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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“We can then come back and seriously look at the number of surgeons it takes to fill six surgical hubs, four elective hospitals and every theatre in the country. When we were doing the urgent project to deliver more endometriosis surgeries, I was looking for an additional 100 surgeries in the final quarter of 2025. One of the responses I got from a surgeon, who really is invested in this and who really is working hard, is that one of the barriers was that he had been told elective work could not be done after 5 p.m. in the theatres in the maternity hospital he was working in. I said "I am sorry, what? Says who?" These are some of the barriers we have to overcome. We have a lot of space. We have to use it.”
“Can the Deputy imagine the number of surgeons it takes to run those all of the time? If we are to run them seven days a week, how many surgeons would it take? How many surgeons does it take to run a surgical hub all of the time, recognising that they will not all be working all of the time and that there will be two or three shifts? How many are required to run an elective hospital and all of the theatres that are already in UHG? How many surgeons does all of that take? I strongly recommend to the members of the Committee on Health who are here that they should invite the team that has done the theatre utilisation project and the OPD toolkit before the committee and interrogate them as to their findings and the use of theatres so that they can see this for themselves.”
“I agree. As I said, we have 181 primary care centres, with eight under construction and 20 more at early planning stages for precisely that. Regarding the Deputy's constituent who could not get surgery, let us count up the different things we have said here. It was said that they cannot get theatre time for her. There is a theatre utilisation project. I would very much like to know the nature of her procedure and to test this case against theatre utilisation across the hospital. The Deputy says that we need a new hospital. I remind him that we are building both a surgical hub and an elective hospital precisely to provide additional theatre time. Let us stay aligned to exactly what is going on, which is the delivery of full utilisation of all of the theatres in University Hospital Galway, a surgical hub and an elective hospital.”
“This is about building capacity, as it always will be with a growing population, but at some point we will reach a juncture where we have built so much capacity and if we have all of this evidence of it not being used or not being used in the most balanced way across the week, we will have to start asking ourselves decent questions about it.”
“There is no point in concentrating consultant work between 9 a.m. and 5 p.m. Monday to Friday with all of this additional capacity. I would rather spend money hiring more people to fill the spare space. However, how can we be sure that will happen if the clinical leadership does not make sure we are implementing the contract such as it is? We have to see evidence of that and the trajectory in relation to it. I agree with the Deputy on all the fantastic people doing fantastic work but we cannot keep saying that in the knowledge that many of them also have to work differently to make sure we are using the space that we have all paid for by making it available for the benefit of patients. We cannot have primary care centres closing at 5 p.m. They have to be open and serving the community until 8 p.m. or 10 p.m. That is what they are for.”
“I agree. That is what we are trying to do. On the primary care centres, we have 181 at the moment, with eight under construction and 21 more in early planning stages. However, if people do not use them and if they are not used for outpatient procedures to relieve pressures on hospitals, we are going to keep having the same conversation. There is an excellent outpatient centre in Merlin Park right beside UHG. It is one of the few that is being used on a three-session per day basis. Good work has been done in that primary care centre but a lot more can be done. This is as much about how people are working as about where they are working. I have talked about the physical capacity increases that we have but we cannot keep building more physical capacity if people are not going to use it differently.”
“Every single person in this House is calling for and looking for the same thing. It has to be implemented and there is a responsibility on clinical leadership to stand up and make sure the clinical community is doing everything it can to adapt and change its ways of working within the contractual parameters its members have signed and that have been set in agreements to make sure we are delivering for the patients of Ireland.”
“This really matters because we have opportunities between the outpatient toolkit and now the surgical hubs in respect of inpatient day-case procedures - or a certain proportion of those - and also freeing up the corresponding activity in the home hospital. The first real application of that, of course, will be with the Dublin north-east surgical hub. This is a huge opportunity to test how the public-only consultant contract is being used or not used, rostered or not rostered, how the five over seven roster is complementing that and how that is being used by all the different hospitals in the Dublin north-east region. We have these different opportunities but it is important that they are delivered. I want to highlight the importance of clinical leadership in this.”
