I welcome the Minister of State, Deputy Moynihan. The first Commencement matter is from Senator Shane Curley.

Gabhaim buíochas leis an Aire Stáit as ucht teacht isteach. I raise this issue in the context of a conversation I had last week with the INTO over in Buswells Hotel. While a lot of what I will raise probably highlights negatives that exist within the education system and offers solutions to them, I also acknowledge the good work that has been done.

In the 2023-24 school year, Ireland achieved its lowest ever student-teacher ratio at primary school level. In the context of the global turmoil we see and the uncertainty that exists across the world, that is a huge achievement and must be acknowledged. However, large class sizes remain the reality. The average primary school class size in Ireland is 22.5 students, in comparison with the OECD average of 21 and the EU average of 19 students per teacher. We in Ireland, as a wealthy country, instead of trying to achieve the average across Europe and the OECD, should strive to be standard bearers in this area. In my party, we pride ourselves on being the party of education. We have huge work to do in this context.

From a teacher's point of view, we talk all the time about the crisis in retaining teachers in the country, and retention is one of the key issues here. We have 419,823 children in oversized primary school classrooms, if we take that EU average of 19. That is 996 teaching posts unfilled, which shows the unattractiveness in some ways of the role and the problem we have facing the retention of teachers. A total of 7,864 substitute teaching roles are being covered by unqualified teachers, which, again, is not a good reflection on our primary school education system and it is something we need to work on. As to what that looks like in practice, we have 51,028 primary pupils who were educated in the 2023-24 school year in class sizes above 30 pupils. That is a lot. That is 1,637 primary school classes that had over 30 students. The fact that our record low number of students in the 2023-24 student-teacher ratio still had those startling statistics shows how far we must go to improve that.

My ask is clear. We need 1,000 extra teachers in the 2026-27 school year at primary level to bring us in line with the OECD and EU averages and to try to push ahead and be one of the standard bearers in this field. Why? First, take a student with special educational needs. As a teacher myself, I think I did my best teaching in smaller classes. It is way easier to spread yourself across a classroom when there are 12, 13, 14 or 15 students in it, as opposed to trying to teach 30 students, which is just not doable. Students with additional needs, in particular, need a lot of the teacher's one-on-one focus. When that is not available, it reduces the effectiveness of that teacher in the classroom, no matter how good a teacher they are.

Second, we could also look at rural Ireland and the number of one- and two-teacher schools that are in danger of closing. A rural school is the focal point of a rural community that might have only the school, the post office and maybe a small shop and the local pub. That school is a vital cog in that whole area's social fabric, and we need to be really careful to make sure that we keep rural Ireland alive when it comes to these schools. Could we look at maybe a lower teacher ratio that we target in some of the more sparsely populated rural areas?

I thank the Senator for his question, his commitment to education and the many engagements we have on education and how we can build on the education system we have. In various reports we have seen the success of the Irish education system. On a continuous basis, we meet the challenges and deficits across the system. The Government and our party are working extremely hard on education, and I am fully committed to education, as the Senator will know. I will give him a few statistics on the education system.

The 2026 budget provides for an investment of €13.1 billion in education, up almost 7% on the 2025 financial year. Budget 2026 provided an increase of €845 million in core funding for education and youth on the figure allocated for 2025, while the total investment figure also includes €1.6 billion allocated for 2026 as part of the national development plan, which goes from 2026 to 2030. This funding reflects the Government's continued commitment, under the programme for Government, to ensuring that every child and young person can learn, thrive and reach their full potential. It builds on the progress made in recent years, while recognising that further work is needed to make education more inclusive and equitable for all.

Funding has been provided for 860 special education teachers across special schools and mainstream settings, along with more than 1,700 SNAs, and a €48 million full-year investment across both the DEIS strategy and the DEIS plus scheme.

Approximately 30,000 children and young people attending DEIS plus schools will benefit from these targeted supports.

