2025-12-10

Tá fearg mhór ann go mbeidh ar dhaoine leochaileacha íoc as pacáistí táibléad blister mar gheall ar chinneadh an Rialtais. Beidh tionchar ar leith aige seo ar dhaoine atá ag dul siar i mblianta agus ar dhaoine atá ag maireachtáil le néaltrú agus galar Alzheimer a bhraitheann ar na pacáistí seo. Tá a fhios againn nach bhfuil sé seo ceart. Caithfidh an Rialtas gníomhú chun a chinntiú go leanfaidh na daoine seo a bheith ábalta a gcuid pacáistí táibléad blister a fháil saor in aisce. The Taoiseach's Government's decision to restrict medications covered under the phased dispensing scheme operated by pharmacies is a disaster. The Government's decision means some of the most vulnerable people will no longer receive tablet blister packs free of charge. We are talking of tens of thousands of older people living with conditions such as dementia and Alzheimer's. They rely on tablet blister packs to help manage their medication. We are also talking about people with disabilities who are under real pressure with the cost of living. The packs help them make sure they take the right dosage at the right time of day. The Government's decision means the cost of dispensing the blister packs - paid for by the State for decades - will now be passed on to these vulnerable customers. They will be hit by fee charges of up to €50 a month in some cases for these packs. This is a bad decision for the Government at any time but it made this cruel choice during a cost-of-living crisis when every euro is precious to people. It is like it cannot stop itself from making life harder for people. It hiked up student fees, the local property tax and the cost of petrol and diesel. It stands back and allows big energy companies to jack up electricity and gas bills and now it hits the most vulnerable elderly people. It is putting huge stress on people during the Christmas period as they know they are going to have to face these charges come 1 January. My phone, and I am sure those of others as well, has been hopping with people very worried and very angry over this. I spoke to one elderly man this morning. He is in his late 70s and told me his lovely wife suffers from dementia. He said without the blister pack he would find it very hard to manage her medication but he does not know where they are going to find the extra money to pay for them. He says they are literally down to the last euro every couple of weeks as it is. The explanation the Taoiseach and his Government have offered is the State never agreed to pay for the dispensing of these blister packs in the first place. Does he really think that matters to people who rely on them? The fact is the government has been paying for these for decades. If there was a mistake in how the packs were being paid for and a correction had to be made, it should have been made to ensure those folks could continue receiving their tablet blister packs as they have been but, no, the Government decided to punish vulnerable people, to ratchet up their costs instead of making sure they are looked after. The truth is the Government had a chance to sort this out. Back in October when it was finalising the new community pharmacy agreement we in Sinn Féin warned it was a big mistake to exclude the blister packs, but the Government chose to ignore that warning, chose to push on and now elderly people and others are paying the price. It is not right, it is not fair and it needs to be stopped. I have simple questions. On behalf of the man I was talking to, and I am sure many others right across this State, I ask the Taoiseach whether he thinks it is right that people with dementia, Alzheimer's and other conditions who received their blister packs free of charge up until now will have to pay for them on 1 January. Will the Government reverse this terrible decision and ensure vulnerable people can continue getting their blister packs free of charge?

