Sir, – I read with interest the recent comments by Minister for Health Jennifer Carroll MacNeill regarding the importance of women’s healthcare and the expansion of access to services.The Minister is right to emphasise choice, equity and access. However, access in principle is not the same as access in reality.The central challenge facing Irish healthcare today is not a lack of entitlement but a lack of capacity. Under Sláintecare, increasing numbers of services are being made free at the point of delivery, a laudable objective that enjoys broad public support. Yet extending eligibility without a corresponding increase in resources, staffing and infrastructure risks creating a system where more people are entitled to care but fewer can obtain it in a timely manner.In healthcare, waiting lists are the true measure of access. A service is not genuinely accessible simply because it is free. It is accessible when patients can receive care within a reasonable time frame.The consequences are already evident. Waiting lists remain stubbornly high across many specialities. Patients who are theoretically entitled to free care often face delays measured in months or years. It is little surprise that approximately half of the population continues to purchase private health insurance, despite living in a country that aspires to provide universal healthcare access. People are not paying for healthcare twice because they reject the principle of universal care; they are paying because they seek timely access to treatment.The effects are increasingly being felt within the private sector as well. As public waiting lists grow, the State relies heavily on outsourcing procedures to private hospitals in an effort to reduce backlogs. At the same time, patients who can afford to do so increasingly seek private consultations and treatment to avoid delays in the public system. The result is that waiting times are now lengthening in parts of the private sector too. Ironically, policies designed to compensate for insufficient public capacity are now placing additional pressure on the private system.Healthcare policy should be judged not by the number of people eligible for a service but by the number who can actually access it when they need it. Announcing new entitlements without providing the workforce, theatre capacity, diagnostic services and hospital infrastructure to support them risks creating the illusion of access rather than access itself.If the Government is serious about improving women’s healthcare, and healthcare more broadly, the next step is not another expansion of eligibility. It is the far more difficult task of investing in the capacity required to deliver on the promises already made. Until then, Ireland risks creating a system where access is universal in theory but increasingly scarce in practice. – Yours, etc,DR RORY STEWART,Creeslough,Donegal.