I welcome the Minister of State, Deputy Troy.

I also welcome the Minister of State. I wish to raise the escalating cost of private health insurance and the growing financial pressure it is placing on many individuals and households. What we are seeing is not a marginal increase or a gentle upward trend. Premiums have risen sharply, and sometimes multiple times in a year. This has pushed many families to the brink. These are people who do everything right. They work hard, they pay their taxes and they try to protect their loved ones by maintaining health cover they see as essential rather than optional. Despite this, every renewal notice brings anxiety as opposed to reassurance. It is not only working families who are feeling the pressure. Retired individuals and older couples - people who have contributed throughout their lives and who rely on timely healthcare more than ever - are finding themselves increasingly unable to maintain the cover they once depended on. At the very stage in life when health insurance becomes most critical, many are being priced out of the system entirely. Their fixed incomes simply cannot keep pace with the relentless rise in premiums.

The tax reliefs available on health insurance premiums were significantly reduced during the financial crisis.

The marginal rate of relief was removed in 2014, 12 years ago. That was introduced as a temporary austerity measure but allowed to become permanent. Before that, relief was granted at the marginal rate, which for many taxpayers was 40%. That support was cut and standardised. Today it stands at just 20%.

Despite the recovery of the public finances and repeated claims that austerity is well behind us, this reduction has never been revisited. The result is a double hit: rapidly rising premiums on one side and a weakened tax offset on the other. Families and individuals who make up the backbone of private health insurance membership have been hard hit. Many households have endured increases of 30%, 40% or even 50% in recent years with no adjustment in tax relief to soften the blow. For some, the cost of cover now rivals a mortgage payment. Families are being forced into impossible choices: either keep the insurance and cut back elsewhere or drop it and hope they will not need timely care.

This is not sustainable and it is not reflective of a Government that claims to support working people. Given the scale of the increases and the fundamental importance of access to timely healthcare, I ask the Minister of State to confirm whether the Government will undertake a meaningful review of the tax relief structure for private health insurance premiums. Will the Department examine whether the reduced rate of relief remains appropriate? Will it consider restoring relief at the marginal rate or introducing a more progressive structure that reflects the pressures on ordinary families? There is a large and growing constituency of working people who feel they are being quietly priced out of private healthcare. They feel unheard and they are right to be frustrated. The same is true for many retirees, who now face the stark reality that the system they supported for decades no longer supports them when they need it most. A review is not only overdue; it is necessary.

I thank the Senator for raising this matter. He has made some very valid points and I share his concern about the need for the Government to support the working family man and woman.

Section 470 of the Taxes Consolidation Act 1997 provides for tax relief for private health insurance. This relief is in respect of payments made to authorised insurers under relevant contracts for medical insurance and dental insurance. Income tax relief is granted at the standard rate of income tax, currently 20%, subject to certain limitations on the amount of the premium, and it covers benefits which are the reimbursement or discharge of health expenses within the meaning of health expenses tax relief.

The amount qualifying for tax relief is limited in the case of an adult to the lesser of 20% of the eligible premium paid or €1,000 per annum and in the case of a child to the lesser of 20% of the eligible premium paid or €500 per annum. A "child" for all such policies is a person under 21 years of age in respect of whom a child premium has been paid.

Where an individual publishes a policy of health or dental insurance, the tax relief is granted at source. This is given as a discount on the cost of the policy so the insurance provider charges the premium less the tax relief to the individual, whether or not that individual is liable to income tax. Where an individual has a policy of medical or dental insurance paid for by the employer and on which they are taxed through payroll as a benefit-in-kind, the tax relief may be claimed by filling in an income tax return.

The current ceilings on the premium values qualifying for tax relief were introduced in budget 2014 as the cost of tax relief had increased significantly in the preceding years. In addition, despite the increasing cost of the relief, the numbers insured were estimated to have reduced by around 150,000 over the period, while the level of medical cover had decreased on some policies. Against this backdrop, the increase in cost was unsustainable.

This is one of the most broadly claimed tax reliefs and, therefore, is very costly to the Exchequer. In 2023, over 1.4 million policyholders benefited from the relief and the associated Exchequer cost was €450 million. The current ceilings for the relief ensure a level of continuing support via the tax system for those who purchase medical insurance policies, while reducing Exchequer exposure to more expensive policies. Providing tax relief at source ensures individuals on lower incomes can receive the full benefit of the available relief.

Tax relief in respect of medical insurance is always applied at the standard rate of income tax and there are no current plans to enhance that tax relief. As an enhancement to the value of relief available may be absorbed by price rises, it is possible that enhancing the relief could lead to price increases further than would have been incurred in the absence of any changes to the relief.

As with all taxation measures, these are kept under review as part of the annual budgetary process. I have no doubt that the Senator will use his position within his own party to engage with his party leader, who is the senior Minister in the Department which I serve, and feed into the budgetary considerations that will commence mid-year.

We can take heart from his interview a week ago which confirmed that as part of budget 2027, there will be taxation changes to favour people who are working and who need a break and support in the budget of next year.

I thank the Minister of State for his response. Without stating the obvious, there is a trend that people are not taking out health insurance because they cannot afford the premiums. I welcome the news that budget 2027 will be looked at thoroughly in relation to getting some reduction and tax relief for the people who are doing it because, as I said, the pressure on the public system will intensify. We need more people taking out health cover. It is disappointing to see that it is estimated that the number of people insured has reduced by 150,000 over the period referred to by the Minister of State.

The current ceilings were introduced in 2014. I will be relaying my message to my party leader, the Minister for Finance, Deputy Harris. There are budgetary constraints but we need to take a serious look at this because it is damaging the health and well-being of a lot of people. A lot of retirees in particular have come to me on this issue because they simply cannot afford the premiums.

