Most of the political focus of recent weeks has been on the Cabinet reshuffle, who will be dropped and who will be promoted-----

It will be the end of the Minister, Deputy Rabbitte.

-----but we all know that the changes will mean nothing if they do not make a serious difference in people's lives, not least in terms of health care. The recent focus on failures in that sector has been on the medical card fiasco, but there are other system failures and they do not all have to do with money.

I wish to highlight the plight of Shay and Finn Guihen, who were born with the rare Pfeiffer syndrome and whose parents, Denise and Dermot, are in the Gallery. I have given the Taoiseach a background note on the case. One year ago, a 24-seven home care package was agreed that enabled the then 18 month old twins to leave Temple Street hospital for home last October. Their care was outsourced to a nursing agency and, from the first week, there were problems. It was hit or miss and resulted in the twins being admitted to the LauraLynn Children's Hospice for eight weeks until a care package could be provided. Five months later, there is still no sight of a care package and the parents have not been included in the process in any meaningful way.

Every day, this couple faces the joy and sorrow of being these two boys' parents. The joy is found in how their parents have been astonished by their progress - they can see and hear, have normal intelligence, clap their hands, wave and pick out their favourite toys. These little guys have between them survived 21 operations to date. They look different, they have shunts in their brains and their breathing is being aided by tracheostomies. The parents' sorrow stems from the fact that their children's lives will be limited. While there is a limit on the time they live, there should not and must not be a limit on the quality of their lives. It is a nightmare for any parent to face the prospect of losing a child, but Denise and Dermot are facing the prospect of losing both of theirs.

This is a question of the management and control of the home care package. It cannot be hit or miss. There must be continuity of care. This is not an issue of money, but of how the process is managed for these two little kids. Will the Taoiseach intervene to try to get a solution so that they can go home to where they are happiest? Will he undertake to review home care packages? Flexibility is great in some cases, but in others it is not and continuity of care is required in this case. If necessary, a few people could be recruited to provide that service, which is critical to the lives of a small number.

Hear, hear.

I thank Deputy Catherine Murphy for giving an indication of this particular case. I would like to say that I think it must be incredibly difficult for Denise and Dermot, the parents of Finn and Shay, to have to live with the stress of what is involved here. I understand that these little boys are two and a half years of age, both have tracheostomies, both have fabulous personalities and both are in a palliative care unit with LauraLynn. It was to be for two months - it has been for five.

As the Deputy points out, it is about ensuring that there is a sustainable home care package put together for Shay and for Finn. As she also points out, it is not about money. As I understand it, the care that was being given to Finn and to Shay while at home was done by particular agency workers. The HSE is very familiar with this case. It is the most complex case that it has come across in a very long time.

It is a case now of working with a different agency to see if it is possible to put together a proper, sustainable home care package so that the two little boys can have the best of their personalities being expressed, their activity levels can be maintained and also, in respect of Denise and Dermot, the lifestyle around that is not one that has an overbearing stress load on it. I understand that the HSE is willing to meet with Denise and Dermot to discuss this. I would like to see that, while we have Shay and Finn with us, the best possible sustainable home care package can be put in place.

I thank the Deputy for bringing this case to my attention. We will keep a close eye on this, together with Denise, Dermot and the HSE, with particular focus on little Shay and little Finn. I hope the outcome can be the very best for two little boys who need nothing but the best.

I have talked to the HSE and the other agencies to see what solutions can be put in place. The big difficulty is that the great strength that is the flexibility of agency provision for some is the greatest weakness in this case. With a tracheotomy, for example, if something goes wrong, one literally has three minutes to change it. It is a life or death situation. We cannot have a situation where it is hit and miss; there must be continuity of care. Denise and Dermot are two people but my concern is that there is a small number of other families who do not want to rock the boat about the care provision and the continuity of care.

I reiterate the point that this home care package needs to be reconsidered. I do not believe it is about money, rather it is about how the service is provided. That is the aspect of it that must be examined if we are not to find more families presenting with this type of very complex and difficult situation. I ask the Taoiseach to examine that continuity of care in the context of a review of the home care packages. This cannot be delivered on an agency basis because sometimes outsourcing is also about outsourcing responsibility. It is at that point that the change needs to be made.

The Deputy made the point about the very short timespan that is available if some little incident happens in regard to these two little boys, therefore, 24-hour absolute care and monitoring is required here. That is the nature of the care process that needs to be put in place. I have correspondence from Deputy Lawlor who has been involved in this case as well and if the Deputy wishes, after this engagement I would like to say hello to Denise and Dermot, Deputy Lawlor and Deputy Murphy to see can we assure people that what we want here is the very best level of care for Finn and for Shay. It must be so stressful for parents to have to see two bubbly little boys with fabulous personalities having to face the challenge that they face. I was in a house further west recently where there are three children facing a different challenge which is also very serious and the stress level in that household is very difficult. I agree that it is not just about an agency, that it is about the people who can provide that 24-hour care. That is where the home care package needs to be. I will obviously contact the Minister for Health and the HSE about the general home care packages in this case, and let us say hello after this engagement is over.