2026-06-09

I now move to our second leader, Deputy Holly Cairns.

There have been a lot of questions raised about our-----

Sorry, could we have decorum, so the Deputy can be heard?

A lot of questions have been raised about our maternity services in recent weeks and there appears to be confusion about a hugely important issue. Which category of patient deserves continuity of care in our maternity services? Can I be absolutely clear about what I thought was obvious? Every woman accessing maternity services should be entitled to the highest quality care. It should not be an optional extra reserved for those who can pay for it. Public maternity services should not feel less safe than going private. However, that is very much the feeling people have been left with because that is exactly what the master of the Rotunda said. He said the reason the hospital was breaching the public-only consultant contract by allowing consultants on that contract to treat private patients was "safety for women". He has not withdrawn that statement but in an interview with David McCullagh earlier, he attempted to clarify it. He said "nobody is saying it is about safety" even though that is literally what he said. He went on to say that having consultants treating private patients at the Rotunda improved safety for public patients because if they happened to be around when a public patient needed consultant care, they could potentially pitch in. I cannot have been the only person listening to that interview in complete disbelief. Are we really saying that safety for public patients in maternity hospitals now depends on blind luck, in that if they happen to be giving birth when a consultant is on site with a private patient, then they will be taken care of? This is the type of two-tier care that the head of the busiest maternity hospital in the country is fighting for. The Social Democrats fully supported the approach the Minister for Health took in relation to the Rotunda but this controversy has exposed deep flaws in our maternity services and the so-called choices that are available to women. The choice that is only available to women who can afford to pay for it is not a choice at all. What woman is choosing not to have continuity of care? Every woman should have that. It is the bare minimum we should expect in our public system and that is what the Government's national maternity strategy is supposed to deliver. The focus now needs to be on delivering this for all women in maternity services. With regard to the particular consultant, will their previous patients be refunded? Are the eight current patients aware of the situation they are in? Does the Rotunda's statement draw a line under this for the Taoiseach, or is he aware of further concerns about the operation of public-only contracts in our hospitals?

I thank the Deputy for raising what is a very important issue. I appreciate her party's support for the Government's position on this and that of the Minister for Health because a lot was at stake here, not just for maternity services but for the entire edifice that should govern public health and the provision of public health into the future in our acute tertiary system. The Government took a decision following negotiations in respect of the public-only consultant contract, which is a cornerstone of the Sláintecare framework and policy. In our view, our very clear reading of this was that it was an attempted breach of the fundamental position regarding the public-only consultant. We were very clear from the beginning. The Minister was very clear from the beginning and I was 100% behind her in respect of her position, having been in the last Government with the previous Minister, the former Deputy Donnelly, in negotiating this contract, which was signed off by the representative organisation of the consultants, the Irish Hospital Consultants Association, IHCA. People cannot sign contracts and then casually deviate from those contracts. On the question of safety, in my view, the private model of care in obstetrics and maternity is not sustainable. It has not been sustainable for a long time. The State had to intervene a long time ago - well over 20 years ago - in terms of indemnifying obstetricians and gynaecologists in respect of maternity care, given that the insurance costs and so on were just not sustainable for any individual consultant. I recall when we built the maternity hospital in Cork, which is actually a very good example. In fact, in Cork, you had a ridiculous situation where if you went to the Bon Secours Hospital, when it was private, and there was a complication, you were sent straight away to the Erinville Hospital, the public hospital, because it was the only hospital that had a neonatal. That was a fairly rudimentary neonatal at the time because I recall having to make decisions around all of that subsequently. When we decided to build a maternity hospital in Cork, the Bon Secours Hospital acknowledged that it would not be able to sustain as a private maternity hospital.

Can the Taoiseach answer the questions?

I will make my point generally. There is an issue here. We are very clear; we support what the Deputy is saying and, as far as we are concerned, a private model is not sustainable in maternity and, therefore, we want to build and develop hospitals where there is universal access and where, eventually, we will move to public-only consultants. Some have opted out of that, and that is their entitlement under the agreement. The patient should be refunded because this should not have happened in the first instance. These contracts were transparently signed up to by all concerned, including the hospital with regard to its service level agreement with the HSE.

