I propose to take Questions Nos. 1 to 9, inclusive, together. On 4 April, I chaired the first plenary meeting of the Labour Employer Economic Forum since the formation of the new Government. The LEEF is made up of representatives from the Government, employers and trade unions and provides for tripartite dialogue on economic and employment issues as they affect the labour market. The meeting discussed the latest economic and trade developments, in particular the challenges arising from the US decision to impose tariffs on imports from the European Union. The meeting was also briefed on the potential to strengthen the all-island labour market for the benefit of employers and workers on the entire island. There were also updates on the preparation of Ireland's action plan on the promotion of collective bargaining, on a number of broader labour market policy developments, and on remote and blended working policies. Finally, the meeting agreed to finalise a work programme for the LEEF for the period ahead and to re-establish a number of subgroups. Alongside plenary meetings, the LEEF also meets in subgroup format, chaired by the relevant Minister. The recent plenary agreed to the re-establishment of the following subgroups: enterprise and employment, chaired by the Minister for Enterprise, Tourism and Employment; apprenticeships, chaired by the Minister for Further and Higher Education, Research, Innovation and Science; early years, chaired by the Minister for Children, Disability and Equality; and pensions, chaired by the Minister for Social Protection. A shared island working group, chaired at official level, has also been re-established. It was also agreed to re-establish subgroups on health and on housing, following further engagement with relevant Departments and LEEF partners on their respective agendas. The date of the next meeting of the LEEF plenary has not yet been scheduled.

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The question is about the LEEF.

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I think Deputy McAuliffe was the first contributor. He raised pensions and pensioners' input into their pension issues. It has been an ongoing concern for pensioners generally across the economy, particularly for public sector pensioners or those in agencies and so forth. There is a sense that once they leave employment, they lack any real influence over their pensions in the future. I will raise that issue with the Minister for public expenditure, who governs pensions within the public service, and the Minister for Social Protection. There is a pensions ombudsman. A lot of frameworks that were not there in times past can help pensioners to access details about their pensions. It is a growing issue. Recently, the CIÉ pensions issue was resolved through good negotiations and the involvement of unions. That illustrates the degree to which unions can play a constructive role on behalf of workers in respect of their pensions. Deputy Murphy raised the PPPs. I presume and draw from my conclusions that he supports the decision not to go ahead with PPPs that were too expensive in terms of the cost per house. That is the decision the Minister for housing took when he looked at the figures that came in after tender. They were excessive and could not be justified at that stage. Deputy Coppinger raised an issue. I cannot comment on any specific company. In Ireland, we are working through the LEEF on a collective bargaining action plan. The directive on adequate minimum wages in the European Union was published in 2022. It was transposed by Ireland by 15 November 2024. Under Article 4, the directive aims to promote collective bargaining on wages in all member states. In addition, each member state with a collective bargaining coverage rate below a threshold of 80%, as in Ireland, shall provide a framework of enabling conditions for collective bargaining and establish an action plan to promote collective bargaining. A technical group was established with the Department of enterprise and social partners in 2023 to consider the possible content of Ireland's action plan. A public consultation was also held on the content of the action plan. That closed in May this year. The Department is now reviewing submissions. They will help to guide the finalisation of proposals, both legislative and administrative, which may be considered for inclusion in Ireland's action plan. It will be published by the end of 2025 in line with the requirements of the EU directive. Deputy McGuinness raised the question of investment in Waterford. I have to disagree; I think there has been significant investment in Waterford over the past five years in particular. There is now a university in the south east, with a strong campus in Waterford benefiting from significant investment. Waterford University Hospital, likewise, has benefited from significant investment. The North Quays project in the urban regeneration and development fund has been a significant investment. On FDI, the IDA is focused on Waterford. Some good companies have located there, across life sciences and financial services, which is positive. You cannot just go on one year because in some years there could be a significant increase and in others there can be a lapse. An individual company could have a decline.