“I have not yet seen what the room vacancy rates are on Tuesday evening or Sunday morning, but we do not need to build more capacity and more rooms until those rooms are filled and being used. They are being heated and insured. All of these things are there and available. The utilisation of the outpatient toolkit is, therefore, enormously important. It means that we are scheduling according to the most efficient use of time. We are not asking people to change the length of their consultations or change the nature of their medical practice. We are simply taking the length of time they normally use and reorganising so that things are done differently and delivered differently, including in primary care centres.”
“The REOs have complete visibility over what is happening with their acute hospitals, their model 4, model 3 and model 2 hospitals and everything that is happening in the community and in their primary care centres. There has to be a complete synergy between the different model hospitals and primary care to use this. We now have tools that we did not have before. We have the outpatient toolkit, which is showing what the actual room utilisation is in every hospital. There should be no resistance to the application of the outpatient toolkit. It is not tenable that some hospitals have room vacancy rates of between 4% and 9% during the week and 24% on a Friday afternoon.”
“It includes significant reductions achieved in the length of time patients are waiting. The plan takes a multifaceted approach in achieving it, setting out six overarching and interconnected targets focused on patients waiting the longest. The plan aligns with the national service plan, NSP, targets for planned care, including targeting increases in the proportion of patients waiting within Sláintecare maximum waiting times and outpatient and inpatient day-case waiting lists. Those targets represent steps towards our ultimate shared goal of all patients being seen or treated within the Sláintecare target times, namely, ten weeks for outpatient appointments and 12 weeks for inpatient and day-case procedures. The devolution of responsibility to the regional executive officers is an important part of this reform.”
“I propose to take Questions Nos. 123 and 136 together. Improving access to healthcare in our hospitals is an absolute priority for me. As the Deputy knows, we have very good outcomes in our healthcare system. Our challenge is making sure we have access as quickly as possible. That is the focus, on making sure we are using our resources in the best way possible. We are focusing on a public healthcare system in which everybody has timely access to high-quality scheduled care where and when they need it. I refer to the waiting time action plan for 2026. This used to be the waiting list action plan, until we all realised together that the length of time spent waiting is more important than the number of people on the list, obviously. This builds on the progress to date.”
“Now it is a slightly different model, and that is true. There may be an opportunity to extend those premises. Just look at the changes we have made today, for example, in relation to planning permissions and so on and exemptions and what we are trying to do to encourage more and more use of space. This is a hugely important piece for any community. I thank the Deputy for his suggestion. We will come back to it within the Department of Health but it is also an important budgetary matter for the Minister for Finance.”
“Exactly, and it is a totally practical suggestion. We want to enable GPs to have their practice as quickly as possible. I have no view as to where they should practice necessarily. Of course, we would like to employ them into the HSE, but private practice is also so important. Whatever we can do to enable more GPs, it has come up again and again in this House, correctly, and I can point out all the new GPs that have been registered by the Medical Council, all of that work to clear the backlog of people looking to restore their practices and people looking to come to Ireland. If they do not have a place to work within the community that people can access, it is very challenging. I recall going to a GP practice. There was one or two in every big housing estate. It was a very natural thing and it was often a front room.”
“The exact nature of these supports has not been finalised but it is under consideration. This could include supports with business education and training, provision of subsidies or grants, and potentially through the taxation system, as I have highlighted, subject to consultation with the Minister for Finance. Then there is also the growing network of primary care centres, from which GPs can practice. That is a really important part as well that may be complementary.”
“The supports for newly establishing GPs are an important part of the strategic review of general practice, as surveys by the Irish College of General Practitioners have shown that concerns about the costs and risks of opening new practices are important considerations. Essentially, it is a matter of establishing a business and that is a challenging thing to do. Whatever about new practices, however, we also have to think about how existing practices, which might make it easier for a new GP rather than having to establish their own practice and their own business, could work more easily within the capacity of an existing practice and how that can be expanded through the addition of better or bigger premises or through the use of satellite surgeries to enable local access.”
