Questions on Policy or Legislation

We can all agree that the days and nights are getting colder. People are turning on their heating earlier and are keeping it on for longer to keep their houses warm. Many cannot afford it. One in four households cannot afford their gas bills. More than 320,000 households cannot pay their electricity bills. Families waited desperately for the Government to provide help in the budget but that help never came. There were no energy credits. There was no real support for working families. No action was taken to take on the big energy companies. Over the past fortnight, what have we seen? Energy company after energy company has hiked its prices. The rip-off bills are going in one direction and that is up. The pressure on folks is intense. I will ask the Minister a plain question. How many more families have to fall into arrears before the Government takes action and delivers the measures that people deserve?

Hear, hear.

I thank the Deputy. As he is aware, the fuel allowance is paid to 26% of households across the country and that increase of €5 will take place next year. We have also tried to take the measures we can at a cost of close to €1.4 billion, which is nearly the total uplift of the Department of Health this year, to try to suppress energy prices in different ways. Carbon tax on home heating oil and gas has been reduced and will not increase in the lifetime of the Government. The rate of carbon tax on kerosene and natural gas has been reduced to €48.50 per tonne. The extent of the intervention by the Government is not enough to meet everybody's need. It cannot be. It is more than comparable European countries, but we cannot meet every measure of this extraordinary energy crisis created by the war in the Middle East.

When is this Government going to take road safety seriously? In a week when we saw the Road Safety Authority, RSA, perform a U-turn on a shambolic plan to introduce breathalysers in pubs, we know that the start reality is that our roads have become a much more dangerous place to be. Statistics published today paint a harrowing picture. Today, there are hundreds of families grieving the tragic loss of a family member and communities grieving the loss of a friend and loved one yet, the number in the Garda traffic corps continues to decline. Simply put, the Government’s response and that of the RSA to road safety does not match the harsh and stark reality on the ground. I have serious questions. Does the Government have any plans to reduce road deaths? Does it have confidence in the Road Safety Authority? Where will that €1.5 million that the Road Safety Authority was going to spend on breathalysers go?

The Government is committed to taking the steps that it can to increase road safety. The number of road deaths is not acceptable. We are going into a bank holiday weekend and darker weather. It is incumbent on everybody to make sure that they are slowing down and taking appropriate steps to maintain their own road safety and that of everybody around them. The Garda continues to enforce traffic laws and engage in breathalysing but it is important that every person in this House and everyone we know continue to take the steps we must take to make sure that we are not speeding or taking risky driving decisions, particularly in the wet weather to come this bank holiday weekend.

Last Thursday night, I attended, with my colleague Councillor Pat Balfe and Members of this House, a meeting organised by the Irish Medical Organisation, IMO, and other unions about very serious staffing and patient safety issues at Naas General Hospital in Kildare. We were told that admissions into the emergency department were already 10% above this time last year. There has been a 28% increase in over-75s attending the ED, ambulance admissions are up by 13% on this time last year and it is now not unusual to see over 100 people in the emergency department at any one time. Staff are at breaking point, saying that the hospital is too small for the population it serves, with every corner and nook of the hospital now being used for patient care. Time and again, staff stood up to say that the hospital was dangerously over capacity and that both staff and patient safety was being compromised. Will the Minister respond to these genuine concerns? What plans has her Department to provide additional staff to Naas General Hospital? No staff member at the meeting wanted to contemplate what could happen to patients if this serious problem was not addressed.

I thank the Deputy. Naas is an important model 3 hospital. It has had a bigger staff uplift than most other hospitals; it has had a 40% uplift in staff since 2020. That is even in circumstances where it has a very high proportion of agency staff. Naas is one of the hospitals where we should be targeting the new graduate recruitment in particular to make sure that it is not dependent on agency and that it has permanent staff, but there is a very significant uplift in permanent staff. I would also like to highlight and compliment everyone in Naas for the fact that, over the last ten days, there have been seven days in the green threshold, which is the safe emergency department. That is due to their work. There is a very significant increase in staff and they are maintaining a very safe hospital, and that is to their credit.

“Cancer can be cured with herbs". "Cancer is actually a yeast". "High fevers in young children are a good thing". This is some of the health “information” that was given to participants in the "A Journey of Healing" seminar that was held in Ireland last week and is discussed in an article in The Journal. The recommendations came from an Australian citizen who has actually been banned from providing any health services, including advice, by the New South Wales Health Care Complaints Commission. As chair of the Oireachtas cross-party group on cancer, the issue of health misinformation, particularly cancer misinformation, is a real priority for the group members. With the huge proliferation of online sources, some of which are giving misleading, incorrect and deeply dangerous information to patients, will the Minister outline what steps the Government is taking to address this? Will she work with the cross-party group on cancer to bring forward legislative solutions to this deeply dangerous misinformation?