Like I said, I am glad that the Minister and Government held the line. The reason many people were surprised to see the Government coming out to bat so strongly for public health is that we do not see that with regard to all aspects of Sláintecare. I hope that we see more of that now. For example, 80% of home care is private now. That is just going up and up. There is no money behind the 2025 plans for Sláintecare. There are so many things that need to be addressed. I asked the Taoiseach two questions and he did not answer either of them, so I will put them to him again. With regard to the particular consultant, will their previous patients be refunded and are their eight current patients aware of the situation that they are in, that their consultant who is providing this care has a public-only contract? Does the Rotunda's statement draw a line under this for the Taoiseach or is he concerned about other governance issues with regard to the public-only contract in hospitals around the country?

I did answer the question. I said the money should be refunded. I made that clear in my original reply. The Minister is concerned about the operation of the public-only consultant contract throughout the entirety of the health service and in all hospitals. There is no going back from the position that we negotiated fully, transparently and comprehensively. Over the last five years, there has been an extraordinary level of investment in our health service at a scale that has dwarfed anything the previous-----

Are the eight current patients aware?

We do not allow a second contribution.

I made it clear that they should be refunded. The Minister has also sought assurances on that front.

I am asking about a different answer.

Deputy Cairns may have to write to the Taoiseach if she did not get the answer the first time.

The investment has been substantial in the last five years. In terms of the Deputy's question about Sláintecare, I do not think what she said about the lack of investment was fair. We could continue to invest more and more in health, but anybody looking at the last five years will see an extraordinary uptick and scaling up of investment in the public health service.

After their great win against the Netherlands last week, I begin by wishing the Ireland women's team every success tonight as they play France. Speaking of international sport, I raise the forthcoming Ireland-Israel football match. Football fans and all of us who are horrified by Israel's genocide in Gaza are concerned that this game will go ahead anywhere. We have been hearing from people who have contacted us in their droves with one message, that they want to stop the game in October. They want the Taoiseach and his Government to take a stand against the normalisation of genocide through sport. They want him to take a stand against Israel's war crimes in Gaza, the West Bank and south Lebanon. They want to stop the game from going ahead anywhere in the world. This is about more than just one football match. Taking on Israel neither starts nor ends with this game. That is why Labour has been calling for full suspension of the EU-Israel trade agreement. That is why our party has called for the full passage of the occupied territories Bill to include a ban on both goods and services. We have been calling for stronger action to prevent US military refuelling in Shannon Airport. This is about whether states that are guilty of grave crimes against humanity can continue to enjoy normal and indeed preferential treatment while atrocities continue. This is not just about Israel, Netanyahu, Ben-Gvir and their acolytes. This is about Vladimir Putin too. Ireland and the Government rightly condemn Russian aggression against Ukraine, as we all should, yet Irish-made alumina is being exported to Russia for use in weapons which are killing Ukrainian civilians. Indeed, exports from Aughinish Alumina have dramatically increased. They have doubled since the outset of Russia's brutal and illegal war. We have spent years in Ireland debating hypothetical military deployments under the triple lock. I deeply regret that the Cabinet is approving plans to abolish the triple lock today, despite strong national support for retaining it, even expressed in the Government's own public consultation. Despite that move, the Government is failing to take practical economic measures against Israel and Russia, which are states engaged in illegal wars of aggression. Aughinish Alumina is undoubtedly a critical industrial facility for Europe and we are all conscious that hundreds of jobs are tied to the plant in Limerick. A solution must be found to protect those jobs and people's livelihoods, but also ensure a ban on deadly exports to Russia. Aughinish refinery is owned by a Russian company with links to the Kremlin though a sanctioned oligarch founder. The Irish Times has reported that 80% of Irish-made alumina went to Russia in the first three months of this year. The trade Minister is disputing this figure and his own Department is investigating the ownership of Aughinish. At the same time, the Government is lobbying to keep Aughinish off sanctions lists. It is easy to condemn war in Ukraine and Gaza. What is harder is taking meaningful action against Putin and Netanyahu and against bullies. Will the Taoiseach use our influence as a proudly neutral country to stand up for international law and protection of human life in Gaza and Ukraine?

