Jennifer Carroll MacNeill
Dún Laoghaire · Fine Gael · Ireland
“It will be provided by a registered pharmacist in accordance with the relevant pharmacy legislation, including this Bill. Section 2 of the Bill makes various amendments to the Irish Medicines Board Act and the Pharmacy Act. Those amendments ensure that whole legislative framework is cross-referenced correctly.”
“We now have a common conditions service where you can go to a pharmacy instead of a GP to get a diagnosis and prescription for eight basic conditions like conjunctivitis or urinary tract infections - the kind of things that just come up in people's lives all the time. We would like to expand more and more what pharmacies can do.”
“In particular, the board will be focusing on aspects of menstrual health, on aspects of postpartum mental health, particularly in traumatic birth cases, on something we have overlooked for some time, which is endometriosis, on women who are finding it difficult to access services in different ways, as Senator Harmon suggested, and on more…”
“The extension to 41- to 45-year-olds could possibly be €5 million to €8 million because there are statistically fewer women in that bracket trying to conceive, so the numbers are higher. It really is a question of funding. I remind Senators that they have also asked me to fund various other programmes.”
“That followed confirmation from the Pharmaceutical Society of Ireland and the Health Products Regulatory Authority that the patch and ring are classified as medicinal products, not medical devices. That is just a correction there.”
“That is why we have put so much money into supporting them in different ways, including the conclusion of a €50 million increase to their fees and to provide for the opportunity to raise private funds in this way, for example, the common conditions service. I want to see pharmacists doing more.”
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“I thank the Deputy. While we have already invested in the University Hospital Galway campuses, there are significant proposals, as the Deputy is aware, for further investments there. The integrated development control plan, DCP, has been informed by population health needs and clinical demand. That has been developed and now provides a clear masterplan for the sequencing and delivery of new facilities. My Department has received a copy of the DCP and a programme strategic assessment report, SAR, which are currently being reviewed against infrastructure guideline requirements. In parallel, the preliminary business case for the first phase of works is under development. The SAR feedback will be returned to the HSE in the coming weeks for inclusion within it. A considerable amount of enabling works will be required to deliver the masterplan.”
“Yes. We are having the third meeting today. I will meet the hip dysplasia advocacy group on Tuesday, 14 October in Leinster House. I will also make clear to all parents who may not wish to be part of an advocacy group, or be connected to that, I am here to hear from them at any stage as well. It is also important to update the House that a meeting was held with the DDH advocacy group and the HSE on 24 September regarding mental health supports. It has been an enormously traumatic experience for many parents, as well as patients, to learn that surgery on their child may not have been necessary. A business case for funding all of the elements on this issue, including counselling, has been submitted as part of the Estimates process. I do not want to lose sight of that element of it too.”
“I am somewhat pleased that close to 200 patients have had that clinical review. Of course, that has been prioritised for those who might be expected to have complications, as I understand it, but I will look at that further.”
“We are imminently close to appointing a lead. I would have preferred to be in a position to do that today, but I am not. It is imminent, essentially. I appreciate what the Deputy said about January. It is for this group of experts to determine their process and not for me to step across that. I expect and hope it would be done within six months but, again, if independent clinical experts tell me differently, then I will take their clinical perspective on it, as I am sure the Deputy would. I remain committed to updating the House, when I have the information, at any stage. I am sorry that I do not have a timeline for the complete group of patients, but I will look into that to see what is possible and come back to the Deputy. Again, it will be an estimated timeframe.”
“The HSE has also committed to the involvement of parents and patient advocates in the terms of reference for the review. We had a workshop to discuss the external expert panel with them on 14 August. A further workshop took place on 13 September, with a further workshop planned for today. Separately, it is my intention to communicate with all of the parents who are not necessarily part of the advocacy group representing parents, recognising that they may not wish to be part of it but also to make sure they have the opportunity to feed into perspectives, should they wish.”
“In relation to retrospective reviews of cases to determine the indications for surgery, as the Deputy is aware, the HSE is establishing a separate process involving external experts. Work to establish that external expert panel is advancing. It is expected that panel will be established this month and the review of individual cases will commence in January 2026. These are international clinical experts. We are trying to establish them to have the availability to do the work here - it takes a little time simply to have their availability - and for them to agree a robust and scientific methodological framework for conducting the review, which will be designed by them between September and December this year, by which everything can be measured.”
