I thank the Deputy. I will update the House that I have now met all of the advocacy groups representing the children, young people and families affected by spinal conditions. I thank them sincerely for their time and their honesty. I have heard directly from them about the impact that gaps in communication and long waiting times can and do have on children and families and I have assured them of my commitment and the commitment of this Government to improving paediatric spinal services. By way of background, the House will be aware that more than €30 million has been allocated to reduce waiting lists in this area over recent years. Targeted initiatives have been making some difference in how we deliver spinal services. It is important to point out that CHI has a ring-fenced theatre providing dedicated capacity. GPs can now access a clear referral pathway to prioritise urgent cases. Additional outpatient clinics have seen more than 600 new patients, which has reduced the waiting list for initial assessment by 40% year on year. We need to maximise capacity. Surgeons have been given the pathways to do so through national and international outsourcing. These initiatives are driving some progress. In 2023, 513 spinal surgeries were completed, which represents a 35% increase on 2019. The initiatives are delivering results for many children and families, although I accept not for all. The number of children waiting longer than four months dropped by 37% last year. At the end of April, 68 children remained on active spinal waiting lists for longer than four months. This is an 18% reduction compared with last year. However, as I have told the House before, what matters is the Sláintecare targets. We must not let the numbers distract from the reality. Progress on the part of CHI and the people in charge of delivering these surgeries has been too slow. Too many children are still waiting. The operational plan I received for spinal services did not propose a significant level of activity to meaningfully address the waiting lists or a level of activity that is commensurate with the level of investment that has been put in. When I met the CHI board on 14 and 28 April, I made it clear that addressing these waiting lists is a top priority and that we need a new and much more ambitious plan. I have asked for a revised plan to be submitted without further delay that effectively addresses the waiting list, obviously with the focus on the longest waiters and recognising the various levers that have been provided to the Government.
Sentiment score: 0.25
I will respond to the second part of the Deputy's question. In respect of both reports the Deputy and I await, which are very important reports that everybody is entitled to see, I am given to understand by CHI that it expects to receive them very shortly and in the next number of weeks. I feel as though I have said that before, however, and I really do expect to receive them. As I have said to the House previously, it is not directly within my control but I do expect to receive those very shortly. On the broader question of addressing the lists and the times, as we discussed previously, the more referrals and more outpatient clinics there are, the more people will be added to the waiting list. That is okay. What is not okay is the duration of time they are waiting. To be clear, the Government has provided significant additional funding, which has resourced an uplift in staffing and provided additional infrastructure. If Deputies opposite were saying there was no theatre or there was no ring-fenced bed or there was no increased access to MRI or there was no additional surgeons or provision for it or if they were saying there was no investment enabling national and international outsourcing to three additional sites in Ireland, as well as two hospitals abroad in the UK and the US, I would accept all of those things but all of those things have been done and there is no excuse for not getting on with dealing with the cases that need to be dealt with.
Sentiment score: 0.09
We are making the same case with regard to CHI and spinal surgeries. I am simply making the point that surgeons have to respond to the investment that this Government and this House has put into the services. I expect them to do that. On CHI and the hip dysplasia, it is a matter for CHI to give that number and to be able to confirm that. I will use every power I have to make sure they do that. I will request they publish that number and there is no reason not to. By way of caveat, I do understand that the reason for the numbers going back to 2010, which I gave to the Deputy in reply to a parliamentary question, is that any follow-up requirement relates to skeletal maturity, which is typically around 15 years of age. This is a clinically based decision as opposed to any other set of criteria. It is really important that CHI confirms the number of letters it has sent. It is not just CHI, it is also Cappagh hospital. They are two different numbers. I expect CHI to provide that and that the HSE would have provided that by now. I expect this information to be clear but I do expect it will continue to evolve. The most important thing is that we get the report, which will stand us all in much better stead on the next steps we must appropriately take.