I appreciate the Deputy has raised quite a range of issues. I will take Israel, Gaza, the West Bank and the Middle East first. Ireland has taken a stand against Israel internationally and that is well recognised internationally and within the European Union. We continue on the humanitarian side to give very substantive contributions to the Palestinian Authority and UNRWA – close to €150 million at this stage. Of course we have also recognised the State of Palestine. We also intervened in South Africa's International Court of Justice case against Israel under the Genocide Convention. We made a submission, by the Attorney General, to the International Court of Justice on the legal consequences of Israel's actions in the occupied territories. Subsequently, we co-sponsored a resolution at the UN General Assembly seeking to implement the court's advisory opinion. We have been evacuating sick children, along with other countries, from Gaza. We have supported about 300 people to leave Gaza to travel to Ireland since the crisis began, and we have done much more than that. On the match involving the Football Association of Ireland, UEFA and FIFA have their rules for members of their organisations. Their rules provide that the national football governance bodies must act independently and be free of political interference. A series of countries have been suspended from international competition in the past because of political interference. That is the reality of it. I am not involved with FIFA, or UEFA for that matter, but I believe the Deputy is correct in saying that, at EU level, we should be dealing in a more robust and stronger way in terms of suspending the EU-Israel Association Agreement. I have just met the High Representative for foreign affairs, Kaja Kallas, and have been making that point. I think she is appreciative of the very strong feeling of opinion in Ireland in respect of that. The challenge has been to try to win over a critical majority of member states to that opinion. We have written to the EU Council. I want the issue on the EU Council's meeting next week and we want to see if we can get a vote on the issue of the suspension of that association agreement. That is the Government taking its role. The problem for the FAI and the football team, and it should not be on them, is that there will be consequences for the football team. To be fair to the Irish football team, it has made a lot of ground recently. It has had good success and is building on that platform. I do not control FIFA, which I think should deal with this globally, as should UEFA in its remit, but the bottom line could be that the football team suffers in terms of seedings and all the rest. That would have repercussions down the line for other competitions ahead. We need to act at European level. I think that is a far more effective way of dealing with the issue.

Time is up. I call Deputy Bacik.

I did not get a chance to deal with every issue but I will come back to the Deputy.

I would appreciate a response on my point on Aughinish Alumina. I acknowledge, as does the Labour Party, the strong steps Ireland has taken at international level in support of the rights of the people of Palestine. I welcome the Taoiseach’s confirmation that he has been engaging with Kaja Kallas on the suspension of the trade agreement. That is welcome but there is more that can be done. I am looking at the recent report by Francesca Albanese, the UN special rapporteur on Palestine. She has identified Ireland as one of 63 countries which she says are complicit in the collective crime of genocide in Gaza. That is a devastatingly serious charge. Clearly, there is much more we can do, and I have outlined some of the measures the Labour Party is calling on the Government to take. On the football game, of course there are complexities but it was a Fianna Fáil Government in 1999 that took a strong stance against Yugoslavia, and rightly so, after the ethic cleansing it carried out in Bosnia and Kosovo. That was a strong stance taken in the context of an international football game. Many of us remember that. That is the stance that football fans and others are now calling on the Government to take in this case.

I reject what Francesca Albanese said. I have significant issues with much of what she has said on this issue, in terms of Ireland in particular. We will work with the European Commission in respect of Aughinish. The Deputy said many jobs are at stake and a solution must be found. Let all of us be honest in the House. We will work with the Commission. We are conscious that there are about1,000 people directly depending on it from a jobs perspective. It is not going to be simple. If a call is made one way or the other, the repercussions will be what they will be. I do not think the Deputy should try to sugar-coat it to say there is a magical way to find a solution to this, and everything will be all right on the other side. We are not in that space. We will engage with the European Commission because there was a view that Aughinish is important for the alumina supply chain in Europe. It is a European competency. Europe decides what gets sanctioned and Europe decides what we do not put on the sanctions list. Europe did not put alumina on the sanctions list, no more than it put-----

I call Deputy O'Donoghue.

