The purpose of today's meeting is to consider the 2026 Estimates for Vote 38 for the Department of Health. As people may have seen, there was a briefing provided this morning to members of the committee by the HSE on the Nayagam report into orthopaedic services at Children's Health Ireland, CHI. The committee also received a letter from the Minister in relation to the delays in the national children's hospital. This letter has been circulated to members. In light of that we may need to come back and have another session on the Estimates if we do not get through all of the items this morning but we will see how the session goes.

I will read a note on the presence of members in Leinster House. I advise members of the constitutional requirement that they must be physically present within the confines of the Leinster House complex in order to participate in public meetings. I will not permit a member to participate if they are not adhering to this constitutional requirement. Therefore, a member who attempts to participate from outside the precincts will be asked to leave the meeting. In this regard, I ask any members participating on Microsoft Teams that they confirm they are on the grounds of the Leinster House complex prior to making a contribution.

I will also read a note on utterances by members. Members are reminded of the long-standing parliamentary practice that they should not criticise or make charges against any person or entity by name or in such a way as to make him, her or it identifiable, or otherwise engage in speech that might be regarded as damaging to the good name of a person or entity. Therefore, if a member's statements are potentially defamatory in relation to any identifiable person or entity, they will be directed to discontinue their remarks and it is imperative that they comply with any such direction.

I welcome to the meeting the Minister for Health, Deputy Jennifer Carroll MacNeill. The Minister of State, Deputy Mary Butler, will join us shortly. She is currently in the Dáil Chamber. I also welcome the Minister of State at the Department of Health with responsibility for public health, well-being and the national drugs strategy, Deputy Jennifer Murnane O'Connor, and the Minister of State at the Department of Health with responsibility for older people, Deputy Kieran O'Donnell.

The committee received the Minister's opening statement late yesterday evening so there may be hard copies available. As we discussed previously, it is more beneficial to the committee to receive documentation at an earlier stage. It helps with scrutiny and being able to engage with the documentation. We ask if we could potentially have documentation at an earlier stage next time.

To commence the proceedings, I invite the Minister for Health to make her opening remarks.

I thank the Chair and I confirm that what is contained in my statement reflects what is in the committee briefing provided a fair bit prior to that, so it is really a condensing of that briefing. I thank the committee for the opportunity to discuss the Revised Estimates for Vote 38 in 2026. As members are aware, the health allocation for 2026 is €27.35 billion. This is an increase of €1.3 billion in day-to-day spending, or a 5.1% increase on the 2025 out-turn. It is €1.6 billion higher than the original 2025 allocation, so it is a 6.2% increase.

Capital, including our digital investment, rises to €1.56 billion, which is an increase of €100 million or 6.8%. That is the largest ever annual investment in health infrastructure and we have quite a lot of work to do on that.

Health now represents 23% of all public expenditure in the Irish State, excluding disability services. It is a very significant investment and with it comes a clear expectation of results and value. The sustainability challenge in health is already becoming evident. In 2025, people aged over 65 years were 15.8% of the population but accounted for over 50% of healthcare expenditure. That is set to increase to 20.8% of the population by 2040. Of course, we regard that as a good thing but it is also something we need to plan for. In 2025, we achieved significant and measurable improvements in financial control. It is a markedly different position than was the case with the health budget in the past. The HSE delivered within the final current expenditure limit, pay pressures were broadly contained within budget and the Supplementary Estimate was sharply lower than in previous years at just 1.2% of the original budget. That is compared to 4.8% to 7.7% between 2022 and 2024. It is a genuine step change in how resources are managed. The context for last year’s Supplementary Estimate is important. As we discussed at the time, as non-pay financial pressures emerged during the year, a mid-year agreement with the Department of public expenditure provided €300 million in additional funding. Despite significant demand pressures, however, the HSE remained within its revised expenditure limits at year end. That outcome reflects substantially strengthened financial controls, tighter in-year management and clearer lines of accountability across the system although we need to go further on all of those things. Crucially, the roll-out of the integrated financial management system, IFMS, now covers approximately 80% of the health budget. With IFMS, we will finally have one national financial and procurement system for health. This will give us faster, more detailed reporting and will clearly show where overspending is happening. As well as stronger financial compliance and accountability, we will also be able to see the price being paid for the same goods and services across the health service. That allows us to have a better approach to procurement and to identify further potential savings without any impact on patient care. We will continue to roll out IFMS across section 38 voluntary hospitals at pace in 2026 to give full and complete coverage of financial information and visibility on how public money is spent in every place in health. As part of the Health Information Bill, which I discussed yesterday in the Seanad, we are giving the HSE clear legal authority to obtain standardised, digital financial and activity data from all providers in the form specified by the HSE. The purpose of that is to help us plan and manage our financial resources. By setting out clear expectations on financial and activity data, the Bill complements the roll-out of IFMS, allowing the system to operate on standardised, reliable inputs across all providers. It was, of course, already part of the service level agreement with section 38s that this be done. The Bill puts the issue beyond doubt. I wrote to section 38 voluntary hospitals in January setting out the imperative to implement IFMS. In their responses, all of the hospitals expressed support for the objectives of full financial transparency and the implementation of IFMS. They are engaging actively with the HSE and the Department. Overall sentiment is one of strong support, constructive engagement and commitment to moving forward. On the ground, I will pay particular compliment to Tallaght and St. James's hospitals, which are moving further ahead and are really seriously engaged with the implementation. I also strongly encourage all voluntary hospitals to sign their service level agreements with the HSE in order that budgets and staffing can be put into effect and we can move forward with clarity, accountability and a focus on delivery in 2026. This year, for the first time, the HSE has given service level agreements at the end of the preceding year. It was given on 15 December 2025 for 2026. That is a marked improvement and a step change by the HSE. I compliment it on that. It is also a requirement that the service level agreements be signed and returned to the HSE within four weeks. To date, unfortunately, only three hospitals have signed, namely, the Royal Victoria Eye and Ear Hospital, St. John’s Hospital, Limerick, and Mercy University Hospital, Cork. We expect section 38 hospitals in receipt of public funding to sign their service level agreements with the HSE and return them immediately.

Ireland is experiencing significant growth in the demand for health services from a growing and ageing population, a very positive thing. We have a population of 5.5 million in 2026, 100,000 people above ESRI projections in 2024. The population aged over 65 is estimated to have grown to 15.8% in 2025 compared with 15.1% in 2022. Despite rising demand, 2025 saw an improvement in the daily average 8 a.m. trolley figures nationally. Admitted patients on trolleys saw an average reduction of 30 per day or 10% nationally. That came even as emergency department presentations rose by 4%. What I really need to speak to the committee about is the variable performance between the six health regions recorded in the reduction of their daily average trolley numbers. For example, Dublin and the north east, where the Mater and Beaumont are, had a reduction of 30%. Dublin and the midlands had a 24% reduction, the mid-west which is Limerick was down 20%, Dublin and the south east including St. Vincent's, Waterford and Wexford was down 15%, the south west, which includes Cork, was down 2% while the west and north west actually had an increase. At site level, some hospitals faced much sharper rises in emergency department presentations particularly the Mater and St. James’s. It was nearly 10% in Limerick and Naas. Despite the pressures of increased demand, because of the way we are reorganising how the system works, we have seen a marked improvement in trolley numbers in particular hospitals that have devoted themselves to it. Connolly Hospital Blanchardstown was down 72%, Navan was down 60% and St. James’s and Tallaght, hospitals under huge pressure and exceptionally busy in well populated areas, were both down by a third. This shows that a relentless day-to-day focus on appropriate hospital avoidance and patient flow from the hospital front door to timely discharge really delivers results that are patient safety results, reducing the number of patients on trolleys. We extended evening and weekend services through the implementation of the public-only consultant contract and seven-day rostering, broadened diagnostic access and strengthened weekend discharge planning but we are only at the beginning. We are really only six to seven months into this and we have a long way to go. One can see this in practical examples I have listed for the committee. The Mater achieved a 30% reduction in 8 a.m. trolley numbers supported by a real increased focus on weekend discharging and strong uptake of the public-only consultant contract. In St. James’s, public-only consultant contract consultants are now ensuring CT and urology diagnostics happen over the weekend, with increased weekend discharges. The core rostering of consultants and other staff over weekends in St. Vincent's, for example, has enabled a nearly 50% increase in weekend discharges and a 63% reduction in average trolley numbers, though it has some way to go yet in St. Vincent's. Despite a 7.5% increase in attendances in Connolly Hospital Blanchardstown in 2025, admissions reduced by 2.5% but the trolley count reduced by 72%. That is such a different experience for patients in the Blanchardstown region. It is so important that we continue to highlight the good progress and ensure that progress is matched by other hospitals around the country.

