been taken over for emergency purposes. The also say nursing and infrastructure shortages mean the service the people of Kerry deserve cannot be provided any longer. Non-urgent surgical referrals can no longer be accepted. I ask the Government to do something about that.

Aengus Ó Snodaigh (Dublin South Central, Sinn Fein)
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I am not being dramatic when I say people on hospital waiting lists are literally dying; it is a fact. They are going blind and their illnesses are getting much worse as they wait, wait and wait again to be seen by a consultant in the first instance. Having been seen by a consultant, they must wait, wait and wait again for the procedure. For those in need of a single hip replacement, for example, the waiting period is so long that their good hip becomes banjaxed. Therefore, instead of one hip needing replacement, both need to be done. Can you imagine your hip being so bad that it takes 20 minutes to get up the stairs to bed or to the toilet? What about the fact that the strain from the stair climbs or crawls and the constant excruciating pain, the lack of mobility and the constant use of strong painkillers often result in other ailments, including heart attacks, ulcers, obesity and mental health strain. I know many constituents who have suffered in this way, including a cancer survivor.

Others face blindness while languishing on the waiting list to see an eye specialist. That is before they are even put on the four-year-long cataract waiting list. These incidents are scandalous enough but for our children on the waiting list, the circumstances are a living disgrace. Shame on the HSE for overseeing, or maybe not overseeing, a waiting list with nearly 100,000 children who are awaiting operations and medical procedures. The 100,000 do not include children awaiting an assessment for speech and language therapy and much more.

Níor chóir don Aire an milleán a chur ar Covid nó ar ionsaithe ar chóras ríomhaireachta an HSE. Níl daoine tiubh. Tuigeann siad gurb é seo toradh polasaithe rialtais Fhianna Fáil agus Fhine Gael ó tháinig siad i gcumhacht nuair a chruthaíodh an Stát seo. Ba chóir don Aire smaoineamh ar na hothair, na leanaí agus na seandaoine atá ar na liostaí feithimh agus beart a dhéanamh de réir an briathar atá ann i rún Shinn Féin. Gabhaim buíochas leo siúd atá sa chóras sláinte atá ag déanamh tréaniarrachta. Níl an milleán ná an locht orthu. Is ar an Rialtas seo, agus ar na rialtais a tháinig roimhe, atá an locht.

Pádraig Mac Lochlainn (Donegal, Sinn Fein)
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I have raised before with the Minister in this Chamber the issue of the funding discrimination that our major hospital in Donegal, Letterkenny University Hospital, continues to endure. There are more than 20,000 people in a county of 160,000 on the waiting list. That amounts to one in eight. I am not even including Sligo hospital, whose waiting list includes people from south Donegal. That is a damning indictment of Government after Government.

The issue for Letterkenny University Hospital is that despite its being the sixth largest hospital in the State, and its having had more than 24,000 inpatients before the pandemic, it is ranked 13th when it comes to the budget. Some allowances can be made for the fact that the major hospitals in Dublin and Galway are dealing with additional specialities but how can we explain the circumstances whereby budgets in the major hospitals are two to three times greater per capita than in Letterkenny University Hospital? I was asked to get these figures by senior hospital staff in Letterkenny because they felt the only way to get to the bottom of this was through parliamentary questions. What is happening is a scandal. There has to be acceptance in the HSE that Donegal is treated like a backwater. It means real impacts in Donegal, where people are forced to travel huge distances for basic procedures unnecessarily. We should have the specialities in Letterkenny University Hospital, the sixth largest hospital in the State. People should not have to travel long distances. This is about equality of access to healthcare. I ask the Minister to examine this. I am going to send to him directly all the statistics I have gathered on this.

Mark Ward (Dublin Mid West, Sinn Fein)
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I thank my colleague Deputy Cullinane for tabling this important motion to tackle the hospital waiting lists. It is shameful that almost 900,000 citizens of this State are languishing on waiting lists just to get the treatment they need at this very moment. It is good to see the Minister of State responsible for mental health present. I am my party's spokesperson on mental health. We are all aware that early intervention is key in a child's development.

The latest figures I have on waiting lists indicate there are still more than 2,500 children waiting for a child and adolescent mental health service, CAMHS, appointment. Almost 9,000 children are waiting for a primary care psychology appointment, which is not good enough. To have testimonies in the debate on this motion, we asked people to contact us and outline their real-life experiences. Some people cannot even get on a waiting list. One response we got was from an individual who stated their daughter was referred to the local psychological service only to get a letter back stating there was no service in her area. This is not good enough.

We have had announcements from the Government on additional funding for mental health services. Back in February, the Taoiseach announced, to much fanfare, €10 million in additional funding for a Covid response to mental health issues. Not a penny of this has been spent yet. We are in a mental health emergency, yet not one single euro of the money announced has been spent.

I got a response to a parliamentary question this week on the money allocated for Sharing the Vision and the early recommendations in that respect. A sum of €23 million was allocated for Sharing the Vision in the budget for 2021. To date, €2.7 million has been spent. That is less than 10% of the money allocated. We need to make sure this money is not rewashed, redressed in a new shirt and tie, and used for the forthcoming budget; we need to make sure it is available and ring-fenced for the people who really need it.

We were in a mental health crisis pre-Covid; we are now in the mental health emergency. This Government needs to get the finger out and start putting things into action. If it is announcing money for mental health supports and services, we need to make sure those resources go to the services that really need them.

Maurice Quinlivan (Limerick City, Sinn Fein)
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As the Minister well knows, my city has a number of hospitals and they have fantastic staff working in them. The waiting lists are not of their making. It is not their fault but it is the staff and patients who suffer. I believe the Minister has no plan for this. There is no direction.

I have raised this issue with the Minister in the Chamber since he was appointed, especially the trolley crisis in University Hospital Limerick, UHL, which is ongoing. This month will see almost 1,000 people on trolleys in UHL. I plead with the Minister again to come and have a look at that.

As has been said, more than 900,000 people are on waiting lists throughout the State. The figures for UHL are particularly stark with 43,656 people currently on outpatient waiting lists for a consultation. More than 23,000 of them have been waiting for more than one year, and of these, 19,000 have been waiting for more than 18 months. This totally unacceptable. We can get lost in the figures but each and every one of those is a person whose life is being impacted by his or her ailments.

Last week, I received a response from a parliamentary question I tabled regarding one such individual, a woman in her mid-60s who is suffering from severe cartilage damage to her knee. It inhibits her movement and restricts her lifestyle. Her status or grading on the waiting list is "urgent". For me, the word "urgent" means she needs her consultation promptly, yet we are advised she will be waiting for 30 months. How can the Minister stand over somebody waiting 30 months for an appointment that is deemed urgent? She will endure 30 months of pain and limited movement. She will be 70 years old by the time she sees her consultant. This is an absolute disgrace.

Recently, a consultant who was on duty at UHL rang me to ask if I could intervene to get a scan for one of his patients. How bonkers is it that a consultant in the hospital has to ring a local parliamentarian to get a scan done in the hospital? There is something seriously wrong there. The Minister needs to intervene.

We need to see a centralised referral system coupled with an integrated waiting system to manage this. The planning and additions will allow for patients to be seen at different hospitals as capacity allows. As I said, UHL consistently has problems with overcrowding.

This month today, we have almost 1,000 people treated on trolleys in the hospital. I refer back to the waiting lists and categories of appointments on which people are waiting. There are so many, and of course the type of appointment which some will be waiting for will be the most important for those individuals. One figure that stood out for me was that of maxillofacial outpatient appointments in UHL. These are people with physical injuries to the face. Some 2,891 people have been awaiting such appointments for 18 months or more.

I do not want to be all negative. We in Sinn Féin have a plan for how to fix the health service. We know the direction to take. It will require significant but necessary investment. We cannot have our sick being treated like this and we cannot leave our healthcare professionals working in such challenging conditions.

Martin Kenny (Sligo-Leitrim, Sinn Fein)
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The issue here is about capacity more than anything else, and that is the same in every hospital in the State. I am very conscious, especially in Sligo University Hospital, that we have a situation where people are waiting on wards but they cannot get in. They are being sent to a four-bed ward with six beds in it. It does not have the capacity or the staff. It is the same in the emergency department, which is overrun and has not got the staff. This issue needs to be dealt with. At the moment, in the Saolta University Health Care Group, there are 54 vacant consultant posts. I am sure that is the same in every other region in the country. This is the core of the problem. The investment is not being put in to employ the necessary staff to deal with this issue.

Our hospitals are all running at more than 100% capacity most of the time. Internationally, it is said that they should be at approximately 70% capacity to deal with the surge, when it comes. The problem we have here is that the private system is being used to back up a public system that is in decline. The Minister needs to get a grip on this and put that public system back on the agenda as being the priority. That is clearly what needs to happen. There needs to be a centralised system for waiting lists to ensure people can be seen as quickly as possible in whatever hospital there is an available appointment in. We have solutions and we need to have those solutions delivered. As long as the Government continues to go down the track of using the private system to back up the public system, however, it is not going to work. There needs to be a clear division as to where we are going to go to get on the right track.

The Sláintecare resignations are a reflection of the frustration felt by the people who were on those boards. They want to deliver Sláintecare. They see the potential of it and yet they see it being held up by the Minister and others in the Department who simply have not got it in them to stand up to vested interests and ensure we deliver for our people. That is what this is about. We have to deliver for the ordinary people out there who are on these waiting lists, in pain and distress, not for months but for years in many cases. I know many people in my constituency who are in that situation. It is simply not right. There is right and left in everything when we talk politics but there is also right and wrong. This is a situation of right and wrong. Until the Minister and this Government are prepared to stand up for the people and ensure we deliver, this health service is going down the tubes.

