Last week I raised with the Tánaiste serious concerns about breaches of the public-only consultant contract in the Rotunda, Cork University Maternity Hospital and University Hospital Galway. I acknowledge the excellent work done by my colleague, Deputy Rice, exposing these systemic breaches - breaches that pose a risk for public patients.

A quarter of all work carried out a Galway University Hospital lab comes from the private hospital, Bon Secours. This extra work is overwhelming the system to the point that samples are being outsourced to private labs. This is done at enormous expense to the taxpayer. Due a service level agreement between Bon Secours and University Hospital Galway, private work is being washed through the public system. The taxpayer picks up the bill.

I raised the significant and dangerous delays this is causing for public patients in the Dáil last week. A statement released by hospital management has since confirmed that there is a backlog of 3,449 samples waiting to be tested. These delays are not abstract. They involve people waiting for cancer diagnosis, people whose lives depend upon timely results, people who cannot afford to be pushed down a queue because 25% of the laboratory's workload is taken up by work from a private hospital.

These consistent delays resulted in the laboratory losing accreditation from the Irish National Accreditation Board. The lab does not meet nationally set guidelines for turnaround times despite the Trojan work of its dedicated staff. Galway University Hospital lab is one of the biggest in the country and in a major cancer centre and yet it has no official accreditation.

The Department of Health and HSE officials we in the Joint Committee on Health yesterday. The CEO of the HSE told my colleague, Deputy Rice, that they were completely unaware of the service level agreement between the hospitals. It is a remarkable statement from the very top of the health service. It raises serious questions about the scale of the issue and how many of these service level agreements are violating the public-only contract.

These contracts were signed in 2023 and were meant to be fully enforced by January of this year. Their entire purpose was to put an end to this kind of behaviour. Instead, we are discovering breach after breach and there is no evidence of any proactive monitoring from the Government to enforce this contract. My questions are: why has University Hospital Galway not immediately stopped this breach of the public-only contract? Is this happening in any other labs across the country? What has the Government done to check? What system has been put in place to ensure full implementation of the public-only contract?

I thank Deputy O'Callaghan for the question. I acknowledge this is an issue he has been rightly pursuing in this House for a period of time. The Deputy commended his colleague, Deputy Rice, the Cathaoirleach of the Oireachtas health committee. Deputy O'Callaghan will understand and appreciate I want to commend my colleague, the Minister for Health, because while I agree sometimes with Deputy O'Callaghan's analysis in terms of the destination we want to get to, it would be unfair to say that we have not seen an extraordinarily proactive approach from the Government since the Minister, Deputy Carroll MacNeill, took office. The Minister has shown very clearly to anybody down the back who did not hear that when you sign on the dotted line we expect you to do what you signed up to do.

The public-only contract holders are not permitted to engage in private practice within public hospitals. This position is unequivocal. There are to be no exemptions, no arrangements or no deviations. We would not accept it from anybody else working in the public service. If you sign a contract and you take the extra salary, you fulfil the terms of your contract. It is as simple as that. If you do not wish to sign the contract, that is also fine but you cannot have this each-way bet, as if to say, "I will sign the contract, take the extra salary, and make me pure but not just yet." That is very simple. It is the Government policy. The Minister intends to implement it in full. It is, largely speaking, the policy of the Oireachtas across parties because, of course, it originated from the work of Sláintecare.

I genuinely welcome, as does the Minister, the work being done at the Oireachtas health committee. It is helpful. It was very helpful in relation to the Rotunda. I believe, possibly next week, the committee may be due to see the Rotunda again and the HSE. That is a helpful opportunity for people who work for the public to outline the process that they are undertaking.

The Deputy used the word "violating". I can understand why but I would make the point that we are seeing the reform agenda being implemented here. What we are seeing now is getting to the phase of full implementation of the contract. I accept that the Government would have liked to gave seen us at this point earlier. The Minister, Deputy Carroll MacNeill, has prioritised this since taking office.

Shortly the Cabinet Committee on Health is meeting with the clinical directors in each of the regions - the top doctors who are paid additional salaries to make sure this happens. The Taoiseach, the Minister and I will want to hear directly what is happening. There are also a number of regional meetings taking place across the country.

We are not for turning on this. The Minister made that clear. We are extraordinarily serious about this and health policy set in this building and in Miesian Plaza on Baggot Street, not set anywhere else. I hope everybody now working in the health service understands that fully.

In relation to the specific issue in University Hospital Galway, the Deputy is right that there is an issue here. The issue here is there is a histology laboratory in Galway. It processes on average 13,200 samples per month. The lab has been recently experiencing periods where demand exceeded available staffing resources and this resulted in a backlog of samples. The HSE has confirmed that urgent referrals will always be priorities. Samples are processed according to clinical priority but it has also advised now that the long-standing service level agreement that is in place with the local private hospital, the Bon Secours, to provide lab service is due to terminate this year. I think it may be due to terminate in September but it is certainly due to terminate this year. That is also an outworking of the reform agenda that the health service is currently undergoing.

The question I am asking here is: what exactly is the system to monitor and ensure full implementation of the public-only contract? Clearly, there is a number of breaches around the country. They are arising one by one. What system has the Government in place to ensure this contract is being enforced?

In relation to Galway, the Tánaiste seems to be okay with the situation that this breach will continue for a number of months. The contract was signed. It was put in place in 2023 and meant to be fully enforced and fully implemented by January of this year. That has not happened. The breaches are continuing. Is the Tánaiste okay with them continuing until later this year? Should the public-only contract not be enforced now? Is the situation where the management of the hospital is telling consultants on the public-only contract to continue to do private work where they have a backlog and where people's tests are being delayed? People are not getting the results in a timely fashion. The lab has no longer got national accreditation because it is not meeting the targets. That is not acceptable. Does the Tánaiste agree that is not acceptable and the public-only contract needs to be adhered to now, not later in the year?

I fully agree with the Deputy. Let me be clear that the HSE has confirmed that any additional payments to consultants on that public-only consultant contract, POCC, contract relating to the service level agreement ceased at the start of the year. There are some consultants who do not work on a public-only consultant contract. It is important in winding down a long-standing arrangement and an agreement that that is done in a safe manner and that is the intention. However, it is ending because we are pursuing Sláintecare. We are pursuing the public-only consultant contract. We are creating a public health service. The Minister for Health does not have responsibility for private health. She has a responsibility for delivering a world-class public health service. That is what we all want to do.

There is a number of activities under way. We have had the HSE audit from the last year. We have had the Minister putting in her own regional structure, engaging on a three-monthly basis in terms of each region over and over again, and the progress we are making as well. The Minister has also asked everyone in this House for their support.

She is working in partnership with the committee, which is a formidable combination and that needs to continue. I and the Taoiseach fully support these efforts, as does all of Government, and we look forward to meeting with the regional clinical directors too.

On a positive note, we have seen benefits with the public-only consultant contract already, whether that is the cardiology clinics on a Saturday and Sunday in Connolly Hospital, a Saturday hub in St. Vincent's hospital, weekend consultant cover in Wexford General Hospital, a minimum of 26 consultants now rostered at weekends in University Hospital Waterford, and the progress in Kerry, St. James's and Mullingar hospitals. We are seeing the benefits. This is a reform agenda. It is one the Minister, Deputy Carroll MacNeill, is going to drive and it will make a big difference. We want to work in support with everybody across this House to get to where we need to.