The Senator makes very well-founded points. It is important that we look at next year's budget in the context of how we can support working families who currently are feeling the pressure. Last year's budget took the prudent decision to protect our economy, to protect businesses and to protect jobs. If we do not have jobs, then we have a bigger problem.

The Government and the new Minister for Finance - the Tánaiste - have very clearly said it is our intention to ensure that we look at taxation measures that will support working families. It is thought that if the Senator's proposal was introduced, it could lead to further increases in premiums by private health insurance companies that would take advantage of the fact that greater reliefs were to be introduced. We can look at other measures to support working families that ultimately will put more money in their pockets at the end of the day, which is needed.

I thank the Minister of State, Deputy Troy, for his time in the House.

The Minister of State, Deputy Cummins, is very welcome.

The Minister of State is very welcome today. I think it is important that I briefly explain what Rathcroghan is and what the Farming Rathcroghan model project is. Rathcroghan - the fort of Cruachan - is an ancient capital of Connacht and is one of the most important archaeological landscapes in Ireland and in Europe. Rathcroghan is recognised as the oldest and largest unexcavated royal site in Europe, a landscape where history, mythology, farming and community life have existed side by side for thousands of years.

It is a landscape where history, mythology, farming and community life have existed side by side for thousands of years. The Farming Rathcroghan project is a pioneering initiative in County Roscommon that works with local farmers to protect this unique archaeological landscape while allowing farming to continue in a sustainable and heritage-sensitive way. Over recent years it has supported 90 farmers and helped to manage and protect more than 260 internationally significant archaeological sites across roughly 40 sq. km.

Continued support for the Farming Rathcroghan project is essential and unfortunately it is urgent because right now, this project is facing a very real and immediate threat. If additional support is not secured the project is due to cease at the end of March. I did try to get this Commencement matter in last week so I am sorry for the short notice. Without additional funding the project office, the staff of five and all related schemes will cease to exist. If the administrative structure is lost the entire project, built over eight years, is at risk of collapsing completely.

The evidence that supports the Farming Rathcroghan project is very clear. Since its launch the project has supported 90 farmers. It has protected over 260 archaeological sites, developed a best practice model for managing heritage within working farmland and leveraged approximately €2.5 million in competitive EU funding to deliver real outcomes on the ground. It has created training programmes, community engagement models and practical conservation measures while building strong trust and participation among farmers acting as custodians of this nationally and internationally significant landscape.

The most immediate priority right now must be the retention of the administrative staff because without them, funding applications cannot be prepared or managed, farmer supports cannot be co-ordinated and heritage protection measures cannot be overseen. The organisational structure that holds everything together would disappear. If there is any hope of maintaining this project, even on an interim basis, the administrative core must be protected. Retaining the small but highly skilled team is the bridge between where this project is now and any future funding solutions. Losing them means losing momentum, expertise, relationships and credibility.

This must become a priority for the Heritage Council, the OPW and the National Monuments Service. These are the agencies with responsibility for protecting our heritage. This project has demonstrated over eight years that farmers can be active partners in heritage protection and not obstacles to it. What is needed now is immediate practical support and at a minimum to retain administrative staff and maintain the core structure of the project while alternative funding streams are secured because once this infrastructure is lost, rebuilding it will be vastly more difficult and far more expensive. We are not being asked to fund an untested idea; we are being asked to fund a proven protective programme, an award winning model that protects heritage, supports farmers, strengthens rural communities and enhances Ireland’s cultural standing. Allowing it to disappear now when it is delivering real results would be a profound loss locally, nationally and internationally. If we want this project to survive, we must act now.

I thank Senator Scahill for raising this matter today which I am taking on behalf of the Minister of State, Deputy O’Sullivan, in my Department of Housing, Local Government and Heritage. I am aware the Senator has discussed the Farming Rathcroghan EIP in this House in the past and I know he has a deep interest in this archaeological and biologically rich landscape.

The archaeological landscape of Rathcroghan is part of the royal sites of Ireland tentative world heritage application that the relevant local authorities are currently progressing towards inscription on the UNESCO world heritage list in partnership with the National Monuments Service and the OPW. Part of the lands at Rathcroghan are in State ownership and the National Monuments Service works in partnership with the OPW to conserve and protect these particular sites.

The Senator will be aware the Farming Rathcroghan project was initially funded through the European Innovation Partnership from 2019 to 2023 and later funded and expanded through the EU just transition fund from 2024 to the present.

The managing authority for the just transition fund is the Eastern and Midland Regional Assembly, which, along with Pobal, acting on behalf of the Department of Climate, Energy and the Environment, has overall responsibility for the implementation, management, monitoring and evaluation of the programme. The Farming Rathcroghan project received more than €900,000 from the just transition fund, just under the maximum funding threshold, which is €1 million. As a result, the project is not eligible for any additional funding beyond the amount already provided. I am aware of how successful this European Innovation Partnership, EIP, project has been in supporting and training up to 90 farmers over the past eight years and in its stewardship of this important landscape, including the protection of more than 260 archeological sites. I also fully understand the disappointment of Farming Rathcroghan at not being successful in its application to Horizon Europe cluster 2 for further funding, and the Senator articulated that well this afternoon.

Last year, the National Monuments Service launched a pilot capital scheme to support minor works across potential world heritage sites. Slightly more than €63,000 was awarded to Farming Rathcroghan EIP via Roscommon County Council for works including interpretation surveys, heritage signage, management of vegetation and livestock interaction around key monuments, and repairs to and registration of traditional dry stone walls. This pilot scheme has again been announced for 2026. I encourage Farming Rathcroghan to reapply.