“In relation to the Deputy's specific question about refundable tax for setting up new GP practices, that would be a budgetary matter for the Tánaiste and Minister for Finance, but I assure Deputy Neville that I will raise it with the Minister. I know he would like to see greater GP practices around the country, and this is certainly something I have heard from GPs that would be helpful.”
“Among the more notable supports available are practice staff supports and subsidies towards the employment of a practice nurse, an administrator or a practice manager. The 2023 GP agreement increased the rates of those subsidies and introduced further staff supports. Specific supports are available for rural practices and, since 2019, in urban areas of disadvantage. The strategic review of general practice, which is currently under way, is examining the ways in which this can be better and differently supported. We have reached agreements with GPs, for example, on chronic disease management, all of which is really improving people's outcomes. It is a different way of delivering care but it is also a financial partnership with GPs.”
“I thank the Deputy for his question. He has highlighted this in the context of the difficulty in new GP practices opening in his area. The region has had very significant population growth but not a corresponding rise in the number of GPs available for either GMS or private patients and I acknowledge that. I also acknowledge the efforts the Deputy is trying to highlight as to what we can do to support GPs to expand their existing practices and to open new practices. That is a very fair question because everybody in this House wants more GP practices to be able to be opened. It is important for me to say that the State - I think people forget this sometimes - provides a significant level of financial support to GP practices. We work in partnership with GP practices both within the GMS scheme and more broadly.”
“I take great comfort in that, that people want to do this, but it is also important to highlight that we are trying to have alternative care pathways as well. About 40% of patients now do not require, because of that intervention, subsequent conveyance or subsequent transfer to an emergency department, so those pathways are working well and we need to invest more in that as well. There is emergency department in the home, for example and all the different alternative emergency pathways.”
“I appreciate that the Deputy may find it difficult to see that we cannot fill posts but I assure her that it is true. Of last year's posts, there were 180, and 134 have been filled. I would like it to be 180 filled. This year we have provision for 263, which is obviously a considerable increase on last year, so the direction of travel in terms of our investment is very clear. This is not unique to the ambulance services; we have this difficulty across home support, we have it across recruiting into the medical profession generally and we have it with GPs. Across the board, we have posts that are unfilled and to which we are trying to recruit. I would welcome these positions being taken. As I said, there were 1,000 applicants.”
“It will provide for 21 additional crewed emergency ambulances for new intermediate care services on a 12-over-seven basis and a range of other investments.”
“It is difficult to answer in light of some of the circumstances involved. The Deputy raised an individual case where somebody identified a specific reason. While I acknowledge that, in other cases it is not clear whether a patient, for example - it is awful to speak about it in this way - was going to die irrespective. I can understand the clinical constraints in providing broad data when dealing with many individual circumstances. It is because of the increased response times and the availability that we are trying to recruit. The recruitment competition in 2025 brought the highest number of applicants ever with over 1,000 people applying. I take some comfort in that. It will help fill the additional 263 posts that we have in the National Ambulance Service this year.”
“Since 2020, we have increased the budget for the National Ambulance Service by 60%. We have increased the personnel by 30%. This year, as I informed Deputy Cullinane, we really are trying to recruit. We have a targeted recruitment campaign. We have posts available. I will speak more to that, because, as Deputy Bennett is aware, we need to have better response times,”
“The HSE has informed me that the National Ambulance Service's response performance in the region between 2023 and 2025 met the key performance indicator, KPI, targets in the HSE service plan. However, it is acknowledged that at times of high demand, some lower acuity patients have waited longer for a response. I also acknowledge that we would like the targets for purple and red calls to be higher in the first instance. I am not saying that KPIs are any sort of panacea; I am simply acknowledging that the performance in the north-east region has been better than the target. That is something, but we have a way to go to build on it. The Government is committed to the continued development of the National Ambulance Service in the context of both capacity and strategic reform.”