Schools in the DEIS plus scheme will receive strengthened, research-informed supports across well-being, attendance, engagement, guidance, leadership capacity, community partnerships and access to services, including the introduction of a new positive mental health and well-being initiative to support a whole-school approach to student well-being. In addition, school leadership supports have been increased and will see additional deputy principals in primary and post-primary schools in the 2026-27 school year.

To go back to the point the Senator made, there are huge commitments to education in the programme for Government that we are working every day to ensure we reach in terms of both mainstream and special education. Under my own remit on the special education side, we have sanctioned 560 special classes, which will open in September 2026. We are constantly looking at how we can best equip the education services into the future. It is Important to note that the Government and I, certainly hold very dearly the issues in relation to smaller and rural schools. They are the focus of communities and lead to better outcomes. We have to be very mindful to protect what we have and to invest in the future in terms of commitment. There is no doubt but there will be additional teachers across the education system in 2026-27 but we have to be mindful, as we head into the summer and budget negotiations, of the challenges. The Senator and many of his colleagues met the INTO and I have frequent negotiations with that organisation in relation to its asks for the next school year and the pupil-teacher ratio and all of that. That is a huge part of its asks. For the very determined and hard-working teachers and SNAs who work within the school communities, we must ensure we support them and have all the resources possible to have better outcomes for the child, not just during school time but into their adulthood as well.

I am conscious that a vote has been called, so we have one minute each and then we will finish up on this.

I acknowledge the work the Minister of State has been doing. An extra 860 special educational teachers is a mammoth investment. Any time I have approached him, whether about school transport or special education, he has been incredibly approachable and I acknowledge my appreciation for that.

The special education side of it is obviously something we need to hugely focus on but what I am trying to get at today with this extra 1,000 teachers is more about mainstream education and the student who has additional needs who may thrive in the mainstream setting if the student-teacher ratio is brought down a small bit. It can be a very lonely place for a child, particularly if they have educational needs, to be in the classroom and feel totally lost and not know what to do, simply because the teacher is spread too thin. What this motion speaks to today is to try to bring down that student-teacher ratio, give the teacher a chance to cater to the needs of every student and allow that student who needs a extra little bit of help to thrive in the context of a reduced student-teacher capacity.

More than 43,000 teaching posts have been allocated across the primary school system at present and that represents an increase of just over 5,000 teachers since the 2019-20 school year. We have been steadily improving the pupil-teacher ratio and the average class sizes during this period. There is continued investment in terms of mainstream and special education. The entire education budget has been the source of some commentary but we are really meeting the need that is presenting at both primary level and special schools and classes, as well as at post-primary education. As we as a society, party and Government believe in education, we are committed to working with partners across Government in terms of the education requirement. The points the Senator has made will be reflected on very carefully. We have a lot of work to do. We have a great education system, but we need to further strengthen and support it into the future.

There is a vote on now.

The Minister of State, Deputy Troy, is paired, so we are going to take him next.

While we are waiting, I welcome Camila Alejandra Blanco, who is from Florida and is interning here with Senator Joe O'Reilly. She is very welcome. I hope he is looking after her well and bringing her in to the Members' restaurant every day for lunch, as is the custom for interns. I have no doubt he is. Ms Blanco is very welcome and we wish her the best in her studies and work experience.

I welcome the Minister of State, Deputy Troy. Is he still celebrating or is he quiet on the football today? Next up is Senator McCarthy.

I thank the Minister of State for being here today and I am grateful for the opportunity to raise this matter. Let me briefly explain the technology. When the Cathaoirleach introduced "tokenisation" into the record, he said "tokenism", and they are radically different. I am conscious of this for myself, as getting my head around it was difficult.

Tokenisation is the conversion of a real-world asset into a digital token on a blockchain, such as a share or an investment fund. It is then registered as a digital token on a distributed ledger. For those who are watching at home, they can think of it like this: instead of their ownership of shares being recorded on a paper register or a centralised database somewhere, it is encoded as a secure digital record, which can be transferred, verified and settled almost instantly at any hour across the world and across any border. What it does is remove layers of manual processing and dramatically reduces costs. It can open investment funds to a far wider range of investors.