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There is going to be a flow and a fluidity in this from year to year, but the overall picture of investment in the south east and in Waterford has been positive and will continue to be in terms of Government commitment to the county. Deputy Moynihan raised the very important issue of SMEs, and that is covered by the LEEF. Divergence in employment standards and taxation issues between North and South were mentioned. We have more work to do under the shared island aegis in the context of cross-Border workers. The Minister for Finance has been engaging with the Minister for Finance in the Executive. The taxation issues are thorny and complex because they also relate to how cross-border taxation is dealt with in the European Union itself. It is a growing issue since the onset of remote working. Deputy Ó Murchú raised this as well. It is a continuing issue. The Minister for Finance is focused on it. It is something LEEF is concerned about. Supply chains are becoming more seamless between North and South and in some sectors like dairy and energy it is a seamless market or a continuum of trade and so on. It is therefore important we try to get some position that is advantageous to workers, but we do not necessarily want to distort the economy of either jurisdiction, especially the North, in terms of its labour force. Deputy Dolan raised schools. Schools do not get considered by the LEEF. SNA allocations will obviously have to be fed through the National Council for Special Education, which makes recommendations. On the allocation of SNAs, the numbers have grown exponentially and there are about 20,000 SNAs in the system. I will alert the Minister for education to the Deputy's raising of these issues. Deputy Ó Murchú raised the tariff and the Army pensions. Again, I will relay that to the Tánaiste. I dealt with remote working. The LEEF has considered that. It is very conscious of the potential implications of tariffs on trade for employment. We have urged that we avoid a knee-jerk reaction. People were immediately looking for subsidies, which would have been the wrong thing because that situation has not unfolded yet. A lot depends on the nature of the trade deal between the European Union and the United States. I hope they reach a headline agreement before 8 July. I am hopeful they will and that the landing zone is one we can all live with, although it will be challenging and difficult for many companies, such as those in agrifood and general exports into the US. If there is a minimum floor of a tariff, that could be challenging for companies, so we will assess it in the round in terms of how we deal with it.

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I propose to take Questions Nos. 10 to 20, inclusive, together. The Cabinet committee on health last met on 4 June 2025 and is due to meet again on 17 July 2025. It oversees the implementation of programme for Government commitments in relation to health, receives detailed reports on identified policy areas and considers health reforms, including Sláintecare and the reform of public health and health system preparedness for future health threats. It also receives reports on programme for Government commitments in the areas of mental health and drugs policy. Path to Universal Healthcare: Sláintecare & Programme for Government 2025+, our latest Sláintecare strategy published last month, aims to forge the way towards accessible, affordable, high-quality, healthcare for the people when they need it and where they need it. We will continue to build our workforce through the recruitment of key roles, retention measures and additional college places for key disciplines. We have capacity to hire a further 6,105 whole-time equivalents, WTEs, to Department of Health-funded posts during the remainder of 2025. We will deliver faster access to care. Funding of €420 million has been allocated for the waiting list action plan 2025. We will continue to review capacity in emergency departments. We will increase the number of public-only consultants in emergency medicine and ensure more senior staff are rostered in emergency departments during weekends and public holidays for better decision-making. The construction of 297 new and replacement acute beds is expected to be completed in 2025. The surgical hub for south Dublin opened in February this year, with additional hubs becoming operational later in 2025 and 2026. We will continue to invest in a healthier future with a national physical activity framework and action plan due to be published in 2025 and a new obesity policy and action plan to be published in 2026. We are launching a new era of innovation and digital transformation in health. The national patient app has been rolled out, with additional features to be added later in the year. The national shared care record will be developed throughout the year and the electronic health record will also be progressed. Additional projects which are key to the increased digitalisation of the health service include a national system for electronic prescribing and remote health monitoring and virtual care solutions. In mental health we will continue to build the mental health workforce and infrastructure and support community-based services. In older people’s services we will support people to live at home within their communities and strengthen the nursing home sector. The welfare of residents is at the forefront of Government’s concerns. The forthcoming national policy on adult safeguarding for the health and social care sector, which is a programme for Government commitment, will set out how existing protections will be strengthened. This policy is near finalisation and will be brought to Government shortly. All these commitments build on the investment and reforms undertaken over the past number of years, including the delivery of approximately 1,282 acute beds, an increased workforce of close to 30,000 since the start of 2020, more affordable healthcare through reductions in the drugs payment scheme threshold to €80, removal of hospital inpatient charges, extension of the eligibility for free GP cards for all children under eight and to all earning no more than the median income, State-funded IVF, free contraception for women aged 17 to 35 and free access to HRT therapies. From September 2021 to April 2025, there has been an almost 60% reduction in the number of people waiting longer than 12 months. Care is being delivered closer to home in 180 primary care centres through 96 community health networks, 27 community specialist teams for older persons and 26 community specialist teams for chronic disease are now operational. Some 23 community intervention teams are operational, with national coverage secured. The new regional structures within the HSE have been established with six new health regions and 20 integrated health areas. Health and social care services are planned and delivered around the specific needs of local populations and this leads to better co-ordination of care and access to services. We will continue to invest and reform.

