It is an official document. It is not a note to me. It is an official presentation to the Oireachtas committee.

I will be sharing my time with Deputy Pádraig O'Sullivan. Rare diseases, as we know, are anything but rare. There are now more than 6,000 known rare diseases. One in 17 people in Ireland has a rare disease, which is 300,000 people. When you include the mums and dads, the brothers and sisters, and the sons and daughters who live with all of those people with a rare disease, it is likely that probably 1 million people in our country either have a rare disease or are living with someone who has a rare disease. To all …

While important progress is being made in ensuring quicker access for children, we all know the waiting lists are still too long. They have been too long for a very long time and Covid-19 made them worse. In response, we adopted a multi-annual approach and we have had several waiting list action plans. We will shortly publish the waiting list action plan for this year. While I fully accept, as we all do, that the waiting lists for children are still far too long, particularly in some specialties, including spinal t…

With regard to hospitals needing to comply with relativity measures, I have instructed the HSE to pause capital investment into any hospital that is refusing to join the productivity drive. We have previously discussed the health performance visualisation platform, HPVP. The vast majority of HSE hospitals are on this platform, which is essential if we are to make sure we get as much patient care as possible. We identify where things are going well and where there are challenges. To date, a small number of hospitals…

These issues were raised with me by patient advocacy groups, and I took them very seriously. On the back of that, I spoke directly with front-line clinicians involved in providing paediatric orthopaedic services. I asked them whether they felt they got dedicated beds, dedicated theatre space and priority access to MRI, theatre, etc. The answer I received was that they did not. I have therefore taken the unprecedented step, which I have never had to do before, of instructing the HSE to send in its internal audit tea…

I am acutely aware of the localised pressures that the pause is causing. I was in Sligo University Hospital on Friday last where I spoke with emergency department teams and various clinical teams across the hospital. They highlighted to me, as others have, that the pause is causing real pressures on the front line. I fully acknowledge that. The issue we have is that the HSE hired between 2,000 and 2,500 more staff last year than it was funded to do. It has either hired or is in the process of hiring between 2,000 a…

I would love to be in a position where the HSE could simply go out and hire whatever staff it believed was appropriate and we could simply write a blank cheque, which is what we would have to do. I know the Deputy is not suggesting we do that. We cannot do that. We cannot run any public service in that manner. I am aware that there are pressures but it is also incumbent upon me and others to challenge the HSE to a certain extent. As some in the HSE, who have seen this over many years, have put it to me, there is a …

I imagine that when we get to the end of this year recruitment will be more than half what it was in previous years. The Deputy is correct that we have hired about 6,000 staff per year for the last three years. That has been very unusual. When we look back at previous years, a normal year in the previous five years would have meant hiring between 2,000 and 3,000 additional staff. This year, we have about 2,300 or 2,400 new staff through new development funding, so the number is still growing, and there will be addi…

I thank the Deputy for raising this matter. I know he will join me in acknowledging the extraordinary commitment of the National Ambulance Service workers in delivering care for his constituents in south Tipperary and across the country. We are investing significantly in the National Ambulance Service. This year, investment will be approximately €227 million, which amounts to a €58 million increase in the lifetime of this Government. Staffing has also increased by nearly 40% increase in the past eight years and jus…

South Tipperary can certainly be looked at in terms of expansion. The National Ambulance Service works from bases in Cashel, Clonmel and Tipperary. The service in south Tipperary has a total allocated workforce of 46 and is recruiting locally for some vacancies. For example, it has been advertising on Spin Southwest and on Beat 102-103. It has had targeted local advertising campaigns through social media. The Deputy's reference to the 45 km rule is relevant and there is no question that in some parts it could limit…

I will bring the Deputy's suggestions on engaging with schools and so on back to the National Ambulance Service and ask it to redouble its efforts in terms of local recruitment. I acknowledge that in spite of the fact the National Ambulance Service has these vacant posts, the ambulance service in south Tipperary has been doing very well. We can look at two of the main indicators that are important for patients in terms of response times, namely, purple calls, which cover life-threatening incidents in cardiac and re…

I thank the Deputy for the question. The project she referenced, namely, the model 3 hospital project, was initiated by the HSE - the RCSI was heavily involved in it - to investigate exactly these issues: the challenges in recruitment and retention of consultants across specialties in the model 3 hospitals, and then, of course, to make recommendations. I was very happy to launch the report with the National Doctors Training and Planning, NDTP, just a few months ago, on 9 November. I acknowledge the significance of …

I will ask the Department to revert to the Deputy with a more detailed timeline both with regard to when in quarter 2, the sites it is going to go to and the recommendations it is starting with. It is important to say that while there is a challenge that has been identified and that challenge is going to be responded to, there are a lot of positive things happening across the health service that will address some of the concerns that the consultants and the NCHDs have in the model 3 hospitals. First and foremost is…

I would challenge the idea that there is a crisis in consultant recruitment here. There simply is not. We have increased the consultant workforce by 1,000 during the lifetime of this Government and there are hundreds more consultant posts in train at the moment. In fact, the conversation I am having with the HSE at the moment is how we are going to fund the consultant posts, given how many are being hired and how quickly it is happening. We now have almost 2,000 consultants on the new public-only contract. I visite…

I thank the Deputy for the question. I visited Ennis Hospital not that long ago and must say I was hugely impressed, especially by the work carried out by healthcare professionals in the injury unit and the medical assessment unit, MAU. We are investing at a significant rate in Ennis Hospital, including in urgent and emergency care. In 2022, I provided €2 million for the Ennis injury unit, which has gone from strength to strength. Currently, one in three unscheduled care cases received treatment in the mid-west inj…

I thank the Deputy. She raised two really important issues. One is the unacceptable level of pressure for patients and healthcare workers in UHL. It is not acceptable. On any given day now, UHL can make up one in five, or even one in four of the number of patients on trolleys in the entire country. At national level, the good news is that the number of patients on trolleys fell very significantly last year, particularly in the second half of the year . The pressures are now in a smaller number of hospitals, Limeric…

I thank both Deputies for this. I fully appreciate where they are coming from in the context of how the people they represent are genuinely worried about going to the emergency department at University Hospital Limerick. I get that. We have to do two things. We must continue to invest in Ennis Hospital. We have been investing in it year on year, we have expanded its opening hours, its urgent care capacity and its medical assessment unit capacity and we will continue to invest in it. At the same time, we must fix th…

I thank the Deputy very much for the question. I will start by acknowledging his ongoing advocacy in terms of new medicines, including rare diseases, but obviously, this is not one of those cases. As the Deputy is aware, the HSE has statutory responsibility for decisions on the pricing and reimbursement of medicines. However, it is incumbent upon all of us, as public representatives, to engage with patients and clinicians and to understand where the real opportunities are for future medicines. Veoza is a very new d…

I thank the Deputy. I will walk through the steps regarding where this is now and where it is going. As I said, the company applied for reimbursement just in the last few weeks. That application is now undergoing a rapid review at the National Centre for Pharmacoeconomics. The NCPE target for that is four weeks but it does not always meet it because it assesses many new medicines. Yet, typically, the target for a rapid review is approximately four weeks. Following the rapid review, it may recommend a full health te…

These are exactly the issues that will be looked at in the rapid review and the health technology assessment. How much would it cost the State if it is on the drug payment scheme? What amount of good would the medicine do, given the amount of money that would be spent? That is how we must look at all medicines. It may be the case that it will be recommended for the drug payment scheme. The figure of €6,000 was mentioned; I am not familiar with the figure, but let us say that it is €6,000. The State would pay nearly…