We have spent years watching Ireland compete and win in a global context with regard to financial services. For four decades, the funds and asset management industry has been one of the great success stories of the Irish economy. Even the International Financial Services Centre, IFSC, when I was much younger, was something that really stood out. Today, it sustains over 20,000 jobs and nearly half of them are outside Dublin in towns and counties that depend on this vital sector. It contributes over €1 billion annually to the Exchequer.

The fund industry is undergoing a rapid digital transformation and tokenisation is no longer a future prospect. It is already happening. Luxembourg has updated its legislation to accommodate tokenised funds. The United Kingdom is moving with purpose regarding financial services and the markets Act reforms. Singapore has been ahead of the curve for years. These are our direct competitors for the same global mandates, asset managers and jobs. We have to ask ourselves what Ireland is doing in this context. The industry has been making submissions to the Department of Finance since last year. It has set out very specific, targeted changes in legislation that would be required, including changes to the Irish Collective Asset-management Vehicles, ICAV, Act, updates to company law and something as straightforward as allowing registers of fund members to be held on a distributed ledger. These submissions have been received but to date there has been no commitment to act and no timeline offered.

The case being made by Irish funds and the industry itself is asking for a political commitment to bring forward the necessary amendments to our laws in Ireland that will allow this to happen. Let us imagine an Ireland where the next generation of global tokenised funds are structured and domiciled here. Whether they are jobs in digital assets, blockchain infrastructure or the operation of a legal ecosystem around tokenised finance, these are Irish jobs. The taxes would then flow into the Exchequer, while a graduate from Trinity College, the University of Limerick or University College Cork can build a career at the frontier of financial technology without ever leaving the country.

I look forward to the Minister of State's response. I think it is something we can be very strong on in Ireland. I hope we can work together across the House to move this forward.

The Senator did not even use all his time.

Unusually.

I thank the Acting Chair. Certainly, us politicians can quite often be accused of "tokenism" but I am very conscious we are not talking about that today. We are talking about "tokenisation". I thank the Senator for raising this important and topical issue.

Given that Ireland is both a large funds domicile and home to significant financial services and technology sectors, there would appear to be obvious synergies that should allow us to keep pace with these technological advances. We are closely monitoring developments across the EU and globally and will continue to engage with industry and the Central Bank to ensure we can remain competitive as a jurisdiction while upholding our high regulatory standards. That is very important.

As the Senator outlined, tokenisation could fundamentally reform how capital markets operate enabling real-time trades, increasing transparency and liquidity, expediting clearing and ultimately providing for simultaneous settlement. The Funds Sector 2030 report included a recommendation that industry should continue to engage with the Central Bank of Ireland and the Department of Finance, as necessary "with a view to mapping out a pathway for adoption of tokenisation". The Department fully supports and encourages the work that industry has undertaken to assess what can be done within the current legislative and regulatory frameworks. Officials from my Department are considering submissions from industry regarding proposed changes to the current legislative framework.

In Europe, the regulatory landscape for digital assets is still evolving both at the national and EU levels. Whether an investment fund is permitted to distribute digitally depends on European and national rules. Some countries such as Germany and Luxembourg have started pilot work on implementing tokenisation. As part of the savings and investments union, SIU, strategy, the European Commission has published the market integration and supervision package, MISP. This package will amend 18 pieces of existing EU financial services legislation across trading, clearing, settlement and assets management and will be a central focus for Ireland during our Presidency.

Amending the distributed ledger technology, DLT, framework among other related measures forms part of the MISP proposal, which seeks to turn the use of DLT in capital markets from a limited sandbox into something that can be scaled across the Single Market. The DLT pilot regime is being amended in order that tokenised securities can be issued, traded and settled at meaningful scale. Other changes amend existing EU financial services legislation making them technologically neutral allowing for the use of DLT and other technologies. This proposal is currently under negotiation at EU level.