“My immediate priority following the publication of the Thomas audit on 23 May 2025 was to ensure there was clinical follow-up and care for patients who had undergone pelvic osteotomy surgery. This is a once-off review to assess any complications that may exist and to determine the current clinical state. After this, patients then enter the recommended normal follow-up process. These multidisciplinary team, MDT, clinics have been under way since 6 June for clinical reviews of patients who had osteotomy surgery in CHI at Temple Street and Cappagh. As of Tuesday, 21 September, a total of 196 patients have had clinical reviews as part of the MDT clinics in both CHI and Cappagh.”
“The NAS and HSE capital and estates have completed the necessary documentation to facilitate the progression of the project in quarter 4 of 2025, which I hope is a good update for the Deputy. The HSE is working to appoint a design team in this quarter, with the aim of developing and submitting a planning application in early 2026 to progress the project. Those are two important updates for Gorey.”
“Stage 1 expressions of interest were received and evaluated and letters have now issued to all parties. It is anticipated that stage 2 priced offers will be advertised on the eTenders procurement platform in the final quarter of this year. The readvertisement and retender process for the project are necessary under the procurement rules. On the ambulance service, HSE capital and estates, in collaboration with the National Ambulance Service, has identified and agreed a suitable facility for use as an NAS ambulance base and is in the process of securing approval to purchase same, subject to planning approval being obtained. The facility will require capital investment to fit it out as a purpose-built ambulance base.”
“I thank the Deputy. I know he has been a very strong advocate for the Gorey primary care centre, the need for which has been well identified. A tender process has been undertaken. As he is aware, a preferred provider had been selected, with a letter of intent issued in 2019. Unfortunately, that selected preferred provider encountered difficulties regarding economic viability resulting in the collapse of the process in 2024. To facilitate the readvertisement of this primary care centre, a full review was taken with relevant stakeholders. A number of stakeholders require accommodation in that centre and a scope has been established. That review is now complete and a tender process is under way. The stage 1 tender advertisement was published on 24 June 2025.”
“Yes, I would also like to do that, but we have to recognise that there are some children for whom it is suitable and who have had good outcomes. I answered the Deputy's question in relation to medical devices. I said I was referring a concern that I had to HIQA. In relation to the clinical lead, I said that I have commissioned an audit, which is a really important process. I do not wish to step across that. I am very happy to discuss the outcome of the audit with the House once I have it, but I cannot step ahead of that.”
“I have a concern generally in relation to governance, equity in patient access and waiting list management at CHI, which is why in May or possibly June - I would like to confirm that; forgive me, please - I asked the HSE to conduct an internal audit specifically into waiting list management and equity of access. I hope and expect to have that back at the end of November or beginning of December.”
“Yes, that is my intention. It is a partnership approach. At the end of the day, some terms of reference are going to have to be settled and it is absolutely our intention to do that in a partnership approach. The person leading it, of course, must have some knowledge of how it is going to be done and some hand in how best it can be delivered as well. That is an important perspective. It should not be coming from me to impose it upon them. We are genuinely trying to deliver a partnership approach. We are some weeks away from trying to get the exact model in relation to that. However, I hear very clearly the Deputy's perspective. Yes, I have a concern in relation to medical devices, which I am referring to HIQA to do an investigation and get its perspective.”
“We are making some progress, but I acknowledge that it is too slow, and too many children are still waiting. I have met with the HSE and CHI board and executive several times over the past couple of months. I have made new appointments, in particular the appointment of Mr. Fergus Finlay to the CHI board, who will be an excellent advocate on the board working and seriously engaging with spinal services in particular. I have great confidence in him. I have also commissioned an audit of governance and equity in patient access and waiting list management, which has a very important qualitative element to ensure the patient and staff experience is also captured.”
“Children requiring non-complex procedures have pathways to Blackrock and Cappagh to maximise the capacity for the complex procedures that are happening in CHI. International outsourcing has supported 19 patients to have surgery abroad. As I said earlier in the House, I am disappointed with the figures this year and I am unclear as to the referral pathways to maximise that. There is a new orthopaedic surgeon adding some capacity since 11 August. Crucially, the Mater hospital is now fulfilling its obligations in the adolescent transition spinal service to support seamless transition of care. I am trying to explore what additional measures can be taken. I have asked for a proposal from the Mater to see what more is possible in that regard.”