In relation to hospital avoidance, we are trying to keep people out of hospital where we can. There are frailty support teams in St. Vincent's and there are initiatives like emergency department in the home, where we move emergency services out of the hospital to the home. That has provided a 24-hour service since January and it is having an impact. We opened acute virtual wards to support alternatives to admissions and help get patients care in the most appropriate settings.

It is not just about urgent and emergency care, although we have to get that right so we can have better predictability. On planned care, we are also making progress. The surgical hub model in particular is extremely important. We opened our first surgical hub in Mount Carmel in February. We expected it to deliver 3,000 procedures as it ramped up throughout the year. We actually got 3,700 procedures done. That meant a 74% reduction in people waiting over 12 months on certain lists in St. James's. There is also more efficient rostering of staff and resources with significant increases in the number of outpatient appointments. That is something we are going to drive hard with the roll-out of the outpatient toolkit in 2026. For example, St. Luke's, Kilkenny, saw 5,700 more outpatient patients and Tallaght saw 9,500 more outpatient patients. We have a long way to go with this. We are trying in every way through outpatients and the examination of the use of theatres and rooms in hospitals to do more with what we have. One of the key pieces of analysis we have is the baseline analysis for the outpatient toolkit. One example from the south west shows the room vacancy rate in the hospital during the week is about 4% to 9% but is 24% on a Friday afternoon. We clearly have more capacity.

Apologies, Minster, we are on the clock and you are a minute over.

I appreciate that.

You can have a minute to conclude.

I appreciate I have given my statement to the committee in advance. What I want to say is that we have had a very tight financial performance in 2025 that is different to what we experienced before. We are driving hard. We have an increase in budget but we are really driving hard to do more with what we already have and what the State has already invested. While I am proud to give examples of different hospitals, I recognise there are others that we need to bring all up together. In particular I will focus on the west and north west in relation to emergency care concerns I have.

I thank the Minister. I also thank her for the extended briefing document she provided last Friday. We will move to questions from members following the rota. I will begin with Fianna Fáil and Deputy Daly.

I thank the Minister for attending and for the urgency and focus she is bringing to her brief. I also thank the Ministers of State, Deputies O’Donnell and Murnane O’Connor, and the Minister of State, Deputy Butler, who has made a lot of progress in the mental health area.

I will start where the Minister finished. She talked about the west and north west. The west and north west area seems to be doing very poorly by a number of metrics, not just in trolley waits and emergency department waits but also in cancer care and access to primary care therapies. When we ask parliamentary questions on these areas, we find the west and north west is doing poorly compared with the rest of the country. Will the Minister comment on cancer care in the west and north west? We have had numerous complaints. For example, women with breast cancer receive their diagnosis in a timely manner but there is a significant interval between diagnosis and their treatment starting. Will the Minister comment on that please?

I thank the Deputy. That is not acceptable. What we want to achieve is that everyone receives a cancer diagnosis and treatment in the requisite period, particularly in urgent symptomatic cases. There has been a difficulty in the west and north west in different ways. That is one of the reasons we are making the regional funding model different this year and we are clearly tracking outcomes. I expect HSE west and north west to devote itself to making sure there is equality of treatment and quick access. That is as much to do with how the hospitals are run and managed as anything else.

That is the question I want to ask the Minister. Is this simply about resources? I have been told, for example, that CAR-T therapy has been funded for Galway for cancer services and has not yet been delivered by HSE west and north west. Is this a management issue? Is this a resource issue? It appears to me that Galway, Mayo, Roscommon and Sligo – the west – is being left behind. The Minister talks about the inconsistency of service throughout the country. I want to know if a focus can be brought on the issues and deficiencies in the west and north west. If wake primary care, the region has the longest waiting lists for occupational therapy, speech therapy, physiotherapy and community ophthalmology. There is something really wrong.

There is something wrong. Last weekend, one third of all the hospital trolleys came from the west and north west, despite it being one of six regions and having nothing like the population that would justify that. In addition, there was a significant weather event in the east, not the west. I agree with the Deputy that there is an issue. Tomorrow, Thursday, I will be in Sligo meeting the managers of every single hospital from the west and north west, with a regional executive leadership team. I will bring directly the Deputy’s concerns on all these issues to them. My conversation is specifically around asking what they are doing to roster people in the way that other regions have managed to roster and to make sure there is weekend discharging. Urgent and emergency care impacts on everything else. If you do not get that right, you will not get the other things right either. If you are not rostering people for quick diagnostics to get them in and our of hospital, you are not doing it for cancer care either.

The Deputy is right. There has been significant additional investment in cancer services in Galway. Last year, there was 14 additional posts fully funded across surgical oncology, breast cancer, family history, radiotherapy, survivorship and CAR-T services. The acute haematology oncology service received additional advanced nurse practitioners. There is, therefore, significant investment. How is that being organised for the delivery of patients? I have an issue with that. I appreciate the Deputy raising it with me because I can now take his commentary directly to that important meeting tomorrow with the west and north west leadership.

I appreciate the Minister’s honesty about this issue. I have the embarrassment, and this is embarrassing for the State and the health service, of having women and their families phone my office for Roscommon and Galway asking for ways to get into the private system and pay cash to initiate their therapy for oncology after getting a diagnosis of breast cancer. I would appreciate if the Minister could bring a focus specifically on the interval between a breast cancer diagnosis and the delivery of treatment for those women. By and large, these are young women with families and there is severe apprehension and anxiety around this. I would also like the Minister to bring a focus on why the CAR-T therapy programme has not progressed in the west and north west. I know it is in St. James’s Hospital in Dublin. I understand the funding was made available to start that programme there but there is no sign of it starting.

Where is the urgency? The Deputy is right. That is due to open in quarter 1 this year. It has to happen, and I will do that. Again, the Deputy is absolutely right. University Hospital Galway has faced challenges in meeting its performance targets for cancer services. That is not okay. Systemic anti-cancer therapy, SACT, services are due to be expanded, with six additional chairs, as the Deputy knows. I have also devoted two surgical hubs to the west and north west region to ensure there is additional surgical capacity. One difficulty I have is that we can put all the resources and all the additional theatre capacity in but if it is not manage and roster properly, all the additional capacity in the world will not change outcomes.

I agree.

It is how people turn up. I will give an example. Tipperary hospital did not receive significant additional resources last year but it recorded an 88% reduction in trolley numbers. There are more people being discharged from small hospitals at weekends than there are in University Hospital Galway. I am sorry to focus on that but it speaks to the way in which resources are being deployed and the way in which things are being managed.

The Minister is right to focus on it because the State is investing a huge amount of money in our health services and we need to ensure there is a proper return on that investment for the citizens of this State. There should not be an inconsistency in access to service in a small country like ours. It should not be beyond us. I thank the Minister for her answer.

We have seen the "RTÉ Investigates" programme and have I spoken to the Minister of State, Deputy Butler, about the issue. This is no reflection on anyone. I note the focus that has been brought on mental health services and the increased funding that has been brought to bear on that service. However, there is no doubt that in our rush to deinstitutionalise mental health care, following the time when we put people with additional and special needs into congregated mental health settings like psychiatric hospitals, we have forgotten a group of citizens. These are the citizens who have enduring mental health issues and whose challenging behaviour makes them a danger to themselves and others. However, there is another group of citizens, the ones with enduring mental health issues who need supervision and care in a community setting, probably a residential setting, because they simply cannot look after themselves. Since 2016, 140 of these community beds have been closed down in County Roscommon. There were issues with some of the homes affected, according to the CEO of the HSE, but that was not a reason to close them down. Many of our citizens who are not able to look after themselves, the most vulnerable in our society, ended up in local authority housing and are going around the streets, for example, in Castlerea, where kindly supermarket owners give them breakfast because they cannot manage their own resources. The promised wraparound services are not there for those patients.

The Mental Health Commission came to Roscommon University Hospital and published a report that showed the psychiatric unit in Roscommon University Hospital had deteriorated in the previous two years ago. It had to issue an immediate action notice. Because it did not receive adequate assurances, it had to have a regulatory compliance meeting. I would like the Minister to comment on that. I feel very strongly about it. We have received a lot of messages on the issues raised in the "RTÉ Investigates" programme. Notwithstanding some of the inaccuracies that might have been in it, there is no doubt there is a sense that we have criminalised enduring mental health issues for people who should be receiving their treatment in appropriate centres, either in secure units or in the community in residential care.