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I will start with Deputy Sherlock's questions on the patient safety (licensing) Bill and cervical cancer screening. The patient safety (licensing) Bill came through Cabinet today and the Minister can go through the details with the Deputy in due course, in terms of specifics on safe numbers, safe staffing and so forth. A lot of it has been introduced without legislation in accordance with agreements. The Minister will continue to resource the cervical cancer programme and other cancer screening programmes. It is important to say screening programmes are the first stage. They are population screening programmes designed to intervene early and identify but they are not the ultimate in diagnostic approaches. If people present with symptoms, they may need more detailed diagnostic assessment. We have to get the balance right. The public needs very clear information on screening programmes and what they can achieve and on the importance of always consulting a GP or consultant. That is extremely important because there are limits to screening programmes. There are calls to expand the number of screening programmes in different areas. We have made a lot of progress on cervical cancer screening because of new technology and new methodology but we are open to improving further and engaging with the various groupings to see what issues have been identified as problematic and how they can be improved. I will talk to the Minister for Health about that. Deputies Daly and Cahill raised the shingles vaccine. My understanding is it is a significantly expensive vaccine. I am struck by the research Deputy Daly cited regarding its impact on the risk of dementia. A figure as high as 20% is very significant. He said the research was published recently in Nature so I will talk to the Minister for Health about that. Generally, I am a supporter of vaccines. As a public health intervention, they have been extremely effective in the history of this country. People are not dying of what people died from 100 years ago anymore, primarily because of the successful introduction of vaccines to deal with a lot of infectious diseases. That is easily forgotten in modern discourse and debates. The Covid-19 vaccine was essential to society coming back to some degree of normality. Without that vaccine, we would still be in deep trouble. It is important to state that. I will go to the Minister in respect of that. Deputy O'Rourke raised CHI. Every family must be told whether their child required surgery. There has to be complete transparency from CHI in respect of that. There has to be diligent follow-up with all concerned, as it declared. We will ensure that happens. I will talk to the Minister on engaging with CHI on that issue. Deputy Coppinger raised CHI, again, and the issue relating to young boys. That is a very serious issue, which needs to be addressed transparently and comprehensively by CHI. The HSE and the Department of Health should be involved in respect of that issue. The Dickson report from 2017 on urology services in CHI proposed the consolidation of all paediatric urology services into a single, cohesive centre, the establishment of a multidisciplinary urology team and so forth. That key issue needs to be further examined in light of that report. The issues the Deputy has identified should have been disclosed earlier. That is a very good agreement between the HSE and the unions. Healthcare staff numbers have risen enormously in the past four to five years, with 30,000 extra. We cannot keep on saying, "Let's get another couple of thousand." There has to be a balance.