“As the Deputy is aware, the Sláintecare target is 12 weeks for an inpatient procedure. That is how we measure performance across the entire health sector. Some 39% of the children on the active spinal waiting list in CHI were within Sláintecare targets at the end of August 2025, which is an improvement on 28% at the end of August 2024. Additionally, only 7% were waiting over 12 months, which is compared to 24% at the same time last year. There is, therefore, some progress being made in reducing waiting times, especially longer waiting times. It is supported by a couple of different initiatives. The dedicated GP referral pathway supports the appropriate prioritisation of urgent patients.”
“I thank the Deputy. Clearly, we are trying to have a network serving counties Kilkenny and Carlow, and we need the staff. The vacancies are there. We are desperately trying to recruit and make sure the complete suite of services is there for the people of the county.”
“These centres are a really important part of our care network. As I said, we have 51 opened since 2020, with five opening in 2024 and others having opened this year, most recently in Dunfanaghy in north Donegal and in Newcastle West. The facility in Roscrea opened in quarter 1 of 2025. Another seven primary care centres are currently in construction, two of which should become operational before the end of this year. They are an enormous support to the community, and we want to continue to see them driven and staffed.”
“Absolutely. When it is operational, it is expected that it will have GP, dental, community nursing, occupational therapy, physiotherapy, speech and language therapy, dietetics and psychology services, as well as diabetic breathanyl screening and outreach for chronic disease help, all of which are so very important. The Deputy is right when he says that recruitment is a challenge. We have vacancies in the system, notwithstanding having the funding for it. I hope the primary care centre model will be a welcome addition to counties Kilkenny and Carlow. The Deputy will be aware of the existing facilities at Kilkenny Ayrfield, Kilkenny city east, Callan, Thomastown, Ballyhale, Ferrybank and Shamrock Plaza in Carlow. There is a further primary care centre in the early stages of development or planning for Tullow.”
“I assure the Deputy that the Department is engaging with the HSE to progress the further development of PCCs throughout the country, including specifically in the Deputy's good county of Kilkenny.”
“The preferred developer will issue a construction programme once approvals of the relevant statutory procedures have been secured. Once that programme is available, the HSE will be able to provide further updates on the timeline of the project, including the date of commencement of construction works on the site. When it is opened, it is envisaged that a wide range of primary care therapy services, community nursing services and GP services will be delivered from the centre. It is welcome news that the development of the new primary care centre in Graiguenamanagh is progressing and nationally we are trying to make progress in developing primary care centre infrastructure. There is a total of 180 primary care centres operational across the country with 51 of those opening since 2020.”
“I thank the Deputy for allowing me to update the house on the new primary care centre in Graiguenamanagh, County Kilkenny. The need for that primary care centre was identified as part of the HSE’s overall primary care centre development programme. It is to be delivered via the HSE operational lease mechanism. As the Deputy is aware, the HSE has advertised for and identified a preferred developer for this new centre. I am pleased to advise that an application for planning permission was lodged by the preferred developer in July 2025. In response to this application, Kilkenny County Council requested further information on 1 September 2025. The HSE has advised me that the developer is in the process of preparing a response to that request.”
“We look in particular at Limerick, where for the first time ever in the health system, there are a number of serious disciplinary proceedings happening there, particularly in relation to the Aoife Johnston case and the circumstances of that. There was review done by Frank Clarke, which had significant powers. I have spoken with Mr. Justice Clarke since to ask if powers of compellability would have made a difference to him. He was satisfied with the model he had. It is my responsibility to scope out the different models and express the pros and cons of the different models. We will ultimately have to agree the nature of it in partnership, but I am conscious of the need for whoever is leading it to be able to do a good job and have their appropriate powers, the requisite timeframe, support and all of those different things.”