I will ask the Minister of State, Deputy Butler, to speak to that.

I have to push back on some of the Deputy’s commentary there. I think it was very unfair. We came from a situation where we had people institutionalised in asylums and we had to move back from that.

If the Minister of State will excuse-----

Please let me answer because the Deputy has made several charges that I cannot leave there.

If I may say this, I have no problem with deinstitutionalisation. My mother described, in 1967, people with Down's syndrome and unmarried mothers being put into St. Brigid’s Hospital in Ballinasloe. I have no problem with deinstitutionalisation but in the rush to deinstitutionalise we have forgotten a cohort of patients. That is the reality in my world. I do not want to have a row with the Minister of State because I recognise her focus on mental health and the increased budgets, but I have to say there is a reality on the ground in relation to this cohort of patients.

I will speak to a couple of points the Deputy made. He said there is a person who is being fed by the local shop. There is not a community in Ireland that does not have people living in the community with enduring mental health conditions. However, I know in Portlaw, where we have one of those people, that he has a social worker who visits every single day and meals on wheels delivered to the house.

There is something happening here where that person is not referred on to having a social worker to protect them-----

I agree.

-----and also being supported by the community mental health teams on the ground. They are doing a phenomenal amount of work. We have 285 community teams across the country comprising CAMHS, general adult mental health and psychiatry of later life. Some 65 of those teams have been put in place since I took up office in 2020.

I accept that.

There are 285 teams. We also have 1,200 people living in communities in houses all over the country with wraparound supports. Some 500 people-----

I accept that.

I am sorry, it is very important. It will take two seconds. Some 500 people with enduring mental health conditions have been rehoused in the past 18 months working with the Department of housing.

I accept that.

There are always going to be people who fall between the cracks but if you know of somebody who is going to a shop being fed, the onus is on you to have them referred to a social worker so they can get the correct wraparound supports.

The Nayagam review into a clinician in Children's Health Ireland is with the HSE and the Minister, Deputy Carroll MacNeill. We learned about this over the weekend, unfortunately, in a Sunday newspaper article and also on radio today. There was a clinical briefing for Oireachtas Members this morning. First, I wish to get some information into the public domain, which I think is important. When did the HSE receive a copy of that phase 1 report? I know there are two phases; this is the first phase that looks at the practice of a clinician. When did the HSE receive that report?

My understanding is the HSE received that report in September 2025 and was prevented from either sharing with me its existence with the HSE initially, and then actually sharing it with me, because of High Court proceedings.

Who prevented the HSE sharing that report with the Minister?

The High Court process.

Did the High Court direct the HSE not to share the report with the Minister?

Not being a party to that, I have to be very careful about what I would say in relation to it. What I know is that the HSE received it. I was not a party to those proceedings; of course, the HSE was a party to those proceedings. The HSE received it in September 2025 and the first time it was in a position to share that with me was last week.

Okay. What I want to understand is whether it was a direction from the court that it not be shared with the Minister, or if that was the interpretation of proceedings.

I am not in a position to answer that, not being a party to the proceedings. There are parts of proceedings that I should not be party to because they are private legal proceedings.

When did the Minister receive the report?

I received it last week and I received a clinical briefing from Mr. Nayagam on Friday.

Okay. I learned over the weekend in a Sunday newspaper article and was contacted by a number of parents when they read the article that the Minister had that report last week. We know that letters were sent out to 91 parents of children who were part of that review, 62 of whom may or will need clinical follow-up. Some - 19 of them - may not but all were notified that the Minister now has the report. Why were they not notified earlier? It always seems to be that the parents are the last to know. That is really hurtful for them. They are the last to know again - not for the first time but again they are the last to know that the Minister received a report which, at this stage, may not even be published. We do not know what its recommendations or findings are. They have not been informed of those, as I understand it, in the letter. Again, they had to find out from the media that the Minister has that report. I find that scandalous. Why were they not informed earlier and why were letters sent out only yesterday?

I agree. Nothing like that should appear in the media and I will be taking steps to identify how that may have happened. I was briefed on this by the clinician on Friday afternoon. There was a meeting to prepare for the letters being sent. That was Friday; the letters were sent last night, Tuesday night, so that is as tight a timeframe as we could reasonably achieve. The clinician recommends ongoing follow-up in respect of some of the children. Some of the children, a very small number who were identified as needing more urgent follow-up, had already been contacted in the past and have already received follow-up where that was particularly pressing from the clinician's perspective.

I understand that.

The other children are the ones the Deputy referred to, correctly. On Friday afternoon, there was a briefing with certain clinicians in order to prepare for this week. For example, I wanted-----

I understand that. I do. We have been briefed on that and I accept it but I want to come back to this point. It happened. It is a fact that it was in a Sunday newspaper article. It is not good enough.

I agree.

We have been here before. The problem is not so much that it was in a Sunday newspaper article. The problem is that the parents again found out through the media. In fact, we as politicians even knew before the parents. I would suspect that some parents may not have even opened the letters because they only received them today. Some of them will be working. They will go home and receive the letter. They will turn on "Morning Ireland" and hear about it. They will read a Sunday newspaper article and hear about it. It will be broadcast again, I am sure, today. It is unacceptable.

I agree with the Deputy and in the 20 years I have been in this building, I have not been one to be giving things to the media. I do not behave that way and neither does my team and I find it appalling that people would give anything to the media in advance of it being appropriately and procedurally dealt with, particularly when the timeline is so tight. I was briefed on this on Friday afternoon. Letters were sent to parents of the children on Tuesday evening for this morning. We obviously want to make sure that is done correctly and that, with the most basic respect, that all of the names, addresses and everything are correct, that we have clinicians who are there to follow up on those children and that those clinicians have been identified and are aware. Could you imagine a parent receiving a letter saying their clinician is going to be X and the clinician not being aware they are going to be? All of those-----

The HSE had all of this. The HSE had the report in September so why were the parents not written to in September, even to be informed that the HSE had it, despite legal issues?

The HSE will have to answer that within the context-----

You are the Minister.

To be fair, the HSE was not able, because of very significant legal proceedings, to share that information with me and has been constrained in its management of this because of different legal proceedings. I have to be very careful, as Minister, that I do not say anything that makes it even more difficult to take the next steps we wish to take. Our concern and priority is obviously those children. All of those children who required more urgent follow-up were followed up at an earlier stage, as identified by the reviewer, the clinician Mr. Nayagam. Those other children we want to have an ongoing follow-up with were written to last night and they will be followed up. There is an assistant director of nursing in CHI ready to take calls from parents who receive letters. There are clinicians identified to provide that follow-up care. That took us two or three days to put in place - from Friday afternoon, when I received the briefing, until Tuesday evening, when the letters were sent.

I will have to come in because I have very limited time.

Of course.

From my perspective - I want to repeat this again because the Minister has given her view - it is unacceptable that the HSE received the report in September, the Minister received it last week, there has been a Sunday newspaper article and then a "Morning Ireland" piece and, only today, parents received letters. This is a pattern I have seen right through this process and it really alarms me. The Minister has responded to that.

It is a pattern that alarms me too and I was-----

If I can, I want to come to the review that the Minister commissioned as well, or that she is going to commission. I spoke to the advocate groups last night and this morning as well in relation to that. What was committed to there was that an independent mediator would be appointed within 12 weeks. Thirteen weeks have passed and there is no independent mediator established. What the advocate groups have said to me is they fear there is now a backtracking from the Minister and the Tánaiste in regard to what was agreed at that meeting. They do not believe they are equal partners in this process. I want to give the Minister an opportunity to respond to that. I accept that the HSE has a role and the Minister has a role in relation to this review but the people who have to be front and centre are the parents and the advocates. They are saying to me that in regard to what was agreed at a meeting with the Minister and the Tánaiste, from their perspective, they see backtracking. As I said, the mediator has still not been appointed. Why is that the case and why is no urgency being brought to this?

A mediator was identified some time ago. We agreed that we wanted somebody of sufficient stature to do this work but who was also available, which is not always the same thing. People of sufficient stature are not immediately available. We have identified a mediator who I believe is of sufficient stature to be able to carry out this work and they will have a 16-week period within which to do it, having been appointed. We have agreed terms with that person and that business case is with the Department of public expenditure and reform. I would have informed many advocates - including those in the task force and other advocates who I would have met with the Tánaiste, as the Deputy referred to - of the proposed name, who is somebody of very serious stature. We would like to make that appointment as soon as possible.