First of all, tá an-chuid déanta i gcoitinne ag an Rialtas chun costais a bhaineann le cúrsaí leighis a ísliú. Tá sé sin déanta againn, go háirithe ó thaobh an drugs payment scheme. Tá an tairseach i bhfad níos fearr anois ná mar a bhí sé cúpla bliain ó shin. More generally on the cost of medicine, and particularly charges and so on, this Government has, over the last number of years, significantly reduced the cost of accessing medicine. The DPS threshold in particular has come significantly down, exceeding even commitments made in various manifestoes and so forth. That needs to be acknowledged, as does the abolition of charges in hospitals and so on, so without question right across the board we have reduced costs in the healthcare area. It is without question and the Deputy just cannot get away with saying we are wilfully increasing costs all over the place as he just did. We are not. If you look over the last number of years, costs have come down in terms of State charges in respect of hospitals - acute hospitals, emergency departments - and in respect of medicine and the cost of medicine, particularly the DPS threshold and other bespoke interventions also. More generally on cost-of-living measures, in the budget we took measures to support families who are on low incomes in particular. The ESRI's evaluation of the budget bears that out in that the two lowest deciles gained the most in respect of the budgetary allocation. Also, if you look at real wages and incomes, they are growing at approximately 3% per annum this year and we have targeted measures effectively on the cost-of-living side to support those most in need. On phased dispensing, we will certainly look at any situation where there is potential hardship on any patient or any person in receipt of medicine, but we have to be clear-eyed as well. The Deputy mentioned pharmacies and so on. There is an issue between the HSE and pharmacies in respect of the whole area of phased dispensing, which was introduced as far back as 1996 for patient safety reasons. The supply of medication in instalments can support patients prescribed certain high-risk medications who would be at risk of medication misadventure if these medications were supplied monthly. Where a phased dispensing claim is submitted the current requirement is an item must be dispensed in the pharmacy across multiple supply occasions. Community pharmacies receive additional payments for phased dispensing. Monitored dosing systems, sometimes referred to as blister packs or compliance aids, are systems that enable the individual medicine doses to be organised according to the prescribed dose schedule. The HSE's contention is that monitored dosing systems and phased dispensing are two separate processes and that phased dispensing requires the patient to present to the pharmacy on multiple occasions in the month each week, as it would be unsafe for the patient to have the totality of their medication in one supply occasion. Monitored dosing systems are ordinarily provided in one visit and packaged to indicate when a medication should be taken. The State had never agreed to monitored dosing systems and that was the context-----

That is not the question.

I am sorry, this is the issue. Invariably Sinn Féin will come in another day and question Government about how the costs got out of control, value for money and so on. There has to be an engagement between the pharmacy sector and the HSE on these matters. Unfortunately in the Oireachtas from time to time, the Deputies opposite just blow all that out of the water and do not even allow interrogation of the issues. Government will interrogate this again with the HSE and others-----

Talking down the clock.

-----but there are issues here. I mean, there are agreements between-----

Three seconds.

-----the Irish Pharmacy Union-----

Two, one. Suigh síos.

-----and the Department-----

Thank you, Taoiseach. Deputy Doherty to respond.

The National Centre for Pharmacoeconomics carried out an evidence assessment.

Thank you, Taoiseach.

I am just giving the background as the question was asked. It indicated the evidence was very equivocal in terms of supporting the programme. We will go back and discuss this with the HSE.

Deputy Doherty to respond.

During discussions with the pharmacy union-----

Thank you, Taoiseach. The time is up. Deputy Doherty to respond.

-----it was agreed that improved controls would be introduced.

I asked the Taoiseach the question and he did not answer it. I asked him the question, with respect, of whether he believes people with dementia and Alzheimer's who were receiving the blister packs free of charge should be charged for them from 1 January. No matter what way the Taoiseach presents it, these packs were being funded. For right or wrong, they were being funded. Of course there are issues. The issue is that the man who was talking to me this morning and his wife who is suffering with dementia will have to pay in January for the blister pack they were getting free of charge. Do not try to pull this one - that the Government is actually reducing the cost of medication - when people out there have been getting letters from their pharmacies saying from 1 January the HSE will no longer be providing blister packs and there will be an additional charge of €20 per month for the packs. Please do not tell people that black is white and white is black. People know what is happening out there. The question is whether the Government is going to reverse this. These are elderly people and vulnerable people who rely on blister packs to ensure they take their medication on time. Many people cannot afford to pay for them.

The time is up. The Deputy’s point is made. I call the Taoiseach to respond.

It was a Government decision that restricted the way in which pharmacies were claiming, and it has resulted in this. Will the Taoiseach please answer the question? Will he reverse the decision? Should people with dementia and Alzheimer's, who were getting it free, have to pay for it in January?

My view on monitored dosing systems is that I am not sure there should be a fee attached to them at all, but I am not so sure either-----

What does that mean?