“I updated the House earlier. They should be fully in sympathy. I also recognise that whoever is leading the inquiry will need to clarify the terms and make a final decision on what they need to be. I anticipate a comprehensive and transparent inquiry where the terms of reference are developed in partnership. The Government is one piece. The advocates are another piece, as is the person leading from both a legal and a clinical perspective on how that is best done. I updated the House on some of my thinking about this. I am conscious that I spoke with regard to other forms of inquiry, where the public nature or the particular model of statutory inquiry precludes the information in that inquiry being used for any other purposes.”
“I am not clear on it, but I asked for an audit into spinal services, neurological surgery and another medical area in CHI precisely to try to determine that, such was my concern.”
“I do not believe so. There is a separate portion of money to do that, so I do not believe that. I will check, but it is certainly not my understanding. I remain concerned about the number of children referred, or not referred, for international surgery. As I said earlier it is a source of deep frustration to me that those services are not being utilised. Part of the audit is an analysis of equity of access on the waiting lists, which is something we have not done previously. This qualitative assessment involves talking to parents and patients and asking them how they ended up in Blackrock, for example, and what the pathway was. I have spoken to parents who told me that the international option was not provided to them or was provided to them too late in the process.”
“While some of this reflects faster outpatient access and better referral pathways, we are also trying to do further analysis to understand some of the source of that demand, which is really important. The services remain an absolutely top priority and I will do everything I can to actively drive progress to address the challenges children face.”
“There are additional outpatient clinics, in particular this year on Saturdays, which have seen over 800 additional patients, and which has reduced the waiting list for initial assessments. We are trying to maximise capacity through national and international outsourcing. As I said earlier, which I appreciate the Deputy was not here for, there is an awful lot more work to do there. I am trying to explore additional options. Activity has increased with 342 spinal procedures completed so far this year, compared with 304 for the same period last year. This is a 13% increase, but at the same time we are seeing a growing need for those services. There are 370 spinal patients who have been added to the CHI active waiting list, which is a 10% increase compared with last year.”
“I thank the Deputy. There is an audit going on into equity of access on waiting list management. I expect to have that audit at the end of November. I will have to wait until then to confirm any figures. At the end of August this year, there were 135 patients on the CHI spinal active waiting list, compared with 150 in August 2024. That is a reduction of 10%. Outpatient lists are also down, with a 45% reduction in the number of new spinal outpatients waiting on an appointment. While I recognise this progress, there is an awful lot more work to do to drive improvements in spinal services. I have met with families and advocacy groups, and it is important to listen to them. The Deputy is more than aware that €30 million was allocated to reduce waiting lists in different areas. There is a ringfenced theatre providing dedicated capacity.”
“That bungalow had been acquired before the EMT commenced but it was for a totally different purpose. It has progressed that as a maternity outpatient department. It should not be the case that we need an external management team in Portiuncula hospital. The patient safety issues have been very significant. I have acted on clinical advice to me that it is not safe for high-risk women to give birth there until the changes that are necessary have been made and sustained in a way that can give confidence to everybody.”
“The Deputy is aware that an external management team, EMT, was put in place in January precisely to try to supervise, assess and make some of the improvements that are needed. There have been some infrastructural works and changes, some of which should have been done before the external management team arrived, which have now been completed, for example a four-bay maternity day assessment unit, MDAU, and a dedicated early pregnancy unit. All of that was in train and should have happened before the external management team arrived. It has now happened. The EMT, and nobody else but the EMT, identified a bungalow adjacent to the hospital that has now been converted to a dedicated maternity outpatient department with six dedicated maternity clinical rooms five days a week from the end of September.”
“I have sat with them and heard the particular experiences of their cases and what happened to them and their babies. It is difficult to accept that those cases should have happened in circumstances where the Walker report was implemented. If we are going to have a political dialogue about a report that has been implemented, which the independent regulator has confirmed as having been implemented, with one recommendation having been walked back, and try to place what happened to those women at the foot of that single recommendation being changed, we are not in a good space.”
“I do not know how else to say it to the Deputy but HIQA has verified that all of the recommendations were implemented. Perhaps we should arrange an opportunity for the Deputy to engage with HIQA about its assessment. It is the independent regulator and HIQA advised that they were implemented. One recommendation of 154 did not work and it was moved backwards. The issues that arose in Portiuncula hospital should not have arisen. They should not have happened, because the recommendations of the Walker report were implemented, yet they arose again. I ask myself the same questions. I have asked that of hospital management and I have asked through the reviews. How is it that the same issues, which are not of resources but of management, culture, communication and responsiveness to women, frankly, are occurring? I have met many of these women.”
