Waiting lists are at a record high. It is all well and good to have a winter plan but we are still waiting for the detail of that plan and what will happen in each of our hospitals around the country. It is difficult to see how our hospitals will cope this winter as some are already struggling and it is still only September and we are facing into a second wave of Covid-19.

At the last Leaders' Questions session I contributed to in July, I spoke about a number of practical measures that could be taken to relieve this pressure.

Patients are also waiting longer for tests. Since April, during a period when only those who are really concerned with their health have gone to the doctor, 38 people have been added every single day to the waiting list for CT scans, MRI scans and other tests. These people are waiting in constant pain. Because of their delayed diagnosis, many will have very poor medical outcomes. We need proactive measures aimed at treating patients as efficiently as possible and we can do this by taking some simple actions.

As an example, I refer to the CT scanner at Portiuncula University Hospital in Ballinasloe, which has been out of action for 144 hours this month alone. Despite this being the tenth time that it has broken down in the past 18 operational months, the HSE has confirmed that it will not be replaced until some time in 2022. It is 63rd on the list for replacement, even though it has been out of warranty since 2017. Where is the logic in that? These machines are breaking down in hospitals throughout the country. This impacts on our waiting lists and adds to the overcrowding in emergency departments. A perverse example of what is wrong with our health service is provided by a CT scanner just down the road in Roscommon University Hospital. It can cater for many more patients but uses a different software system from the one in Ballinasloe. This is despite the fact that for the past eight and a half years both hospitals have been meant to be working together closely as part of the same hospital group. Is it not about time we had a small bit of joined-up thinking and started to get the basic things right?

I am not responsible for operational decisions at the level of individual CT scanners, but I do not accept that this issue must wait until 2022. I will talk to the Minister for Health and the HSE about what is going on there. To be fair to all concerned, Roscommon hospital has been advanced in recent years. There were political rows about emergency departments and election commitments which perhaps were not grounded in the proper medical approach, but nonetheless effective investments were made in Roscommon hospital's outpatient and diagnostics capacity. There is no reason the CT scanner there should not be used. The Deputy has identified the issues around the CT scanner in Portiuncula. It is faulty to say the least and is not operating to satisfactory levels. It needs replacement, the sooner the better. I will pursue that issue.

On the wider issue, the National Treatment Purchase Fund, NTPF, had arranged up to 66,000 outpatient appointments at the end of August. This supported public hospitals in providing access to diagnostics for patients as well as services for their outpatient departments. The treatment purchase fund will now work on both the diagnostic and the operational side where outpatients are concerned, and it will work to procure additional private sector capacity where it is required to facilitate increased diagnostics along with procedures. That will continue.

It has to be said that Covid-19 did impact on the entire health service. There is no point in pretending that Covid-19 or the lockdown did not happen or that there were not huge restrictions on hospitals which stopped a lot of elective procedures and diagnostics from happening for two or three months. There has been something of a recovery in that regard, albeit constrained by guidelines provided by public health advice, which is important. Patient safety in the context of Covid-19 is always at the forefront of these decisions. Unfortunately, this has negatively impacted on throughput, volume of procedures and volume of diagnostics. Of that there is no doubt. The work to improve the situation around diagnostics is continuing.

I know the Deputy has for several years raised the issue of the situation in County Roscommon and the utilisation of the technology there. He has been pursuing the issue for the past five to six years and may know operationally what is going on there on the ground and be familiar with the inability of the two groups in question to connect more effectively. I will certainly pursue the matter and work with the Deputy and others to see whether we can get it resolved.

I accept this is an operational matter, but every Member can tell a similar story in respect of other hospitals across the country. It is not just about the lack of upgrading of equipment or the purchase of a software package. The issue of medical politics is also at play. After I placed pressure on the then Government in 2015, it eventually installed a state-of-the-art telemedicine rapid access for stroke and neurological assessment, TRASNA, telemedicine stroke machine at Portiuncla University Hospital which would allow doctors at other hospitals to make life-saving stroke diagnoses of patients in Ballinalsoe, thus providing it with a 24-7 stroke service. However, that never happened because clinicians within the Saolta University Health Care Group would not agree to operate the machine or another machine at Mayo University Hospital. The same type of machines were installed in hospitals in Mullingar, Kerry and Wexford, as well as in St. Luke's General Hospital in Kilkenny. How many stroke patients were treated using those machines in those hospitals? These are basic things that the taxpayer is funding to a significant scale within the hospital system, but A is not joined up to B and then not connected to C and, as a result, patients' lives are being put at risk and hard-earned public funds are being wasted.

Medical politics should not be dictating these issues. There should be a commonsense approach in these situations. As I stated, I am not aware of the detail of the situation on the ground. The Deputy is saying to me that clinicians within the Saolta group are not willing to use these facilities whereas clinicians in other HSE hospital groups are prepared to use them. That seems to be the Deputy's assertion.

Deputies representing other parts of the country can speak for themselves as to what is happening in their areas.

The Deputy made that assertion and it raises legitimate questions in respect of why this particular technology is not being used within the Saolta group. I will initiate inquiries as to why that is the case and ask the HSE and the Saolta Group for a report on the points raised by the Deputy. As soon as I have it, I will revert to the Deputy.