I am aware the Senator is reflecting the feelings of many farmers in the area who are disappointed with the outcome of the funding application to Horizon Europe. It is important to note the National Monuments Service does not have responsibility for developing or managing agri-environmental schemes. However, that said, the National Monuments Service intends to establish in the coming years a support scheme for landowners across world heritage properties in Ireland, supporting farmers in the custodianship of these historic landscapes and the archeological features on them. This support scheme will be both complementary to existing and future agri-environmental schemes and stand-alone in nature. However, given the complexity of developing the scheme, it will require consultation with other key partners, including the Department of agriculture, the Department of Climate, Energy and the Environment and critically, local authorities, which are leading the world heritage nomination bid in partnership with the National Monuments Service and the OPW.

I am sure the Senator will appreciate that the Department's priority is the archeological landscape. We can certainly get the National Monuments Service to examine what level of support can be directed to the Farming Rathcroghan project for the archeological elements.

I thank the Minister of State for his response. He mentioned the National Monuments Service intends to establish in the coming years a support scheme for landowners across world heritage properties in Ireland. The blueprint for that idea is the Farming Rathcroghan project because over eight years it has demonstrated its ability. It has gone above and beyond accessing European funding. As the Minister of State mentioned, between the just transition fund and the European Innovation Partnership, 88% of its funding has been secured since 2019. Only 1% of its funding in that time came from the National Monuments Service.

The Minister of State mentioned the world heritage strategic investment fund. Some 2.8% of the project's funding came from that. The Heritage Council gave it approximately 6% of its funding over the period, as far as I know. At this point, the team on the ground has reached the end. It needs support and to be given the opportunity to try to source additional funding, which it has proved it is able to do in the past. If the Minister of State, Deputy Christopher O'Sullivan, were here, I would ask him for a meeting. I will pass the request on to him to see if he can facilitate that meeting. I thank the Minister of State, Deputy Cummins, for coming.

I will relay the Senator's comments to the Minister of State, Deputy O'Sullivan, and ask him to facilitate a meeting.

As the Senator will appreciate, and as I said in my initial response, the heritage unit in the Department of Housing, Local Government and Heritage has to focus on national monuments, heritage and archaeological elements as opposed to the agri-environmental scheme, which accounted for a significant chunk of the funding secured through the European just transition fund and the European Innovation Partnership. The Senator rightly pointed this out by way of a diagram provided to me before this debate.

I will take the points the Senator made back to the Department. In devising a scheme in the context of something that has been shown to have worked well, his feedback will be taken on board.

I thank the Minister of State for giving of his time. It is appreciated. We have six Commencement matters and six different Ministers coming in, which is a big story in itself.

I thank the Minister for Agriculture, Food and the Marine, Deputy Heydon, for attending. He is very welcome. It is a busy week for him.

I thank the Minister for attending and for giving of his time to deal with this matter, which relates to the corporate governance responsibility and credibility of Bord Bia, and, in particular, the credibility of Bord Bia if it continues to have Larry Murrin as its chair. For nearly two weeks now, this matter has been allowed to drift. With every single day that passes, the credibility of Bord Bia, and in turn the credibility of Irish produce, is at risk. Ireland’s reputation internationally is being put at risk while this continues.

As the Minister and I know, Bord Bia is one of the most important agencies we have when it comes to how Ireland is seen abroad. Its credibility is not optional; it is foundational. It exists to champion Irish food, farming and produce on the world stage and to sell the story of quality, integrity, sustainability and trust. That story falls apart when the chair of Bord Bia simultaneously associates with business practices that directly contradict the standards Bord Bia promotes. This is not about perception alone; it is about a clear conflict of interest. Pretending otherwise insults the intelligence of farmers and producers.

Conflict-of-interest rules are not box-ticking exercises. They exist because you cannot credibly regulate, promote or oversee a sector while benefiting from practices that undermine it. When the chair’s personal business model cuts across the very values Bord Bia is meant to defend, that position becomes untenable. There is no argument about that.

Farmers are not reacting emotionally; they are reacting rationally and justifiably to the blatant double standards that are evident. They are asked to meet ever-higher standards, absorb rising costs and protect Ireland’s reputation while seeing the standards ignored from the very top. Confidence has been damaged, and once trust is broken it is extremely hard to rebuild. International markets are watching this very closely. If Ireland tolerates conflicts of interest at the highest level of its food-marketing body, our claims of integrity ring hollow. This damages Bord Bia’s authority, weakens Irish exporters and ultimately hurts family farms, which depend on Bord Bia’s credibility to access premium markets.

I ask the Minister not to let this go on any longer and to say that the position is untenable and that Larry Murrin should step down as chair of Bord Bia. The Minister should go see all the farmers who are protesting and who have locked themselves into a Bord Bia office. Farming is their livelihood and they have to meet certain standards. If the chair who holds them accountable regarding those standards buys his beef from Brazil, it is a complete conflict of interest and it needs to be addressed.

I am delighted to have the opportunity to address this important issue in the Seanad. In the context of Senator’s numerous uses of the phrase "conflict of interest" – I did not keep count – I heard no proof offered. I heard rhetoric. Where is the proof? Has Sinn Féin sought a briefing from the chairperson of Bord Bia? The Senator has sullied someone’s name under privilege in this House but has offered no proof. Her party has tabled a Private Members’ motion that will be debated in the Dáil for two hours this evening. I look forward to debating it.

At no point did the Senator explain the point. I will explain a few things about international trade deals. I will explain a number of things about the importance for Irish farmers of the work Bord Bia does in marketing the produce the farmers produce to the highest standard. I will explain about the work that Bord Bia does in having a quality assurance scheme that our farmers have to meet very high standards for. I know that audit system. I have gone through it myself. It is frustrating, laborious and challenging but it means farmers get a bonus payment for their produce - their sheep meat, their beef and their dairy produce. They get that because we export 90% of the food our farmers produce. What happens internationally is hugely important. Everything Senator Collins is talking about is national and relates to Ireland, which makes up just 10%.