I thank the Deputy for highlighting this and for his own work on HPV and the HPV vaccine, which he raises consistently. In many ways, it speaks to the intersection of this – the importance of preventing cancer where possible and the importance of good-quality information and of trusting that information. This is a state that is based on science and respecting science. We have seen other states move away from that very fundamental principle but that will not happen in Ireland. We are committed to the truth about health and vaccinations and to science-based, evidence-based decision-making in healthcare. That is going to be the case whether it is bringing a new drug into Ireland, being very honest about its efficacy or otherwise, being very honest about the efficacy of different types of vaccination, and being transparent in how we make decisions. I am happy to work with every group on improving cancer care. We are evaluating the cancer strategy at the moment and will be developing a new one. It is really important that the Deputy’s cross-party group is involved in that too.

Vape shops are growing at an extraordinary rate across the country. Regional and small towns often have three or four popping up overnight. We all know that vape shops are targeting young people in terms of smell, their other senses and marketing. Some of these vape shops are located very close to schools and appeal very strongly to our young people. They are a huge concern. There appear to be no regulations that assist local authorities, the Department of Health or any other State agency to try to restrict the proliferation of vape shops in our country. I am asking the Minister to engage with us on this and try to restrict vape shops. I ask she Minister research the matter. I am also concerned with the lack of monitoring on this.

The Minister of State, Deputy Murnane O’Connor, brought legislation through the House to ban smells, flavours, colours and anything else that made nicotine addiction products more attractive to children. That has passed and gone to the President to be signed. That is an important part of this. We are already in a conversation with local authorities in respect of the proliferation of vape shops, which are bad for public health in terms of the availability of vapes and which are not good for our towns and villages, given the proliferation of such disgusting shops. We are already in that space and would welcome the Deputy’s support for it.

I welcome a line in this year’s budget that got very little attention, namely, the pilot scheme to support early access to new medicines. For the 300,000 people in this country living with a rare disease, that budget line is incredibly important. As the Minister knows, Irish patients still wait longer than most of our European counterparts for access to these medicines. It is often in excess of 800 days. For a person with Duchenne muscular dystrophy or Friedreich's ataxia, those 800 days or so are time they do not have. This summer, we saw Skyclarys approved for Friedreich's ataxia after a long and exhausting campaign, so I welcome the early access scheme that the Department is devising. How much has been allocated to the pilot scheme? Which medicines and conditions will it cover? There are rumours that it might exclusively be aimed at cancer, so I ask that the Minister clarify. When can we expect the first patients to benefit from the scheme?

This year is evidence that we have prioritised drugs for rare diseases and the speed with which they are approved. What we cannot control is the conduct or participation of the drugs companies. The Deputy will be aware, particularly in relation to Skyclarys, that we were waiting for an extremely long time for the drugs company to submit the different pieces of documentation, including its commercial proposal. I am very glad that it got resolved in a way that was cost effective and, therefore, possible for the State. There are patients now getting that medication, as there are patients getting givinostat. Indeed, I have met many who have now got it. We have been able to execute getting that to patients very quickly. We will continue with that focus but we are not going to prejudge what those applications may be or what those medicines that come to the Irish market will be. As the Deputy is aware, we had to convince and invite Italfarmaco to bring givinostat to Ireland because, as a small market, we compete in terms of attractiveness. We had to work very hard to even have the application made.

The integrated design team for a 300-bed block project for University Hospital Galway was appointed and approved last May. Ward blocks A and B, each comprising of 150 beds, are the first two phases of the capital programme for University Hospital Galway, which will be followed by a cancer centre, new laboratories, a permanent helipad and a new emergency department. What engagement has the Minister had with the HSE, the Saolta University Health Care Group, and the regional executive officer, REO, of HSE West and North West on the designation of blocks A and B, or initially block A, under the Critical Infrastructure Act 2026 or are we at an advanced enough stage to designate the project if another designation list goes to Cabinet this year?

I thank the Deputy for his repeated advocacy on behalf of University Hospital Galway and the master plan to develop this over some period. I also thank him for facilitating a meeting recently between myself and Cancer Care West to be able to discuss some of the detail of that. With regard to critical infrastructure designations, there is more work to be done by the project team and hospital, but it is exactly the kind of project we would like to see included in critical infrastructure processes. The hospital has to get to a further stage of the business case and planning application preparation to reach that point, but I will be an enthusiastic supporter of it then.