Hold on. I am not sure either that the State should be ponying up for everything here. There is no analysis by Deputy Doherty of both sides of this engagement. That is my point. There is too much of that in the House. The easy thing to go for is that the Government must pay for everything, no matter how it is presented or manifested. Deputy Doherty, even though he is finance spokesman, just casts aside any sense of controls whatsoever – “just let it rip” is his approach. We want to look after people with Alzheimer's and dementia, and we have done in this Government. We have done far more in the last number of years for dementia patients than was done in the previous decade or more. That is a fact.

You put up the cost.

The Minister of State, Deputy Butler, was responsible for a lot of the very proactive work in respect of dementia.

The Taoiseach has just ten seconds left. What is he going to do?

There needs to be an engagement between the Irish Pharmacy Union and the HSE on this, but it cannot be the case that every new system or modification of a system or approach is just agreed. That cannot be it either.

The Government has just agreed a deal but it left out blister packs.

Yesterday, we saw the announcement from the Minister, Deputy Norma Foley, that the Government will replace the existing assessment of need process with a new system. However, I have deep concerns about the proposal announced to replace the requirement for a formal diagnosis when determining access to a special class or special school. As a former teacher, I cannot overstate the seriousness of this development. This proposal has profound implications for schools, teachers and the children and families who rely on appropriate, timely and specialist assessment. Replacing diagnostic criteria with an educational assessment places an unreasonable and unsafe burden on schools. To me, it seems that we will streamline the process of receiving therapies, but leave a massive void in how special classes and places will be assigned. The Minister, Deputy Foley, reiterated yesterday that people will no longer need an assessment of need to get a place in a special school or class, instead saying it is up to education to decide on how these places will be assigned. She outlined that some sort of special educational assessment will be established to get a school place for a child, saying it was her hope that the Department of education would have the new system in place for the September 2027 academic year. Who will carry out this new special educational assessment? Will it be teachers or SENOs? There is no point in the Government suggesting that more psychologists, clinicians or multidisciplinary teams will be required, because the Government has made that money available to hire for these roles, but the roles are not being filled. I also ask whether the Minister, Deputy Naughton, was aware of these changes yesterday, or was it a surprise to her? It was duly noted that there was no representative from the Department of education at this announcement yesterday. Teachers themselves will say that they are not the ones who should be in the position of determining an appropriate place for a child with additional needs. In reality, this leaves parents in a worse-off position. They will now be chasing two parallel pathways, one to get the therapies they need, and one to get the diagnosis and school place they need. Does the Taoiseach believe that this makes sense? Yesterday, 85% of the teachers surveyed reported moderate to high work-related burnout. Is the Government now placing this burden on them? Teachers cannot and should not be expected to take on duties that belong to psychologists, clinicians or multidisciplinary teams. This shift undermines the integrity of the entire assessment process and places schools in an impossible position. It also risks leaving families unsupported and pupils at genuine risk of not receiving the appropriate provision that they are entitled to. The proposal seems to be driven not by what is best for children, but by the inability of the health and disability sector to manage the assessment of need backlog. Who will carry out these educational assessments? How will the Department of education manage and resource this responsibility? Crucially, and I want an answer to this question, has the process of establishing this new special educational assessment begun within the Department of education?