In general, if you take an Irish food company that does a multimillion euro deal with an international client that is to supply Irish food produce to 40, 50 or 60 countries, including countries in the Middle East and Asia, that may be way beyond Europe, Ireland and the UK. If that deal is worth hundreds of millions of euro and the Irish food company wins that contract and ensures the majority of the meat produce in that contract is Irish produce worth hundreds of millions of euro to Irish farming interests, it is obviously in the interest of Irish farmers that Irish food companies win those contracts.

More than price and more than anything, what international clients need, particularly since the pandemic, is guarantees of continuity of supply. They can never afford to have a day they do not have supply. Built into these highly integrated global international deals that Irish food companies are doing regularly is proof that you have spare capacity of five or six weeks at any given time that can be leaned on tomorrow. If you are dependent on a country like Ireland which is producing the majority of the produce, you need proof there is a contingency. If there was any food scare in Ireland or across Europe, you need to have alternative sources of supply so you will not fail to meet your contractual obligations.

To take the example of the pork dioxin issue that happened in Ireland back in 2008, every bit of Irish pork had to come off the shelves overnight. Large clients cannot afford to have that happen. What they need an Irish food company, or any other company that wins these contracts, to do is prove it can access supply from somewhere else. Some clients will actually stipulate the countries or the regions. A company and a client might insist that 1% of produce must come from Brazil but that facilitates the use hundreds of millions of euro worth of Irish farmers' produce. It is only 1% to prove the channel is there if all of the supply from Ireland and across Europe was to face a problem because of a food security scare or something like that on very short notice.

If this was about price or conflict of interest, it would be way more than 1%. It is purely about proving contingency of supply. That is why farmers benefit from these trade deals. If the Irish food companies did not agree to what the clients wanted in the deals and did not win the contract, and let us say a food company from the Netherlands, Germany or any other country other than Ireland won that contract, does the Senator think those companies would have hundreds of millions of euro worth of Irish farmers' produce in the deal? No, they would not. That is why these deals are of benefit. We need to explain that to our farmers instead of employing rhetoric to whip them up and trying to jump on a bandwagon. We need to explain the integrated nature of international supply deals and how they benefit Irish farmers.

The fact that Bord Bia is overseeing year on year record growth in the value of our Irish food and drink exports is testament to the fact that this approach is in Irish farmers' best interests and delivers for their bottom line.

Not for one minute am I saying Bord Bia is not a fantastic company. I have said this from the start. We need Bord Bia. However, it is the farmers who make Bord Bia look good as well because-----

It is a partnership.

It is a partnership, yes. The farmers must have faith and trust in it. Farmers see the chair of Bord Bia import from Brazil, which has been in the news recently with the callbacks and the recalls because we cannot trust it. We have seen this with Mercosur. We cannot trust what comes in from Brazil because it does not have the same controls we have here. The farmers in this country feel like they are being sold out for a cheaper product. It might not be about the price. It is about how they feel. The Minister has to see that, in the round, the farmers in Ireland feel as if they are being sold out because you can get a product that is not up to the same standard, bring it in for cheaper and sell it off as Irish meat. It is very unfair, whether it is being done that way or not.

I have no problem with Bord Bia. It is an absolutely amazing State company and it does unbelievable work abroad for us. Without it, our farmers would not be able to get into the markets they do but, without our farmers, Bord Bia would not be there. We have world class beef because of the standards we have to stick to. The 1% will not make a difference to these farmers. It is about the fact the chair is importing in for his private business while trying to promote Irish beef. There is a conflict.

It is a partnership between the farmers who produce the top-quality food to meet the very high standards set down and the audit system Bord Bia has put in place which allows us to give information to clients at the end and which, in turn, allows our farmers to reach higher value markets. Internationally, Irish beef is not competing on commodity markets with Brazilian beef because we go for higher levels of sustainability. It is due to the very data our farmers are inputting through the audit system that Bord Bia is able to work with Irish food companies to market produce internationally and to attain higher values for Irish farmers. The system is completely integrated. My Department plays an integral role in making sure that we continue to gain access to new markets along the way.

The mask has slipped. The Senator let the cat out of the bag in her supplementary question when she alluded to the fact that it is not about the 1%. It is all about optics. She does not care about the fact that she has sullied a man's name in the Chamber.

I did not sully-----

That man has waived his fee and worked gratis, as a matter of public service, because he fundamentally believes in the important role Bord Bia plays. He sees what it has delivered for our farmers, our agrifood sector and for the thousands who are employed in our processing industry. However, for optics, let us just tear the House down and whip up farmers rather than explain the thing to them. The Senator did not want to know the detail here today.

I thank the Minister for coming to the House and giving of his time.

Our next matter is in the name of Senator O'Loughlin. The Minister of State, Deputy Higgins, is very welcome.

I thank the Minister of State for being here. She and the Government have acknowledged that the current system in relation to assessments of need is not fit for purpose. I welcome that, but families in Kildare and nationwide need to see that recognition matched with action, additional staffing, transparent timelines and a very clear plan to eliminate the existing backlog.