Stephen Donnelly (Wicklow, Fianna Fail)
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I thank the Deputies for tabling the motion and for their contributions. It is a debate we need to have and one we need to come back to repeatedly.

Some time ago, a constituent of mine in County Wicklow, Sarah, needed a hip operation. She was suffering. Much like the scenario recounted by another Deputy, she was waiting in intense, debilitating pain. She did not have private health insurance and she was told that on the public system, it was going to take two and a half years before she could be operated on.

I went to the National Orthopaedic Hospital in Cappagh to find out what was going on. The problem was not that we did not have enough doctors, nurses or operating theatres. It was that the budget allocated for buying the titanium hips was gone. We were still paying all the overheads, but because of this broken system, Sarah and many other people were not being seen. Three of the seven operating theatres in Cappagh were closed and surgeons were having their lists cancelled again and again.

When I took office, one of the first places I visited was one of our children's hospitals. I was told that right now, many children in our country who have been referred for an MRI by their GP or consultant must wait in some cases for years for that MRI. That is not acceptable. I will not stand over it. No government and no Member of the House would stand over it.

Before Covid-19 arrived here, our waiting lists were too long. They were described regularly as some of the longest and worst waiting lists in Europe. The number of patients waiting for a procedure in one of our hospitals peaked in mid-2017 at approximately 87,000 people. It has come down by approximately 12%. Today's figure is approximately 12% lower than that peak but it is still completely unacceptable. The figures were coming down. The inpatient and outpatient waiting lists were beginning to fall, but as we all know, because of the pandemic and the cyberattack, they have gone up. We have seen that a lot of planned and scheduled care unfortunately had to be delayed.

I want to be absolutely clear about this. As the threat from Covid-19 continues to recede, and, please God, it is going to keep receding, tackling the waiting lists is the greatest challenge we face in healthcare in our country. Addressing the waiting lists is my number one priority as Minister for Health. They will receive the same intense focus, attention and determination that I, my officials, the HSE and many of our partners have put up against Covid-19 and used to roll out the vaccine programme.

What are we doing? We are tackling the waiting lists in several ways and doing those all at the same time. The first thing we are doing is adding permanent capacity to the public healthcare system. We are adding that capacity in spite of the pandemic and doing so at record speed.

This year, we have added approximately 800 beds to the public hospital system so far and it is still September. We intend on adding beds right to the end of the year. That is the biggest number of beds that have been added to our public system going back several decades, as far as we can tell. At the start of last year, the number of critical care beds stood at 255. We have been adding beds all though the pandemic. By the end of this year, we intend to move from 255 critical care beds to 321.

That will be an increase of about 25% in our critical care capacity during the pandemic, which is welcome but not enough. I have secured agreement from the Cabinet that we will continue after this year and I have agreement to extend critical care capacity to 446 beds, which is very necessary and will help greatly with these waiting lists and stop the continuous cancellation of planned care that so many people have to deal with.

We are also adding to the workforce, again at a record speed, with more doctors, nurses, midwives, therapists, scientists, clinicians and specialists throughout the system. Last year, during the pandemic, saw the largest increase in the public health workforce since the establishment of the HSE, while this year will be another record year. Deputy Cullinane rightly stated we have funded just above 14,000 posts. We are on target to hit more than 7,000. While we would all like the original target to have been met, nobody last October anticipated the full year the world has seen in the context of the pandemic. In spite of the pandemic, however, and even though people have not been able to travel and all sorts of restrictions have been in place, we will see another record year in terms of increasing the workforce and we intend to continue in this vein. At the same time that we increased the permanent capacity in the HSE, we recruited, with external partners, 3,200 women and men to work in areas such as contact tracing, testing and tracing and the vaccination programme.

Consultant numbers continue to grow. In the past five years, more than 700 additional consultant posts have been filled, with more than half of them in the past two years. The number of consultants has increased over the past two years from 3,153 to 3,506. There are clear recruitment challenges, in certain specialties in particular and in particular locations. We all know that and it has to be addressed. Issues in Letterkenny University Hospital and University Hospital Kerry have, understandably, been raised during the debate and other hospitals are also finding it very difficult to recruit people. The majority of posts, however, that have been identified as vacant are currently filled under fixed-term or specified-purpose contracts. We want people full time in those roles and the new Sláintecare public-only contract will be essential to that end. In disability, mental health, home care and addiction services, there has been much progress over the past year or two. The Ministers of State, Deputies Butler and Rabbitte, will outline some of the successes and plans in these areas.

Elsewhere, we are innovating to improve how and where patients are treated. As the story of Sarah from Cappagh shows, it is not just about money and capacity; it is about using what we have as well as we can. It is about our clinicians working to the full extent of their licences. It is about ensuring that our operating theatres and diagnostic suites will not just run from 9 a.m. to 5 p.m., Monday to Friday. We have to staff them, run them longer and build and use the capacity within our public health system as well as we can. Right now, we are not doing that. There are some notable good examples but there is much opportunity to do better.

Change, as we all know, can be difficult. On my visits to the hospitals, including Our Lady of Lourdes Hospital in Drogheda in recent days, Tallaght University Hospital and many other places throughout the country, I have been meeting a galvanised, determined workforce who have been living change and innovation throughout the pandemic and who are passionate about universal healthcare, our public health system and their patients. They talk to me about a desire to continue innovating, continue changing and continue finding ways to treat patients more quickly and in their communities where possible when they need the care.

This year, we have provided funding to ensure GPs have access to diagnostics, MRIs, X-rays, ultrasound scans and CT scans. At a cost of €25 million, it has not been done before. We estimate that by the end of year, we will have funded about 140,000 additional scans, and we are getting strong feedback from the GP community on this. We are scaling up the provision of advanced nursing practitioners, one of the most exciting opportunities we have.

Advanced nursing practitioner-led teams in the community are treating and discharging a majority of patients waiting to see a consultant. In Tallaght University Hospital, for example, the urology waiting list has fallen from five years to 12 weeks, and we are going to be doing an awful lot more of this.

Third, I am launching a plan to tackle the waiting lists. In the immediate term, through the waiting list action plan, we will examine the impact of Covid-19 and the cyberattack. This is all the more necessary given that we expect hundreds of thousands of patients to come into the system between now and the end of the year. The second component of this is the development of a longer term, multi-annual waiting list plan. It will be overseen by a ministerial task force I am establishing, which will be led by my Secretary General. Targets and detailed hospital-by-hospital lists and plans are being established and it is our full intention to keep driving and investing on this until we meet the prescribed Sláintecare waiting list times for inpatient, outpatient and diagnostic care.

I welcome views on this issue from throughout the House. Sinn Féin will have been examining it in Northern Ireland, where the inpatient waiting list per capitais more than twice that in the Republic, while the outpatient list is about 70% higher than it is in the Republic. I expect, therefore, that there will be many ideas. We need to work on this together. I welcome the debate and look forward to sitting down with Deputies and figuring out how we can do everything possible to ensure men, women and children will get the care they need when they need it.

Imelda Munster (Louth, Sinn Fein)
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I am curious about the case of Sarah from Wicklow that the Minister has cited. It reflects part of the frustration over the HSE's management of funding and so on. He stated the funding to purchase the replacement joints Sarah needed was gone but the State was nonetheless paying for overheads and staff, with theatres closed. Was that changed there and then? The Minister is nodding. That is a start, because that would be the most frustrating aspect of all.

We have talked about 900,000 people, a figure I heard all the previous speakers mention, but we should stop and think because we all know these people. There are 900,000 people in pain, stress and worry, waiting for their scan, in a small State such as this.

Some 100,000 of those 900,000 are children, with many of them, almost one third, waiting over 18 months. We cannot blame the Covid-19 pandemic or the cyberattack. The number was 870,000 in January 2020. That has nothing to do with the Minister, but it is a damning indictment of the last Government and this Government.

Two weeks ago, at the Committee of Public Accounts, I asked representatives of the HSE about the additional home help hours. There were 5 million additional hours to be delivered this year. The HSE has only delivered 2 million thus far and it is hoping for a further 1.5 million by the end of the year, but who knows about that given that it is the end of September now? Therefore, it is short 1.5 million. Of the 612 public beds that were to be developed in the winter plan for last year, only 288 were delivered. It appears that the Minister is failing to address waiting lists in every sector of the health service, be it for scans, outpatients or inpatients. It is the whole shooting gallery. People have been waiting so long to be seen.

There are over 15,000 people on waiting lists at Our Lady of Lourdes Hospital and they have been waiting for a long time. The Minister said he was at the emergency department there last week. People are actually getting up and going home to take their chances at home because they have been waiting up to 14 hours. It is crazy, and it has to stop.

Brian Stanley (Laois-Offaly, Sinn Fein)
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I welcome the opportunity to address the motion. The constituency that I represent, Laois-Offaly, has witnessed the healthcare system struggle consistently for years. This is despite the exceptional work of the front-line staff in the services. There are now almost 30,000 people in Laois and Offaly on hospital waiting lists. This is from a population of 150,000. In Laois, 13,411 are on outpatient waiting lists and 2,038 are on inpatient waiting lists. In Offaly, 11,572 are on outpatient waiting lists and 1,709 are on inpatient waiting lists. As has been said in this debate, behind each of those figures is an individual who is suffering deteriorating health, delayed diagnosis, which obviously leads to other problems, stress and dreadful pain. People are waiting for hip replacements and so forth, and it is unacceptable that they are fed with painkillers year on year, which leads to them developing ulcers and other health problems. The Minister and I have seen that in our constituency offices and we must stop it.