First, I reject completely the assertions made by the Deputy in respect of this. I think he is missing the fundamental point. The assessment of need framework as it currently stands is not fit for purpose, and recent High Court decisions have made it less fit for purpose. The objective of the legislation, along with a whole series of other measures, is to prioritise and increase timely access to therapies for children. That is the fundamental point: to free up therapists in providing services and treatment. The Department of education was intimately involved with the Department of children and other Departments under the Cabinet subcommittee on disability regarding this legislative change. We made a very clear decision early on in this Government that we were going to do this, and grasp the nettle in respect of it. We can go on here for another two years, with people coming in and complaining about this list and that waiting list, and they will keep on doing that - it is great stuff, wonderful - as the lists keep going up. The system is completely not fit for purpose. We want to utilise therapists to provide services to children, and we are going to do it. Bottom-line legislation is the first step, but there is a whole series of other measures that we are taking as well. That basically means we are creating statutory guidelines to support assessment officers in making earlier determinations of disability, reducing the need for unnecessary or repeated clinical assessments. There will be proportionate assessments based on each child's circumstances, including the use of existing diagnostic information or reports, allowing for streamlined, desk-based reviews, where appropriate; and faster delivery of assessment reports provided at the earliest possible point, without affecting anyone's right to an assessment of need and without changing the statutory timeframes set out in the Act itself. We will be doing a wider review of the Disability Act in early 2026 to ensure it reflects modern, rights-based child and adult-focused supports. A dedicated autism diagnostic assessment panel will be established. There will be a new autism assessment and intervention pathways protocol from 5 February 2026, ensuring consistent practice across primary care, CAMHS and CDNTs, and removing the requirement for an assessment of need to access non-health supports, such as special classes and school places. We do not want children waiting to get into a special class or a school place where the need is obvious. We do not want delays. We want to get the child access to facilities and therapies immediately. There will be 11 new in-reach teams, with four staff in each team, to provide expert clinical guidance to the assessment staff. A new single point of access model from 2026 is being established - Bernard of Gloster and the HSE have led out on this - giving families one consistent entry route to primary care, CAMHS or the children's disability network teams. The Deputy knows that we are rolling out the education therapy service in 45 special schools from the new year, and then, for the 2026-27 academic year, all special schools will have an education therapy service.

The time is up. I call Deputy Kenny.

The private procurement of assessment of need will be supported by €20 million in this year's budget, and there is more on top of that, but I do not have time to elaborate on it.

The question was simple. Who will carry out these educational assessments? Will it be teachers? Will it be SENOs? Who will it be? John Boyle from the INTO said this morning that teachers were not consulted, briefed or even informed in advance of these proposals. It is grossly unfair that Government Departments are using vulnerable children as political footballs after failing to provide them with timely assessments and therapeutic supports. The question is fairly simple. Who will carry out these educational assessments that were announced yesterday? I never said that I was against what was announced yesterday.

You did.

I never said that. What I asked was who will carry out these educational assessments. That was quite clear. The Taoiseach did not answer that question.

I did.

The question is fundamentally clear. Will the Department of education have this programme established by October next year? Right now, to me, it seems that it will not. The Government cannot even answer as to who will carry out these educational assessments. That is the question I am asking. Will it be teachers? Will it be SENOs? Who will it be?

Again, you did criticise it, by the way.

I did not, not once.

From the outset, you have been extremely negative. The whole question was articulated in a negative way.

That is not true.

That is your reality, Taoiseach.

Fine. I welcome Deputy Kenny's turnaround and reverse within five minutes. As for the question, I did say that there will be assessment teams. Teachers will not be assessing. I would appreciate, if the INTO has issues, that it would engage with us and engage with the Department of education. Do not be shooting from the hip.

Who will do the assessments?

People should not be shooting from the hip all the time. The current system is not fit for purpose. Many children will present with special needs from the earliest diagnosis, when it is very clear they have special needs. They do not need to go through elaborate further assessments of need before being allocated a school place. We do need to streamline this. Therapists need to be freed up to provide services, to engage. That is what we want here, not endless long lists of people stuck for six or 12 months. We have to do this. No matter what political perspective one holds the system has to be unblocked.