We acknowledge that there is a big backlog nationally. When we look at the figures, we can see that the scale of the backlog in CHO 7 in Kildare and west Wicklow is one of the largest in the country. As of May 2025, there were 1,692 children awaiting assessments of need. The majority of those had been waiting for more than six months. That is huge. Basically, when children do not get an assessment of need in a timely manner, it means they must wait longer for speech and language therapy, occupational therapy and early intervention supports. That is a major issue. These delays are not abstract. They have a very meaningful and negative impact on the children and their families, and undermine trust with families. It leaves families navigating crisis after crisis. It leaves them in a situation where applying for early childhood education places and primary school places is very difficult. I always feel that families know best. They know when there are developmental delays. They know when there are issues and their children are facing challenges. However, trying to just explain that without having a formal assessment of need is very difficult when they go looking for a place for their child in a special school or a special class as part of the DARE system within early childhood education. There is no doubt that families are being left behind, particularly those in Kildare.

We need urgent reform and urgent resourcing. It is simply far too long for children to have to wait for these vital healthcare services. Even when the assessments are carried out, we still see very large numbers of children waiting for the services, but at least they are on the list at that point. At least, they have a chance and an opportunity. For those who are waiting, the waiting list has gone up quite substantially, as I know from speaking to many families. There has been an increase of about 25% over the past two years in the number of families looking for an assessment of need, AON. Families are heartbroken because they want to do the very best for their child. Not having an assessment of need means they do not have the tools to be able to support their child in the way they wish to.

Before I call the Minister of State, I welcome to the Visitors Gallery the students who are guests of Deputy Donnchadh Ó Laoghaire. They are all very welcome to Seanad Éireann.

I welcome the students to the Seanad. I thank Senator O'Loughlin for raising this very important issue and giving me the opportunity to talk about assessments of need and the reforms we are introducing in this area.

As the Senator said, Government recognises there are absolutely unacceptable delays in accessing assessments of need, not just in Kildare but right across the country. The Department and the HSE are committed to addressing these delays and ensuring the assessment of need system becomes more efficient and more effective. Demand for assessments of need at a national level has risen significantly. In fact, the number of applications for assessments of need for children has doubled in the past five years. This is reflected in the continued growth in assessment of need applications in the Kildare and west Wicklow local health office area - the Senator's own area.

Last year, there was an 18% increase in demand for assessments of need in the Kildare and west Wicklow area and significant efforts have been made to increase the completion rates of assessments of need in this area. The completion of 162 assessment reports last year represents a marked increase on the figure for the previous year. However, as the Senator said, despite this improvement, the number of children on the waiting list waiting too long is too large. The numbers she outlined in her contribution are stark and highlight the need to do a lot more, not just in Kildare and west Wicklow but at a national level, to ensure assessments of need are completed as soon as possible.

That is why on 9 December, two months ago, the Government announced a series of reforms to the assessment of need process. This will make it more efficient and more effective for children and their families. These reforms include changes to Part 2 of the Disability Act 2005, which provides for assessments of need. It is very important for me to say these changes will not remove any rights for parents to apply for an assessment of need for their child, nor will they alter that statutory six-month timeline I set out in the Disability Act.

The Senator asked in her contribution for the Government to take action. I am pleased to be able to outline some other key action areas we are bringing in with regard to assessments of need and addressing that issue. In addition to these legislative reforms that will go through the Oireachtas Joint Committee on Disability Matters, there are a series of operational actions which are being progressed as a matter of priority. They include the development of statutory guidelines to ensure that assessments of need focus on identifying a child’s needs, engaging in more intensive assessments only where there is an identified need. This should help reduce delays and allow therapists to spend more time delivering services to children. The establishment by the HSE of 11 new teams, initially to support HSE assessment processes, including assessments of need, are also being set up. Each team will include a psychologist, a speech and language therapist, an occupational therapist and an administrator, who will provide clinical guidance to families throughout that process. I also take the opportunity to remind Senators, when they are speaking to families, to encourage them to refer themselves on to our children disability network teams, CDNTs, if they think there is a need. An assessment of need is not required for that.

Government recognises the need for urgency when it comes to addressing delays in the assessment of need system. That is why we are committed to addressing the measures I have outlined, because we want to benefit children and their families.

I thank the Minister of State for her response. I mentioned the figures from last May because I did not have the up-to-date figures but, obviously, since May and December another 500 children went over that period of time. Some 2,125 applications are overdue and, at any level, that is shameful. I acknowledge the Minister of State outlined some of the changes that are being made and I appreciate that and the fact that 11 new teams have been established. I also appreciate the fact the Minister of State mentioned the CDNTs, which are important and give a service. However, I said at the start that families in Kildare need to have action, additional staffing, transparent timelines and a clear plan. In fairness, with 11 new teams, there is extra staffing. There is a plan. We still do not have transparent timelines. We need to have them. That has to be a priority.

As I have outlined, there are a series of reforms being progressed to ensure children can access assessments of need in a timely manner. In addition to this, we are also using measures such as the targeted wait list initiative which was introduced in May 2024. This year, that initiative will support the delivery of 6,000 clinical assessments. That is another one of those actions. There is very much a timeframe for that.

When it comes to staffing, I reassure the Senator that our CDNTs are also recruiting and there will be prioritisation within recruitment for teams that have the highest vacancy rate. If her area is part of that, it will be prioritised. It is about making sure that while we are utilising that private capacity in terms of the targeted wait list initiative, we are also continually investing in improving the public system through training and adding additional clinical and administrative supports. That is all about assisting the HSE assessment and liaison officers throughout that assessment of need process. It is also about ensuring children then have access to the therapies they need. That is why we are making such an effort to ensure our CDNTs get additional resources to be able to support children in that way.

The Minister is very welcome. I thank her for taking time out of her busy schedule to be with us today. It is always greatly appreciated in the Seanad.

I thank the Minister for coming in. I really appreciate her spending the time on this issue. I know it is an issue she cares about. I am raising it today because I have received significant feedback from many women suffering from endometriosis about the continued challenges they face.