Sentiment score: 0.10
I thank the Deputy for the question; it is an important one. I thank colleagues for their support on the approach taken to date. I want to be absolutely clear in relation to the intention with regard to the HRT initiative. Budget 2025 aimed to continue the good work ongoing to improve women's healthcare, and in particular to support women on their menopause journey. It was originally intended the State would pay for the HRT product - for the medicine - and pharmacies would be free to continue to charge a professional service fee to women who are not eligible either for the GMS or the drug payment scheme, DPS, while recognising there are many women who are getting this for free already. The programme for Government then re-emphasised the scope of that commitment. I have prioritised substantial engagement with the Irish Pharmacy Union to find a pathway forward on the issue. I listened to its position - and this is important - that its members did not want to see the cost of medicine and the dispensing fee decoupled under a State-funded arrangement. Nevertheless, the Deputy will be aware that I did of course give them that option to charge the fee they are currently charging. In the spirit of compromise I offered to invest healthcare funding on dispensing fees, which was not intended from a healthcare budget perspective and not intended as Government policy in this space. I offered every participating pharmacy a €5 dispensing fee for each and every HRT product. The €5 fee is the highest fee paid under the community drug scheme to date. It is essentially a 15% to 20% increase on the existing dispensing fee for those products under the GMS and DPS at present. I made that in order that it would be an uplift for all of the women who are on the GMS or DPS. It would be a 15% to 20% uplift on the average dispensing fee paid in that case. Of course it would be €5 for all of those private patients who are paying at the moment. I made that offer to every pharmacy by writing directly to them. I also spoke at the IPU conference last Saturday.
Sentiment score: 0.27
The first thing is that I issued a press release in relation to this and then went on a media outlet. I must check when the Deputy last went on a media outlet and whether she regards that as an effective way of communicating either her party's position or to her constituents in any way. It is certainly a way for the Government to communicate, as we often do. The fact that we go on a different show means what, exactly, aside from being a way of communicating directly and taking questions, having issued a press release and having engaged? There is no question of power in this regard; it is a question of delivering for women. I suggest, very carefully, that the Deputy goes back and discusses the IT system issues with whoever has briefed her regarding it. I have correspondence that says there are no IT issues, and we should watch that progress over the coming days and weeks. I acknowledge the lack of HRT. There is an issue of medicine shortages across Europe, as we have discussed before. That is precisely why I have tried to recognise the experience and expertise of pharmacists to make sure they are recognised for what they do. I am not exactly sure what the Deputy would have me do differently. I made them two offers: one was an uplift of 20% and the other was an offer to charge anything they liked. I am not sure what the Labour Party position would have me do on behalf of the women of Ireland in order to get this effected, but perhaps the Deputy might advise me.
Sentiment score: 0.11
I did.
Sentiment score: 0.00
I did.
Sentiment score: 0.00
That is just not true.
Sentiment score: -0.33
A diktat.
Sentiment score: 0.00
I cannot believe this.
Sentiment score: 0.00
Sure.
Sentiment score: 0.32
The €5 is the top fee that is paid under the current structure. The €6.50 is the once-off fee for contraception. I gave pharmacists the option to charge above €6.50 - €7, €8, €9 or €10, whatever they wanted - and they refused that. It is a very interesting position for the Deputy to have adopted this evening. I am trying to give every option possible to deliver for the women of Ireland, but I am hearing IPU speaking notes back, which is an interesting position for the Labour Party to take. What is the cost of setting the fee at €6.50 for the rest of the schemes that we have? We can tease this through over the coming days, but I strongly suggest and hope that pharmacists will sign up. The best option for the women of Ireland is a €5 dispensing fee to be paid to pharmacists because it makes it completely free for women. I would have thought that everybody in this House on the side of the women of Ireland would be behind that and working through the other issues that are also there. I engaged strongly with the IPU at its conference and since its conference. I thanked it for its continued engagement. I hope we will find a way through on all of these issues, but I have learned a lot about the Labour Party's position this evening.
Sentiment score: 0.35
I thank the Deputy for his ongoing work on this. Safeguarding adults who may be at risk of abuse is a very important objective for me, my Department and all health and social care services. A framework of standards, policies and procedures for safeguarding adults in the health and social care sector is already in place. This includes a national safeguarding office in the HSE, specialist safeguarding and protection teams in each health region, designated safeguarding officers within services and specific regulatory requirements for residential care services which are inspected by HIQA and the Mental Health Commission. Further measures are now being developed to strengthen that framework. My Department is at an advanced stage of finalising a national policy on adult safeguarding for the sector, in liaison with the Department of Children, Disability and Equality. This will be the first national policy in this area and is a significant development. Considerable work has already been undertaken to inform this policy, including an international evidence review, stakeholder engagement and a public consultation last year, which received more than 250 responses. I hope to bring this policy to the Government in the coming months. Second, the Government has included a health (adult safeguarding) Bill in its current legislation programme. This will facilitate underpinning legislation for this sectoral policy. Drafting of this legislation will commence once the policy is finalised. There is a pressing need for robust safeguarding frameworks. That was thrown into sharp focus for all of us again with the recent publication of the Farrelly commission’s report on the Grace case. I am mindful too of other safeguarding failures that we must work hard to ensure never happen again, including the recent Brandon and Emily cases. I assure the Deputy that this is a priority for me. I expect to see progress within my Department and on a cross-departmental basis this year. I expect to be able to update the Deputy in that way.