In March this year, the Central Bank published a discussion paper on tokenisation. This discussion paper is to encourage informed debate on how DLT and tokenisation could shape the future of financial services in Ireland. The paper seeks input from a wide range of stakeholders to explore the impacts of technology, understand how its benefits can be realised and identify how risks should be managed. Submissions on the discussion paper are invited by the Central Bank with the deadline earlier this month. The Central Bank intends to publish a feedback statement following the consultation period. My officials will continue to engage closely with the Central Bank on the matter and the outworkings of the feedback received on its discussion paper will be used to inform the Department’s next steps on this important policy matter.

It is also worth noting that at the end of May, I convened a round table with some of the leading thinkers in digital assets and blockchain technology to better understand the opportunities and challenges for the sector. There is great industry ambition in this regard and I am confident we will match that ambition with the forthcoming launch of the Ireland for finance strategy. I intend that strategy to have a dedicated focus on digital assets so that we can realise the opportunities that are in front of us.

We understand that the strategic risks of inaction might be significant. However, it is crucial to note that the regulatory framework for tokenised assets requires extensive consideration for issues like data protection, anti-money laundering, tax, beneficial ownership, insolvency or enforcement scenarios or property rights. We are closely monitoring developments in other countries to ensure we remain competitive but importantly uphold our requirement for strict regulation.

I welcome the engagement. I want to be constructive here. What the Minister of State's statement does say is that we understand the strategic risks of inaction, which might be significant. We are also waiting on the Central Bank to come back with its findings and we are also looking at other countries. I do not think the industry is asking for a whole lot here. It is looking for specific amendments to existing legislation regarding the Irish Collective Asset-management Vehicles Act and company law and practical changes that will clearly signal to global firms that Ireland is ready to play a huge part in the next chapter. When the Minister of State is looking at countries that already do this, I have mentioned Luxembourg, Singapore and the UK and they certainly are not waiting.

However, I understand that the Government has to be careful. I understand the concerns regarding GDPR, money laundering and so on. I ask the Minister of State to take one question away with him today. Can we commit to the amendments in this year's finance Bill?

I thank the Senator for raising this very important and topical issue. I will not give a commitment to amendments in the forthcoming finance Bill but I think I have been very fair in what I have outlined regarding the work officials in my Department and the Central Bank have done to date in engaging with industry. We acknowledge the huge opportunities this presents. We want to capitalise on them. That is why I have confirmed publicly here today that there will be a section within the Ireland for Finance strategy. That strategy outlines our priorities for financial services from this year right out to 2030. A key component of that will be tokenisation. I am not going to publish part of the strategy in the Seanad today. I do intend to publish it in the coming weeks. I do not believe there will be any doubt about our commitment to tokenisation once it is published.

I thank the Senator for raising this matter. I also thank the industry, which has engaged very fully with me, most recently in round-table discussions a number of weeks ago, and which has had ongoing engagement with officials in my Department to ensure we are acutely aware of the opportunities being presented to us.

Cuirim fáilte roimh an Aire Stáit. Last Friday morning, I attended a protest in Cavan town. It happened to be all mothers who were there. It was organised by mothers of children with additional needs. They were pointing out that they are not getting the supports and therapies they require from the children's disability network team, CDNT, based in Cavan. The longer children go without supports, the more complex their difficulties become. Families are finding it difficult to engage without supports and schools are finding it difficult because they are not getting the supports either. They are struggling as they try to provide the best form of education for these young people. This is the fourth protest the group has held in a year. Parents are just trying to highlight what is happening. They do not have the time or energy for this. They should not have to fight for their children all the time but they are forced to.