I know we have the endometriosis framework and that the endometriosis surgery abroad interim scheme is temporary. However, I fear that, given the state of endometriosis care in Ireland, it is likely to be in place for several years. Patient advocates have expressed specific concerns about the operation of the scheme. I heard from one woman who was refused surgery in Cork due to fear of poor surgery outcome as the clinicians could not sufficiently answer her questions about follow-up care. She was then considered ineligible for the surgery abroad scheme. Women report being scared to go abroad and cannot afford the upfront payments. The administrative burden of filling out the forms is a barrier for many women. I spoke to a woman named Helen who spent €8,700 on surgery in Germany and is still waiting for her reimbursement. Referral for treatment abroad remains a serious concern. Under the scheme, only consultants can refer but, as the Minister is well aware, gynaecologists have huge waiting lists and diagnostic laparoscopies cannot always be fulfilled due to the long lists.

There is uncertainty for clinicians about what is required under the scheme. For example, are scans required for referrals? Do clinicians need confirmation of stage 3 or stage 4 endometriosis before referring? I recognise there may be concerns about GPs referring due to a lack of expertise, but can GP referrals be considered in the short-term with targeted training to upskill them?

This would greatly reduce waiting times for women suffering from debilitating pain who must often wait years to see consultants. I was deeply disheartened to find out that obstetrics and gynaecology are optional training for GP's despite the fact that women make up 50% of the population. This training should, of course, be mandatory. Women are being forced to go private and pay thousands of euro to travel overseas simply to get a diagnosis. It can take many months to get a scan while they are living with unbearable pain. That is after years of waiting to see a consultant in the first place. It has been reported to me that the locations of the hospitals for the surgery abroad interim scheme seem to have been randomly selected. There is no detail on whether the hospitals selected for the scheme are fit for treating stage 4 endometriosis, for example. Patient advocates have been asking for the inclusion of countries like Greece, which is known for its high-quality endometriosis treatment. Why has Greece been omitted from the list? Patients are frustrated by the lack of understanding around endometriosis. It is still being treated like a gynaecological issue when we know it is a whole-body disease affecting the bladder, bowel and pelvis. Paracetamol and ibuprofen are still being suggested for use as pain management. I recently heard from one woman who went to the emergency room with a burst cyst and who was given paracetamol by means of a drip.

I also have serious concerns about fertility options for endometriosis patients. Under HSE guidelines, only cancer patients qualify for egg freezing. While endometriosis patients can get IVF, they have to immediately get pregnant, and this is despite the fact that endometriosis is the most common reason for infertility. I have met patients as young as 15 who are being recommended chemical menopause and women in their late teens and early 20s who have had hysterectomies. Unless they are ready to have a baby immediately, they cannot have their eggs frozen. This is devastating for them. They have to choose between living with excruciating pain and being a mother.

For the women who get surgery abroad and finally get some relief from the agony, there is the impossible cost of medicine to keep them pain free. Ryeqo is prescribed to women who have had endometriosis treatment to reduce the growth of internal lesions. It is expensive. It costs about €140 per month and is not available on the drugs repayment scheme. There is a similar drug that is used in the treatment of prostate cancer; it is available. It is really hard for women to trust the system when similar drugs for a particular condition are refundable but those relating to endometriosis involve a significant cost. The optics of the disparity in this regard are incredibly jarring.

Will the Minister commit to expanding referral options to include GP's under the treatment abroad interim scheme? Will endometriosis patients be allowed to freeze their eggs through the HSE? Will the Minister include Greece in the approved list of countries under the scheme? Will she make obstetrics and gynaecology training mandatory for all GPs? Will she consider the inclusion of Ryeqo to the drugs payment scheme?

The Senator raised quite a number of issues. I suspect that she and I have spoken to many women who have many of the same issues.

We must recognise that endometriosis is a whole-system condition, but it does in many cases start from a gynaecological position as well. We have to acknowledge both of those things. We are very much trying to move the dial in terms of how it is understood and described. That is why the framework has been advanced beyond where it started out to really try to recognise, as the Senator said, that this is a whole-system condition for many women, although not all, and that it impacts maybe one in six women. It is a very common condition indeed.

I launched the national framework for the management of endometriosis on 18 October. It is the first time that we have had such a framework. It gives a presumptive diagnosis background for GPs rather than their having to articulate and advance an argument. It gives a presumptive diagnosis basis, which is an enormous step forward for people on a pathway to get proper specialist care in the regional centres.

Let me speak about the endometriosis surgery abroad interim scheme, ESAIS, scheme in particular, because there are a couple of important pieces in respect of that. We created the scheme specifically because we did not want women to have to pay upfront in the way they have done for either the treatment abroad scheme or the cross-border directive where they can be reimbursed. I recognise that, first, the treatment they were looking for was not necessarily available in Ireland and, second, it was too expensive to try to pay for that upfront. It is really important to understand that. The only way we could legally set up a scheme is that it is absolutely essential that it is a temporary scheme to meet a need we cannot meet today while we are on a pathway to meeting that need clinically. Otherwise, the scheme would not survive. It has to be understood that it has to be temporary and time limited. As a result, it is limited to two years.

We have an enormous body of work to do in order to try to upskill and advance imaging and surgical options here. I am pleased to say that work in this regard is progressing. For example, there have been a number of different study abroad opportunities. We are creating fellowships for surgeons to do much more detailed work. The Royal College of Physicians of Ireland around the corner is having a dedicated day on endometriosis in March. This is a big step forward for the clinical community, which had not previously recognised endometriosis at that level before.

The Royal College of Surgeons in Ireland is also leaning in. There has been a very big change in the clinical community's understanding of endometriosis and their commitment to upskilling, imaging and surgery options.