Sentiment score: 0.31
I agree with the Deputy. I also want to reflect the work of the Law Reform Commission report in this regard. I hear what the Deputy is saying with regard to policy. Of course, the policy analysis is to bring us to the legislative path, because that has to be agreed across the different Departments with regard to that. It is also important to note, though I know the Deputy is already aware, that while legislation is important, it is everybody's business to do this correctly in the meantime. It is everybody's responsibility. Driving a proactive and open culture of safeguarding is also a key focus of the policy, though I accept what the Deputy has said with regard to legislation. It is important to consider and acknowledge the role of the newly appointed chief social worker in the HSE. It is a newly created position and a person was appointed last year. It is a significant appointment. Similar to the chief nursing officer, these are important cultural signs about the importance of those roles and the functions they carry out. However, I agree with the Deputy in respect of legislation.
Sentiment score: 0.31
I agree and accept that. The health (adult safeguarding) Bill is in the current legislative programme, but the policy must be considerably settled and developed on a cross-departmental basis. This is as much a question for the committees on disability and children as for the Joint Committee on Health-----
Sentiment score: 0.21
-----because the roles of the Departments are equally important in how we take this forward and they must be clearly working together on it. This would be an important piece of work for the committee and I look forward to working with it on it.
Sentiment score: 0.37
The programme for Government commits to ensuring a transgender healthcare service that is based on clinical evidence, respect, inclusiveness and compassion. A new model of care is currently under development to strengthen and standardise care, ensuring safety and best practice. My Department provided €770,000 in budget 2025 to support this. The clinical lead has been appointed, a cross speciality clinical advisory group has been established and a review of the evidence base is under way. A community pilot project to identify the needs of children and young people who are gender questioning will also commence in the coming months. The model of care will be developed in a consultative way, engaging with healthcare professionals in gender healthcare, stakeholders, including people with lived and living experience and the families of people who use and receive support from services. It is important that the HSE is given time to develop a model of care that is based on the best clinical evidence and that will deliver the best outcomes for people with gender dysphoria based on respect, compassion and understanding. As the Deputy may be aware, the WHO’s international classification was updated to its current version, ICD-11, in 2019 and gender identity-related health diagnoses were moved from the chapter on mental and behavioural disorders into the new chapter on conditions related to sexual health. It is important to note that the ICD-11 is not clinical guidance for gender healthcare. It is a system of classification where criteria for various diagnoses are described. From our perspective, we want a holistic, compassionate, respectful service at every stage of a young person's or adult's journey, at every point of contact. That is the approach I will take as will everyone in the Department of Health, including all the Ministers of State, to this issue and I know it is the approach of this House.
Sentiment score: 0.40
I fully hear what the Deputy is saying. His feedback is important to me, as is everyone's. I did not congratulate him on his new position as Chair of the Oireachtas Committee on Health. I look forward to working with him on this and many other issues. We have a similar approach to these issues. It is important to recognise that demand for transgender healthcare services has increased and I acknowledge that the current public services are not meeting people's full range of needs. For that reason, the HSE is developing the new model of care for gender healthcare services. The Deputy is right to identify that it is not a mental health condition. Of course, it is not. What absolutely is the case is that a multidisciplinary approach, including endocrinology, psychology, appropriate counselling, psychiatry if and as needed and the support of social workers if required, offers the best pathway of support and that is certainly the approach I hope the model of care will lead towards.
Sentiment score: 0.16
I agree with the Deputy and the person-centred approach is what we want to get to. Everyone is entitled to healthcare. I agree completely with him on the points he raised and I hear his important perspective on the national gender service. It is important that it be articulated here this evening and I hear him clearly on it. I do not want to get distracted by the WHO definition, which is slightly more technical and does not sit against what we are speaking about in any way. It is not a clinical guideline. It is a classification system. I can give the Deputy more information on that by way of background if it is of assistance. It will not cross over the sort of model of care I want to get to, which sounds like what he is describing. There is no reason to be at cross-purposes on it. Perhaps we can speak about it in more detail. The model of care we are talking about is intended to be based on a consultation - putting people at the centre - with stakeholders, healthcare professionals and crucially those who use and receive support from the services and their families.
Sentiment score: 0.21