To conclude on this issue, I would say that I spoke to parents and advocate groups over the past 24 hours. In fact, I spoke to some of them on Sunday when they read the Sunday newspaper article.

They are really upset.

I agree.

The Minister knows that trust is on the floor. We assume this review will now not be published. I am right in saying the first volume or phase of that report is not going to be published?

I would like the report to be published.

I know the Minister would like it to be published but will the report be published?

I cannot answer that yet because I have to examine all of the legal options that may be open to me in relation to that.

That is my point. We are here today without-----

I do need to answer the Deputy's question-----

I am going to finish my point. We are here today talking about a report which is in the possession of the Minister and the HSE. A letter has been sent to parents which will not go into any of the findings or any of the conclusions. We do not know when the report will be published. In fact, it may not be published until the second phase is done. I find that unacceptable.

The original-----

My question to the Minister is this-----

Deputy Cullinane, if we want answers to the questions we pose, we must allow time for the Minister to answer them.

I will. I gave the Minister a lot of time. My question is: has the Minister been directed to not publish the report? Has any legal direction been given to the Minister to not publish this report?

There is a legal agreement. I have to be very careful here. Phase 1 and phase 2 were always to be published together. I cannot comment on that as Minister because these are proceedings to which I was not a party. The HSE was a party to High Court proceedings. It is necessary that I refer this in the first instance to the HSE until I can explore what options may be available to me as Minister.

In respect of the inquiry, which Deputy Cullinane has asked me about, we are absolutely committed to moving ahead with this facilitative process. I have identified somebody for some time and we would like to move ahead with that to the next stage.

In relation to hearing news and media reports, I find that absolutely appalling. I also note that there was briefing to "Morning Ireland" this morning which did not come from my office in respect of both the letter to this committee in relation to BAM and in relation to the briefing that was being provided. I can assure Deputies and everybody else that did not come from my office, nor did anything come from me to the media in respect of this report. I wonder who it did-----

I thank the Minister. We have Fine Gael next and Deputy Burke.

I want to refer to a paragraph which I know the Minister did not go through this in her statement. It relates to key performance indicators in relation to cancer services. The paragraph refers to Cork University Hospital only having a 69% compliance with the 15-day rule. It is important to highlight that in Cork for well over 12 months there was a 30% shortage of radiation therapists. There were 11 people appointed in November. Eleven new radiation therapists were appointed over the past two-to-three months. I understand that Cork University Hospital is now in full compliance with the 15-day rule. It is important that when we are looking at where there are glitches in the system, we should look at all of the issues. The issue here is that Cork University Hospital was looking for these appointments for quite a long period of time. As well as 11 additional radiation therapists, there were also oncologists appointed. It is important that we give credit to the hospital and to the staff for the work they are doing. There was a 40% shortage of radiation therapists. When looking at other hospitals where there are delays, it is important when looking at all the issues as to why those delays were occurring. It is important to highlight that issue.

Regarding cancer care and ensuring we can continue to deliver a fast response and provide the care that is required, we will have increased numbers because we have an increased population. What is in the programme for 2026 as regards looking at the eight cancer care units around the country and adequate staffing levels? Has that been looked at? In particular, has it been looked at from the point of view of the next three to four years?

In respect of Cork and radiologists for cancer diagnosis, it is challenging to get radiologists and radiographers but they also must be rostered in a way that is going to maximise activity.

I lobbied for 12 months to get the appointments.

Yes, and if the Deputy is satisfied as the representative for Cork with the standard in Cork then that is fine and I will take that back. I want to make sure that everywhere is operating to the highest standard and that all hospitals are using their diagnostic activity as best they can to meet patient need. For example, Limerick has very significantly increased its diagnostic activity and I would love to see the same happen in the south west to meet people's needs. Deputy Burke is right that we have to look at every aspect of a hospital's performance and the resources that they have. In particular in Cork they do extremely well in making sure they are not reliant on agency and that they have whole-time equivalents being recruited. That is going extremely well. They could do significantly better on their room utilisation route. They could do significantly better on their diagnostics. They could do significantly better on the consistency.

Could I just ask a question in relation to forward planning? Because of the increase demand, are we looking at forward planning in relation to recruitment? In this case in Cork there was a 30% to 35% shortfall in the number of radiation therapists. As a result, it was not possible to look after the volume of patients. Now, it is possible to do it because we have appointed them. I am looking into the future, over the next 12 months or two years. What plans are within the Department as far as looking at that issue?

Yes. We look at the uplift that we get overall. We are aware that we have 3,300 additional staff across the system on every piece. Each region has different challenges. We have just heard about the particular cancer challenges in HSE West and North West as compared to the HSE South West. Each region has to look at its own particular need. It may be that the allocation in the HSE South West needs to be on mental health or needs to be within their allocation of what is necessary. More broadly, we continue to put money into the cancer care programme itself. With the cancer care programme, I always think it is slightly overstated in terms of the overall care for cancer. Money that we are putting into oncology drugs is care for cancer. Money we are putting into equipment for placement programmes is care for cancer. The additional staff uplift is care for cancer. The Deputy is right that we are going to have more and more cancer diagnosis because of the growing and ageing population as he highlighted. That is a good thing and we know people are living with cancer so much better than before. However, we have to look at cancer as one of the many diseases that each region needs to treat and one of the many things it needs to support its people with.

I want to move on to the totally different issue of immunisation. In terms of the budget for 2025, the figure is increasing in 2026 from €10 million to over €50 million. Is it planned to have a number of new immunisation programmes in place in 2026 because there is additional funding being provided? How is that figure increasing so substantially? I am reading it from the health budget Estimates and the increase that has gone from €10 million up to €50 million.

Yes, it is intended that we spend more money on immunisation. For example, the Deputy will be aware of the broader RSV immunisation programme we have, which we will maintain. We have extended the HPV vaccination to fifth and sixth years as well as-----

This is a substantial increase. It is important that we get the information out there on time regarding making sure we have full use of whatever immunisation programmes we are doing.

The Deputy is right. This year we were pleased to see a very significant increase in immunisation uptick rate. For example, for the flu vaccine we had an increase from 17% of children to 24% or 25% of children in the end. I would like it to be 100% of children, so we make that provision. In particular, this year of 2026 more than any other year is the most important year for immunisation to reduce flu and respiratory illnesses because of what we hope will be the move from the children's hospital and reducing the pressure on the hospital system more broadly.

Immunisation obviously helps the whole health system in reducing issues that arise. On the issue of reducing the time people are waiting in accident and emergency departments, last week I raised the issue of the minor injuries unit in Cork, which is a really successful unit in that from the time people go in to being fully treated and discharged is, on average, between two and three hours. This unit has proven to be successful. We do not appear to have a programme of developing further minor injury units around the country to take people away from accident and emergency departments and get them seen in a timely manner.

I wonder whether that is going to be looked at.

I know we are talking about the surgical hubs being rolled out but the next issue I want to talk about is that of the elective hospital for Cork. We have not even gone to the planning stage at this point. Even if we went to planning in the morning, it would still take three years. We seem to have parked this issue. We have an increasing population in Cork and the Munster area and, therefore, we need to plan to cater for the growing demand for services.

In relation to the injuries units, we have 15 such units around the country and we will open four more this year. The Deputy is right in saying they are extremely successful and a very important hospital avoidance measure. I pay a particular compliment to Cork University Hospital, which also has a virtual urgent care hub able to provide support to GPs on the margins of deciding whether to send somebody to the emergency department. This has also proved to be an extremely successful and safe hospital avoidance measure, which is very important.

In relation to the elective hospital, of course, we will deliver the surgical hub this year. I understand that the particular difficulties in relation to the planning, which had been rooted in Cork County Council, as regards the connecting road, have been resolved and we will be in a position to go to planning. If I may, I will bring in Mr. Derek Tierney on this point.

There is no rowing back on our commitment to the elective treatment centre in Cork. As was committed to, we will get the planning application by the middle of the year.

I am sorry but am I right in saying it is by end of the year?

It will be by the middle of this year.

Why can it not be brought forward if the issue with the county council has been resolved?

It is because we have to complete a design for the planning application.

In fairness, though, we have been dealing with this now for nearly five years.

I will take this aspect.