Again, the criteria for this scheme must be tightly set. It is not that we are selecting countries or clinics at random. We are looking for specific accredited lists. The British Society for Gynaecological Endoscopy and the European Endometriosis League both provide specific clinical criteria. The clinic in Greece that the Senator mentioned is not on that list, which is why it is not part of this scheme, but we have asked clinicians to visit the clinic to see whether it meets the standards and the reason is as follows. As before, consultants were reluctant to recommend that women get their treatment abroad because they could not stand over and verify it. We are now saying to them that we have done that for them based on these internationally accredited lists and therefore, this clinic is fine and they do not have the option any more. We are telling them they should be comfortable referring to a clinic because it is against a measurable list. Greece and Romania were not on the list but we have tried to take extra steps to see if they can meet the standards. Some will and some will not but unless we keep within the criteria of the scheme, the scheme itself cannot survive. That is why this is so important. We are trying to do something very different. We have never created a scheme like this. We are creating it to try to meet a need. In many cases, there are women availing of this already and we are trying to do our best to make sure that women are supported in every way but we do operate within certain constraints. I appreciate that I have not answered all of the questions but I have run out of time and will answer if I have another opportunity.

It would be great if the Minister could answer some of my other questions, particularly that important piece about fertility.

I am delighted to hear that there is a time limit for introducing this scheme. Best efforts are being made but with the reality of training and building up expertise, will we get there in two years? I suppose that is why the feedback from patients has been to ask for the scheme to work as well as possible for patients while it exists. I recognise that it is a bridge until the end goals of the framework can be put in place.

About 20 hospitals in the UK are on the scheme but I have spoken to clinicians who say that these are not particularly renowned hospitals. I appreciate that these hospitals might fall, under a certain amount of criteria from British medical guidance, but clinicians here are not sure if they will take Irish patients or if these are hospitals of renown. There is confusion among clinicians about how to refer and when to refer and on the quality of the hospitals. I recognise that there have been study abroad opportunities to build up that expertise. I think that is incredibly positive and thank the Minister.

As this is an internationally accredited list, we would simply use the list because we can stand over it both legally and from a clinical perspective. Those clinicians mentioned by the Senator should speak to the clinical director, Dr. Cliona Murphy, about this matter.

We also have tried to expand the surgical options here. I demanded a programme of an additional 100 surgeries be done in quarter 4 of 2025 using every tool that we could among our maternity hospitals. I am pleased to say that we got 142 extra surgeries within our own system. That shows we really are trying to make progress in this regard.

The Senator is right to highlight obstetric training for GPs and it is very important. As for fertility, that is a different scheme and I am expanding it as best I can. I am certainly very alive to the concerns of endometriosis patients.

As for the drug mentioned by the Senator, as she will be aware, we have a drug assessment process operated through the HSE and I leave value-for-money analysis and health technology assessments, HTAs, to it. We must also ensure that the applications are made. This matter is more complex than simply me deciding.

We are trying in every possible way that we can to change the dial in terms of how endometriosis is understood. Bernard Gloster and I wrote to every GP in the country to highlight both how common endometriosis is and the presumptive diagnosis pathway. We are trying to upskill and train. We have hired an additional colorectal surgeon to work in a multisystem way alongside obstetric surgeons to make sure that we have the personnel to perform more complex surgeries here.

As I said, the Royal College of Physicians of Ireland, which includes the Institute of Obstetricians and Gynaecologists, will host a day dedicated to endometriosis. The Royal College of Surgeons in Ireland is also leaning into it. We are developing treatment and long-term fellowships abroad in order that we have a much better standard of surgery here.

Yes, a two-year scheme is challenging. Are we going to meet that clinical need within that period? It is a race to do so but we are trying to pull every lever we can to deliver a much better service for endometriosis patents. I also recognise what the Senator said about pain and pain management. Again, there is a huge spectrum. The clinical guidance includes paracetamol. While I know women who take paracetamol for pain relief and that is fine for them, paracetamol is absolutely not enough for very many endometriosis sufferers who have felt patronised in the extreme by being told that taking paracetamol is the solution for them.

It might be the solution for one woman but it is not the solution for every woman and we have not reached a solution in relation to pain management for the more complex and severe cases of endometriosis.

I thank the Senator and the Minister for her time. I appreciate the Minister coming to the House.

As a vote has been called in the Dáil, we will need to suspend so that a Minister can attend the Seanad.

I welcome the Minister, Deputy Calleary, to the House.

Cuirim fáilte mhór roimh an Aire go dtí an Teach. Gabhaim buíochas leis mar tá a fhios agam go bhfuil sé an-ghnóthach agus faoi bhrú.

The Minister is very welcome. I thank him for taking time out of his busy schedule to be here. He has a lot going on and I appreciate his time in the Chamber.

The rural regeneration and development fund, RRDF, is a capital investment fund that has been hugely successful. It has transformed many towns and villages the length and breadth of the country, including in counties Cavan and Monaghan, which I represent. Fortunately, we have experience of the fund and the success and new life it has breathed into many towns and villages. Indeed, there are many projects ongoing there, the progress of which I am regularly in contact with the Minister and his good staff to discuss. I thank him and his staff for their engagement on those matters.

Today, the particular project I raise is in Kingscourt, County Cavan. As the Minister knows, Kingscourt has a population of approximately 3,000 people. It is a thriving business town and a very friendly place. It has a great mix of local businesses, many of them very well known, including Gyproc, Kingspan Group, O'Reilly Precast and Paramount Doors, to name but a few. There is also a strong retail mix in the town. It has a brand new school, Coláiste Dún an Rí, with more than 700 students. It is home to Cabra Castle Hotel, which is one of the leading wedding venues in the country, as well as Dún a Rí Forest Park and the greenway stretching along the disused railway line to Nobber and Navan.

