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-----
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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-----
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-----but there are issues here. I mean, there are agreements between-----
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-----the Irish Pharmacy Union-----
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-----and the Department-----
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The National Centre for Pharmacoeconomics carried out an evidence assessment.
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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.
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During discussions with the pharmacy union-----
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-----it was agreed that improved controls would be introduced.
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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-----
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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.
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The Minister of State, Deputy Butler, was responsible for a lot of the very proactive work in respect of dementia.
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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.
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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.
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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.
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You did.
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I did.
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Again, you did criticise it, by the way.
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From the outset, you have been extremely negative. The whole question was articulated in a negative way.
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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.
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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.
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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.
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Some 462 schools have drawn €6 million in respect of that, which shows people have responded positively to the initiative.
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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.
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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.
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So have our regulators as well. We are part of the harmonised regulatory framework.
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The Digital Services Act is a game-changer in respect of this.
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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.
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We have made a lot of progress but I acknowledge we have more to do.
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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.
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