Yesterday, the High Court heard details of a deeply disturbing case of child abuse. A 13-year-old boy who abused his six-year-old sister was given a tablet at the age of five. There was no parental controls on the device and he had totally unsupervised access to the Internet. By the age of just six he was viewing pornography for hours every day. This boy ultimately uploaded child abuse images of his sister online, prompting his arrest. Sentencing the boy, Ms Justice Mary Ellen Ring likened unchecked Internet access to children playing with matches. Details of that shocking case were being heard as Australia introduced its social media ban for children under 16. It is a world first and we will all certainly be watching with huge interest to see how it progresses. However, I have a number of concerns about that kind of ban. For a start, most social media companies already have an age limit of 13 and we all know that just its not being enforced. Raising the age limit to 16 will similarly be easy to evade with teenagers creating fake accounts using virtual private networks, VPNs. Crucially, delaying access to social media sites does nothing about the recommender algorithms that are feeding children toxic content. We now have mountains of evidence about the threats posed by these algorithms. One study found teenage boys were being "bombarded" with misogynistic content within minutes of signing up to TikTok. Another study found 13-year-old users being shown videos about self harm and suicide within 20 minutes of setting up accounts. Social media platforms now routinely show graphic, violent or racist videos to people who are not looking for that content. This is not just having a hugely damaging impact on children but it is massively corrosive for society. It is spreading misinformation and hate through communities like wildfire. I will be the first to acknowledge this is a hugely complex issue and there are no easy solutions. In know the Minister is currently looking at age verification for social media users. While I think that is part of the solution, it amounts to putting a sticking plaster on a gaping wound. There are also huge privacy concerns about mandating something like a digital wallet to access services online. Each of us in this House knows we have to do more to protect children online. We know the current system is failing them. An obvious first step is to regulate the algorithms that boost extremist content to huge audiences online. By default, those systems should be off. Does the Taoiseach agree and will the Government act on this?

I thank the Deputy for raising what is a very important issue. The Government is talking a whole-of-society and a whole-of-government approach to online safety, recognising the rapid pace of change in the digital world and also the need for very co-ordinated, robust and rights-respecting responses. That response spans regulation, education, parental supports, age verification measures, curriculum reforms and school-level policies. I am aware of that case yesterday and I heard reports in the media in relation to it. It does illustrate the enormous challenge and dangers here. Overall, we have to, through our education system, create a culture of strong self esteem and self respect among children from the earliest of ages. We have had to do this in the past to varying degrees in respect of other issues, be it drug addiction, alcohol addiction and so on. The most fundamental way of assisting society to cope is through very good policies at an early age and programmes from a psychological level which increase the self esteem of children to withstand and be resilient in the face of whatever comes at them in life subsequently. Of course, we can do much more than that. Curricular reform is happening. There are school level policies and so on. The Minister, Deputy O'Donovan, with Coimisiún na Meán, now have stronger powers. There are obligations around harmful content. Stronger age verification for adult material is very important and risk mitigation requirements are designed to protect children. At EU level, we are engaging. The digital age of majority must be considered across all member states to ensure harmonised protections under the Digital Services Act. We are also developing a secure privacy-focused approach to age verification and we are working to include age verification functionality in Ireland's digital wallet under the EU eIDAS project. That is about giving parents and young people a robust Government-backed mechanism to protect privacy. A large-scale pilot is planned for early next year. We are strengthening digital well-being and online safety supports in schools. We have updated our child protection procedures. There is a lot happening in education, to be fair. There is a digital strategy for schools up to 2027. Oide technology in education provides professional learning for teachers and Webwise continues to lead on national awareness training, classroom resources on cyberbullying, image sharing, social media and emerging online risks. We have also acted to reduce mobile phone distraction and support student well-being during school day. We have introduced the full ban on personal phone use in primary schools and strict restrictions at post-primary level. I remember last year when the pouches were introduced, they were ridiculed in here. It was a classic Opposition response.

The time is up Taoiseach. Deputy Cairns to respond.

Some 462 schools have drawn €6 million in respect of that, which shows people have responded positively to the initiative.

This is something governments across the world are grappling with and in many ways the horse has already bolted. Social media companies have been around for 20 years and they have never been properly regulated. To date, it has been self-regulation which has amounted to no regulation at all. Now we are playing catch up. One things is clear; the algorithms are increasingly dangerous. Violent, racist and misogynistic content is not just tolerated but it is literally boosted by these algorithms, making them go viral. I recognise there are loads of things in the Taoiseach's list of things the Government is looking at but none of them were the algorithms and a lot of them placed the responsibility on the user and on teaching the user about safety online. What we need to do, as a very first and obvious step, is address the algorithms. Will the Taoiseach reconsider, and will he look at this?