In 2024, the people of Kingscourt were delighted when a funding allocation of €10.4 million was received for a regeneration project in the town centre. This was to increase the civic space within the town core, making provision for new off-street car parking, a new library and a brand new working hub with meeting spaces. This will transform the physical, economic and social landscape of Kingscourt and, as I said, residents are hugely excited about it. I commend Cavan County Council and, indeed, the local community. People have worked together, along with the officials in the Minister's Department, to progress the project.

I welcome that the project has now received full planning permission to proceed. I recognise that there are a number of procedures and stages to go through. We are progressing those quickly to get to a point where there is some activity on site. I am delighted the Minister is here to give me and the good people of Kingscourt an update as to when this long-awaited project will commence. Without meaning to put pressure on him, they are all looking forward to his answer.

Gabhaim buíochas leis an Seanadóir Gallagher as ucht an t-ábhar seo a ardú inniu. As he is aware, the rural regeneration and development fund is a major capital investment programme. It seeks to support large-scale, ambitious projects that can achieve sustainable economic and social development in rural areas. The focus of the RRDF is on supporting rural towns and villages with a population of fewer than 10,000 people. Since its introduction in 2017, the RRDF has allocated more than €613 million to 273 projects across Ireland, including over €35 million for 13 projects located in County Cavan.

In 2020, following an application by Comhairle Chontae an Chabháin, the council was awarded more than €787,000 in RRDF category 2 funding. This funding facilitated the acquisition of a derelict former Bank of Ireland building on Main Street in Kingscourt. The funding was also used to develop plans for the building's renovation and use as a community and remote working hub. The council subsequently made a category 1 RRDF application for a Kingscourt town centre regeneration scheme. In May 2024, approval was given for RRDF funding of €10.9 million.

The council’s regeneration plans include three main areas of works in Kingscourt. First is the refurbishment of a building on Market Square from its derelict state, which will provide a new public building to serve as a community library and focal point within the town core. Second are public realm enhancement works. This includes a redesigned Market Square and Main Street which aims to bring back its historic function, including the creation of a new civic and events space for the town, situated next to the community library. It will incorporate a main lower-level plaza area with paved patterns, seating, planting, feature walls and seat walls. Third is the refurbishment of the vacant former Bank of Ireland building on Main Street to create a multi-functional remote working hub. This will be for use by local business and will include office space, training facilities and meeting rooms and should act as a catalyst for regenerating neighbouring town centre buildings.

Cavan County Council, as the designated lead body, is responsible for managing, procuring and developing the works. The council is joined by other project partners locally, including Kingscourt Development Association - I join the Senator in acknowledging its work - Cavan local enterprise office, Cavan county local development and Cavan-Monaghan Education and Training Board.

The project is at the detailed design stage and the council advises it has undertaken a project execution plan and a detailed review of all design documentation to ensure compliance with the required standards. In addition, a stakeholder workshop on the community library was held in early January.

A project team was appointed in quarter 4 last year. The council will now progress through the stages of the capital works management framework, including completion of pre-tender cost estimates, the issuing of an invitation to tender for main works and, thereafter, the awarding of contracts. Subject to a satisfactory completion of the pre-tender obligations, the council has confirmed its intention to procure and deliver the project in two main parts under separate contracts running concurrently. The first part relates to the public realm enhancement component of the project. I am advised by the council that this contract is expected to take 12 months to complete. The second part relates to the library creation and remote working hub creation components of the project. I am advised by the council that this contract is expected to take 18 months to complete.

The contractor procurement will be completed through a two-stage restricted procedure for both works contracts. The pre-qualification and suitability tender packs for the first stage of this process are nearing completion. I anticipate that the tender process will commence in the coming weeks. Based on these timeframes, Cavan County Council has provided an indicative date of quarter 1 2028 for completion of the works.

Before I call the Senator, I welcome the guests of Senator P. J. Murphy to the Gallery. I also acknowledge that earlier we had the guests of the Minister of State, Deputy Dooley. They are all very welcome to the House.

I thank the Minister for his very comprehensive response to my Commencement matter. I thank his Department for the speedy way it is progressing this project, which the people of Kingscourt are hugely excited about. I commend everyone involved in this project, including Cavan County Council, the local development committees and everybody involved, along with all the political voices who have been trying to push this project forward, none more so than the local councillor, Clifford Kelly, who has been a champion for all things related to Kingscourt for many a day. I thank the Minister for his response. I hope we will be inviting him down le cúnamh Dé in 2028 for the official opening of this project.

I beg the indulgence of the Acting Chairperson to welcome members of the Moy ICA in County Mayo who have joined us in the Gallery. I hope they are enjoying their day.

I assure the Senator that the RRDF continues to support high-quality and transformational projects across rural areas of Ireland in line with the objectives of Our Rural Future and the town centre first policy. I acknowledge the huge work being done by Cavan County Council in co-operation with local partners. I visited Councillor Kelly in Kingscourt on many occasions and I know how proud he is of the town. This will provide public realm, a new public library and a new remote working hub. The Kingscourt project is an example for other communities of what can be done through the RRDF.

I confirm today that I intend to launch a call for proposals to local authorities and other public bodies for larger-scale category 1 RRDF projects in the very near future.

This follows on from my approval of €20.5 million for 31 category 2 RRDF projects nationwide in October. It is a priority of mine within the Department to ensure that we continue to fund RRDF and projects, such as those in Kingscourt, get to the completion stage.

I also welcome the two guests of Senator Murphy O'Mahony in the Gallery. I hope they enjoy their visit here today. I thank the Minister for his time and I thank the Senator for raising his Commencement matter.