On behalf of the Minister, I thank Deputy McCarthy for the opportunity to update the house on ambulance service provision in east Cork. I thank him for the manner in which he raised it and am sorry to hear about the person who passed away. As the Deputy will be aware, the National Ambulance Service, NAS, serves east Cork on a 24-7 basis through a highly skilled workforce of paramedics, advanced paramedics and emergency medical technicians; a fleet of modern emergency ambulances, intermediate care vehicles and rapid response vehicles; and 12 ambulances bases covering the entire county of Cork. The region is also served by several NAS alternative care pathways designed to treat patients at the most appropriate level of clinical need while avoiding unnecessary patient conveyances to busy hospital emergency departments where it is not clinically necessary. These pathways include the Pathfinder "See and Treat" service located in Cork, the NAS National Emergency Operations Centre Clinical Hub "Hear and Treat" service, the community paramedic service, and NAS intermediate care services. Further emergency response capacity in the region is provided by the Government-funded Southwest Helicopter Emergency Medical Service, HEMS, operating out of Rathcoole in County Cork. Additional HEMS support is provided in the region by the Irish Coast Guard, RCG, search and rescue service from its bases in Waterford and Shannon on an "as available" basis. As the Deputy will be aware, this Government has continuously invested in NAS with significant increases in investment in recent years. Government investment in 2026 will support HSE plans to further increase capacity in NAS with 263 new posts representing an investment of €20 million. This will help to improve emergency ambulance response performance, provide for additional intermediate care service capacity and further development and expand NAS alternative care pathways, including community paramedic services right across the county. Regarding the south west, including east Cork, additional NAS resources for 2026 will include additional emergency vehicles in Cork city and Killarney as well as a further intermediate care vehicle in Bantry. Further investment in 2026 will also include an additional community paramedic post to the region to provide care for lower acuity older patients. The Deputy will be aware that NAS has also established a new NAS tertiary education training facility in Cork to further support paramedic education and training. I am delighted to learn that the first intake of student paramedics took place in January of this year, which has increased overall training capacity by 20%. That is very welcome. I know it will take a while for them to come through. I should also add that investment in 2026 will also see significant increases in NAS capital funding, including €34 million for renewal and expansion of the fleet of emergency ambulances and other response vehicles. In addition, the provision of a replacement ambulance station for Midleton is at the design feasibility stage. I know this is very important to the Deputy and other Government colleagues in that area. Overall investment in recent years has also seen total NAS staffing rise to 2,470 at the end of December 2025, which is a rise of 28%. Notwithstanding that, I appreciate the issue raised by the Deputy concerning east Cork, which is a vast area bordering my own county of Waterford. There are a lot of people on the border area there between Dungarvan west and into Youghal. I suggest the Deputy put some of the specific questions he asked regarding the number of call outs and times into a parliamentary question.

Sentiment score: 0.28

I join with the Deputy in extending my thanks and that of the Department of Health to the staff of the NAS for their commitment and dedication to patient care in east Cork and across the whole country. I was just checking as the Deputy was speaking. In 2025, the following additional resources were added to the south-west region. Twelve paramedics and 12 emergency medical technicians were deployed to the south-west region. Seventeen staff were allocated to the region in 2025 under agency conversion to the following locations: Cork city, four; north Cork, two; west Cork, one; east Cork, one; and Kerry, nine. The new college campus in Cork will have its first intake of student paramedics starting in January 2026. The college will initially be based at the National Maritime College of Ireland in Ringaskiddy, pending development of the new site that we spoke about in Midleton. I know the Deputy is genuinely concerned about that particular region and I will speak to the Minister later today and tell her the Deputy raised the matter in relation to east Cork in the Dáil today. It is a vast area, covering all the way from the Waterford boundary, all the way up to the Limerick boundary and right across Cork but the additional capacity that has been added overall should help.

