Matt Shanahan warns UHW underfunded as waiting lists grow
Matt Shanahan addressed University Hospital Waterford and the South East regional hospital's resourcing and waiting list crisis, arguing the hospital is the least resourced Model 4 and is underfunded compared with peers. He criticised the minister's plan to rely on national treatment purchase funds and private hospitals as an outsourcing response, saying that approach is inadequate and will entrench inequity.
Funding and resource comparison
Matt Shanahan highlighted stark budget and staffing disparities. He said University Hospital Waterford serves a catchment of approximately 520,000 yet receives €194 million annually, while University Hospital Limerick, with a catchment of about 400,000, receives €266 million — a €72 million difference. He attributed part of that gap to roughly 865 additional whole-time-equivalent staff positions at Limerick compared with Waterford.
Waiting lists and hospital performance
He detailed long waiting lists across specialties at UHW, citing cardiology, ophthalmology, endoscopy, elective trauma and colorectal surgery, and noted national media ranked UHW third worst for waiting lists last year. He argued that the hospital’s procedures-per-euro efficiency is strong and questioned why that performance had not been matched with additional funding, consultant posts and diagnostic and theatre capacity.
Use of national treatment purchase funds
Matt Shanahan criticised the Department’s use of national treatment purchase funds to send South East patients to private hospitals in Cork and Dublin rather than expanding capacity at UHW. He referenced the recent cardiac service investment by UPMC, including a new lab installed during COVID, and recalled that an NTPF contract subsequently bypassed that local facility — sending vulnerable cardiac patients 80 to 120 miles instead, with less than half taking up the offer.
Policy concerns and equity
He warned that outsourcing low-level elective work to private hospitals will simply move patients from one waiting list to another and that money alone will only dampen waiting lists temporarily. He said proposals for new elective hospitals in Cork, Dublin and Galway risk giving more to those already advantaged and embedding health inequity and persistent waiting lists in the public system.
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Minister, I note your announcement that you are proposing a task force to deal with waiting lists and that you have put in a funding request for a budget allocation, hundreds of millions of euros, to pay for this multi-year plan. Wonderful news, Minister. Again, we can find emergency money to outsource waiting lists, yet we cannot find the money to support expansion within our own hospital settings. Can I speak about the Regional Hospital of the South East, which is University Hospital Waterloo? A Model 4 hospital that is servicing a catchment of approximately 520,000 people. A hospital that continues to be the least resourced Model 4 in the entire country. To put that in context, UHW, with its 520,000 patient catchment, receives 194 million annual funding. University Hospital Limerick, by contrast, with a catchment of 400,000, receives annual budgets of 266 million EUR. 72 million budget deficit for a hospital providing exactly the same services and to a smaller patient number. What is this additional 72 million paying for in Limerick, Minister? Well, certainly, a portion of it is paying for the additional 865 all-time equivalent employee positions the hospital enjoys over the hospital employee number allocated to the South East and Waterford. I often hear deputies in the House describing the funding deficits at University Hospital Limerick. And if that is the case, which I am sure it is, what does it say about the treatment of the main regional hospital of the South East? You have long been aware, Minister, of the extensive waiting lists that have been a feature of University Hospital Waterford's treatment landscape. Record waiting lists nationally in cardiology, ophthalmology, endoscopy, elective trauma, colorectal surgery and the list goes on. In fact, national media reported last year that UHW waiting lists were ranked third worst in the country. And what has been the response of the Department of Health in the interim? Did you decide to revisit the budget issues to examine the efficiency metrics in terms of procedures completed per Euro spent in this hospital, which ranks amongst the best in the country? Did you decide to provide additional funding and approve all-time equivalent positions to consultant staffing, specialists and general nursing, radiography and lab technicians to build on the capital efficiency of this hospital? The answer is no. Not you, not your department, not the HSE, not the Southwest Hospital Group. Instead, you have found money from national treatment purchase funds to begin targeting South East patients for treatment options in Cork and Dublin private hospitals. Most calling of all, Minister, the significant rescue provided to the cardiac service during COVID, where UPMC installed a new lab system. But no sooner did the resumption of procedures happen in UHW than an NTPF contract was drawn up, which bypassed the UPMC facility in favour of sending vulnerable cardiac patients over 80 and 120 miles to Dublin or Cork Cork to have cardiac diagnostic procedures completed. Less than half the people selected on this list took up that option, Minister, which clearly shows that medical management are totally out of touch with the needs of people to have these procedures in their own regional hospital where they regularly attend. The issue of waiting lists has always been a component of poor capacity staffing and recruitment issues, available theatre and diagnostic space and the ability of patients to attend appointments. Many of these factors are solvable by increased health resourcing. This is the status that private hospital concerns have to reach to remain commercially viable. That is why they, as opposed to public health systems, can offer a solution to low-level elective procedures. For many of the patients that your new initiatives will target, they will just move from one waiting list to another minister. Having received one future procedure, their care plan and management will likely still fall back on the regional hospital for which they attend. Money will not solve the waiting list problems but will only dampen them for a number of months. Your recent talks, Minister, of looking at new elective hospitals in Cork, Dublin and Galway, tells me that you are deciding to continue to give those who have much more. In so doing, you will continue to embed health inequity and waiting lists within our public health system. Thank you very much. YourO
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