These parents tell me that 578 assessments of need, AON, reports are overdue in Cavan-Monaghan, 511 of which have been overdue for more than three months. Only 12 AONs were carried out in the first quarter of 2026. Thousands are on the waiting list for AONs across the country and Cavan-Monaghan is no different. As the group has pointed out, delayed assessment wastes time when children should be accessing vital supports. Even those children who do have these assessments are not getting the therapies and supports they require. These children deserve support not waiting lists.

The group has said that, while staff numbers within the CDNT were dismal a few years ago, they have improved majorly in the last few years. That is welcome but these parents are not seeing that in the interactions on the ground. One parent told me that she had a meeting last week with two psychologists employed in the CDNT, who hold less than one whole-time equivalent position between them. She met with the two and asked them why they were meeting with her and not with her child. It turns out that one of those psychologists has never had any meetings or support sessions with a child. The meetings with parents and training courses are important. Parents are willing to participate in those so that they are in the best position to help their children. However, that is all they are getting. Children are not getting the one-to-one therapy they require. The parents are told that if they do not undertake the next training session, which may be one they have already undertaken, their children will be removed from the list or moved down the list.

There is this sort of threat over them. As I said, parents are happy to do what they need to do, but they are not trained psychologists, speech and language therapists, occupational therapists or whichever professional the child may require.

Some services are being outsourced, and this is causing a problem in itself. Some of the therapists are leaving the service and going private because it is more profitable for them. Parents are trying to access the supports privately, which is putting a huge financial burden on them. However, they have to do it because they realise that early intervention for their child is so important. If children are missing these important interventions, they will not be able to progress in life as they should.

Parents have also told me there are huge problems accessing CAMHS. Children may have an autism assessment, but they may also have suspected ADHD. They need the diagnosis to get treatment but CAMHS is refusing to see them. Some parents have had six refusals before finally getting an appointment for an assessment for ADHD. I know CAMHS is different but there was supposed to be a single point of access between the CDNT and private care, and that does not seem to be happening yet. Perhaps I could have an update on that. It is unfortunate that CAMHS is not intervening.

Parents are exhausted. Some of the children are a flight risk and parents have to watch them all the time. The children are awake at 4 a.m. so parents are not getting the sleep they need to be able to give the child the care they need. Some are at breaking point. What can be done to address this? It is not just about increasing staff. Even if we had a full complement of staff at the CDNT, they would not be in a position to deal with the backlog of needs.

I thank the Senator for raising this important issue, for all of her advocacy on this issue and for her determination to ensure that things improve. I assure her that this is also my determination.

The Government fully recognises the importance of providing adequate supports at the right time for children with disabilities throughout the country, including those in County Cavan. As she said, parents are exhausted and need support. That is why the HSE children’s disability services have undergone significant reform and restructuring over the past few years to provide more accessible, family-centred services for children with complex needs. Progress is being made, although I appreciate it is not being made fast enough. At the end of March 2026, 45,472 children with complex needs were receiving supports from the children’s disability network teams. This progress is also reflected in reductions in waiting lists, which fell by 28% in 2025. While this shows movement in the right direction, it is important to acknowledge that significant work remains to address waiting times and unmet needs.

In the national service plan for this year, the HSE has committed to a further 25% reduction in waiting times because at the centre of this remains a clear goal, which is to ensure that no child will wait longer than 12 months for the service they need, while also recognising that, over time, we must go even further. At the moment, many children registered with children’s disability network teams, including those on waiting lists and on open caseloads, are still waiting for some aspects of the support or services they need.

As with other areas, disability services within the Cavan-Monaghan integrated health area, IHA, are continuing to experience significant recruitment challenges, as the Senator said. We have a clear need for more qualified healthcare staff nationally and internationally. There are two CDNTs in the Cavan-Monaghan IHA. In Cavan, the HSE is the lead agency, while Enable Ireland leads the CDNT in Monaghan. At the end of May, the team in Cavan had a vacancy rate of 32%, with a total number of staff of 19.35 whole-time equivalents. At the end of May, 226 children were waitlisted for services from the CDNT, with 394 children on an open caseload. Some 264 children, and in many instances their families, received an intervention during May, with 1,003 direct and indirect supports provided to children and their families during the month. The Senator mentioned that in some cases, people were going through a course they had been on previously. I have received that feedback and I am taking it on board.