“The network supports Portiuncula hospital in all aspects of clinical maternity care and joint processes have been in place since 2018. Although changes were made in Portiuncula hospital following the Walker review, frankly, similar issues have emerged in Portiuncula hospital, as the Deputy is aware, which is incredibly disappointing for us, but is of life-changing significance to the women whom it impacts and their babies. Twelve reviews are ongoing, which are at various stages of progress. Seven have been completed. Fifty-two recommendations have arisen from these seven reviews to date. Work to implement many of those recommendations is already in place.”
“That was in place from November 2021 until June 2024 but was recognised by both sides, I understand, as a challenge from the outset. There were elements of risk due to the distance between the two units and the associated split of the clinical director's time. The model did not lend itself to consistent on-the-ground leadership, and as a result gaps in governance emerged. Following prolonged consideration, the HSE reverted to having a clinical director on both sites from August 2024. All 154 recommendations were implemented and that is one which just did not work and the HSE reverted to having two clinical directors as opposed to one overseeing the complete group. HSE West and North-West has an established clinical network which includes Portiuncula hospital and University Hospital Galway.”
“I thank the Deputy for his ongoing concern, driven first by patient safety in Portiuncula hospital, which I greatly appreciate. It is an important focus. As the Deputy is aware, the Walker report came from a review commissioned by the then Saolta Group in 2014 following a number of serious maternity cases at Portiuncula maternity services from 2004 to 2014. It covered 18 cases and was published in 2018, making 154 recommendations. The HSE has advised my Department that all 154 recommendations were independently verified as implemented by both HIQA and an independent national HSE team. HIQA has verified that. One of the recommendations related to the integrated clinical director model, with one clinical director covering Portiuncula hospital and University Hospital Galway.”
“We know how much people have to offer. We have the funding for the additional posts. We want people to come and work in this service. We are taking all of the steps we can to try to attract them. We cannot compel people to be in the public health system either.”
“There are a couple of different things. Staffing vacancies have decreased considerably, from 30% in 2024 to 14% in Dublin, 15% in Galway and, I acknowledge, 22% in Cork. CORU has changed some of the registration requirements, which has brought Ireland closer to international standards, providing access to work in Ireland for more radiation therapists generally. We have funding allocated in 2025 for the development of advanced practice roles in radiotherapy, which, again, is an effort to help people to work at the absolute top of their profession, which is really important. Recruitment is ongoing for vacancies in radiotherapy services. We are actively looking for people to come and work in these services. We are trying to enhance the workforce through advanced practice opportunities and to really drive in that direction.”
“There are five public radiotherapy treatment centres with a total of 22 linear accelerators across the services. Galway has four, Cork has five and St. Luke's has 14 machines across the three sites in Dublin. The HSE also contracts radiation oncology services for public patients to centres in Waterford and Limerick and has a service-level agreement with the North West Cancer Centre in Altnagelvin to provide radiotherapy services for patients within a 90-minute road journey of Derry. Under the National Plan for Radiation Oncology, NPRO, Ireland has developed state-of-the-art radiation oncology centres, as the Deputy is aware. I will look into the examples the Deputy has given relating to the management and replacement of different machines. I just need to spend more time doing that. I thank the Deputy for highlighting it.”
“The national radiation therapist review, completed in 2024, provides a strategic review of the profession in Ireland and recommendations are being progressed by the HSE. The review recommended the development of new advanced practice radiation therapist roles and those posts are expected to be advertised in the coming weeks. To maintain improvements, NSP 2025 included 5.5 radiation therapy posts and six advanced practice radiation therapists.”
“On staffing, I wish to acknowledge the incredibly important role of radiation therapists in the provision of cancer services in this country. There are currently 220 radiation therapists in Ireland, an increase of over 20% since 2020. While recruitment for radiation therapists is challenging globally, radiation therapist staffing vacancies in the HSE have improved from 30% in 2024 to about 15% to 22% at present. It is not fully staffed but it is going in the right direction, notwithstanding a challenging global environment. There are currently 40 radiation therapy student places available annually across Trinity College, Dublin and University College, Cork. In the last six years, the radiation therapy training programme has grown by 32% and more than 20 additional specialty training posts have been established in the last three years.”