The hospital waiting list crisis can be resolved. I know it is a challenge, but no job is easy, particularly turning around our health system. It requires leadership and commitment. This means facing down the vested interests. The Minister knows what they are better than me because he has had a closer look in the last year. In the 11 years I have been a Deputy and in the decades before that when I was a councillor, I got a glimpse of what it was like. Those private vested interests need to be faced down. Hospital managers must be running hospitals, not private consultants. That is what happened in Cappagh, if it was traced back to what went on. The hospital managers must run the hospitals.

Our motion sets out some of the solutions and our vision for resolving the crisis. We would introduce single integrated waiting lists. That is one of the can-dos. It is a system that we believe would significantly speed up the process and reduce waiting times across the hospitals. We would also provide a major capital fund to increase the number of beds, staff and capacity within the system. This is the type of ambition that we must see from the Government. What is particularly worrying, however, is that we are not seeing the progress that is necessary. Sláintecare is one example. This is very concerning. I pinned a great deal of hope on Sláintecare, as did other Members. The report notes that there is still no waiting list management and reduction plan in place, despite the waiting list in the State being at 907,648. There is an estimated €300 million which will go unspent in the health budget this year, despite the Covid-19 pandemic. If this is not happening, that is good. The money is there and it must be well used.

Over 700 consultant posts are still vacant. I heard what the Minister said earlier and that is welcome, but there are still over 700 vacancies. I do not see an urgency to address this from the Government. We must be training and promoting doctors into those essential vacancies. There should also be public-only contracts for consultants to work in the public system, unlike the current mess where they do private work during their working day in public hospitals. That must stop. There must be new public-only contracts for the new consultants coming in.

Violet-Anne Wynne (Clare, Sinn Fein)
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As somebody who lives in, and represents, a rural region and county and as the mother of a child who has endured the child's unfair share of waiting lists, the findings of the survey brought forward by our spokesperson on health, Deputy Cullinane, who put Trojan work into the collection of this information, confirm what I have experienced and what the people of Clare are dealing with daily. We had the curtailment, as it was called at the time, of the Shannondoc services, which resulted in their disappearance. Dentists are opting out of the medical card dental treatment services scheme, DTSS, and GPs are not taking new patients. People are left without access to primary care.

The people of Clare are definitely feeling disadvantaged when it comes to accessing healthcare. If they must present to University Hospital Limerick, for example, which has one of the busiest emergency departments in the country, they will more than likely spend a few nights on a trolley. Every week a constituent contacts my office asking for representation to the HSE because those constituents feel they have been completely forgotten. They do not understand how they could possibly be expected to wait and endure chronic pain and anxiety caused by having an untreated illness. I am working with a woman who has been trying to access rheumatology care for the last nine years and who is coping with severe daily pain. In the meantime, I have another constituent whose surgery, which was deemed urgent at the time of the consultation in 2019, has been cancelled three times, but only once because of Covid-19 restrictions. He was told he was at the top of the list nine months ago and he is still waiting.

In terms of children with additional needs, the average waiting time is 19 months. That is in spite of the legally imposed timeline of three months. Sadly, once a child accesses an assessment of needs the child is basically back to square one, left out to dry and made to source, resource and secure the intervention needed to support the child's development, as if the assessment of needs had not happened. This is truly ineffective and, to be frank, immoral. It must be addressed by the Government.

Major healthcare reform is absolutely necessary. Key Sláintecare personnel are dropping away and nobody seems to know why. It is not exactly a vote of confidence in this Government.

Duncan Smith (Dublin Fingal, Labour)
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I thank Sinn Féin for bringing this motion forward. It is very timely. I apologise for not being present for the start of the debate. I had a scheduled meeting with Care Champions, who the Deputy and members of his party have met. They are relatives of people who passed away in nursing home care in the last 18 months and, with the indulgence of the proposers of the motion, I ask the Minister to engage with the group. I know the Minister of State, Deputy Butler, has done so. I am still absorbing the half hour that I was on the call with them. It was very powerful.

This motion is very important and timely. Again, I thank Sinn Féin for proposing it. There are currently 652,344 people on an outpatient waiting list, an incredible number. Some 263,354 of these have been waiting on a list for more than 12 months. What is even more shocking is that since January 2020 the number of people who have been on a waiting list for more than 18 months has increased by over 80%, from 107,000 to 192,764. It is very hard to conceptualise these numbers. We could say it is two or three Croke Parks or whatever, but it is a huge number. These are people in our lives whom we know personally, not to mention the countless people who contact us through our constituency offices. They are not just numbers on a page, but real people with real conditions who need treatment. With every passing day and week they are getting further away from the treatment they need, with their conditions in many cases deteriorating in that time.

It is not a problem that is exclusive to one part of the country. Five kilometres from here there are 45,000 people on a waiting list for the Mater hospital. There are 60,000 waiting for treatment in University Hospital Galway, 48,000 are waiting to be seen in University Hospital Limerick and in Cork, the Taoiseach's city, 36,700 are waiting in Cork University Hospital, 26,000 in South Infirmary Victoria University Hospital and 7,500 in the Mercy University Hospital. Age does not appear to be a discriminatory factor in whether one is on a list, with over 12,052 children waiting to be seen by an ENT service. Shockingly, there are 71,369 adults waiting to get orthopaedic treatment, accounting for over 11% of those on waiting lists. That is so wrong. In terms of orthopaedic treatment, we think about mobility.

Make Way Day last Friday was one of those days where we got to shine a light on the impact of the obstructions of everyday life for people with mobility issues and those who are using wheelchairs.

Whether it is a young girl in County Kerry suffering from scoliosis who has been on a waiting list for 18 months or a man in his 70s waiting for hip replacement for more than a year, the State should not be keeping people on a waiting list for significant periods. Never before in the history of the State have so many people been on waiting lists. Unless the Minister takes action, this will spiral further out of control.

Staggering waiting lists are not a symptom of the Covid crisis. It may seem like a long time ago, but this was a major problem with our health service long before the pandemic. Unfortunately, our health service was always described as being in a crisis - throughout my lifetime at least. While we have been dealing with a pandemic which is an enormous crisis in itself, we are now returning to the pre-crisis state of our health service. As we come out on the other side of the pandemic, we are faced with a broken health service.

The sad reality is that the Government thinks the National Treatment Purchase Fund is the be-all and end-all that will solve all our problems. The NTPF was established by Mary Harney on a promise that it would deal with waiting lists, that we would move beyond it and that we would not need to use it in the future. It has now become a crutch. Successive governments have promised to end waiting lists, but the reality is that as the drive towards a two-tier health system continues unabated, the NTPF will be a fundamental tool used by the Government which is wrong.

Thanks to Fianna Fáil's and Fine Gael's ideological commitment to for-profit medicine, there is a danger that those who can afford to pay get the best attention while those who cannot end up on waiting lists. We see it in many different areas of care. Families with children awaiting speech and language therapy are being forced early in the child's life to go private. It is only €150 or €200 for an initial consultation. People will scrimp together and get that initial consultation, but of course after that there is further care and suddenly they find themselves in the private healthcare system. They cannot afford to be in the private healthcare system, but they have been led there and because it is their child and they want the best for that child, they will do everything they can. It is fundamentally unfair; it is not good practice and it is not providing the solutions we need. We need a patient-centred healthcare service that caters to the needs of the individual regardless of their ability to pay.

There are different types of waiting lists. Today's Irish Examinercontained a very harrowing story about Emma-Jane Stoker-Phelan who has suffered from anorexia for the past 12 years. She said she feels like she is "slowly dying" due to a lack of services. Bodywhys has pointed to a 60% increase in hospital admissions for people suffering from eating disorders. We need to ring-fence money in the budget, but we need to ensure that mental health gets the funding it desperately needs.

We need to move our system to a more community-based system. If we can treat people in the community, they will not be on waiting lists for our main hospitals. They will be getting the treatment they need where they need to be getting it. For areas like this, which seem to be on the fringes of healthcare provision, it would make a major impact on our overall healthcare system if we can deliver that model and if we can deliver this care where it is needed.

We cannot keep trundling from crisis to crisis in our health service. It is always one thing after another. Staff and patients in our hospitals are incredibly frustrated by what they perceive to be the hands-off approach of this Government and the previous one to solving the waiting list crisis and the trolley crisis. The funding of our public health service must now be multi-annual and focused on investing in and retaining all staff - doctors, nurses, midwives, healthcare assistants, porters and medical scientists. The professionals in our healthcare family are multifaceted and we need to recruit them and retain them. There are too many long-term vacancies across a swathe of healthcare jobs and that issue needs to be tackled.

It is depressing that every time we mention a health-related issue in this House, it is followed by the word "crisis". Until we do something about it, that will always be the case. As we all know, it is not the fault of the amazing workers in our health service. It is incredible that over the past 18 months the HSE has been on flags and bunting hung out of people's windows as a source of pride. That is the first time that has happened in my lifetime because people have really felt connected with their front-line workers and all workers in the health service. We are in danger of losing it but we cannot lose that. The way to ensure we do not is by investing in the system and trusting the great professionals in there to improve and increase the care they provide. If we do that, we will tackle the waiting lists.

We are still a small country, but we are a rich country. We should not have these crises. We should not be rolling over and accepting every year that we will have debates about waiting lists and access. We can solve this. Hopefully, the Minister can solve it and not leave it for subsequent governments.

Róisín Shortall (Dublin North West, Social Democrats)
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I commend Deputy Cullinane on a very good, detailed and timely motion tonight, providing an opportunity to take stock of the state of our health service. We have had many accounts this evening of the shortcomings in our health service. Various people read out letters outlining the incredible difficulties people are having in accessing healthcare. It is important to take a bit of time to listen to another letter which was delivered to every home in England in 1948 about the new National Health Service. It reads as follows:

Your new National Health Service begins on 5th July. What is it? How do you get it?

