Despite billions of euro being pumped into the health services, our system still fails to meet the needs of service users. There is not just one reason for this. A myriad of issues combine to paint a picture of endless waiting lists, patients on trolleys, the inability to retain and recruit professional qualified staff, front-line staff burnout, under-resourced carers and mental health services, ambulances idling outside accident and emergency units and overburdened general practitioners.

While there is a consensus that Covid wreaked havoc on our health services, it cannot be denied that the system was in disarray prior to the pandemic. The health system has been inefficient for years. Covid is the latest reason being used to mask that reality. Close scrutiny would reveal that billions of euro invested in health services long before Covid have not yielded the results intended. The national picture shows outpatient waiting lists with in excess of 600,000 adults and children. A further 75,000 are on inpatient day-case waiting lists.

A week ago, I raised with the Taoiseach the fact that Limerick regional hospital recorded the highest number of triaged patients waiting on trolleys since records began. An expert group has been assigned to investigate the situation in Limerick. An independent expert group should be appointed to assist health services nationally. Every aspect of this dysfunctional service should be dissected and explored. The implementation of Sláintecare is limping forward.

In my constituency, Tipperary, we face the same issues and frustrations faced in every other constituency in the country. Every single day, my office receives calls from people pleading for medical care for themselves, their families and, increasingly, their children. An example of the neglect is the fact that people in south Tipperary suffering from Parkinson’s disease are desperate for neurological services. There is no neurologist, nor are there Parkinson’s nurse specialists. Ireland has just 30 neurologists, fewer per head of population than Mongolia. We rank 33rd in the world in the provision of neurologists. South Tipperary lies at the bottom, with no neurologist at all.

The HSE’s model-of-care documentation states we need 140 neurological nurse specialists. We have 42 nationwide. Neurological nurse specialists are vital to Parkinson’s patients. South Tipperary patients have been campaigning without success for this service since 2016. Parkinson’s disease is the second most common neurological disorder in the world, second only to dementia. The lifetime risk of developing Parkinson’s now stands at one in 15. It is the leading source of disability.

The billions of euro invested in the health service over recent years must be scrutinised. Why is it that we cannot see or measure improvements as a result of massive investment? Many in the HSE with first-hand knowledge tell me the service is going from bad to worse. When will the Government insist on holding the HSE to account and act on that?

I thank the Deputy for raising this matter. I fully accept the huge challenges and pressures on the health service. On the question on why we cannot measure the improvements in the service, I wish to make a general point. There have been dramatic improvements in health outcomes over the past 20 or 30 years. In 2000, we were 16th in the EU league table regarding life expectancy; this year, we are number one. That is because of a combination of factors, including public health measures, in addition to the significant investment in health services, cardiology care, cancer centres, stroke centres and so on. These are having an impact but sometimes we forget about all that, which is understandable given the very high pressure on accident and emergency departments and hospitals. Coming out of Covid-19, the pressures are enormous.

Let me make another important point. Our population has increased from less than 3.5 million in the early 1990s to 5 million today. That is going to grow. The next census will be interesting. The population increase is having an impact on our services. I argue that, in recent decades, we may not have fully accounted for that in terms of the expansion of services and bed capacity.

A team has gone into University Hospital Limerick. I accept the Deputy’s points on that. With regard to the waiting list, the Minister has outlined a plan. Many people stayed away during Covid but have come back in significant numbers. Obviously, there have been delayed diagnoses and all that. An allocation of €350 million has been made to improve waiting times in 2022, on top of an annual core funding budget that is now €6 billion higher than in 2018. I take the Deputy’s point that there needs to be constant analysis of the additional funding and its connection with service increases and outcomes. There are very extensive aims. By the end of 2022, the Minister wants the number of patients on active waiting lists to be at its lowest in five years.

Every patient waiting more than six months for 15 high volume procedures will receive an offer of treatment by the National Treatment Purchase Fund, NTPF, in 2022. The 15 high-volume procedures such as, for example, cataracts, cystoscopies and hip replacements, represent about a third of people currently on active waiting lists. Treatment will be offered to all 75,000 patients on the active inpatient and day patient waiting lists at the end of 2021 by the end of 2022. We will ensure 1.7 million patients will be removed from waiting lists for scheduled care in 2022. They are very challenging targets and aims. Funding has been provided in respect of that plan and also the winter plan.

That said, the Deputy's point on neurology and Parkinson's disease is well made. The neurology services in Tipperary University Hospital are a hub-and-spoke model that are part of the wider neurology service in Cork University Hospital. The HSE has advised that Tipperary University Hospital recently submitted a business case to the South/South West Hospital Group for consideration for the appointment of a consultant neurologist and a CNM2 clinical nurse specialist. I will follow up on that.

I ask the Taoiseach to expand on his reply in regard to the neurology service in south Tipperary. The inability to retain and attract medical professionals to work in Ireland is given as the key reason for medical deficiencies. We hear that constantly. A high percentage of our young and newly qualified doctors and nurses choose to leave the country to work abroad. Many make this decision after a short period working within the Irish health service. Last year alone, 391 visa applications were granted to Irish doctors to work in Australia. The high cost of rent in our cities and towns is a key factor for emigration. Younger medical professionals are struggling to make ends meet. Front-line staff are frustrated and demoralised. A significant number of older staff have retired, taking with them experience and skills. Older staff retire because of stress and burnout from working in our hospitals and medical practices. This is a key area that must be tackled. If we cannot attract and retain healthcare staff, we will make no progress with the waiting lists and problems we have.

It is important to retain healthcare staff. Many current staff in our hospitals are senior and experienced, and have garnered experience and expertise overseas. There has always been that balance. There should be better retention in the early years of those who have gone through our medical schools. That considerable investment by the State should be retained in our hospital system to a far greater degree than is currently the case.

On the neurology question, the HSE is now working closely with the Tipperary University Hospital management team on the provision of neurology services. The application that has been made for a shared appointment between Cork University Hospital and Tipperary University Hospital, in addition to a CNM2 clinical nurse specialist, is being very actively examined. The HSE and the South/South West Hospital Group are working with Tipperary University Hospital on neurology services in Tipperary. That will represent a significant improvement in the care patients will receive when attending with neurological disorders. I will follow up on that and make sure it is brought to a conclusion.