I think there will always be private hospitals. To be honest, from a public healthcare perspective it can be useful to be able to dip into additional capacity from time to time when it is needed and if there is a shortage. However, it should be the exception rather than the rule. I hear what the Deputy is saying but I do not agree with the Deputy's language. It is a little unfair. I have met people who are providing health insurance - the State owns the main health insurer, VHI - from the chair of the board and the…

The people I have met at the VHI are doing their very best to try to provide the best possible care.

I move amendment No. 8: In page 3, line 14, to delete “Principal Act” and substitute “Act of 1994”.

I move amendment No. 9: In page 4, line 32, to delete “Principal Act” and substitute “Act of 1994”.

I move amendment No. 10: In page 4, line 35, to delete “Principal Act” and substitute “Act of 1994”.

I move amendment No. 11: In page 3, to delete lines 5 to 9 and substitute the following: “An Act to provide for the making available for supply, without charge, to certain women, of certain products used to alleviate the symptoms of menopause; and, for that purpose, to amend the Health Act 1970 and the Health (Pricing and Supply of Medical Goods) Act 2013; to amend the Health Insurance Act 1994 to specify the amount of premium to be paid from the Risk Equalisation Fund in respect of certain classes of insured perso…

I thank the Deputy for the question. The national review of adult specialist cardiac services is finalised and I have received the report. I do not have the date but I have received it and I will move to publish it very shortly. I want to bring it to Government. It is a very good and comprehensive report. One of the reasons I did not publish it right away was I did not want to publish a review that did not have any money behind it. The report makes a lot of recommendations. Additional funding for cardiovascular ser…

I fully accept the Deputy's point. We will bring the review to Government imminently and it will then be published. The review kicked off after the focus on University Hospital Waterford. That was the genesis of it. I thank Professor Nolan and his team for their work. When the Deputy sees the report he will see it is a comprehensive piece of work. What Professor Nolan and his team have done goes well beyond where 24-7 care should be. They did the work around cardiovascular diseases. As the Deputy will be aware, mor…

I will not do the topic justice here. There has been a lot of careful thinking. We will publish the report and allow everybody to look at it in the round. The Government has progressed substantially in terms of the second cath lab in Waterford University Hospital. As the Deputy will be aware, the second cath lab opened in September of last year. That was an important milestone. The opening hours of the first cath lab were extended the year before that from 8 a.m. to 8 p.m. from Monday to Friday. We are going furthe…

I appreciate that. We will publish the report. Let us all review it in the round.

I thank the Deputy for the question. I support his call for ongoing investment in the medical assessment unit in Nenagh Hospital. The unit has been providing a valuable service locally. In many cases, it is an alternative to the emergency department for GP referrals. It is currently open seven days a week from 8 a.m. to 8 p.m. Last year, more than 4,000 patients were referred to the medical assessment unit in Nenagh. Already this year, the number of patients is in excess of 3,000 and climbing rapidly. The Deputy wi…

The number of presentations does not reflect the concerns that people are bringing to the Deputy. I will share the relevant numbers. In 2021, there were 1,300 referrals. In 2022, there were 2,500 referrals. Last year, there were 4,100 referrals. This year's number will be in excess of that. Between 2021 and 2023, years for which we have the figures, there was a 300% increase in the number of referrals. The referrals are climbing rapidly. If the Deputy has specific concerns that have been raised with him, he should …

This is probably the first conversation I have had where any Deputy has called for a reduction in healthcare service provision in a constituency. I do not think I have ever heard hospital staff calling for fewer services to be provided. We need to treat this carefully. As I said, the number of referrals is not in line with what the Deputy is hearing. The number of referrals tripled in just two years. There is a run rate of nearly 100 referrals per week. If there is more that the GPs can be doing and there is a need…

I know the Deputy is not saying that, and of course we will do as he says. It is interesting that the concerns the unions are raising with the HSE are that they do not want to work the rosters that are being offered. That is what the HSE is hearing. The Deputy might share specific examples of unfilled slots and I will ask the HSE about it on the back of this conversation. It goes without saying that we must fully use the capacity we have. Perhaps further engagement with the GPs is required. Let us see.

I thank the Deputy for his question. As we are all aware, the main contractor has now missed its own deadline 14 times. It missed its own deadlines four times this year alone. Neither the HSE nor the Government has confidence in deadlines that a contractor puts forward when the contractor misses its own deadlines 14 times. Our position and that of the board has been clear, in that the contractor needs to fully resource the project. The board’s view is that the contractor has consistently failed to do so. In my last…

The Deputy raised a few points. Let me be clear, in that I wanted the State to take ownership of the hospital around now. The contractor told us it would be in October or November, but it has missed its deadline. It has under-resourced the project repeatedly and failed to meet its deadline. I agree with the Deputy about how the hospital development board, which is acting on our behalf, must use all of the levers available to it in the contract. Having met the board and been in regular communication with its chair, …

At this point, it would be a futile exercise to second-guess the contract. The contract is what the board has and we must manage the project within it. The board is using the contract to the fullest extent possible. I acknowledge the Deputy’s role in this. He must, and should, put pressure on us. I would were I in his chair, and did. There is value to us speaking with one voice at least in terms of shining a light where it must go, namely, on the contract.

I just acknowledged that. I will cite an example that the Deputy’s colleague, Deputy Doherty, raised with me at the health committee. I believe Deputy Cullinane might have been present for it. It had to do with grilles. Clearly, he had been given information. I believe he was acting in good faith. He made an impassioned contribution and said that this was a design flaw and, therefore, the fault of the board, designers or whoever it might have been in the State. We can all guess where that information may have come …

-----approximately €24 million and delay the project by months.

That is clearly what he had been told and he brought it-----