Why should it take another ten to 12 months to get the project into planning? Once it goes into planning, it will take another 12 months after that.

I hope it does not. I hope that Cork County Council will be able to expedite it, considering the difficulties have sat there for some time. I am very pleased that they have now been resolved.

It will involve two planning authorities now because we are dealing with Cork City Council and Cork County Council, as I understand it. This will mean it will be a complicated application. I am just wondering about that.

Indeed. I am sure that because Cork City Council and Cork County Council have been so seized of these issues for so very long and the connected road issue that seems to have blocked the progression of this planning application, both local authorities will put their best resources together to expedite, as best they can, the appropriate consideration of this planning application, because we are very keen to go ahead.

I am asking about this because this is an elective hospital not just for Cork but for the whole of Munster.

I agree.

It is important that we forward plan that.

I am sorry, Deputy, but we are over time.

Can I ask one final question?

Very briefly.

In relation to people being admitted to hospital from nursing homes, a procedure was rolled out very effectively in Dublin where rather than people being admitted from nursing homes into hospitals, a system was put into place where the hospitals would have a team that would call to the nursing homes. As a result, there was a 90% reduction in the numbers of people being transferred from nursing homes. Is there a plan to roll out that kind of system throughout the country so we can reduce the numbers?

That is my expectation for the regions, yes. They should be doing that already.

I thank Deputy Burke. We will have time to come around for a second round of questions if members do have additional questions. There should be time on the agenda for a second round.

I have a number of questions at this point. I will start with the HSE briefing this morning on the Nayagam report. It has been described as a case study of neglect of international proportions. It is quite significant in terms of what has happened at CHI and the orthopaedic unit in particular. What I expect will happen now in the steps going forward is that there will be debate going back and forth. We will be calling for the Minister to publish the report and the Minister will say she cannot. This will be followed by more back and forth. My worry about that process is that we will lose sight of the children, the patients, the families and the people directly affected. There is a saying which goes, “You are only as sick as your secrets”. I think that also applies to public services. Sunlight is a very good disinfectant. As much of this as is possible needs to be published and put into the public domain as quickly as possible.

I want to focus on the process here. My understanding and from what I can see, I think the process has been very poor. Parents were first contacted in October 2023. The previous Minister for Health said that phase one would be completed by April 2024. We learned this morning that it will be completed by the end of this year, almost three years later. I am quite concerned about the process here, the delays and the impact this is having on families. I would like the Minister to comment in terms of the process and that timeline and the delays we are seeing, given that commitment that this could be done in April 2024.

I cannot speak to that because I cannot speak to the experience the reviewer had in the conduct of his review with the clinicians. Quite a number of issues have been in the High Court. I will just say that I would very much like to publish this report and I am sure the committee would very much like the report to be published. The committee is, of course, entitled to make an application to the High Court if it wishes to in the same way as I would. It has all the same challenges that I have in relation to this and the same intent. I believe sunlight is a disinfectant as well and I would very much like to see this report published.

What I do believe will ultimately be helpful is that this report will, hopefully, form part of the inquiry we will ultimately be establishing to shine light on all these different practices because I agree completely with the Cathaoirleach. Nevertheless, the committee is, like I am, constrained by the rule of law. I have to be very careful. I was not a party to any of the proceedings. It is for the reviewer to describe difficulties that he may have encountered along the way.

The Minister mentioned this relates to the public inquiry. Will the delays here delay the public inquiry?

No. The inquiry will proceed along as quickly as it possibly can because that is the commitment we have made. What, of course, I would like-----

In the absence of the report?

Well, I would hope the report would become available. Would the Cathaoirleach prefer that I delayed the inquiry, hoping to get the report and hoping to be able to publish it and give it to the inquiry, or would he prefer that I establish the inquiry and then hope the report would be able to be made available to the inquiry at the earliest juncture?

I would have liked to have seen this concluded much earlier.

Well, of course, but those are the two choices. There is not a third choice. Which would the Cathaoirleach rather I do? I think it is better to progress with the inquiry and try to make everything available to it that I can make available to it. I do not want the perfect to be the enemy of the good here. These are binary choices, both imperfect. I have to make one of them. I think it is better to progress.

The Minister’s commitment is to publish as much as she can.

At the moment, I cannot publish anything. I want to move ahead with the inquiry and I want to make everything available to it, as I want to make it available to everybody. I will do the best I possibly can, within the constraints of the rule of law, to try to achieve that.

This is not the only report pending. The Dixon report has not been published. There is an audit into waiting list management. Are we going to see those other reports as well?

The audit into waiting list management has not been completed yet. I expect-----

It was due in December.

Precisely. I expect it. I hope I will have it. It was to look into three areas: spinal, urology and respiratory. I am hoping that I may have one of the elements of that by the end of February and be in a position to progress with it. That is my hope.

What was the delay with the audit?

It was the access to information.

From CHI? The continuous delays with these reports are unacceptable and it is a real cause of concern for the committee and, in particular, for the parents and families.

I want to move on to the parents and families. I understand the letter has been issued to the 91 patients this morning. What are the supports? Are they in one place? Is there a phoneline people can engage with?

There are two things. Parents will also be phoned this morning, in addition to receiving the letter. Obviously, then, people will miss phone calls because they are not expecting them when they are at work and going about their day. A phone line is also being staffed by an assistant director of nursing who can take calls from parents as well. That number is there in the letter as well. We are trying to find ways to make sure we are reaching people where they are, either by letter, a proactive phone call or by a phone line staffed by a senior member of staff able to take calls and give support. I hope that will meet people’s actual lived reality when they receive the letters.

I understand that 62 of the 91 patients will need follow-up.

That is what the clinician has recommended.

Is there a timeline in terms of when they will see these follow-up appointments or engagements?

That is what we are trying to create this week, namely that they will have a consultant to be there for that ongoing follow-up. It entirely depends on the clinical situation of the child. Some may need some measure of check-in and follow-up, while others may need more ongoing follow-up and some are already in the system in a follow-up process. It will entirely depend on the circumstances of the child.

I thank the Minister.

I will move to the Children’s Hospital Ireland. Last week, the CEO of CHI said that 30 April was the latest completion date, which was the eighteenth delay to the hospital. This was confirmed in the Minister’s letter to the committee, which we received yesterday. The CHI CEO also said that the commissioning of the hospital would then take seven months. The Minister’s letter says that senior representatives from BAM UK and Ireland and members of the Royal BAM Group are now involved in a project and are reviewing BAM Ireland’s progress.

However, the number of workers on the site has dropped. In December 2024, there were 900 productive staff on site. In December 2025, there were just over 500 productive staff on the site.

In the week ending 30 January 2026, staff dropped by a further 82, a reduction of more than 15%. To meet the new deadline, BAM would need to deliver 450 rooms per week, on average, doubling what it is currently doing, yet in the first week of February, just 90 rooms were completed. Given the substantial completion date for the new children's hospital has been delayed 18 times, how confident is the Minister that the 30 April deadline will be met?

That is up to BAM, how it shows up and whether it brings people to finish it or not. I cannot be more transparent with the committee, the Oireachtas and the people of Ireland than to point out the reduction in the number of staff who were there. We did see a step-up in October, when a new person was appointed to try to finish out this hospital but, unfortunately, that person had to step back, and they really have not met their commitments since then.

We obtained early access to the sixth floor in December. I assure everybody that CHI worked so hard to maximise access. Everything has been cleaned properly, and the flooring was put down. That really matters. Beds have been moved in, computers have been moved in-----

We understand that.

In addition to that, where we realised there was a day or two of slippage by BAM, they used that space to do other things, to construct other machinery that would be necessary for the rest of the hospital.

What I want to know is what the Minister is doing to ensure that BAM meets its obligations to deliver this hospital.

Can I ask you what you believe it is within my power to do, Chair? What are the procedural tools that are available to me? We have a contract with BAM, which has missed its deadlines again and again on behalf of the Irish State, which is the customer. I have provided evidence to the committee of the detail and the reasons for that. I have challenged BAM, as did my predecessor, privately, in the media, in public, by way of letter and by way of an update to the committee to provide clear evidence as to what needs to happen for it to finish it. If we were in a commercial arrangement and we were building a factory, for example, and the contractor did not put staff there to finish the factory, there would be a consequence. If somebody is building a house and the contractor does not have staff, or a plumber or whatever, to finish it, there would be a consequence. This is the same thing. The Irish State is the customer.