It will provide you with all medical, dental and nursing care. Everyone - rich or poor, man, woman or child - can use it or any part of it. There are no charges, except for a few special items. There are no insurance qualifications. But it is not a “charity”. You are all paying for it, mainly as tax payers, and it will relieve your money worries in time of illness.

Is that not a wonderful letter? Imagine everyone in England getting that through their door. Imagine the value system and the ethos that underpins the political thinking behind that. Here was a country emerging from the war. It was broke, but the Labour Party government at the time and the Labour Party Minister for Health, Aneurin Bevan, had that vision for a civilised society, part of what has to be a modern, caring and inclusive society. He created the NHS and he spelled out to people why he was doing that and what it was.

The most impressive part of that letter was in telling people that it was not a charity but that they were paying for it. Is that not a million miles away from our health service where successive governments have regarded the public health service as some kind of charity? Indeed, for many decades it was provided as a charitable service, mainly from religious organisations. To a large extent, there is still that element and the ethos behind our public health service that somehow this is a charity.

This goes to the core of why we do not have a modern public health service that is universally available and that everybody is happy to use. There has been a mindset within successive governments, including this one, that the public health service is merely for people who cannot afford to go private. Fundamentally that is what the thinking is. I grant that is not to the same extent in Fianna Fáil, but it is a very prevalent view within Fine Gael. That view is not only in respect of the health service. It is also about childcare and housing. There is an attitude that there must be something wrong with someone who cannot afford to pay their own way. That absolutely goes against the thinking in any kind of modern inclusive social democratic society where there is a social contract, where people pay a fair share of tax and in return they get access to good quality public services in a timely way.

I have quoted the origins of the NHS. I am not saying the NHS is perfect by any means. Successive Tory governments have starved the NHS of funding.

It is probably the least good model of universal healthcare across Europe. We are an outlier in not having free access to primary care and other levels of care. What happens in this country is unheard of in other countries. Looking at the NHS and its current shortcomings, almost 90% of people in the UK are happy to use it. The level of private health insurance in Britain is only somewhere around 12% to 15% even after all of the cuts but the vast majority of people there are more than happy to use the NHS and they are proud of it. We know that and there have been many demonstrations of that.

It is part and parcel of the social contract to know there is a service available and the vast majority of people are more than happy to use it whereas almost half of the population here feel they have no choice but to scrimp and save, as many have to, to pay for private health insurance in order to access timely care. It is a massive indictment of successive Governments in this country that people feel they have to fork out thousands of euro every year. It is effectively a health tax and people feel they have to do that in order to be able to access care. People who cannot afford to do that, which is nearly half of the population, are told that they can wait, which is what they do. Some of those people are left waiting for too long and they lose their lives as a result. Other people suffer massive impacts on their quality of life because of health conditions that they cannot access services for. Many thousands of people cannot go to work because they are waiting for hip operations or some kind of procedure. These people are effectively disabled and dependent because they cannot access healthcare.

Many thousands of children are robbed of critical years of their childhood because they cannot access services. We have early intervention teams for children under five years of age. The theory behind them was to pick up on difficulties or conditions that children had at the earliest possible stage. The tragic irony is that some children age out of that because they have been waiting for so long by the time they reach five years of age and the early intervention team is not available to them any longer. Hundreds of thousands of children are waiting for speech and language therapy and assessments of need. Many elderly people have a seriously diminished quality of life because they cannot get access to the kind of physiotherapy and other therapies that they need. We know there are 900,000 people waiting for hospital appointments or procedures of one kind or another. There are the hidden waiting lists, including the many hundreds of thousands of people waiting for community services and then there are the other thousands of people waiting for mental health services, including children and adults. It is a scandal and it is a massive indictment of this Government and successive Governments that they have not been able to tackle that.

I listened carefully to the Minister's speech earlier and he barely referenced Sláintecare. The Minister and his predecessor had the unprecedented opportunity of being handed an all-party plan to take us from the current unfair, dysfunctional, uneconomic and two-tier health service to a point where we could be equal to every other European country in having a universal public health service. The Minister did not have to devise a plan or come up with policy. He was handed a plan and he was told that everybody in this House would support him in implementing it. It is disappointing that the Minister is squandering that opportunity.

The Minister talked about more of this, that and the other. That is fine and extra money and capacity are being provided, which are fine and important but unless the Minister implements reform and, in particular, accountability, that will only amount to throwing money at a dysfunctional health service. The Minister has to do much more than that and follow the reform plan which is set out and which is about establishing accountability. Central to that is the aspect of the regional health authorities because that incorporates a legally-based accountability system for the provision of services and the spending of budgets. Unless the Minister does that, this will be another flash in the pan with more money being provided but without any substantial long-term difference being made. Please follow the plan.

Gino Kenny (Dublin Mid West, People Before Profit Alliance)
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I want to start on a very positive note about the past 18 months, which have been testing to say the least. The doctors, nurses, auxiliary and care staff and everybody who works in hospitals had the most challenging 18 months of their professional lives. They saw their patients, loved ones and family members die of this particularly terrible disease. The public health system protected and saved us and at its greatest hour it saved many people in the most difficult of circumstances. Notwithstanding the public health emergency we have faced, before that Ireland had one of the highest waiting lists for inpatient and outpatient care in Europe.

As a consequence of the pandemic, the parameters have changed fundamentally. Those parameters are what people accept and do not accept anymore. The underfunding and mismanagement of our healthcare system has led to this crisis of waiting times for procedures, including surgical procedures, and that is completely unacceptable. We all agree on that. There is a reason that happens and it is not a simplification to say that it is down to the policy of successive Governments. If you look at the policy of a two-tier health system, which we have, it involves private and public healthcare. Once there is that kind of split in society you will have a dysfunctional health system.

Deputy Shortall mentioned Sláintecare and the recent resignations do not bode well. There are reasons those members have resigned from Sláintecare and that does not bode well for reforming our health system. Sláintecare was the vehicle for reform and I have issues with the Sláintecare policy but it was going in the right general direction to see a universal healthcare system. When we see waiting lists there are huge numbers and there are people behind those numbers but if you are from an area of socioeconomic disadvantage and waiting on a procedure or operation, the consequences of that will be severe.

Deputy Shortall mentioned the NHS, which is a cherished institution in Britain. It came from the ashes of the Second World War. I do not know who said it but somebody said that if you do not give people a health system they will give you a revolution. We have to learn the lessons of this pandemic. The parameters have completely changed. The Government has to address the issues around recruitment, capacity and the historical legacy of those who are waiting and those who have suffered from that split in society between private and public healthcare.

I see that the Minister's statement is positive enough. We are, hopefully, at the tail end of this pandemic and I hope the Government will focus on trying to address these issues. If it does not address the issue of waiting times, the political cost will be extremely painful and one no doctor can remedy.

Mick Barry (Cork North Central, Solidarity)
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From 1918 to 1920, the Spanish flu epidemic swept the world killing tens of millions of people. The pandemic clearly revealed to the masses that the existing health systems based on private ownership and charities were not fit for purpose. The demand for public health services grew louder and unstoppable. In 1945, following six years of world war, the people of England, Scotland, Wales and Northern Ireland resolved there would be no return to the poverty of the 1930s. They fast-forwarded the creation of a welfare state and the jewel in its crown came in the form of the National Health Service. In this country, after more than one and a half years of a deadly pandemic, our health services stand at a crossroads. The health system has nearly 1 million people waiting for treatment, a list that contains untold numbers of stories of pain, frustration and hardship. These waiting lists are the product not merely of Covid but of a health service that is not fit for purpose.

We have a Government made up of Fianna Fáil, Fine Gael and the Green Party, which is blocking and frustrating the progressive Sláintecare reforms, irrespective of what the Minister might say. I have no confidence in Fianna Fáil, Fine Gael or the Green Party to deliver, even on the limited Sláintecare reforms. They will only be fully implemented when these parties are removed from office and an alternative Government is elected, one that is brought under such pressure from below - this is the key point - that it is forced to take the necessary steps. I hope that pressure is so great that such a Government will challenge the vested interests of profit and privilege embedded in the Irish health system and move towards what is needed, which goes beyond Sláintecare. What is needed is a not-for-profit Irish national health service.

The resignation of the Sláintecare duo of Laura Magahy and Professor Tom Keane clearly indicates they felt hugely frustrated in implementing their mandate. I am certain, however, the frustration they felt was as nothing compared to that felt by the nearly 1 million people on our waiting lists. The Minister was quoted in the press today as saying he intends to bring a memo to Cabinet shortly regarding new elective hospitals for Cork, Galway and Dublin. The people on waiting lists in Cork, and no doubt in the other cities also, are tired of vague formulations and the Minister's talk of mañana. Like me, they want some straight answers to some straight questions. Will the Minister clarify if this memo will be brought next month, the month after that or next year? Will it include details of selected site locations, a commencement date for construction work and a date by which the hospitals will open?

Verona Murphy (Wexford, Independent)
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I thank Sinn Féin for bringing forward this topic for discussion. The issue of hospital waiting lists has, in many cases, been exacerbated by the impact of the Government's response to the Covid pandemic. I have highlighted many times the scandal of curtailing services such as cancer screening as part of the Covid response. I hope big lessons have been learned from those decisions. We also need to remember hospital waiting lists have been a long-standing, unresolved issue and a major problem long before Covid entered our vocabulary, as has overcrowding. News reports on how many people were left on hospital trolleys or in corridors were a regular occurrence, yet in the last 18 months we have been conditioned to panic upon hearing the hospitals were only approaching capacity. Hospitals and our public health service are, unfortunately, now used to operating at levels exceeding capacity.