Using the available funding, the Cavan CDNT has put a number of measures in place to help manage waiting lists. That includes outsourcing assessments, where possible. As the Senator said, it includes engaging private providers in crisis cases where there are vacancies in disciplines and making temporary staffing adjustments, such as in senior or staff grade and therapy assistant roles, to maintain capacity.

I am concerned to hear the Senator describe what sounds like inefficiencies. I ask that the Senator follow up with me directly in relation to the particular example she gave. I will seek some information and clarity on that.

As the Senator said in her contribution, staffing levels have improved over the past year, allowing the team to begin to work through the longest waiters now. Recruitment remains ongoing. Agencies and local advertising are being used where needed. There are plans to re-establish student placements as capacity allows. More generally, there is a strong focus across Government on filling vacant posts across the 93 CDNTs as quickly as possible.

Additional funding has been put in place to build capacity and to reduce wait times, including the €8 million in this budget to fund a further 150 posts. This is starting to have an impact, with the HSE reporting a 28% increase in staffing nationwide between October 2023 and October 2025. That would equate to an additional 448 whole-time equivalents, and 321 of those are additional health and social care professionals. Recruitment is continuing both at home and internationally alongside wider workforce initiatives to support the long-term growth of the children’s disability network teams. The HSE will also be developing a dedicated disability workforce strategy this year to help tackle ongoing recruitment and retention challenges such as those the Senator has described. While we recognise there is more to do, there is very clear momentum, not just across the HSE but also across the Government and the HSE's funded agencies to strengthen services, grow the workforce and improve access for the children who really need it.

The Minister of State mentioned that over 45,000 children are receiving support through the CDNTs but parents have said to me that when they have been told that their child has received X number of interventions, and they know their child has not, the CDNT is counting interaction with parents. They are counting phone calls, meetings, letters.and emails. That is not intervention. I do not know who they are trying to fool by that. The parents know that the child is not getting intervention that he or she requires. While all of the interaction is required, it should not be counted as an intervention. Yes, parent training is an intervention that will help the child but other than that, it should not be the only thing. There should be more one-to-one interventions.

Another issue I want to raise is the hydrotherapy pool in the CDNT space in Enable Ireland in Cavan. It is not open to the children who are using the service. It has not been open to the children for years. I appreciate that some work was required last summer but it is now being rented out to private organisations because they have their trained attendant who can come and ensure safety at the pool. Parents have no issue with it being rented out to different groups where children need it, and it is a money raiser, but it is not open to the children because the management maintains that it does not have an attendant. When I engaged with the manager more than six months ago, she told me that the HSE had approved a business plan to employ someone but there is still no one employed. I do not how what is happening there but it really is an issue of frustration to them.

They need the one-on-one therapies for the children and they need the use of the pool. The CDNTs need to stop trying to fool people into thinking that there is more intervention with children than there is.

I thank the Senator. Perhaps the Senator will follow up with me directly in relation to the hydrotherapy and the pool. I will seek an update from HSE as to where that is at. If, as the Senator said, a business case has been approved, I will ask where recruitment is on that particular issue.

I reiterate that the Government’s commitment to strengthening services in order that adults and children with disabilities in Ireland are better supported is clear and is backed up by sustained investment in the disabilities sector. It remains a clear priority with €3.9 billion allocated to the HSE's disability services in this year’s budget. That was a €628 million increase, or a 20% increase, on funding from last year. This level of record investment recognises both the growing demand for services and the complexity of the needs being met and that need to be met. It builds on significant year-on-year investment in recent years, with overall funding for disability services having increased by 91% since 2020. Alongside this funding there is also a strong focus on people, and building and sustaining a workforce that can deliver the supports that families rely on. That is why we are preparing this year’s workforce strategy for disability services.