I am asking you what tools or levers you believe we have. The development board has some tools that are available to it, and it has taken some steps within the Irish courts to try to exert maximum influence on what is a commercial entity that should have delivered the contract for the Irish State.

If the Minister is saying there is nothing she can do to ensure delivery, does she-----

I am asking you what you believe I should do.

You have not given us any examples of things you can do within your power.

One of the things that I can do is to be very clear.

Let me put one question. If the Minister is saying there is nothing additional she can do beyond writing to BAM and meeting with it, as the previous Minister did, does she accept that the contract signed by the previous Minister for Health, Deputy Harris, is fundamentally flawed?

I do not. With the current projects that we are moving forward, we would not have a similar contractual structure. I think we will see that in respect of the National Maternity Hospital and other major projects that we will be advancing. May I ask Derek Tierney-----

You would say the contract is flawed.

I will ask Derek Tierney to speak to the tools that the hospital development board has been able to use, and some of the procedural tools within the contract that have been available to us.

I will ask the Minister one question on that. Does she accept that the contract designed by Deputy Simon Harris is fundamentally flawed?

No, I do not think that. That is not what I am saying. What I am saying is that we would not take that step again, and we will be taking a different step in respect of the maternity hospital.

Were mistakes made in the contract?

I am dealing with today and finishing out the contract as best we can.

It is relevant to today because it means we are not getting the hospital delivered on time.

The contractual structure is not one we would adopt again. I believe it is important to hear about the tools that we have.

If the hospital is handed over at the end of April, will patients move in seven months later, in November or December? What is the timeline?

If the hospital is handed over at the end of April, and if everything goes well with the commissioning, and we really have worked hard to try to make that as tight as possible, then that would be my expectation.

Can I answer about the hospital development board? It is important for the legal process.

Under the existing contract provisions, the board has withheld payments. It has applied LDs, or liquidated damages. If there is a delay by the contractor and there is a true economic cost realisation as part of that, the board has an entitlement to apply liquidated damages. It has also sought to bring its own client-side claims through the dispute resolution process.

If I look at the position as we go forward, we have adjusted the contract terms. We have taken the benefit of our experience in this programme in terms of the design, independent reviews and business case reviews. We have adjusted the contract terms, so we are increasing the-----

We can come back to this. No doubt, other members will have questions on this as well. We can come back to it. The next slot is for the Labour Party. I call Deputy Sherlock.

I thank the Minister, the Ministers of State and the officials. I thank the Department for the briefing this morning.

I think we all want the Nayagam review to conclude as soon as possible for the patients at the heart of it. I want to ask about all the other patients who are going through the orthopaedic, neurology and other departments in CHI at the moment. The HIQA report last year set out a number of very clear recommendations. We understand, as of this morning, that only 12 of the 19 have been implemented. Why have they not all been implemented almost 12 months on? Surely that is a concern. I know parents are concerned about attending CHI and the quality of care that their children are getting. What is the hold-up in the implementation of those recommendations?

There should not be any hold-up in relation to that. I will come back to the Deputy with a detailed update as to the other seven.

That needs to be made public as soon as possible.

That is no problem.

Huge credit is due to Conor Ryan and his team in RTÉ for the programme over the past two nights. It has made for harrowing viewing on the appalling state of our forensic psychiatric services, and the failures with regard to people with very serious mental health conditions in this country. It is scandalous that we have had this new hospital in Portrane open since 2022, yet only two thirds of the beds are operational.

I have a question for the Minister of State, Deputy Butler. If I heard her correctly this morning, she said that two 15-bed intensive care rehabilitation units and two smaller units are in the process of being opened. A Vision for Change set out a target of four 30-bed intensive care rehabilitation units. Is the Government retreating from the A Vision for Change recommendations that were put in place by a previous Fianna Fáil Government?

A Vision for Change is no longer the mental health policy. It was announced in 2006. When I came into my role in July 2020, the Minister of State, Jim Daly, my predecessor, had just announced Sharing the Vision, which is our mental health policy.

I appreciate that. My key point is this. A very noble target was set out in A Vision for Change. Is the Minister of State saying that the current Government has a much-reduced target for the provision of care? She has seen what the waiting lists are. We should not have needed a television programme to tell us how bad the services are. Very few places seem to have been put in place to meet the enormous demand out there.

In 2022, the Central Mental Hospital moved from Dundrum to Portrane, and 93 patients moved on that date. Today, as I sit here, there are 114 beds open. Last year, I secured 41 whole-time equivalents to open an additional 18 beds. Two opened in December, and the other 16 will have a staged opening in February and March of this year.

In budget 2026, there were developments with regard to the ICRUs. We already have two intensive care rehabilitation units. These are at a very high level for people with enduring mental health conditions who are a risk to themselves and others, and need specialist care. This is not the norm. This is a small cohort of people who need these supports. We have one ICRU in Dublin and one in Cork. We have two buildings in Portrane. It is the most amazing facility in the country. There are 15 beds in each intensive care rehabilitation unit. I have funded the opening of ten beds this year, which requires 30 staff. These are specialist staff. These are not just ordinary mental health staff.

I appreciate that.

It is difficult to get them. I worked with the national forensic service. I allowed it to recruit last year outside the HSE, and 41 staff have been recruited. That is really positive.

I appreciate all of the Minister of State's efforts. I really do. I want to focus on the numbers.

I will answer the Deputy’s question. What was looked for in 2006 is different from where we are in 2026.

Does the Minister of State think there is a lesser need now?

No, I am not saying that. What I am saying is that A Vision for Change was uncosted and unfunded. I am dealing with Sharing the Vision. The difference with Sharing the Vision is that there is a national implementation and monitoring committee that sits over me, the Minister for Health and the HSE. It meets regularly, and it has a website. We produce documents every quarter showing exactly what we are doing in relation to the short, medium and long-term views.

I know I am taking up time but I will finish the point. There are 36 on a waiting list. There will be an additional 28 beds. There were 26, and two opened in December, so, in total, 28 new beds will have opened. That will bring us to 140. I will go back into the Estimates again in September to secure more funding for the ICRUs.

If I had all the money in the world this year, I could not open all the beds because I could not get the staff.

I just want to be clear. I see that what is in the opening statement is what is being committed to in the HSE service plan. Is the Minister of State telling me the Government is not responding in any shape or form to what has been revealed to the public over the past two nights?

No, that is completely inaccurate.

Has there been an updating of the position on the service plan?

Long before this programme ever started, my focus has been on opening new beds to ensure that people who are unwell can access the hospital and the specialist support they need, but we also need community supports. We have 1,200 people living with enduring mental health conditions across the community. We have 500-plus people who were rehomed in the past 18 months working with the Department of housing. Not every community wants somebody coming in to live beside them with enduring mental health conditions. We have to make sure they have the correct wraparound supports.

This is a whole-of-government approach. It is not only mental health. It is the Department of justice as well. If the Deputy was to ask for my honest opinion, I genuinely believe that there has to be a layer in between national forensic and people in prison who might have low-level mental health issues. There is a request in the programme for Government for a wing in a prison that is an approved centre as against a prison. If a prisoner at the moment refuses to take medication for his or her health and well-being, it cannot be forced. That is why I believe-----

I appreciate that. The thing is that because of the lack of services, people are ending up being held indefinitely on remand.

There is not a lack of services. What I am saying to the Deputy-----

Really?

Yes. We have a waiting list of 36. That waiting list has grown-----

Sorry, but if I develop psychosis in the morning and punch somebody, I could end up on remand indefinitely because there is nowhere else to put me.

Yes, but there are many people in prison who have committed crimes.

There is a difference between a minor crime arising from a person's mental health condition and murdering someone.

I get that.

That is the critical thing here. People are ending up in jail because of a disorder. Someone was talking to the wall in Dublin Airport and ended up going to jail.

What has been lost in the programme is that the Central Mental Hospital is a hospital for people who need forensic care. We also have people who do not come through the justice system and have enduring mental health conditions. They might have been instutionalised for 30 or 40 years and be a risk to themselves and others. They need a pathway as well. I have to protect that 10% who need a pathway into the hospital. It is a hospital. The Central Mental Hospital is not a prison. That is where the confusion is happening.

There are two separate but related issues here. I am not confident from listening to the Minister of State that by the end of this year, we are going to have the supports in place for those who need them with severe and enduring mental health conditions.

I am confident.

I need to ask another question.