“The Dublin North and East region, which includes Cavan and Monaghan, has benefited from recent investment, with 12 additional paramedics in 2025 and a further 12 scheduled for this year. Six additional emergency medical technicians are planned for Cavan. This will help to preserve front-line ambulances for emergency calls. I highlight this because the National Ambulance Service is focused on addressing areas where there is a clear need for greater resourcing. A particular emphasis is on targeting potential applicants in areas of need, including the Cavan-Monaghan area, where there have been challenges with recruitment in the past. That is the only reason I set some of that out. I acknowledge that there have been challenges with recruitment, notwithstanding our desire to recruit more people in the area.”
“There is more than one human involved in these and we have to be careful and balanced. I am not trying to limit anybody but I just have to say it as well.”
“I am not saying this specifically to this but I do remember questions, when I started working here and we were dealing with, for example, adoption, the Hague Convention and the restrictions that were put in place because some of our actions at that stage were, frankly, exploitative or potentially exploitative. That was pulled back and for good reason. It changed the adoption rules for the future and they were very significant changes that were made. There were people who felt that they had a right in a particular way, but those rights always have to be balanced and because we are an outward-looking, humanitarian society, we have to take the rights of everybody into account. I know the Deputy will be at the front of that, having advanced looking at things through a human rights lens.”
“I agree with the Deputy. Indeed, this is something I have been involved with in different ways since working in the Department of children and since advancing the Children and Family Relationships Act, as I did when I worked in the Department of justice in 2013. I have been working on this for a really long time and I share the Deputy's frustration. I want to see people having access to families where they can. We need to speak about rights in totality, however. Yes, there is a right to family, a right to procreate and all of those different things. There is also a right, and we have an obligation as an outward-looking country, to make sure we are doing everything we can to protect everyone else.”
“It is not that I wish to be in that situation; I do not wish to be. That is simply the factual reality of that situation. There is nothing I can do about that but I will do everything that I can control as quickly as possible.”
“The Deputy is a practical person, as am I. If a court case is before the Supreme Court, then there is a court case before the Supreme Court and there is nothing I can do about that. I would be in breach of my own responsibility not to cross over in the separation of powers were I to do anything other that wait for the outcome of that. I do not have any discretion in relation to that. As for people threatening to take legal cases, people are entirely entitled to take legal cases if they wish to do so. That is the essence of being an Irish citizen. There is no quid pro quo in relation to it. I am dealing with what I am trying to get resolved now. The reality is that we are advancing the legislation. We will not be able to take it to Committee Stage until the Supreme Court case is determined.”
“Some administrative sections of the 2024 Act have been commenced, specifically to establish the Assisted Human Reproduction Regulatory Authority, as the Deputy knows. The Deputy mentioned that three subsections of section 232 of the 2024 Act have been commenced. It is complex and there are very many slightly competing and multifaceted perspectives to be considered. We are going to have to think about the sequencing of some of it but I hope to advance it as quickly as I can.”
“I can give the Deputy an update on what is happening with that, but there is also an important relevant Supreme Court judgment pending. I understand the case is due for mention on Monday, 27 April but it will be very difficult for us to get to Committee Stage without that having been resolved. That is really important. As the Deputy is aware, our formal drafting of the AHR Bill is at an advanced stage. It is very substantive. It is on the priority list for publication. Department officials in my Department are scheduled to meet with the Office of the Parliamentary Counsel tomorrow to discuss what is expected to be one of the final drafts and I expect to be in a position to introduce it to the Dáil this term.”
“I thank the Deputy for his ongoing engagement on this. As he knows as well as I do, this makes a huge difference to families around the country. Much progress has been made now. The Health (Assisted Human Reproduction) Act 2024 was signed into law by the President in July 2024. I have a difficulty with a definitive timeline as to the complete commencement of the AHR legislation as there are a number of interdependencies and considerations involved, not least the timing that I do not control over a Supreme Court case. On the full commencement of that and the full application of the legislation, there is an interdependency there that is outside of my hands. The others include the second Bill, the AHR amendment Bill being enacted, and the regulatory authority being fully operational.”