I thank the Cathaoirleach Gníomhach for the warm welcome earlier for my wonderful colleague Camila. I welcome the Minister of State, Deputy O'Donnell. He is a very apt person to address this question as he comes from a distinguished medical family himself, in the present generation and in past generations.

I wish to raise an issue concerning people living with Addison's disease. Could the Minister for Health consider whether this condition should be included under the long-term illness, LTI, scheme? It is my contention that it should. Addison's disease is a serious lifelong condition that affects the body's ability to produce essential hormones needed to regulate blood pressure, metabolism, energy levels and the body's response to illness and stress. For those living with the condition, medication is not optional. It is something they depend on every day of their lives. In fact, up to 90% of cases are caused by permanent autoimmune damage to the adrenal glands, meaning patients rely on lifelong hormone replacement therapy because their bodies can no longer produce hormones naturally. Nobody chooses to live with Addison's disease. It is quite the contrary. Nobody can take a break from it, and nobody living with it can simply stop treatment and carry on as normal.

I will list the symptoms, which include severe abdominal, back or leg pain, vomiting, diarrhoea, weakness, confusion, loss of consciousness and dangerously low blood pressure. Treatments can include emergency hospital admission, intravenous steroids and fluids and ongoing monitoring. Without medication, people can become seriously ill very quickly and may suffer an adrenaline crisis and a medical emergency, involving what I just listed, that can require urgent hospital treatment and can, in some cases, be fatal. The reality is that people with Addison's disease must carefully manage their condition every day. They must take medication consistently, carry emergency medical information and be prepared for situations where illness or injury can suddenly increase their need for treatment.

We often speak about supporting people with long-term illnesses. We speak about preventative healthcare. We speak about ensuring that people receive the treatment they need before their condition becomes a crisis. That is why I believe there is a strong case for reviewing the position of Addison's disease under the long-term Illness scheme. This is not about seeking special treatment; this is about recognising the reality of a lifelong condition that requires continuous medication and ongoing medical management. I therefore encourage the Minister and her Department, through the Minister of State, Deputy O'Donnell, to engage with clinicians, patient representatives and relevant stakeholders to examine the case, which I believe firmly exists and should not take long to establish.

The current arrangements do not adequately reflect the needs. There is a compelling case to include it in the long-term illness scheme into the future. The question is not how many people are affected; the question is whether people whose health depends entirely on life-long hormone replacement therapy are receiving appropriate supports from the State.

My final contention is that there is an inherent injustice in not treating this illness comparatively and in an equitable way with other illnesses, some of which in fact do not have as grievous symptoms.

I am taking this matter on behalf of the Minister for Health, Deputy Carroll MacNeill. I thank the esteemed Senator for raising this matter.

The long-term illness scheme was established under section 59(3) of the Health Act 1970, as amended. Regulations were made in 1971, 1973 and 1975 prescribing 16 conditions covered by the scheme. There have been no changes to the list of 16 conditions since that time.

Under the LTI scheme, patients receive drugs, medicines, and medical and surgical appliances directly related to the treatment of their illness free of charge. While there are no plans to extend the scope of this scheme, it is important to recognise that it exists within a wider eligibility framework.

People who cannot, without undue hardship, arrange for the provision of medical services for themselves and their dependants may be eligible for a medical card. Eligibility for a medical card is determined by the HSE, primarily based on an assessment of means. The HSE may exercise discretion and grant a medical card, even though an applicant exceeds the income guidelines, where he or she faces difficult financial circumstances such as extra costs arising from illness. The HSE affords applicants the opportunity to furnish supporting documentation to determine whether undue hardship exists and to fully take account of all relevant circumstances that may benefit them in assessment, including medical evidence of costs and certain expenses.