To finish on this, I am confident we will have an additional 26 beds opened by the end of this year. Nevertheless, it has to be respected that there are 580 staff funded to work in forensic mental health services. There is outreach into ten of the 12 prisons across Ireland and we will expand it to the other two as well. I am happy to take this offline and have a meeting with the Deputy to discuss it.

I am happy to do that.

I wish to say two things in my remaining time. First, I am relieved we have confirmation that there has been a cut to the drug and alcohol task force because there was confusion about that. Second, with the EU Presidency this year, what are the Minister's priorities for that? She is going to be chairing the Council of health ministers. What are her plans for that?

Two items of legislation are of critical significance to the complete EU mandate for that period. Those are the biotech Act and the medical devices update. We are hoping-----

I am interested to hear if the Minister is going to say anything about drugs. An EU directive has been stalled and we understand that the Government is opposing it. Is that going to feature in the-----

That is just the ongoing piece of work. For the Presidency, our priorities are to try to make as much progress on those two items of legislation as we can. There is a lot of expectation on us to do that because we are being preceded by Cyprus and then Lithuania on the other side, which do not have the same depth of experience either as EU members or within those particular fields. There is a lot of expectation. That has to be-----

What will Ireland get out of those two initiatives?

A different regulated system for clinical trials and for access to medical devices. It is a huge part of the competitiveness agenda as well, concerning medical devices and life sciences within Europe. Bizarrely, the competitiveness agenda at the moment within the Irish Presidency falls to health. There is the safe hearts vascular plan, which was published by the EU in December. That will also form a theme, although it is not a legislative theme.

Our conference events will be around the two major pieces of legislation, where Ireland has to take the lead to drive as hard as we can to make sure we are making a difference for access to clinical trials and better regulations and simplification of medical devices across the board. It is hugely important for patients. It is also hugely important for the Irish economy. As the Deputy knows, however, Ireland will of course be adopting a neutral stance as the President of Europe at that stage. Our priority is to make the best legislative contribution and get those pieces of work done. It is very technical, but that is the way it is.

I welcome the Minister and the Ministers of State. In two weeks' time, it is Rare Disease Day and Rare Disease Week. I can see the Minister of State, Deputy Butler, nodding away. It is something I bring up regularly. In relation to the programme for Government commitments specifically on an early access programme or developing one, and a review of the reimbursement system in its entirety, what progress has the Minister made in that regard? Where is she taking that? It is 12 months in. I am worried that the review is going to take a significant period of time. I do not want us to miss the boat.

That review has begun. We spoke about that when I met Deputies with an interest in rare diseases. We spoke about some drugs in particular. That work has begun. As the Deputy is aware, officials from my Department are examining what other models in Europe are working and not working and how we can best apply that. I do not have a date for the Deputy at the moment as to when that will be completed, but it has already begun.

On the early access programme, I am only reading stuff in the media and it might not be true or accurate, but there is a suggestion that the early access programme specifically might only deal with cancer drugs. Is that the case?

I cannot speak to that because that is not information that I necessarily have. That is just speculation. We have not completed a programme in relation to what that would look like. What we can see from the Department is a real focus on all the different areas that are supportive of people with rare diseases, such as the genomics and genetics piece of work that is happening, the rare disease strategy itself and the beginning of clinical trials in different ways. There is a commitment to try to do more in this space. I do not have information that would suggest that is the case in relation to early access.

Whether it is or not, and I appreciate that the Minister does not know if it is, I implore her to bear in mind that a wider net-----

Yes, it would not be my intention that that would be the structure, but it is a body of work that has not been completed. Personally, I would certainly look at it more broadly than that. Being very honest with the Deputy, when we have this new structure regarding the 180 days that we have agreed and that we are investing money in, our real challenge will be the constraints on our drugs budget. We have additional funding this year for new drugs as well as additional drugs. We will never be in a position where we can say "Yes" to everything straight away or at the first price that is offered to us by the pharmaceutical company. We are always going to have to negotiate to try to get the best value for the Irish people and the State through negotiations with pharmaceutical companies. I might add, and this is not related to rare diseases, that just because loud campaigns are run by different drug companies in favour of their drugs, that does not mean the State will buy them at any price.

Most people in this room are grown-ups and realise the politics of what goes on. That said, the most vociferous and loudest of campaigns are normally run by the parents and it is out of pure desperation. The Minister has met some of them, to be fair to her.

I agree with the Deputy completely on that.

I would like us to be a bit more ambitious when it comes to it. To be fair, since the Minister has come in, she has met people and said she is taking these different steps. I appreciate that and I know families do. In the next 12 months, we need to see a bit of activity and delivery. I have been in here during previous Governments with the previous review of the reimbursement system in the form of the Mazars report. By the time the bloody thing has started, the Government is nearly at the end of its term. I urge the Minister to keep the pressure on.

I wish to move on in that vein to spinal muscular atrophy, SMA. I was reading the press release back again in my records. In November 2023, it was announced that SMA would be tested for in the heel prick test for newborn babies. Fast-forward to February 2026 and it is still not being tested for.

Does the Minister have any update on that? There have been media reports that it is imminent.

It is imminent. I will come back to the Deputy later today with a more specific answer on that. I cannot recall the eSubmission, eSub, off the top of my head but, yes, it is very close. I will come to the Deputy today with a more full update on that.

That was approved by the previous Minister, to be fair to him, but it was not implemented for, as I said, the best part of two and a half years. I do not understand how a Minister can have green-lit something in November 2023 and we are here sitting in a committee with his successor and it is still not being done.

Yes, and I do have an update. Forgive me. Usually I can recall things but I just cannot recall this exactly. I have already signed off on an eSub in relation to that. I will provide the Deputy with a much more detailed update today. Forgive me for not having that.

I appreciate that.

Following on from that, I will finish with the rare disease piece. We compare ourselves internationally and with our EU counterparts. In terms of heel prick tests specifically, Italy are streets ahead of most of the Continent at this stage. In parts of Italy anyway, they test for 20 or 30 different rare diseases from birth, and at present we test for ten or 11. Whether or not we are going to test for SMA, at present we are not, so I will not count it and, therefore, we will say it is ten. Are there any plans to role that out further beyond SMA to capture more rare diseases at testing stage?

Yes, that is absolutely my intention. I have already had that conversation with the Chief Medical Officer. The heel prick test will be extended in April. I am trying to get an update for the Deputy as quickly as I can in live terms. I will provide the Deputy with a full update today.

If the Minister does not have the information during the meeting, that is fine. I am happy to take it afterwards. I appreciate the Minister coming back.

I will even come back before the end of the meeting. I just need to check. Forgive me.

I appreciate that.

I will move on to the flu vaccine and respiratory syncytial virus, RSV. I raised it here in the last few weeks, including with Bernard Gloster when he was sitting in that chair. The national immunisation advisory committee, NIAC, has recommended that the RSV vaccine be expanded to an older patient cohort. They have done it in Scotland. The evidence there suggests it is dramatically reducing the number of hospitalisations. I spoke to Mr. Gloster here last week. It was his last occasion to come before the health committee and I wish him the best of luck in his retirement. He is a good man and it was great of him to come back to us. That said, the news he gave us that day was very disappointing. He more or less conceded there were no plans to expand the RSV vaccine into that older patient cohort. What information does the Minister have on that and what plans does she have for it? Is that something she can revisit or look into? As I said, it would reduce the number of hospitalisations. I appreciate there is a financial aspect to this. Acknowledging what the Minister stated earlier, I do not expect her to sign off on every drug and every vaccine, but specific to those ones, it makes sense due to the potential for reduced hospitalisations and it needs to be looked at.

The Deputy will appreciate that when I made that point earlier, it was not for him directly. It was for those who might wish to engage in such campaigning from a commercial perspective.

In relation to flu, RSV and Covid-19, the RSV vaccination take-up rate in the maternity hospitals where we have provided that was exceptionally high. It was close to 88%. It was incredibly impactful in reducing RSV and the severe illness we had seen in the previous two years, in babies and in children's hospitals. I will speak to the Chief Medical Officer in respect of its extension, but her bigger concern was the flu vaccination rates more broadly.

I do not say this for the whole flu period, but at one point the analysis showed me that three quarters of people who had been hospitalised with flu. and it was a very severe flu, had not had the vaccination. There was very high uptake of the flu vaccination among those over 80 because, of course, we have a nursing home programme, and there were very good rates in the over-60s and improved rates in children, although it is a mystery to me how, with a free vaccination, only a quarter of children took it up. Here we are celebrating the fact the rate is up from 17%, but it is only a quarter. Most of the illness was circulated among children, with impacts across society. It is incredibly important to get the flu vaccination at every age. The rates, for healthcare workers, were higher this year than last year but, again, I hope they will be higher again next year and that the vaccination rate will be higher generally.