Of all the billions spend on health-related matters over the past 18 months, what have we really got to show for it as we go forward? Will any of the billions spent have any lasting positive effect on our health service? The bigger picture appears to have been lost in a blaze of panic. How useful could all the billions have been in providing a type of SwiftCare clinic in every large town, for example, to ease pressure on the hospitals, or in adding to the money raised by the people of Wexford to fund an MRI scanner, which has yet to materialise? The HSE has spent billions on ventilators that did not work and personal protective equipment, PPE, gear that was not fit for purpose. That was pure waste.

It is not all about spending money hand over fist. It is about trying to use the financial resources available in the most useful way possible. That cannot be said of the HSE, as we have seen at the Committee of Public Accounts for the past two weeks. If these wrongs go without accountability, how will things change? Accountability must be part of change.

As the population ages and life expectancy rises higher and higher, we will see further demand for certain medical procedures. We not only need to ensure we have capacity but that we have excess capacity to be able to meet the rising demand over the next few years. In Wexford, we have more than 500 families waiting for home care supports. There are no carers. Massive waiting lists are being reported across all areas of the health service, from scans and consultant appointments to primary care services, such as dental, occupational therapy, audiology, speech and language therapy, mental health and dietetics. I spoke previously of an orthodontic waiting list for teenagers of more than six years. These waiting lists mean that problems go untreated and, often, become worse. We need to tackle the issue head-on across all sectors.

Seán Canney (Galway East, Independent)
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I welcome the opportunity to speak on this very important issue. We all know of people in chronic pain who have been waiting four years for pain management clinic appointments. Many Deputies have spoken about these kinds of issues tonight but I will concentrate on something else and I am glad the Minister and the Ministers of State are here to listen. The Saolta group, which covers the west of Ireland, deals with cancer and cancer treatments. The probability of receiving a timely diagnosis of cancer and surviving the disease varies substantially across Europe. Due to majority inequity in access to cancer diagnostics and treatments, the chances of surviving cancer are reduced in the west of Ireland relative to the rest of Europe.

The Saolta cancer centre, based in the model 4 hospital, University Hospital Galway, delivers a programme of cancer care to an overall catchment area of approximately 1 million people across the Saolta group area of Connacht and Donegal, which includes others in the mid west and midlands. The Saolta group covers some of the most rural and deprived areas nationally, mainly associated with the western seaboard. Cancer is a leading cause of premature mortality for those living in the Saolta group area. According to National Cancer Registry Ireland, cancer patients from this region have the worst cancer outcomes in Ireland. In addition, the impact of the Covid-19 pandemic means the mortality rate is expected to increase.

Cancer services in the Saolta group have been working beyond full capacity, with no resilience, within the cancer programme to deliver a safe, staffed and sustainable service prior to Covid-19. While we produced the national cancer control programme in 2006, which designated eight cancer centres, the cancer programme for the west of Ireland has not received any infrastructure supports for the past 12 years and has not been able to develop into a sustainable, staffed and secure programme. It is important we develop a smart, integrated programme, which will allow timely access to diagnostics, therapeutics and follow-up in a sustainable manner throughout the region. The people of the west deserve this. The national development plan gives the Minister and the Ministers of State an opportunity to positively discriminate in favour of this region.

We cannot allow this situation to continue ad infinitumand we cannot continue to pay lip service to it. We have had enough of it. We need to put the infrastructure in place. We have enough plans, reviews, etc. It is important the Ministers and the Ministers of State bring this message back to central government. It is time to make sure the Saolta group is properly funded and given the proper infrastructure to make sure we can deal with cancer inequality like everyone else.

Matt Shanahan (Waterford, Independent)
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I note the Minister's announcement that he is proposing a task force to deal with waiting lists and that he has put in a funding request for a budget allocation of hundreds of millions of euro to pay for this multi-year plan. That is wonderful news. Again, we can find emergency money to outsource waiting lists, yet we cannot find the money to support expansion within our own hospital settings.

I will speak about the regional hospital of the south east, University Hospital Waterford, UHW, a model 4 hospital that is servicing a catchment of approximately 520,000 people. It is a hospital that continues to be the least resourced model 4 in the entire country. To put that in context, UHW, with its catchment of 520,000 potential patients, receives €194 million in annual funding. University Hospital Limerick, by contrast, has a catchment of 400,000 and receives annual budgets of €266 million. That is a €72 million budget deficit compared to a hospital providing exactly the same services and to a smaller number of patients. What is that additional €72 million paying for in Limerick? A portion of it is certainly paying for the additional 865 whole-time equivalent employee positions the hospital enjoys over the hospital employee number allocated to the south east and Waterford. I often hear Deputies in the House describing the funding deficits at University Hospital Limerick and if there are such deficits, and I am sure there are, what does that say about the treatment of the main regional hospital of the south east?

The Minister has long been aware of the extensive waiting lists that have been a feature of UHW's treatment landscape, record waiting lists nationally in cardiology, ophthalmology, endoscopy, elective trauma and colorectal surgery. The list goes on. In fact, national media reported last year that UHW waiting lists were ranked the third worst in the country. What has been the response of the Department of Health in the interim? Did it decide to revisit the budget issues or examine the efficiency metrics in terms of procedures completed per euro spent in this hospital, which ranks among the best in the country? Did the Government decide to provide additional funding and approve whole-time equivalent positions to consultant staffing, specialists in general nursing, radiography and lab technicians to build on the capital efficiency of this hospital? The answer is "No". The Minister did not do that and nor did the Department, the HSE or the South/South West Hospital Group. Instead, money was found from the National Treatment Purchase Fund, NTPF, to begin targeting south-east patients for treatment options in Cork and Dublin private hospitals. Most galling of all was the loss of the significant rescue provided to the cardiac service during the pandemic, where UPMC installed a new laboratory that gave a massive service to our hospital system. No sooner did the resumption of procedures happen in UHW than an NTPF contract was drawn up which bypassed the UPMC facility in favour of sending vulnerable cardiac patients more than 80 and 120 miles, respectively, to Dublin or Cork to have cardiac diagnostic procedures completed. Less than half the people selected on the list took up that option. That clearly shows medical management are totally out of touch with the needs of people to have these procedures in their own regional hospital where they regularly attend.

The issue of waiting lists has always been a component of poor capacity, staffing and recruitment issues, available theatre and diagnostic space, and the ability of patients to attend appointments. Many of these factors are solvable by increased health resourcing. This is the status that private hospital consultants must reach to remain commercially viable and that is why they, as opposed to public health systems, can offer a solution to low level elective procedures.

Many of the patients the new initiatives will target will just move from one waiting list to another. Having received one procedure,their care plan and management will likely still fall back on the regional hospital they attend. Money will not solve the waiting list problems but will only dampen down them for a number of months. The Minister's recent talk of looking at new elective hospitals in Cork, Dublin and Galway tells me that he is deciding to continue to give to those who already have much more and in so doing, he will continue to embed health inequity and waiting lists within our public health system.

Carol Nolan (Laois-Offaly, Independent)
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The impact of Covid-19 on the delivery of health services in this State has been catastrophic but we know there were issues with waiting lists long before the pandemic. We know that the waiting lists across nearly all medical specialties have increased significantly and that it will be years before we can finally determine the sheer magnitude of the crisis that has been created in non-Covid-related areas, such as cancer, coronary and paediatric care. Not only that, in my constituency of Laois-Offaly, thousands of adults and children remain on lengthy and unacceptable waiting lists for occupational therapy and speech and language therapy. I accept and welcome the fact that there was a recent decision to allocate increased funding for the assessment of need process, especially given how bad the backlog of cases is in Laois-Offaly. However, we currently have at least 1,118 children waiting for speech therapy and we also have 159 children waiting in excess of 12 months for occupational therapy. That is to say nothing of the waiting lists for dental treatment. The current orthodontic waiting list in Laois-Offaly is unacceptable. I am aware of too many children and teenagers who are waiting on a list for at least six or seven years. It is unacceptable. The waiting lists must be tackled, once and for all.

Michael Collins (Cork South West, Independent)
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We have massive waiting lists in this country. There is no point in my saying any different because that is quite evident. The lists are, unfortunately, growing. People are waiting for four or five years for a 20- to 25-minute cataract procedure. That cannot be allowed to happen because those people will go blind if some solution is not found. Waiting lists for knee and hip treatments are two to three years. The waiting lists for orthodontic treatment for children go back to 2017. The lists go on and on. I could be here for the next two hours explaining the crisis. People are not waiting just five or six months, they are waiting very long periods of time. The health crisis in west Cork is remarkable at this stage. We have a massive crisis and the Minister has been very quiet on the whole issue. Admissions to the accident and emergency department of Bantry General Hospital were closed for 16 days due to a staffing crisis. SouthDoc's after-hours service in Castletownbere has collapsed due to a staffing crisis. The following may be more of an issue for the Minister of State, Deputy Rabbitte, who I have emailed about it, but CoAction is closing its residential service. That flies in the face of everything about independent living for people with intellectual disabilities. CoAction in Castletownbere has announced that due to staffing problems, it will close its residential service. That is outrageous. It is an attack on the most vulnerable in society.

One slight solution we have, and it is not the greatest solution in the world, is the Northern Ireland healthcare scheme. There has been no announcement as to whether that scheme is going to continue or not. People do not know if they are going to be blind. They do not know if the Minister is going to pull the plug on the scheme at the end of the year or if it will continue. It is desperately needed. Thousands of people have gone abroad for healthcare under the European cross-border directive. I ask the Minister to announce whether that scheme is going to continue. It has benefited thousands of people in west Cork by allowing them to get their cataract surgery. Deputy Danny Healy-Rae, Councillors Ben Dalton O'Sullivan and Danny Collins, and myself have worked very hard to make sure that people can get to Northern Ireland to get treatment for their hips and knees if they are in desperate situations.

Stephen Donnelly (Wicklow, Fianna Fail)
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Yes.