Sentiment score: 0.12

I thank Deputy Connolly for raising this matter in the House. Varicella is a common and highly infectious disease caused by the varicella zoster virus. This virus is associated with two distinct clinical syndromes, varicella, commonly known as chickenpox, and herpes zoster, commonly known as shingles. Primary infection with the varicella zoster virus results in varicella, after which the virus becomes latent in the body's nervous system. The virus may reactivate after a period, sometimes several decades later, resulting in herpes zoster or shingles, as we know it. Currently, a non-live, recombinant shingles vaccine called Shingrix is available in Ireland and is administered as a two-dose vaccine. The national immunisation advisory committee guidelines state that the Shingrix vaccine may be considered in those aged 65 years and older, due to the greater burden and severity of disease and post-herpetic neuralgia in this age group and in those aged 18 years and older at increased risk of shingles. It should be noted that in advance of any change in policy, the Minister can request that the Health Information and Quality Authority, HIQA, carry out an evaluation of the impacts of a potential policy change. HIQA has a statutory remit, under the Health Act 2007, to evaluate the clinical and cost-effectiveness of health technologies, providing advice to the Minister for Health on budget impact, organisational and social aspects and ethical and legal issues. These evaluations take the form of health technology assessments or HTAs. A HTA is a multidisciplinary research process that collects and summarises information about a health technology in a systematic, unbiased and transparent manner. The use of the HTA facility assists decision-makers in assessing the merits and potential shortcomings of a new health technology, policy or service based on accurate and reliable evidence. The Minister for Health advises that following a request from her Department, HIQA carried out a HTA on the herpes zoster vaccine which protects against shingles. The HTA examined the evidence on the safety and clinical effectiveness of shingles vaccines. The cost-effectiveness and budget impact were also reviewed, in addition to the ethical, social and organisational implications of including the vaccine in the adult immunisation schedule. This is an area I know quite a bit about because I was Minister of State with responsibility for older people for four and a half years and I can remember dealing with it at the time. HIQA's HTA was published on 19 July 2024. The HTA found that including the shingles vaccine in the routine immunisation schedule, at the vaccine price at the time, for all adults aged 65 years and over would not be cost-effective and would have a substantial budget impact. While the HTA found that the introduction of the shingles vaccine was not cost-effective based on the cost of the vaccine, it found that it could be cost-effective for vaccination of those at 75 years and 80 years if the price of the vaccine was reduced by 80%. The healthcare budget is finite and this year alone we will spend €4 billion of the €28 billion health budget on medicines. Decisions regarding increased spending relating to a change in one area could impact the provision of other health technologies and treatments within the healthcare system, the cost-effectiveness must be considered in any decision-making process. The Department considered the findings of the HTA in 2024 and determined that the introduction of the vaccine could be reconsidered when the cost-effectiveness of the vaccine was confirmed as being more favourable. I will come back to the Deputy with more information.

Sentiment score: 0.12

I understand the points the Deputy makes. I agree with many of them but we must stop and think. He says the vaccine would cost €500 per person. We have an ageing population. We actually have more than a million people over 65. The Deputy can quickly do the maths to see what that would cost. Following detailed consideration of the findings of the HTA in 2024, it was determined that the introduction of the shingles vaccine to the immunisation schedule in Ireland could be considered if and when the cost-effectiveness of the vaccine is confirmed as being more favourable. I think there is an onus, too, on the companies that provide the vaccine to come to the table. That is an important element of it. In line with this, the introduction of the shingles vaccine to the immunisation programme in Ireland is again being actively considered for a cohort of immunocompromised individuals in line with NIAC advice and cognisant of the cost-effectiveness of market pricing and available funding, so that is welcome. The Deputy will also be aware that the immunisation programme in Ireland is based on the advice of NIAC. The information I have, and I have no doubt they looked at it for those aged 50 and the whole way up, is that the HTA found that vaccinations could be cost effective for those aged 75 and 80 if the price of the vaccine was reduced by 80%. I will certainly raise this again with the Minister for Health. It is kept under constant review. As I said, €4 billion, which is a huge proportion of the overall spend of our health budget, is spent on medicines. We will keep the situation under constant review and I will speak to the Minister on the Deputy's behalf.

Sentiment score: 0.09