“I thank the Deputy. The Government is obviously committed to improving cancer care generally. As the Deputy is aware, a total of €105 million has been invested in the strategy since 2017, including €23 million in budget 2025. Under the national plan for radiation oncology, state-of-the-art radiation oncology centres have opened in Cork and Galway in 2019 and 2023, respectively, which was €120 million capital investment. In Dublin, the St. Luke's Radiation Oncology Network, which includes St. James's and Beaumont Hospitals, were developed under phase 1 of the national plan in 2010. The design of the phase 1 facilities made provision for future expansion for phase 2, is now under way at Beaumont Hospital as a priority.”
“There was a recruitment process, and there you go. I stood, as I am sure the Deputy has done, and his party colleagues were there with me, outside the pretty magnificent surgical hub that is being completed there. We would very much like to see that. If anybody is going to run that well, I am confident that Waterford will do it. Those projects are being delivered and I look forward to seeing the physical transformation of that hospital as much as every other hospital with the ongoing capital investment that has happened and continues to happen, and the major projects, such as the one in the Deputy's own constituency, which is being delivered in front of his constituents' eyes.”
“There is no barrier to them in the context of the funding side of it. The bigger issue is the planning side but we will work through it together. I had the good fortune to be in Waterford, a really excellently run hospital. I was in the CAT labs and got to see the different theatre configuration, which, of course, has been delivered. It is the case that the cardiologists have been recruited and that was confirmed to me by the hospital management and the IHA management so we will see that commitment delivered. The current funding was put beside it.”
“That was fine and necessary but there has been an underspend. I have secured a large capital portion of the NDP and the additional programme that is there. I have the assurance that where I get something to shovel-ready, I will get the funding for that and I would welcome the Deputy's support when I get to that point.”
“The question is around what is capable of being delivered to absolute completion within the next five years and how we balance and manage that. I do not think it is question of right or wrong. Both the Deputy and I want to see the infrastructure delivered immediately if possible but we both live in the real world where we have to go through planning and procurement processes. There is a slowness in doing that, unfortunately - in the Government and the public sector doing that - which does not challenge the private sector in the same way. It is very frustrating but we both want to see the projects delivered. I now have a capital envelope the size of which we have not had in health. There was an underspend on capital investment for a very long time in health, with significant additional funding on the current side.”
“We have a challenge to meet that and get those to construction phase. Where we get something else to shovel-ready, I will be going to the Minister for public expenditure and reform looking for unspent allocation in other NDP programmes, the first call on that and indeed the first round of funding. My challenge is, frankly, getting things to shovel-ready stage. I am confident of the funding for electronic health and for the infrastructure projects we have. Our bigger difficulty is getting them to shovel-ready.”
“The NDP settlement recognises that there are certain key programme for Government priorities in health that will progress to statutory approval towards the latter part of the current NDP. In relation to shovel-ready projects, I have assurance from the Minister for Public Expenditure, Infrastructure, Public Service Reform and Digitalisation and his Department that they will be priorities for funding in the post-2030 NDP. The basic point is that if we get something to shovel-ready, we will be making the case to central Government for the funding to be enabled for that. The Minister for public expenditure and reform has also confirmed that should there be underspends evident in the overall NDP allocation, the first allocation for that will go to the Department of Health. We have a programme of funding for the next five years.”
“I thank the Deputy. As he is aware, the programme for Government will set out a review of the national development plan as a key priority. Through the NDP review, we are prioritising critical economic growth but also the health infrastructure we need to have, which the Deputy has articulated. The substantially enhanced NDP provision for the health sector of €9.25 billion will support the delivery of equitable, accessible and high-quality healthcare across Ireland. We have seen a number of examples of that happening so far but there is quite a lot of work to do, such as the new surgical hub at Mount Carmel, the HSE health app and the 96-bed ward block in UHL. That is what has happened so far. As the Deputy and I both know, we have to drive further ahead.”
“Aligned to that is the theatre utilisation project, which is changing start times of theatres and maximising the flow and capacity within that. As I said, if there is a particular issue in a hospital I would be very glad to know about it.”