I raise mental health services for young people in Kildare South. As the Minister of State will be aware, we are in a crisis in youth mental health, with services oversubscribed across the State. In Kildare, the situation is particularly acute. Some 14 people died by suicide in Kildare in 2023 and, in recent times, one of the essential services supporting young people was shut down. I welcome the €1.1 million investment announced in budget 2027 for a new Jigsaw service in Newbridge, which is badly needed. However, there is currently no building for the service to operate out of and no obvious alternative. Will the Minister of State personally intervene to provide for a new building and ensure that there is no further delay to the establishment of the new Jigsaw service in Droichead Nua?

I thank the Deputy for her question and for welcoming the extension of the Jigsaw services for young children and adolescents who suffer with mild to moderate mental health challenges. I recently opened a service in Waterford, which was only the second in the past three years because Jigsaw changed its model of care for a while. However, I am delighted that, working with the Minister, I secured €3.6 million in the budget to extend the provision of Jigsaw services across Kildare, Dún Laoghaire, Cavan-Monaghan and Sligo-Leitrim, which will be welcome. The funding provided for the Kildare area was the largest proportion at €1.1 million. It will be a hub-and-spoke model based in Newbridge, with spokes coming out of it to cover the whole of County Kildare. I have been working closely with my colleague, Senator O'Loughlin, who is in correspondence with the local authority to try to secure a premises. I believe we are close to securing one. It is helpful if we have the support of local authorities in providing premises at a reasonable rent so that the bulk of the money can be spent on providing the services by the multidisciplinary team that is in place.

Earlier this month in Britain, the Medicines and Healthcare products Regulatory Agency announced that new safety measures were being implemented for all patients taking antidepressant medications. This follows the completion of a detailed review involving patients and their families of how the risk of suicidal thoughts and behaviours are associated with these medications. Campaigners such as Ms Stephanie McGill-Lynch from my area and Mr. Jim Connell from Meath lost their children by suicides that were related to side-effects of prescribed medications. They have been calling for similar measures to Britain's to be introduced in Ireland in the interest of patient safety. Will the Health Products Regulatory Authority, HPRA, adopt the changes implemented in Britain? If not, we will have a situation where patients in neighbouring counties, such as Fermanagh and Cavan, will be getting different information about the dangers of the medication they are taking. Can this disparity be justified in the interest of patient safety? What does the Government plan to do to address it?

I thank the Deputy for raising this important issue. As he will be aware, we launched the new national suicide reduction and self-harm reduction strategy earlier in the year. Since 2000, we have seen a 33% reduction in suicides in Ireland. Every suicide is one too many. Currently, our number is 8.6 per 100,000 in the Republic of Ireland and we want to get to a complete reduction of that. The lowest number of suicides anywhere in Europe is 6 per 100,000 in the likes of Cyprus and Malta, which has been put down to the fact there are some benefits from being in sunlight. A worrying statistic is that the number of suicides in Northern Ireland is double that in the Republic of Ireland at 16.5 per 100,000. The deputy chief medical officer, Professor Philip Dodd, is in contact with the Northern Ireland Minister for Health, Robbie Butler MLA - no relation. I met him recently about the suicide challenges being dealt with in the North. I will certainly refer the Deputy's question to the Chief Medical Officer, CMO's office and the Irish College of Psychiatry because anything we do will have to be evidence-based.

The cost of childcare for families with young children has often been described as carrying the burden of a second mortgage. While the budget provided some welcome relief for some families, parents are still feeling the pinch of childcare costs. Notably, parents are concerned that the childcare fee cap will not assist crèches that opted out of the core funding scheme, that it is limited to children in full-time care and that it still does not go far enough. Parents who are not in the core funding scheme or are not using full-time care need more help to bring down childcare costs. Will the Minister advise on whether further action can be taken by the Government in this regard?

We are trying to place a continuing focus on childcare because I, like many others in the House representing their constituents, know well the cost of childcare. The core funding scheme is the mechanism in place at the moment. It is an effort to try to bring as many crèches and childcare facilities into a State-based scheme as possible. However, I recognise that there are people outside it. There was an effort to try to increase childminding in the home by extending the tax-free threshold and the number of children who can be cared for in that environment. I will discuss it with the Minister, but the core funding scheme is the model that works. That said, I recognise that many childcare providers, including some in my constituency, choose not to be in it for one reason or another. The State is trying to provide a maximum benefit to the maximum number of people and has done that through the core funding model.