Michael Collins (Cork South West, Independent)
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I appreciate that. It is a good solution if that is happening today. If that is the best I can pull out of the Minister, I appreciate it and thank him.

Mattie McGrath (Tipperary, Independent)
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I am glad the Minister and the Ministers of State are here to listen. The situation is truly shocking. I was again contacted yesterday evening to go to the accident and emergency department in the hospital in Clonmel. There were five ambulances parked there at 5.45 p.m. on a beautiful September evening. What are we going to do in the winter? When I arrived, there were three big ambulances that were full, one fast-responder paramedic car and a private ambulance that was just leaving. The pressure the staff are under is shocking. There is mismanagement and dysfunction in accident and emergency departments. The Government will blame it all on Covid but it cannot do that. We saw the horrific thing that happened in Cork University Hospital, which started in November 2020.

The Government must recruit managers who are able to manage people. There are sometimes no doctors in the accident and emergency department because they have to leave with a patient and go elsewhere. Is the Government trying to close down that hospital?

I ask the Minister of State, Deputy Butler, to correct the record of this House. Earlier today she whispered to the Taoiseach when I asked a question about the number of people waiting for home help in Tipperary. There are thousands and thousands of people waiting nationally. The Minister of State told the Taoiseach to tell the House that no one in south Tipperary was waiting. The Taoiseach told the House that in good faith. The Minister of State can wave all the sheets of paper she likes. I ask her to correct the record.

Mary Butler (Waterford, Fianna Fail)
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There is no one on the waiting list.

Mattie McGrath (Tipperary, Independent)
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I checked with our head of services and was told there are 118, as of today. I sent the Minister of State a text and she came back to me to say she was giving figures for August. Why mislead the Taoiseach and, in turn, the House? The Taoiseach was trying to answer the question without the Minister of State misleading him. She also misled him last week with regard to St. Brigid's in Carrick-on-Suir. The Minister of State said she had met the committee but she had not. She met two members of the committee later that day outside the front door so that information was correct then. The Minister of State has been whispering untruths to the Taoiseach.

The Minister of State should have more respect for her electorate in Waterford and for those in south Tipperary who use St. Brigid's Hospital in Carrick-on-Suir. It is scandalous that the Minister of State would deliberately mislead them. I want her to correct the record. She texted me back to say that she checked and there are 118 waiting. When she rises to speak, the Minister of State should correct the record of the House. She should also correct it regarding what she said last week. It is disgraceful what has been done to the people of east Waterford, where the Minister of State lives, and to the people of south Tipperary and south Kilkenny. The hospital was closed. The Minister of State has a letter from an official. There was supposed to be a report. There was no report condemning the hospital. It was closed without any good reason. The Minister of State is now cobbling that up with a letter.

Anne Rabbitte (Galway East, Fianna Fail)
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That is a personal attack.

Mattie McGrath (Tipperary, Independent)
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It is personal.

Mary Butler (Waterford, Fianna Fail)
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I am glad the Deputy accepts that.

Richard O'Donoghue (Limerick County, Independent)
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Children with minor ailments on waiting lists do not get an early diagnosis, which has lifelong consequences. The development test for babies is missing disabilities. I am talking about basic speech therapy and about eye, ear and mobility issues. Some 106,000 children are awaiting tests in the public system. Some 8,000 are awaiting ultrasounds and CT scans while 2,700 children and young people are on waiting lists for children's mental health services. This is very well documented.

I can list problems in the health service. The Minister inherited many of them. People can say that certain things are the problems. The first day I spoke in the Dáil, I gave the Government a solution but not one of its members listened to it. If they go back on the recording, they will see that on my first day in the Dáil, I told the Government that it needed a management system within the hospitals. This is the Government's solution. Does the Minister know if there is a roster in the public hospitals for the senior doctors? Does he know if there is a roster for the senior consultants? From what I know, nobody in management knows who is on and who is off. The health service is not a Monday to Friday operation. After 5 p.m. on a Friday, you cannot get a consultant. There is then a waiting list come Monday morning. The private hospitals in this country have got it right. They have management systems because they know that, if they do not get it right, it will not work and their hospital will fall. Public hospitals need a management system for doctors and consultants. Our front-line staff are there seven days a week, morning, noon and night but there is no roster system for our consultants and doctors. We need to fix that.

Michael Healy-Rae (Kerry, Independent)
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I acknowledge Deputy Cullinane for instigating this debate and I thank him for his interest in matters affecting Kerry, as well as the rest of the country. Our university hospital in Tralee is under severe strain at present. I acknowledge the work being done by management and the actual workers, including the people in the accident and emergency department tonight, who I often deal with during the night and at different hours over the weekend. They really do their best under an awful lot of pressure. Why, for heaven's sake, is our hospital being run into the ground? Why are we playing second fiddle to Cork? Cork University Hospital is a great hospital. We are very grateful and thankful that the hospital, a centre of excellence, is there, as is Bantry General Hospital. However, why is our hospital, the university hospital in Tralee, being run into the ground, because it is? There is a never-ending list of people who are suffering and waiting to have hip, knee, back or general surgery. There are even people waiting for orthodontic treatment. The health service is in shambles and the Ministers are at the helm. Will they please stop the mismanagement? I compliment the people in our community hospitals, both management and the general staff of the hospitals, whether in Kenmare, Cahersiveen, Killarney, Listowel or Tralee. I also compliment the people who work in our ambulance service, who are also under unreal pressure. The centralisation of the ambulance service in Dublin definitely led to the downgrading of the service delivered and its speed as a result of different mistakes and things that happened, which are no fault of the people who actually work in the service. Again, it is a question of management. Billions of euro are being put into health but it is not directed or managed properly. I will not stand over University Hospital Kerry in Tralee being downgraded, which seems to be what has been happening over recent years and the past ten years in particular. It is not right and I will not stand idly by and let it happen.

Joan Collins (Dublin South Central, Independents 4 Change)
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Today the Minister announced plans to bring forward proposals to establish a task force on waiting lists and to seek extra funding to resource this in the forthcoming budget. This is to be welcomed but the question has to be asked, why is it only now, with waiting lists approaching nearly 1 million, that emergency action is being considered? The plan to provide three new elective hospitals in Dublin, Galway and Cork is also long overdue. The response of our public health service staff to the Covid-19 pandemic shows what is possible and what can be achieved if they are given the necessary resources and funding. However, decades of underfunding have left us with insufficient staff capacity, bed capacity and infrastructure. The task now is to urgently build capacity. Unless this is done, no amount of plans or task forces will resolve the crisis.

The details on waiting lists make for alarming reading. I will not repeat them. They are outlined in the motion. It is an absolute scandal that 98,000 children are on waiting lists, with one third of these having been on those lists for more than 18 months. These include children with special needs who face an average wait of 19 months for an assessment of need.

I will refer to the pre-budget submission of the Irish Medical Organisation, IMO. It has said that, with just below 1.5 consultants per 1,000 of population, we have the lowest number of specialists in the EU, where the average is 2.5 per 1,000 of population. The number of consultants needs to double to meet present needs and the needs of a growing population. Over the past five years, almost 3,000 doctors left the Medical Council register to work abroad. This is a serious problem in respect of recruitment, training and retention of staff. Poor working conditions, poor work-life balance and career uncertainty are the key factors. These were, of course, greatly exacerbated by the pandemic, but they existed before Covid and will continue to exist if the necessary action is not taken.

According to the IMO, at three beds per 1,000 of population, our bed capacity is significantly below the EU average of five beds per 1,000 of population . Our rate of five beds per 100,000 of population for critical care is again way below the EU average, namely 12 beds per 1,000 of population.

The Minister has quoted the extra funding and the increase number of beds and critical care beds but the Government's plans are based on the minimum - and I stress "minimum" - requirements identified in the health service capacity review of 2018. These requirements were dependant on significant expansion of GP and community-based services, as well as community and long-term services for older people, none of which have been achieved. The Government plans, even if they are achieved, which is very unlikely, are not sufficient to meet the needs of our population.

The IMO is also calling for an additional 5,000 public acute beds, serious investment in a stand-alone hospital for elective care, a doubling of critical care capacity to 550 beds and an urgent assessment of resource diagnostics, radiology and laboratory requirements to eliminate bottlenecks and ensure timely results for hospital doctors and GPs. We need investment in GP facilities to enable a shift to greater community care, as well as investment in women's health, mental health, ehealth, IT infrastructure, social care and social care needs for older people.

Taking the Sláintecare report out of the drawer it is confined to in the Department of Health and waving it around occasionally will not do any more. We need the political will - which I have not seen since the resignation of our two head people in Sláintecare - the resources and the finances to meet a very basic human need, that is to say, access to timely, high-quality healthcare based on need rather than on ability to pay.

Catherine Connolly (Galway West, Independent)
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I thank Sinn Féin for tabling this motion. The whole idea of Sláintecare was to avoid this. We were supposed to avoid coming into the Chamber to talk about waiting lists while mentioning Galway and every other city. However, one cannot avoid doing that now because Sláintecare has not been implemented. I do not wish to misquote Professor Tom Keane but he said that there was no will and "that the requirements for implementing this unprecedented programme for change are seriously lacking". That is what he said. Laura Magahy is also gone, as is Professor Geraldine McCarthy down in the south west. That is an indication. It is also an indication of the advisory council not functioning to 100% when some of the members did not even know why others were resigning. There are serious questions on every level but there is no doubt in my mind that, as Deputy Shortall already eloquently pointed out, there is no will to implement a public health system, in comparison to the situation in England. We have never made that leap.

I spent ten years of my life on a health forum, from 2006 to 2016, watching the public health service being dismantled every day. Different language was used. We started with "bed refurbishment", when beds were closed. I never heard of "bed refurbishment" until I sat on a health forum and then I saw the systematic wearing away of the public health system and, at the same time, public money going into the private system and it has never stopped.

