Cian O'Callaghan: Exposes Galway lab backlog and contract breaches

Deputy Ciann O'Connolly. Tánaiste, last week I raised with you serious concerns about breaches of the public-only consultant contract in the Rotunda, Cork University Maternity Hospital and University Hospital Galway. I want to acknowledge the excellent work done by my colleague Padraig Rice exposing these systemic breaches, breaches that pose a risk for public patients. Tánaiste, a quarter of all work carried out at Galway University Hospital Lab comes from the private hospital Bonsacours. 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 to a service-level agreement between Bonsacours and University Hospital Galway, private work has been washed through the public system. The taxpayer picks up the bill. Tánaiste, 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 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. Tánaiste, 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 in a major cancer centre, and yet it has no official accreditation. Tánaiste, the Department of Health and HSE officials were in the Joint Committee on Health yesterday. The CEO of the HSE told my colleague, Padraig Rice, that they were completely unaware of the service-level agreement between the hospitals. It's a remarkable statement from the very top of our 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. Tánaiste, 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 your government to enforce this contract. So, Tánaiste, 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? And what system has been put in place to ensure full implementation of the public-only contract? I want to thank Deputy O'Connell for the question. I want to acknowledge this is an issue he's been rightly pursuing in this House for a period of time, and he commended his colleague, Deputy Rice, the Chair of the Arachnid Health Committee. You'll understand and appreciate that I want to commend mine, the Minister for Health, because while I agree sometimes with your analysis in terms of the destination we want to get on, I think it would be unfair to say that we haven't seen an extraordinarily proactive approach from the government since Minister Karen McNeill took office. I think she's shown very clearly to anybody down the back who didn't 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 is to be no exemptions, no arrangements or no deviations. We wouldn't accept it from anybody else working in the public service. If you sign a contract, you take the extra salary, you fulfil the terms of your contract. Simple as. If you don't wish to sign the contract, that's also fine. But you can't have this each-way bet, where I'll sign the contract, take the extra salary and make me pure, but not just yet. So that's kind of very simple. It's the government policy. The Minister intends to implement it in full, and I think it's largely speaking the policy of the Oireachtas cross-party, because of course it originated from the work of Sláinte Care. I do genuinely welcome, as does the Minister, the work being done at the Oireachtas Health Committee. I think it's helpful. I think it was very helpful in relation to the rotunda. I believe, possibly next week, I think you 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. I would say, and you used the phrase violating, and I can understand why, but I would make the point we're really seeing the reform agenda just be implemented here. What we're seeing now is getting to the phase of full implementation of the contract. I accept the point that the government would have liked to see us at this point earlier. Minister Karen MacNeill has prioritised this since taking office. One of the things we'll be doing shortly at the Cabinet Committee on Health is meeting with each of the clinical directors in each of the regions, so that the top doctors who are paid additional resources, additional salaries, to make sure this happens, and myself, the Taoiseach, the Minister, will want to hear directly as to what's happening. There's also a number of regional meetings taking place across the country. We're not returning on this. The Minister made that very clear. We're extraordinarily serious about this. Health policy set in this building and in Meazin Plaza on Bagot 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, you're right, there is an issue here. The issue here is there's a histology laboratory at Galway. It processes, on average, 13,200 samples per month. The lab has been recently experiencing periods where demand exceeded available staffing resources. This did result in a backlog of samples. The HSE have confirmed that urgent referrals will always be prioritised. Samples are processed according to clinical priority. But they've also advised now that the longstanding service level agreement that is in place with the local private hospital, the Bond Secures, to provide lab services is due to terminate this year. I think it may be due to terminate in September, but it's certainly due to terminate this year. Again, that's an outworking of the reform agenda that the health service is currently undergoing. Thank you, Conor. Tánaiste, the question I'm asking here is what exactly is the system to monitor and ensure full implementation of the public-only contract? Clearly, there's a number of breaches around the country. They're arising one by one. But what system as a government do you have in place to ensure that this contract has been enforced? Secondly, in relation to Galway, you seem to be OK with the situation that this breach is going to continue for a number of months. The contract was signed. They were put in place in 2023. They were meant to be fully enforced, fully implemented by January of this year. That hasn't happened. The breaches are continuing. Are you OK with them continuing until later in this year? Should they not? 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, where people's tests are being delayed, they're not getting the results in a timely fashion, the lab has no longer got national accreditation because they're not meeting the targets? That's not acceptable. Do you agree with me that's not acceptable and the public-only contract needs to be adhered to now, not later in the year? I fully agree with you. And let me just be very clear that the HSE has confirmed that any additional payments to consultants on that POC contract relating to the service level agreement ceased at the start of the year. There are some consultants who don't work on a public-only consultant contract and it is important in winding down a long-standing arrangement and an agreement that that's done in a safe manner and that's the intention. But it is ending, because we're pursuing slaunter care, we're pursuing the public-only consultant contract, we're creating a public health service. The Minister for Health doesn't have responsibility for private health, she has a responsibility for delivering a world-class public health service, that's what we all want to do. There's a number of activities underway. We've had the HSE audit from last year, we've had the Minister putting in her own regional structure engaging on a three-monthly basis in terms of each region, over and over again, had the progress that we're making as well. And the Minister has also asked everyone in this house for the support as well. She's working in partnership with the committee, I think that is a formidable combination, I think that needs to continue. Myself and the Taoiseach are fully supporting these efforts, as is all of government, and we look forward to meeting with the regional clinical directors too. But can I just say on a positive, we have seen benefits of the public-only consultant contract already, whether that's the cardiology clinics on a Saturday and Sunday in Connolly, whether it's a Saturday hub in St Vincent's, whether it's a weekend consultant cover in Wexford General, a minimum of 26 consultants now rostered at weekends in University Hospital, Waterford, the progress in Kerry, St James's, Mullingar, we're seeing the benefits. This is a reform agenda, it's one Minister Cara MacNeill is going to drive, it's going to make a big difference, and we want to work in support with everybody across this house to get to where we need to get. Thank you.