I thank the Deputy. He will be aware that 36 hospitals have a charge for parking, with a maximum daily rate, and another nine do not have a charge. Parking is entirely free at Bantry, Mallow, Ennis and even in St. Luke's Hospital in Rathgar. There are four hospitals where the fixed daily rate is above €10: St. Vincent's University Hospital; St James's Hospital; the Mater Misericordiae University Hospital; and St. John's Hospital. In many cases, they are in an arrangement with a private contractor. However, we are trying to limit car parking charges for patients. We are engaged in a review of it at the moment. There is one factor I am concerned about, which is that I do not want to make car parking so accessible that people who are not using the hospital choose to use its car parking. There is a balance around that I am concerned about, particularly in inner city Dublin or inner city Cork. We are trying to provide maximum accessibility - the Deputy's suggestion is good - while making sure that car parking in hospitals is used for the benefit of patients and not third parties.

According to the Irish Nurses and Midwives Organisation, INMO, September was the worst September on record for hospital overcrowding. Facts matter in these debates. There is a permanent state of crisis in the accident and emergency departments. Some 70,000 people left an emergency department without being seen or completing their treatment between January and July of this year. This is utterly unacceptable. More than 30,000 people waited longer than 24 hours to be admitted or discharged. This should be setting off alarm bells in the Department of Health. There are three solutions that need to be advanced. We need to build more beds. We have the fifth lowest number of hospital beds per capita in Europe, according to Eurostat. We need 300 additional beds per year according to the Economic and Social Research Institute, ESRI. Last year, the Government was 100 short. This year will be even worse. However, the answer cannot be found in hospitals. We must invest in community care. There is a shortage of GPs, step-down facilities and home care. Some 100,000 bed days were lost due to delayed discharges last year. There are solutions to be found in investing in community services and, ultimately, we must reorient our health service away from acute services into the community and deliver Sláintecare in full, focusing on prevention and early intervention. Will the Minister provide the beds? Will she provide the staff? Will she commit in full to Sláintecare?

I am conscious that the region the Deputy represents has been the beneficiary of exactly that type of care outside Cork University Hospital, CUH, in Mallow in community nursing units, yet there is a continual articulation about putting money into CUH and vacancies there when, as the Deputy correctly said, the emphasis must be on the community. In this year's budget, we have increased yet again the budget for older persons, for meals on wheels and for all of the types of day-to-day hospital-avoidance pieces that are so important. We will continue to do that. People waiting in hospital is not a uniform experience; it is very much a hospital-by-hospital experience. Patients in the Beaumont region, the Connolly region or the Drogheda region, all hospitals that have improved, will have a different experience from those in Cork based on how their hospital is managed, one that is not linked to resources that have gone into that hospital. The hospital in Tipperary has had a difficult few weeks but it has consistently improved over 2025 with an 81%-----

This is one of the largest hospitals in the country.

Indeed. It has the highest recruitment and yet has never improved its position, depending on how it has been managed.

It needs investment-----

Is it not extraordinary? St. James's is a bigger hospital and it has ten people on trolleys today. It is in an area of just as big a difficulty. There is an onus on management to make sure that it is using the resources it has.

Hear, hear.

As the Minister knows, one in ten women in this country suffers from the condition of lipoedema. It is a chronic progressive condition. As the national lipoedema working group on diagnostics and management does not actually specify surgery as part of that management, women end up having to go abroad. There are huge delays in processing the cross-border directive scheme applications at the moment. The women who are approaching us point to a 12-month wait. For most people, it is a nine-month wait. The HSE should be getting back to people within 30 days. Is there something specifically happening with regards to the treatment of lipoedema patients travelling abroad? Some women coming to me have spent over €10,000. They cannot afford to wait 12 months or longer to be reimbursed by the HSE.

The Deputy is right on both counts. The cross-border directive scheme reimbursement has slowed down. I have put in place a deadline of Christmas to get back to where we had been. The Deputy is quite right to highlight that it had slowed down. Lipoedema is an issue raised by her and also by Deputy Maeve O'Connell. I have spoken to Dr. Colm Henry about the programme of care for that. This is an area of women's health that has not been understood. It is a very serious condition. It impacts about 11% of women and can lead in different ways to lymphedema, which is even more impactful on women. I am very aware of what the Deputy is saying and it is something I need to follow up more on.