I will speak to the Chief Medical Officer about her perspective on RSV for other people, but we are trying to target the most impactful each year. Of course, as the Deputy will be aware, that changes every year with the nature of the presentation of flu. It could be that RSV is more severe next year. I will discuss it with her.

My final point relates to the elective hospital in Glanmire, because I have been hearing about it for months inside here. There is stuff happening on the ground, which I am not going to comment about publicly. There have been meetings with landowners, etc., and I have been party to those. Progress is being made. I would like to make a point in the round rather than ask a question. When it was announced a number of years ago that it was the intention of the State to build this hospital, a lot of the preplanning that is being done now and being hashed out in this committee should have been done then. We are here now dealing with this. We are here chasing landowne and trying to get concessions and mediate between people. That should have been done two years ago. It would have avoided Deputies and Senators having to come in here and ask the same questions. As I said, progress is being made. Maybe some people are not aware of it. It is not a negative story in the round. The hospital will be delivered and the landowners are forthcoming, but a lot of this work could have been done a few years ago.

I agree. I thank the Deputy for the work he is doing behind the scenes to resolve some of those issues as well.

I suggest at this point we take a five-minute break and come back at 11 a.m.

I thank our guests for attending. I will start with the Minister of State, Deputy Butler. Most of us have watched the "RTÉ Investigates" programme over recent evenings regarding the treatment of prisoners with severe mental health illnesses who are currently in prison. It is my understanding that this situation has become almost intolerable, which is probably the best way to describe it, since therapeutic bail was suspended about six or seven weeks ago. We know that the Central Mental Hospital is there. We know how much it cost to build and we know how many people it is capable of holding. However, we still have 38 people in prisons who really should be in the Central Mental Hospital. While I acknowledge that this does not fully under the Minister of State's brief has she had any engagement with the Minister for justice on this issue? I do not think anybody wants to see this continuing. It is unsafe for the prisoners, it is unsafe for the remaining occupants of the prison and it is unsafe for the staff. It is not really best practice at all.

I thank the Deputy for her question. It is a really good one. There is a whole-of-government approach. The Minister for Health, Deputy Carroll MacNeill, the Minister for justice, Deputy O'Callaghan and I visited the facility in Portrane during the summer. We recognise the fact that there are issues relating to justice, mental health and other areas. I have had engagement with the Ministers. We also have a high-level task force in place between the Departments of Health and justice. The Deputy may have heard her colleague Deputy Quinlivan speaking about the community access support team, CAST, that we have in Limerick. Where somebody has a mental health challenge, members of that team accompany the relevant gardaí in order to deal with the situation. I know that is in the community, but the point I am trying to make is that there is very good and solid communication between us in the context of trying to resolve this issue.

What resolutions are the Departments examining at the moment? In Cloverhill recently there were 55 people on the medical landing. That landing has capacity for 27. The figures have gone up ten times over ten years and have tripled in the past four.

I cannot answer the questions on the capacity in prisons. In this year's budget, the Minister secured support-----

These people should be in hospital-----

-----for an additional 600 to 700 prison places. We have the outreach services. We have over 45 mental health staff that are doing outreach into prisons. Ten of the 12 prisons have outreach services. I am working to find out why the other two do not. I accept the Deputy's comments, and those of Deputy Sherlock, on the challenge that arises when a person is psychotic and is inappropriately placed. I get that 100%.

On the subject of mental health again, the Government did not oppose the Sinn Féin motion on the accident and emergency departments and the need for specialised spaces within those. There are eight accident and emergency departments where these rooms do not exist at the moment. I am looking at reply here to a parliamentary question on the national clinical programme for self harm and suicide-related ideation. It also identified some deterioration in the quality of remaining accident and emergency departments that were audited. In terms of the Estimates, how many more of these rooms will be delivered in our emergency departments?

I expect all of them to be delivered-----

Is the funding there for all of them?

I would expect that they will be able to pivot. Accident and emergency departments are very busy places. A lot of money has been provided to them in the form of capital funding. It is not an issue of funding, it is for them to identify a place and to make sure. Emergency departments are not the ideal place for anyone who is presenting who is psychotic or who has a mental disorder and is very unwell. The last thing he or she would want is to be sitting under the lights. We are down to eight hospitals now that have not provided this. Limerick University Hospital is one of them. I spoke to the regional executive officer only recently in person. I have zero tolerance for not having those rooms in place. I will continue to work on that. I have secured €470 million for mental health in capital in the national development plan out to 2030. This level of funding is unheard of. I have never had a budget like that before. It will not be an issue if it is a small amount of capital to facilitate a room. That will not be the issue.

Has the Minister of State given those eight hospitals that do not have these rooms and these specific spaces available a timeline to have them in place?

I will be giving a timeline very shortly. I want them to be in place by the end of this year.

It is part of the service plan.

I want to move on to the gaps that exist in respect of adult ADHD assessments. It brings me absolutely no joy to say to the Minister of State and to this committee that I had three families in to me on Monday alone who are caring for adult children in intolerable circumstances. These are really the most desperate situations. They are pleading for ADHD assessments. They have been told that the boxes are being ticked left, right and centre for these, but they are being told this by people who are not in a position to carry out the assessments. In terms of the Estimates, will the Minister of State provide an indication as to how the current policy can be extended to fill the gaps that exist?

I introduced the policy on ADHD assessments for adults in 2021. The clinical programme was devised at that time and I was told that we would need 14 teams in place across the country. The 14 teams have been funded, and the final five teams that were funded in budget 2025 are being recruited for.

When will they be in place?

I had hoped they would be in place by the end of last year. An ADHD team, for some reason, is quicker to set up than other teams and we are normally talking about five or six staff. If it is okay with the Deputy, I will get a more detailed note on the matter and come back with timelines.

And on the other piece also.

I will say one thing in relation to ADHD assessments for adults. This was specifically to catch older people. For example, children get an ADHD diagnosis now, notwithstanding the waiting list, but there are adults of 50 and 60 who need to be diagnosed too. I met a person who is 68 and who got an ADHD diagnosis. When they were younger, they did not have the opportunity or the options was not there. The diagnosis has made a difference. I want to compliment ADHD Ireland, and I know the Deputy does too, for all the work it does in relation to that. I will come back to the Deputy on the timelines, because this is something I really want to push.

Is there a policy change or tweak that can be made specifically in the areas where teams do not yet exist or may be funded but not staffed? I ask so that we do not have the repeated scenario of people meeting brick walls because they do not have the €1,500, €2,000 or whatever it may cost to pay for a private assessment. It should be possible for them to be referred to an existing team.

It should be able to be freed up. As the Deputy will know, previously we had nine CHOs and now we have six regional health areas. For example, CHOs 5 and 6 amalgamated and that area now goes from St. Vincent's in Dublin and all the way down into Waterford. We have no team in the south east but there is a team. I cannot see any reason somebody cannot be referred to a team within their regional health area just because they do not fit in the geographical area. I suggest the Deputy brings me the cases, please.

I will and I appreciate that. My next questions are for the Minister. I fully acknowledge that, in the scale of things, this is not the most high-profile issue but it really annoys people. Last summer, I mentioned to the Minister the emergency supply scheme and the virtual appointments that people are being offered in hospitals, where they are provided with a prescription and only have 24 hours to get a repeat prescription from a GP.

Yes, I recall.

It is still a problem that consistently crops up.

It should not be a problem.

Has any progress been made?

That should not be a problem. The Deputy is absolutely right to identify the issue with me again. I raised it with the HSE afterwards. I do not have an update for the Deputy but I will by the end of the day. I apologise to the Deputy for not having the information. The Deputy is so right.

I appreciate that but there is an obvious solution.

There is.

Pharmacists should be able to extend the time. If I leave a hospital on a Friday with a prescription, I will not get to a GP before the following Thursday, possibly.

The reality is that it is so consistent with what we have done to extend the role of pharmacies in that space. We need to make sure that this fits into what we have done elsewhere. We have given pharmacies the power to extend prescriptions in other cases so that people do not have to go back to a GP. We have even given pharmacies the power to issue prescriptions as part of the common conditions service. The Deputy is right to identify this issue. It is a technical piece that should be fixed and I will update the Deputy by the end of the day.