Before I start my question, I give my sympathies to the Fossett circus family on the burial today of Marion Fossett. Their circus will have been in existence for 138 years this year. They have been going around the country and internationally. They come to Limerick every year and have always had a charity day where people come in for charity. On my own behalf and that of Independent Ireland, I give my respects to the Fossett family. My question is about Foynes and Uisce Éireann. For decades Foynes, the port in County Limerick, has been looking for a sewerage system. In Foynes, we are getting an upgraded sewerage system, for which we have been waiting decades. I welcome that. However, the problem is that the system that is being proposed only deals with secondary waste. Basically, it is to remove the solids and let the rest go to source. The Taoiseach is a person who loves to go swimming. He often says he goes swimming on New Year's Day. The discharge for this in Foynes is in the yacht club. I see people across the Chamber smiling at me. This is a health and safety issue. This is waste going back into the River Shannon and a health and safety issue with a yacht club next to it. All Uisce Éireann is going to do is remove the solids. I would welcome all of Members on the bench on the other side of the Chamber to come to Foynes to go for a swim in it. That will tell me how much they think of it when we bring it to them at source. Why is Uisce Éireann not putting in a tertiary system that removes all waste and treats it before it goes back to source? The tidal system has been investigated by professors in the field and they have shown that the waste goes off and returns two hours later to where it originated. However, all of this information is being hidden from Government when Uisce Éireann is putting in this system. We are talking about a waste of money. Why can a proper system not be put in in accordance with health and safety guidelines for everyone?

I thank the Deputy for raising this important issue. We have made a lot of progress in the country with regard to wastewater treatment facilities. I am of the view that it should be tertiary and not secondary where possible. I am not aware of the specifics of the actual proposal for the wastewater facility earmarked for Foynes. I will check with Uisce Éireann on this. It may not be a waste of money because I presume it can be designed and constructed with a view to adding. Let us not look a gift horse in the mouth on one level. We need more treatment plants, particularly if planning has been secured and so on. We just need to get infrastructure in place. There may be funding issues. There may originally have been cost issues, although we have substantially increased the allocation to Uisce Éireann now and into the foreseeable future through the national development plan. I will ask. The Deputy is absolutely correct that tertiary treatment is the optimal way to go to ensure quality of water, particularly where it is discharged into the river, which has implications for ecology, biodiversity and human health. We will respond to the Deputy's query. I will seek a response from Uisce Éireann on the specifics of the proposal.

I appreciate the Taoiseach looking into this matter. The concerns of the people of Foynes is the location. They welcome the system but the location chosen will be prevent the future-proofing of Foynes. Anyone who knows Foynes will know there is hilly ground to the west. On the Limerick side, it is all flat ground. The proposed system will involve pumping it upwards and then letting it flow down with gravity. This is the perfect place for infrastructure for future housing but this will limit the amount of housing that can be put into Foynes. The town is to be connected by motorway by 2030 so it is going to be a vibrant place. We should do a bit of forward planning. The system should be put in on the Government-owned lands across the road. That is also on the side of the port. It would make sense and this infrastructure would allow for housing in the future.

I also pay tribute to Marion Fossett and the Fossett family for their extraordinary contribution to Irish life. I remember attending Fossett's Circus as a young child. Some might say I learned a few tricks from that experience.

Motion carried.

Our thoughts and prayers are with them on this sad day for the family. We thank them for what they do. On the wastewater treatment plant, from what I can see, Uisce Éireann is now engaging in extensive works. The Foynes sewerage scheme will include a new wastewater treatment plant and 3.5 km of new pipelines to convey wastewater to and from the new treatment plant site and an upgraded terminal pumping station with storm storage and an extension to the existing marine outfall will be constructed. It is fairly significant in and of itself.

It is secondary.

I will make the point that, on location, there may be people for or against any given location but someone has to decide on a location from an objective engineering and wider planning perspective. I know of a wastewater treatment plant whose location was decided by one vote but, 30 years later, no one has complained. It did the job and it was the correct decision at the time.

Thank you, Taoiseach. I am sure there will be further engagement on this.

There was a lot of heat around that decision.

That concludes Leaders' Questions. Before I move on, we have a lot of groups to mention. We have a full Public Gallery. I welcome everyone. I particularly welcome visitors from Ballinamore Men's Shed, who are here at the behest of Deputy Martin Kenny, and visitors from Déise Day Centre, Dungarvan, who are guests of the Chief Whip, Deputy Butler. They are all very welcome.