“More than anything else, I need Deputies' help with the implementation of the public-only consultant contract and five over seven. I cannot have the NTPF buying activity in hospitals from 5 p.m. to 8 p.m. and not have consultants rostered at those times. That intersection is going to be really important between surgical hubs, the NTPF and the actual rostering. I am going to need Deputies' help.”
“I totally agree with the Deputy and I think we will get there with Galway and Cork much more quickly. I would like to discuss with all Deputies options around Dublin because clearly we have the option in relation to Connolly hospital. The Deputy may have noticed that we put in some high-dependency unit, HDU, beds in advance because that is really going to be an important enabler. We did that in the past number of weeks. We put the staff in to have significantly expanded HDU capacity in Connolly hospital with a view to where that goes for the elective. It is well worth us considering constructively the best other use of brownfield space that is available within other Dublin hospitals, how we might consider that as alternative elective capacity and what we do with Crumlin. It is a useful open conversation that we should have.”
“We have appointed additional people specifically to Bantry but how can that be, and why are we buying any endoscopy action in that area? Why is there endoscopy happening in Roscommon when there is a very good suite there that does not operate after a certain part of the day? How are we using our own resources and how are we going to collectively, as the political leadership in health here, make sure that we are using the assets we have as we build? The elective hospitals are entirely necessary but we have capacity that is not being used. There is room after room in different hospitals and we are not using them.”
“I agree and I thank the Deputy for his support on these reform programmes. He is right about the elective hospitals but before then, we have the opportunity with the surgical hubs, which will be delivered in 2026. The delivery of the surgical hubs is going to create all sorts of different waves. We are looking at what procedures need to go there immediately and what that will free up in the hospitals where they would otherwise have been done. How is that going to be staffed and when? I am looking at the National Treatment Purchase Fund, NTPF, buying capacity in our own hospitals but I am also looking at underutilised capacity in our own hospitals, like the endoscopy suite in Bantry. There are two of them. One of them is used a half a day per week.”
“It is envisaged that the same structure will be co-chaired by the new Secretary General and the HSE chair, so there will not be a change there, which I think is very welcome. That is really the answer to the Deputy's question.”
“At that meeting, progress across all of the Sláintecare projects will be reviewed in respect of the action plan for 2026, the second of three action plans under Path to Universal Healthcare: Sláintecare & Programme for Government 2025+. The Deputy knows what they are. For quarter 1 alone, this includes 90 actions across 12 Sláintecare projects. In total, the programme board oversees 23 projects with approximately 400 actions. What does that mean? It relates to reforms being driven through, for example, with the enhanced community care programme, the public-only consultant contract, POCC, and, crucially, the implementation of the POCC, the digital health transformation and women's health.”
“I thank the Deputy, and I join him in thanking the Secretary General, Mr. Robert Watt, and the previous CEO of the HSE, Mr. Bernard Gloster, who both did outstanding work in the Department of Health and the HSE in different ways. They have really stabilised and improved the service more broadly since 2022 in particular and I thank them for that. I also wish both the new Secretary General, Mr. Derek Tierney, and the new CEO, Ms Anne O'Connor, well in their new roles, which are very significant roles for everybody. Notwithstanding those changes in personnel, there is no change to the programme of work. That needs to continue. We remain fully committed to the Sláintecare vision. The next meeting of the Sláintecare programme board will take place on 28 April.”
“The Deputy is right about acquired brain injury and dementia but the HSE has to focus on healthcare and partner with bodies like approved housing bodies that are experts in building housing.”
“Exactly. What we can do is work with an approved housing body, AHB, to build that residential. The HSE is for delivery of healthcare and we try to make it work as well as we can but here are the things we are not: we are not a transport company and we do not build homes. What we can do is partner with AHBs to make sure we are developing long-term residential that is adjacent and appropriate for needs of that kind. On that site in particular, what we are looking at is what capacity we can have for people who need to come to that facility and that form of residential. We are trying to work with the sites we have adjacent to a primary care centre. I used that example because I happened to be there so recently.”