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There is not a huge shortage. Thousands of people have been recruited. Let us be straight about it. The seven-day use of hospitals is something that should happen. It should not be dependent on more and more staff. The assets were not being used. Expensive diagnostic equipment was not being used optimally and the hospitals themselves were not being used optimally when there were five-day, nine-to-five services. Productivity matters, as do new devices and new technology. We need a broader approach to get better value for money. We have invested hugely in health and that needs to be acknowledged. Productivity and value for money are also factors. We are recruiting a further 6,000 in 2025, in addition to the 30,000 that have been recruited. I accept the population is increasing and that will create demand for services. It has created a lot of demand for health services. The population is ageing, which is creating further demand for the health service. That deal is a good one and will lead to greater productivity in hospitals and health services. On mental health issues, the Minister of State, Deputy Butler, has been doing significant work on eating disorders. Deputy Devine could talk to her about the specifics of the cases she has raised. We need more investment in eating disorder centres but we have had some. A lot of progress has been made in that respect. Deputy McGuinness raised cardiac care. Much progress has been made in the past five years in respect of cath lab investment in Waterford. It has been incrementally building up. There has been quite good investment in the past two to three years. Now we will complete that in terms of 24-7 provision. That is a Government decision that has been taken and that will happen. Recruitment in healthcare takes time. It does not happen within two months but it will happen and that will be developed, as committed to by Government. Deputy O'Sullivan raised the reimbursement of medication. More progress needs to be made on the reimbursement of medicines. Quite a lot has been made. I met IPHA representatives who represent the pharmaceutical industry here. Understandably, it is promoting this but when I questioned IPHA members two years ago, they were more or less saying they had a good enough relationship with the national pharmacovigilance unit. As a country with a strong concentration of pharmaceutical companies and which produces some of the most effective medicines in the world, we should have a modern, up-to-date reimbursement process. However, that has implications for public expenditure. Progress has been made but we need to make more, and we need to meet the standards and European norms. Deputy Cahill raised the shingles vaccine. I do not doubt the benefits but the expenditure would be significant. We need to bear that in mind. I join Deputy Ó Murchú in offering sympathy to Kofi's family. It is heartbreaking that any young person so talented and with so much to offer in life should die in such circumstances. The Deputy mentioned Isobel McCluskey as well. The national emergency forum - there is a more precise title for it - did a lot of work on water safety in terms of swimming in rivers and in the sea over the past two years, and on prevention. One of the most effective interventions in healthcare is prevention. Public health messaging on accidents is a key dimension of that and is a factor in injuries and deaths. Our sympathies go to all in the community and the families affected. Deputy Murphy raised the issue of allergies. We have multidisciplinary teams involved in allergy. I defer to medical and professional advice within our own system on the provision of oral immunology therapy. It is a complex area that takes a lot of building up of immunology. A lot of children have spent a lot of time with consultants so I am slightly worried. I am not an expert on this but I defer to proper, professional advice as to when such medicines could be accessed or used. I say to everybody out there to consult their GP and consultant in respect of the utilisation of any therapies in that regard. Deputy Connolly mentioned nursing and 6,000 critical skills permits, of which I think he said 5,000 were in nursing. There are two ways of looking at it. A lot of young graduates travel and have been travelling for a long time in the medical world. There may be an issue of retention. Some come back to work in Ireland later on and there are huge specialties available to nurses in Ireland. There are huge programmes, including postgraduate programmes and specialist programmes. We have developed the likes of intensive care nursing and cardiac nursing very well with native talent. There has been phenomenal change in nursing in Ireland over the last 20 years, from the degree programmes to the postgraduate programmes. However, there is an issue of retention and retraining people and we have to be more innovative in terms of how we do that into the future and we then attract nurses from other jurisdictions into the country.

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That is very unfair of Deputy Tóibín. He arrived late himself.

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I am normally very generous, Deputy. Come on. I am normally very generous.

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In the first grouping, there were many questions answered. I accept there are several questions in the third grouping. A lot of people did not turn up at all at the beginning. It cuts each way. All of the Deputies wanted this session------

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-----but the number of Deputies who were absent at the beginning of this session left me surprised.

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