I will keep to my time and finish on Galway. I will not read out the lists for the orthopaedics. I have read them out so often, including the letter from the consultants, which I always preface by saying consultants rarely write to me but they wrote to say the pain the patients were suffering was unbearable. Respite care has never been restored. We have words like this, straight from Kafka. Regarding agency 1, whoever that is, the waiting list for respite includes 34 children. The waiting list for enhanced features is 14, along with 45 adults, and for enhanced services the figure is 41. The waiting list from agency 2 includes 15 children and 50 waiting for family support. I could go on and on.

I have begged and appealed to Ministers. I have great respect for their efforts, particularly the two junior Ministers, regarding a hands-on approach, but still we have no respite services or day centres restored in Galway. Nobody can explain why. Some 90% are vaccinated. The Government has reached the magical figure and yet we have not restored services. I will be here for the rest of my elected life pointing out that it is intolerable to have people on waiting lists for any length of time while those with private medicine jump the queues. I do not denigrate those with private medicine or private insurance. Every one of us does what he or she has to do in life. The State has to provide public medicine.

Marian Harkin (Sligo-Leitrim, Independent)
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The number of men, women and children on waiting lists is truly shocking. I do not use that word lightly or often but "shocking" is an appropriate word to describe the fact that nearly 18% of our population is on a healthcare waiting list. I thank Sinn Féin for bringing forward this motion.

While the national figures are stark, the figures in the north west, at Sligo University Hospital and Letterkenny, which has already been mentioned, are dreadful. They are among the worst in the country. Trolley Watch figures for today show that the total number without beds in Sligo University Hospital is 18 and in Letterkenny it is 42. To put those figures in perspective, out of 32 hospitals nationally, Letterkenny is third worst and Sligo is seventh worst. In case those figures were an aberration, I looked at the figures for August and May of this year. I did not choose those, but just took them out of the figures to get a more complete picture. In August, Sligo had the fourth highest numbers waiting for a bed in the hospital, and in May, it was the third highest nationally. Those figures are unacceptable. Every one represents a father, daughter, grandmother, cousin, aunt or husband waiting for a diagnosis or treatment. In some cases it is life-threatening, in many it is life-limiting and it always impacts negatively on a person's health and quality of life.

I read the countermotion and it lists a number of contributing factors to the waiting lists. For example, Covid. We all recognise its impact but it has simply made a very bad situation much worse. I looked at figures on Trolley Watch from 2006 to 2021 for Sligo and, again, took the month of August. For the first four years, 2006 to 2009, it ranged from 13, lowest, to 70, highest. For the last four years, 2018 to 2021, it ranged from 225 to 484. In other words, it is seven times worse. That is not down to Covid or cyberattacks. It is down to health policy for the last 20 years.

The Minister said he continued to implement Sláintecare yet the two recent high-profile resignations from the Sláintecare board are at least partly due to the non-implementation of a regional strategy. The figures in Sligo and Letterkenny show how urgent such a strategy is. I have real concern we will be left behind again.

Anne Rabbitte (Galway East, Fianna Fail)
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The main point I want to address is the Opposition's claim that children with additional needs are forced to wait an average of 19 months for an assessment of need, despite the legal right of three months. As I have said in the House a number of times, one of my priorities on assuming ministerial responsibility for disability was to remedy the number of overdue assessments of need for children across the country. At the end of June 2020, the backlog had risen to approximately 6,500 children. Having successfully secured Sláintecare funding of €7.8 million to tackle the backlog, I am pleased to inform the House that, by the end of last month, the waiting list had been reduced to approximately 600 cases, a reduction of 91%.

This breaks down across all the CHOs. In CHO 1, when I inherited the role, I had 138. Today there is nil. In CHO 2, there were 100 and today there is nil. In CHO 3, there was 589. There were 16 at the end of August. In CHO 4, there were 1,098. At the end of August it was nil. In CHO 5, it was 643. It is now nil. In CHO 6, it was 257. It is now nil. In CHO 7, it was 1,056. It is now nil. In CHO 8, it was 764. At the end of August it was 21. In CHO 9, it was 1,913. At the end of August it was 585. The total amount at the end of August was 622. It is worth reminding the House that HSE staff and clinicians achieved this despite challenges posed by the current pandemic and the cyberattack. This Trojan work needs to be recognised and I thank everyone involved for their efforts.

Even more important, the clearing of the backlog allows services to focus on intervention to support the child, which is the key piece I will focus my energies on over the months and years ahead. The old assessment of need, AON, system has been replaced with a uniform approach across the country using a preliminary team assessment, PTA, which ensures these children timely access to services and intervention. There is a current review of that system while we are using it at the moment. From January 2020 to the end of August 2021, a total of 2,504 children received a PTA. A staggering 89% of these children were referred to an intervention pathway based on the outcome of that assessment. This means instead of languishing on waiting lists to find out their diagnosis or the supports they need, parents find out sooner and get on an intervention pathway sooner. This is at the heart of progressing disability services and completely changes how we deliver services and supports to children with additional needs from birth to 18 years of age.

At some stages, this change has been hard for families and clinicians. This is a major cultural shift in how we deliver therapies to children with complex need. Deputy Shortall referenced the word "reform". Progressing disability is one reform Deputies will see in 2021. It has been ten years in the making and is being delivered under this Government.

The HSE is establishing 91 children disability networks across the nine CHOs. I am pleased to say 83 of these network teams are already in place. Under PDS, these teams will provide specialist support services for all children with significant disability, regardless of their diagnosis, where they live or where they go to school. It will mean the end of unacceptable situations where children age out of early intervention teams and will help tackle the current waiting lists, which we all acknowledge are at an unacceptable level.

Now that the issues with waiting times for an AON have largely been addressed, attention must move to the focus on delivery of interventions.

As a result of the formations of the children's disability network teams, CDNTs, I will be able to get a clearer picture of children who are waiting to access therapies under disabilities and those waiting to access therapies under primary care. This will help give clarity to a number of interventions being delivered on each side and every child supported. More importantly, I will have a clear sight of where specific roadblocks in each CHO may be and I will address them. I will meet with the CDNTs every week to track progress. This is an important step in reducing the number of outstanding matters. I will focus on management styles, management delivery and cost-effective measures.

I will hand over to the Minister of State, Deputy Butler.

Mary Butler (Waterford, Fianna Fail)
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I move amendment No. 1:

To delete all words after “Dáil Éireann” and substitute the following: “notes that:

— the population aged 65 and over has increased by 35 per cent since 2009, with the result that there have been increasing levels of demand for health and social care services;

— arising from the Covid-19 pandemic, which broke out in March 2020, routine scheduled acute hospital care had been severely curtailed during the periods when surges occurred, and capacity reduced generally for reasons of social distancing and infection control measures;

— arising from the Health Service Executive (HSE) ransomware cyber attack, which occurred in May of this year, these services were further seriously disrupted as hospitals endeavoured to maintain emergency and urgent time-critical services;

— other jurisdictions have experienced increased pressures on waiting lists due to the Covid-19 pandemic; and

— notwithstanding the enormous challenges facing the health care system, it is projected that acute waiting lists will be reduced, from a peak of 740,000 in May, at the end of the year through the implementation of a waiting list recovery plan, which is being finalised;

acknowledges:

— the commitment in the Programme for Government: Our Shared Future to the implementation of the Sláintecare Plan;

— the major investment made this year to tackle waiting lists through the establishment of the Access to Care Fund of €240 million;

— the increase of permanent bed capacity of 795 beds to date, with a target of 938 by the year-end;

— the increase of 44 Intensive Care Unit (ICU) beds to date, with a target of 66 ICU beds by the end of the year, a 25 per cent increase over the level at the beginning of 2020;

— that the National Development Plan provides for health capital projects, including 2,600 acute hospital beds and 4,500 social care beds;

— the measures taken to ensure national coverage of community intervention teams and structured general practitioner access to diagnostic programmes;

— the additional allocation of €50 million to commence implementation of the recommendations of Sharing the Vision - A Mental Health Policy for Everyone, and €15 million once-off funding to combat Covid-19 related issues in mental health services;

— the implementation of a new standard operating procedure to ensure that children with disabilities have timely access to assessments of need and interventions;

— the progress made in relation to the Individual Health Identifier;

— the increased investment in the health services, including an increase of 6,000 more whole-time equivalent staff, with 2020 and 2021 seeing the biggest annual growth in staff since the HSE was established;

— that a multiannual plan to reduce waiting lists and bring waiting times in line with Sláintecare targets is being developed; and

— the publication of the Sláintecare Implementation Strategy & Action Plan 2021 — 2023: Progress Report January – June 2021, which shows that the Government is largely on track with its implementation; and

agrees to:

— the continued implementation of the Sláintecare Implementation Strategy & Action Plan 2021 — 2023, to which the Government is committed and has the support of all parties; and

— support the Government’s measures in relation to the waiting list recovery plan for this year and the finalisation of the multiannual waiting list plan.”

I welcome this debate. We are all acutely aware of the waiting list challenges. The Government is acutely aware of them as well. We discuss them every day of the week.

In response to the pandemic, the broad range of mental health services and supports provided by the HSE and its partner organisations have been significantly expanded to meet existing and new and emerging need. There has been progress in respect of certain initiatives and I will go through them now. This has been achieved through developments in the national mental health clinical programmes and models of care. These programmes will not only promote standardisation of evidence-based care but also improve access to supports when and where they are needed.