The issue of providing a patient with medical card eligibility on the basis of illness or a disability was previously examined in 2014 by the HSE's expert panel on medical need and medical card eligibility. The group concluded that it was not feasible, desirable or ethically justifiable to list medical conditions in priority order for medical card eligibility. In following the expert group’s advice, a person’s means remains the main qualifier for a medical card. However, over the past several years, there has been a significant focus on improving access to, and the affordability of, healthcare services. This has been advanced through substantial policy, legislation and investment to deliver expanded eligibility and services in line with Sláintecare.

Major expansions in eligibility include the following: the removal of public inpatient charges in public hospitals for children in 2022 and for adults in 2023; in 2023, the provision of free GP visit cards to include children aged six and seven, and those earning no more than the median income, and these changes had an impact on up to 500,000 people; and the reduction of the drugs payment scheme, DPS, threshold, which caps monthly expenditure for approved prescribed medicines. The DPS threshold was reduced to €80 per month in March 2022, which is a 35% reduction since 2020 when it was €124 per month. The DPS is not means-tested and is available to anyone ordinarily resident in Ireland. Taken together, these significant changes and expansions in eligibility continue to create a health and social care service that offers affordable access to healthcare to more people.

In respect of the points that the Senator made about Addison's disease, these are matters that I will bring to the attention of the Minister for Health and her Department officials.

While I appreciate the support that is available, Addison's disease a particular challenge because the medication involved is not simply therapeutic. It replaces hormones that are essential for life.

The question before us is not how many people are affected; the question is whether people whose health depends entirely on lifelong hormone replacement therapy are receiving adequate support from the State. People living with Addison's disease do not have the option of stopping treatment. Their medication is required every day for life. Ensuring reliable access to that treatment protects patients, helps to prevent avoidable medical emergencies and reduces pressure on our hospitals.

I ask the Minister of State, Deputy O'Donnell, to ask the Minister for Health, Deputy Carroll MacNeill to review this situation, to examine it once again and to look at it on equitable grounds. I do not mean to diminish any other condition when I say that this condition is grievous and is among the very serious conditions. It presents equal challenges, if not even more challenges, to some illnesses already listed. I hope the Minister of State can convey that to the Minister so this can be reformed into the future. It is something we cannot avoid looking at.

I thank Senator O'Reilly again for raising this important matter. As I stated previously, I am taking this matter on behalf of the Minister for Health, Deputy Carroll MacNeill. I have very much taken on board the points the Senator has raised. I will revert to the Minister for Health on those specific points.

While there are no plans to extend the scope of this scheme, the long-term illness scheme exists within a wider eligibility framework. The Government is focused on expanding eligibility and improving the affordability of healthcare through a wide variety of measures. As mentioned, measures such as the substantial reduction of the drugs payment scheme threshold; the introduction of a GP chronic disease management programme, under which eligible patients will receive annual scheduled reviews with a GP and practice nurse; the expansion of access to free GP care to include more children and adults; and the abolition of all public inpatient hospital charges for both children and adults have had substantial impacts on the affordability of healthcare. These measures continue to create a health and social care service that offers affordable access to quality healthcare.

Senator O'Reilly will be aware that individuals may also be entitled to claim tax in respect of the costs of their medical expenses including medicine prescribed by a doctor or dentist with relief at the standard rate of 20%. Aside from eligibility and affordability, there remains a continued focus on improving the services available to people, as seen in the programme for Government commitments. The Senator raises important points. As I said previously, I will bring back to the attention of the Minister, Deputy Carroll MacNeill, the specific points raised around Addison's disease and the long-term illness card.

I thank the Minister of State and Senator O'Reilly. I want to welcome Una, Kathleen and Anthony Doolan and Richard and Theresa Shepherd, who are from Sligo, I think. No, they are from Roscommon and Sligo; I am offending them already. They are guests of Deputy Eamon Scanlon but he has found them a good guide in the form of Deputy Cleere who is looking after them. They are very welcome and I hope they are enjoying the tour. I imagine Deputy Scanlon is treating them to the bar and restaurant. If he is not, they will have to get onto Deputy Cleere.