In recent years, the State has proven itself to be particularly adept in offering State apologies - long sought and richly deserved apologies. I am thinking of yesterday's quite appropriate apology to the family of Brian Stack. I am thinking also of the apologies offered to Shane O'Farrell's family, to the victims of Kennelly in Waterford and to the families of the Stardust victims. All of them had to wait a very long time to receive their apologies. There is one glaring omission from that list and it is the survivors of thalidomide, the 40 or so people still living who were abjectly failed by the State over 60 years ago. I know the Tánaiste met with survivors in July. When can we expect those 40 survivors and maybe even more significantly the tiny number of remaining mothers who are at a very advanced age to receive from this State the apology to which they are most definitely entitled and the supports they need to live out the rest of their lives in dignity?

I thank Deputy Ó Fearghaíl raising this. I am very conscious of the ongoing quest that the survivors of thalidomide have had, including Finola Cassidy from my constituency. I know that they have met the Taoiseach and Tánaiste at least once, if not several times. There is a strong desire by the Government to address their very real concerns. I hope and expect that that may be resolved and that any remaining barriers on any side would be set aside for that to be completed for the benefit of the survivors of thalidomide.

I ask the Minister about the drug-related intimidation and violence engagement, DRIVE, programme, which is funded by her Department. We all recognise that drug-related intimidation is endemic the length and breadth of Ireland at the moment. We have seen the horrors of that in its full force last week. Last year, the DRIVE programme received annual funding of €280,000 from the Department of Health. That was increased in September with an extra €65,000. What funding has been allocated to the DRIVE programme in this year's budget?

The Deputy is right; that is within my Department. We are in the process of developing the letter of determination for the national service plan for 2027. I will have to come back to him with a specific amount because that is not finalised. However, we have put significant additional funding into the implementation of the drug strategy this year, of which, of course, that is an important part. There is an additional €7 million on top of what was there before, so it is now €11 million for the implementation of the drug strategy. A key part of that is working in the community, with communities, with drug and alcohol task forces and the DRIVE programme, which is important and excellent. I hope people will have confidence in it. That comes in part by continuing to fund it and make it available. I will come back to the Deputy with more specifics.

Over the last number of years, landowners have been terrorised by Transport Infrastructure Ireland, TII, and its compulsory purchase order, CPO, powers to railroad walkways, cycleways and greenways through their farms, splitting working land and pulling down farm sheds, all in the name of walkways and cycleways costing tens of millions of euro without a worry in the world. If a landowner says "No", TII waves the CPO. This scandalous carry-on has to stop. It has to be taken out of the hands of TII and the CPO needs to be dropped completely. I will give the example of one landowner in Ballinascarty. After being told that a proposed walkway would go through his yard and after he explained that there were a milking parlour, calf sheds and cattle buildings, he was told not to worry about those and that TII would shove those sideways. It was as if his whole livelihood was Lego. Landowners know that they are in real trouble with this mindset. Landowners on the Cork-Kinsale road, the quiet road in Belgooly, the Bandon-Ballinascarty road, the Skibbereen-Baltimore road and others throughout Ireland do not want their lands compulsorily purchased for greenways. The delivery of walkways needs to go back to be being delivered by communities, not dictated by TII.

The reaction and support for greenways are very significant. TII is doing a study to ascertain everybody's view on how locals feel when a greenway was put in. Results may be only preliminary but they are very positive, with 95% believing that greenways benefited their communities while 92% would recommend greenway development to other communities. It is very much about how the whole community benefits from an investment of that kind, which is a key part of using our community but also the health and well-being aspect of greenways. There is broad positivity towards greenways and I hope they will continue appropriately.

It is scandalous.

I am not in the habit of bringing up traffic on the floor of the Dáil, but such is the scale of the traffic chaos in my home town of Swords that I am having to do it for the second time in three months. I am glad the Minister for Health is here. Due to long-term road closures to facilitate works and huge traffic reorientation projects on the R132 dual carriageway, people's lives are being impacted. They are getting stuck in traffic for 45 minutes when it should have taken five. Right in the middle of this is a Dublin Fire Brigade station and a HSE ambulance station. I have received reports from workers at both those stations that their ability to respond quickly and effectively to emergency calls has been impacted by these road designs. I cannot go into the detail because I do not have the time, but the Minister for Health needs to investigate this because it is impacting the ability of ambulances to get to sick people.

Of course, I will follow up with the National Ambulance Service to see if it has had any specific issues. The Deputy will forgive me; I am not familiar with the road, which is on the other side of the city from me. I will, of course, flag this with the Minister for Transport, who is trying to put significant long-term investment into finding alternative transport solutions for that area.