We will be examining all aspects of this, including the impacts and use of algorithms to direct people to certain areas. That clearly is an issue. In terms of legislation, that is already in place in the powers Coimisiún na Meán has. In terms Digital Services Act, in particular, we are in a position to hold platforms to account. The European Commission has launched investigations into the influence of these powerful algorithms, especially on young users online. The European Commission is already working on that aspect.

I am asking what the Taoiseach is doing.

We are part of the European Commission. We are part of the European Union. The big row and argument between the US and Europe is that the US thinks we are over-regulating. I do not think we are but that is the US's assertion, that Europe is over regulating in the digital space. The Commission has been very strong.

Thank you, Taoiseach.

So have our regulators as well. We are part of the harmonised regulatory framework.

Thank you, Taoiseach. Deputy Paul Nicholas Gogarty is next.

The Digital Services Act is a game-changer in respect of this.

Today I raise the chronic shortage of radiographers and the related fragile state of our diagnostic imaging capacity. As the Taoiseach is probably aware, the HSE has acknowledged that radiology and radiation therapy departments remain under-resourced, with waiting lists for diagnostic scans continuing to grow. We saw earlier this year a report on RTÉ showing that, despite over 200 radiography graduates qualifying annually, many are being forced to emigrate because of appointments not being made. This is not just poor workforce planning; it could be called a misuse of public finds, wasting money training professionals who we then lose abroad while we scramble to import more. The HSE radiology workforce report outlines workforce projections and training requirements and recommends increasing the radiology trainee intake from 39 in 2025 to 75 in 2028, highlighting that Ireland's radiologist numbers per capita are substantially below European norms. This report was prepared to feed into the broader national radiology strategy and while the Minister for Health has confirmed a strategy is being developed and under consideration, we have not yet seen the finer details. Then, of course, we have our diagnostic imaging capacity problem - a shortage of machines. Where machines go in, that is only half the story. I want to put a human face on one element of this to explain. A constituent wrote to me. He had just had surgery for prostate cancer this month but twice now his PET scans have been cancelled because the batch of radiation required for the scans failed. This happened because the HSE and the Department of Health rely on a single provider and when that supply chain breaks down, no patient in the country can get their scan. This is not an isolated incident. The European Medicines Agency has warned that radiopharmaceutical supply chains across the EU are fragile, with occasional shortages already reported in other member states. The OECD confirms that Europe's reliance on a small number of reactors and suppliers for specific isotopes creates a systemic risk. In Ireland, we are directly exposed to these vulnerabilities and we have no contingency plan. Imagine the stress. The scans people have these conditions are not optional. It is the way of knowing whether or not the cancer has spread beyond the prostate. It determines the course of treatment and cancelling it not once but twice leaves the patient in limbo facing surgery without the full picture. The person who wrote to me said, "I am one of God knows how many people experiencing this stress, yet it is never heard about. The teams I have been dealing with are phenomenal but they are also been put under huge pressure"’. It is not only related to systemic failure in terms of prostate cancer. It also relates to other areas, such as breast cancer, for example, because PET scans used for staging in treatment and planning in breast cancer require radiopharmaceuticals, such as fluorodeoxyglucose, FDG, as well, which are isotope dependent. This needs to be addressed.