“There needs to be an understanding that every hospital sits within a region, and patient flow works in that way. That is the only way this can possibly work. I am glad to hear the Deputy highlight that because it is the sort of reinforcement I need, particularly in the south west, to make sure that the patient flow experience is fully understood and that every bed is opened. As regards the Killarney unit, I am told that will be in the next couple of weeks. There was a HIQA registration problem and there is engagement with the union but, frankly, it is not good enough that those beds and other beds have not been opened. Mallow's 24 beds were supposed to be opened in quarter 1. It will now be very shortly but it should have been done.”
“The Deputy is 100% right. It does not necessarily lie with the hospital management. For example, in Cork, with the IHA managers, there is no governance element to this. They are not CUH beds or Mercy Hospital beds, and nobody had better tell me that they think they are. They are beds for the south west, and they have to be managed from a single centre, which happens to be in CUH at the moment, but we will see about that. They have to have visibility over what is the situation in Blarney, Bantry, Mallow, South Infirmary and other places. It is their whole responsibility to be able to move people through. As for the hospital managers' responsibility, I do not want to hear from consultants who say they cannot move X patient because they need to be in CUH instead of the very good care in Mallow.”
“That is why the focus on urgent and emergency care, UEC, is important. It is a complete piece. There is no point in focusing on UEC without making sure they have a full awareness of what is available in the nursing homes. University Hospital Waterford does that particularly well. It has visibility in its patient control room of all of the passages out of the hospital. There are others that could do it dramatically better, such as Letterkenny University Hospital, and many of those have a DTOC problem, except for St. James's Hospital, which is a weird one that I will come back to.”
“It lost some of its private capacity for egress or transferring out of the hospital, and because that happened, the trolley numbers built up, and it has had seven very poor days. In the previous 25 days, it had only two red days, 22 green days and one amber day. In the 25 days before that, that was essentially inverted, and it was all red and maybe one green. Patient flow matters, and it matters all the time. It matters because of the impact on people in emergency departments, but it also matters to the hospital's ability to bring in inpatient day cases. As the Deputy highlighted, the use of surge means hospitals cannot do endoscopy investigations and so on. They cannot bring in non-time-critical electives. Of course, they bring in time-critical electives like cancer surgery, but not non-time-critical electives.”
“My apologies for the mix-up, whatever the source. I will get the Deputy a full and more official answer. Nevertheless, I will speak from my own experience. The focus on delayed transfers of care is an integral part of the focus on trolleys - the whole thing goes together. What we are really talking about is patient flow. Hospitals that experience ongoing delayed transfer of care, DTOC, problems include Letterkenny University Hospital, for example, where the number was in the 40s, but is now down in the 30s and moving towards 25. Directly across the road, there is a 100-bed community nursing unit that will open in 2026 and take some of the pressure off. It is also about the management of this. For example, in Galway, we have gone through a deliberate reset. This speaks to the Deputy's example. The last week in Galway hospital was not good.”
“It is important that we discuss reform in the health service because while we can set a target of 4,000, if we are at 2,500, the Deputy and I both know that we have to deal with the practicality of today. There are 134 already in place out of the 180 posts that were funded towards the end of last year. We are desperately trying to recruit into all parts of the health service. However, it is not a realistic conversation for the Deputy and I to say that we are going to go from 2,500 to 4,000 within six months. We have to recruit where we can, and implement the reforms to make sure that everybody is working in different ways, including in a much more modernised structure. We cannot stand over one that comes from a pay structure from the 1970s.”
“I am very invested in resolving disputes, and that is why we put so much effort into the industrial relations architecture that we have. It is important to highlight some of the models of the proposed reforms under the agreement reached between union representatives and State representatives in those structures, for example, a modernised pay and allowance structure, which replaces a complex pay arrangement dating back to the late 1970s with a simpler, transparent structure aligned to wider HSE norms. It standardises overtime arrangements to HSE rates and incorporates rostered working requirements, including weekends and night working, to core pay structures. These are important reforms.”