Deputy Ward stated that he was concerned that of the €23 million that was allocated for Sharing the Vision, only €2.77 million has been spent to date. As of this week, we are up to €9 million, and recruitment is under way. Most of the money will be spent in quarter 4 of this year, and I can guarantee that none of that money will be repurposed. Take eating disorders, for example. The three existing eating disorder teams will be completed by the end of the year in addition to the establishment of three new teams. This will have a significant impact on improving access to these vital services.

The perinatal model of care has progressed significantly, with funding made available this year for the recruitment of outstanding staff. All six main hub sites are in operation and all 13 spoke sites now have mental health midwives in place. I know everybody will welcome the fact that we have 19 perinatal mental health midwives in place. Progress has also been made on the development of CAMHS telehubs, which will enhance access to mental health supports out of hours.

Other initiatives include the selection of Waterford, Dungarvan and south Kilkenny for provision of a crisis resolution team and the opening of a community café in Galway. Some €13.5 million was allocated this year to increase surge capacity for mental health beds during the pandemic.

Many speakers touched on the primary care psychology list. It is something I wanted to work on, so last month I announced the approval of €4 million to reduce the number of children and young people waiting over 12 months to access primary care psychology. That €4 million is for the spend between September and December of this year.

Work is progressing across all the CHOs on regional, local-based initiatives, including the recruitment of new staff. They are using public capacity, private capacity and locums at the weekends and doing overtime on Tuesday and Thursday evenings to try to tackle this. We are acutely aware of these challenges but we must also have a sustainable future for primary care psychology. That will be addressed in the Estimates process.

I was delighted to announce earlier today that I had cleared a historic deficit in mental health funding, which had grown to €53 million by the end of 2020. This achievement is critical to ensuring that our mental health services can operate effectively and efficiently from a stable funding base and enable enhanced development going forward. This includes improved access and reduced waiting lists across a broad spectrum of mental health supports. It will, on a separate basis, enable the HSE to allocate €49 million to new developments in mental health. This includes the €23 million we have already spoken about from budget 2021 and €26 million in historical development funding. More than 400 new mental health staff are at various stages of recruitment as part of these developments. There are huge issues and challenges in recruiting staff. I am not happy about the fact that it takes 50 weeks to recruit somebody and that sometimes the post has to be backfilled. That is where we are seeing the challenges, but I am working really hard with my colleagues to see how we can tackle these problems.

To conclude, I will touch on the waiting list hours that were referred to earlier. Overall, the number of home support hours has increased, with the number of people now waiting reduced to 1,460. It was at a high last May of 7,295. The one point I wish to raise is that because we delivered in excess of 1.5 million additional home care hours up to July of this year, 1,200 people did not have to enter a nursing home. That is an important point to put on the record.

Seán Crowe (Dublin South West, Sinn Fein)
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I listened to the Minister earlier and I think the biggest challenge he faces is that no one believes him. I am not talking about people on these benches; I think the people who are on the waiting lists do not believe him. We have a broken health system, and that is a big problem. We heard the numbers earlier: 900,000 of our citizens are on waiting lists. That is a staggering statistic. One in five people is on a waiting list for some form of healthcare. There are 36,000 people on the outpatient waiting list of Tallaght University Hospital. That is just one hospital. Of those 36,000, 12,000 have been waiting more than 18 months. That is not acceptable. Fine Gael has been in power for ten years. It has made zero progress in improving the waiting lists, and there is no real sign I can see that anything has changed. Waiting lists are up 15% since the beginning of the pandemic, and we heard the reasons the Government outlined tonight, but they have almost doubled since 2014. It is unacceptable that sick people who require urgent care are left in limbo for years waiting to see a hospital consultant. Of course, if you have money, you can skip the queue, and that is not right. Without urgently hiring key staff to fill posts, the problems will only get worse.

The health service needs major investment to boost capacity if it is to take on the waiting lists. The Government must use budget 2022 to drive money into targeted areas of the health service to seriously tackle waiting lists and overcrowding. We will hear about the biggest health budget ever, but that is irrelevant unless it is targeted and spent wisely. We are playing catch-up as our population grows every year. We need to spend more every year just to stand still. That is why we need targeted investment in key areas, as outlined in our motion. We need delivery of a major increase in beds, staff and diagnostic capacity to meet current needs and tackle waiting lists. We must introduce a centralised referral system and an integrated waiting list management system. We need a 21st-century health system. We cannot leave sick people on waiting lists for months and years and when they need vital treatment. We cannot consign them to a life of pain and suffering and a broken health service. The Minister has a big job ahead of him, but that is the reality.

Kathleen Funchion (Carlow-Kilkenny, Sinn Fein)
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As my party's spokesperson on children, I will focus my short time on children. We know there are 106,000 children waiting for an assessment, treatment or a diagnostic scan in a public hospital. The largest waiting lists are in ear, nose and throat and general paediatrics. I do, though, acknowledge the work the Minister of State, Deputy Rabbitte, has done on the assessments. I know that that is an area she has been working on. She herself acknowledges a lot of the difficulty. One example in my constituency is somebody who has been waiting three years for speech and language therapy. We all know about early intervention and it being key. At three years, it is hard even to know what to say to a parent in that situation. It is really important that the occupational and speech and language therapy and all the other therapies that are needed are followed through on. If that is what the Department will focus on now, I welcome that because it is really important.

Developmental checks are absolutely crucial for young children. Many of these appointments have been pushed out due to Covid and then the cyberattack. People feel like there is always something, and it is important we reflect that message tonight because people are really frustrated.

Doctors and consultants tell us routine procedures are being pushed further out and many children are not being seen until they are adults, which is a whole other issue.

In the time remaining, I want to raise an issue with the Minister of State, Deputy Butler, the details of which I will email to her. It relates to a nursing home in Ballyragget in County Kilkenny, where a patient has been approved for home care but cannot find a carer and, as a result, has been in the home since last February. This is an example of a person who could be moved on from nursing home care. The family wants the person home and approval has been given for a home care package. All that is needed is a person to provide the care. This situation will lead to waiting lists. I conclude by commending my colleague, Deputy Cullinane, on his work on the motion.

David Cullinane (Waterford, Sinn Fein)
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I had intended to respond to the debate by going through the Minister's opening speech and unpicking much of what he said. I will not do so, however, because I want to make a number of other points instead. Many Deputies have spoken tonight, from both Government parties and the Opposition, who obviously care about our health services. I care very deeply about healthcare. It is an issue in which I have taken an interest throughout my political career. For the 20 years I have been involved in politics, I have been interested in it because of what I have seen in my constituency. The Minister of State, Deputy Butler, is from the same constituency, as is Deputy Ó Cathasaigh, who was in the Chair before the Leas-Cheann Comhairle arrived. We have battled for radiotherapy services, a mortuary and cardiac services. People in the constituency have taken to the streets time and again to demand better healthcare. They have heard all sorts of promises, some of which were delivered over many years and others that were not delivered at all.

I also care about these issues because of the experience of my mam, whose story I have told before. She got sick a number of years ago and was ill for three or four months with stomach pains. Her condition got so bad over the Christmas period that my family brought her to University Hospital Waterford, where she was treated very well. She was taken into the emergency department, a preliminary inspection was done and she was told she would need a scan, for which, however, she would have to wait possibly six months. A staff member pulled the family members aside and told us: "I do not like what we have seen and the symptoms; you should take her to the private clinic and get a diagnosis." That is what we did and we paid for it. Other families would not be in a position to do so. She was diagnosed with cancer within three weeks and was then seen in St. James's Hospital, where she got very good treatment. Unfortunately, she passed away in the palliative care centre in Harold's Cross, the staff of which gave her tremendous care.

I vowed at that time to do everything I can to end the two-tier health system. That is why it is so important that we bring about these major reforms in healthcare. It is about people's experiences. It is absolutely unacceptable that we have a two-tier system whereby if one has money and wealth, one can get quicker and faster care, while people who do not must wait longer for treatment. The Minister talked about the situation of Sarah earlier, which I am sure was heartfelt, and how he was able to solve a problem in that case. However, there are hundreds of thousands of people like Sarah right across the public healthcare system for whom we must provide.

It might not come as any surprise to the Minister that I want to be sitting where he is and for him to be sitting where I am. I want to be a future Minister for Health. In seeking to achieve that, I believe we must not so much stand up to vested interests but work with people to bring about the big changes that are necessary. We will have to face hard choices. For example, if we want to remove private healthcare from the public system to achieve equality, we are going to have to do it, not talk about it. If we want to realise universal GP care, then we are going to have to do it instead of talking about it. That is what I meant earlier when I referred to the snail's pace of progress on some of the major reforms. If the Government comes under pressure on some of those big challenges, I will be standing with the people who want to implement the major reforms and deliver a single-tier Irish national health service. I will be standing firmly there because I want those changes to be made.

I have heard many politicians, from many parties, talk about the Ministry of Health as a poisoned chalice. We hear all the time in the media that health is the one portfolio Ministers do not want to get. In my view, it is the one they should seek first because of the changes they can bring about and the impact they will have on people's lives. For every one of the 900,000 people who are on a waiting list, all the children on waiting lists and all of those waiting too long for assessments or to get into hospital and receive treatment, the current system is a disaster we need to fix. The challenge is not just the numbers of people on the lists but also the length of time they are waiting. I accept that the Minister is going to put a plan in place. I have a limited number of staff but I have produced an alternative budget this year that is credible, realistic and deliverable. I will launch it on Thursday and, as always, I will send it to the Minister. There are solutions and I am prepared to work with anybody, including the Government, to make them happen. I hope that what comes from this debate is that, once and for all, a serious plan is put in place to tackle the waiting list crisis and make the health service work for everyone.

Catherine Connolly (Galway West, Independent)
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A division has been called. In accordance with Standing Order 80(2), it is postponed until the weekly division time tomorrow evening, Wednesday, 29 September 2021.