First of all, I thank the Deputy for raising this issue. I take the Deputy's overall point that there are challenges in terms of the European-wide supply chain issues here but also personnel. Globally, radiologists and radiation oncologists are in short supply and in high demand and that creates challenges. This may not be consolation but if you look at where we were ten years ago or 20 years ago as compared to where we are today, we have significantly improved but I do not in any way understate the challenges that lie ahead. Since 2017, approximately €105 million has been invested in the national cancer strategy. Capital funding of over €140 million has been used since that date - one is current and the other is capital - to provide state-of-the-art radiation oncology facilities in Cork and Galway and to establish a national cervical screening laboratory, and then to update cancer infrastructure and chemotherapy wards and lab facilities. In the past six years, the radiology training programme has grown by 32% and more than 20 additional radiology specialty training posts have been established in the last three years. New radiology posts will enhance the specialist care of many specialties, including cancer care. Budget 2025 included funding for five additional training specialist registrar posts along with four additional training posts. On the replacement programme, the demand is increasing in line with expectations identified by the National Cancer Registry and the National Cancer Control Programme. We have five public radiotherapy treatment departments in Ireland, with a total of 22 linear accelerators in operation across these services. Galway has four machines. Cork has five machines. St. Luke's Radiation Oncology Network has 14 machines operating across three sites in Dublin: St. James's, Beaumont and St. Luke's. The HSE has a planned radiotherapy equipment replacement programme in place and has advised that all linear accelerator, Linac, machines in the St. Luke's Radiation Oncology Network will be replaced over a five-year period out to 2030 with an additional two machines to be located at the Beaumont site. The design process is currently under way. Step 1 of the procurement process for the works and equipment will commence in Q1 of next year, with a contractor in place later in the year. If we can accelerate that, we will. The replacement programme has come under the national development plan. It is being progressed under its aegis. It is included in the capital plan for 2025 and the health sectoral capital plan from 2026-2030. The facilities in Cork and Galway are newly-built facilities, opened in 2019 and 2023, respectively, involving capital investment of €120 million. Advanced radiotherapy technology in Ireland has also been implemented, including the stereotactic ablative body radiotherapy and the stereotactic radiosurgery, SRS, which aims to reduce the number of treatment sessions. However, we are coming from a low base historically in this sector.

I thank the Taoiseach.

We have made a lot of progress but I acknowledge we have more to do.

What the Taoiseach did not go into was what contingency plans are in place or whether he can commit to putting contingency plans in place to ensure that patients are not left without scans because of single point of failure. The diagnostic imaging is hugely important in modern medicine but without some sort of action to have a separate contingency plan in place when the radiation fails, will we have these lists lengthening and lengthening? It is not a good or an efficient way to run a health service. Obviously, I take on board that more machines are being put in place but we still have a situation where qualified radiographers who we have paid for through the system and who want to live and work in Ireland are being forced to go abroad. Like teachers and other professionals, once they go abroad, it is hard to get them back. It is a two-pronged thing. It is about putting the staff in place with secure long-term jobs and about making sure we have a plan B for when we are missing the isotope provision. We need a second supplier.

I will inquire of the HSE in respect of that, although I would make the point that we have an alternative. The HSE outsources selected patients to private radiotherapy providers to ensure timely access to treatment when clinically appropriate. There is room for improvement and we will continue to work towards meeting the targets. In St. Luke's Radiation Oncology Network, 65% of patients are within the target while all other centres are meeting the 90% KPI. Approximately €10 million is spent on outsourcing radiotherapy appointments every year and that is in addition to the privately provided services in Limerick and Waterford, which are contracted to deliver services on behalf of the HSE. Then there is an important service level agreement between the HSE and Health and Social Care Northern Ireland to provide radiotherapy on a cross-Border basis at the North West Cancer Centre, which I visited in Altnagelvin Hospital in Derry. That initiative offers cancer patients within a 90 minutes road journey of the city of Derry access to radiotherapy in Altnagelvin and this provides important access in the north west to patients who would otherwise face long travel distances. We are utilising private capacity and Northern capacity, which we have invested in as part of the North-South co-operation. We are trying to build up the capacity on all fronts.

Before I move on, Deputy Richard O'Donoghue would like to welcome TY students and teachers from St. Mary's Secondary School in Charleville, County Cork. The students include students from Limerick, Cork, India and Ukraine. I make special mention to the Deputy's niece, Eimear. Eimear O'Donoghue is also the Deputy's godchild. It is going to be an expensive day for Deputy O'Donoghue. Thank you for attending Leinster House and I hope you enjoy your visit.