I propose to take Questions Nos. 1 to 20, inclusive, together.

The Cabinet committee on health last met on 30 April 2026 and is due to meet again shortly. The Cabinet committee oversees implementation of programme for Government commitments in relation to health, receives detailed reports on identified policy areas and considers health reforms, including Sláintecare, the reform of public health and health system preparedness for future health threats. It also receives reports in relation to programme for Government commitments in the areas of mental health and drugs policy. In addition to me, it is attended by the Tánaiste and Minister for Finance, the Minister for public expenditure, and the Minister for Health.

Sláintecare 2025+, our latest Sláintecare strategy, published in May 2025, aims to forge the way towards accessible, affordable, high-quality healthcare for the people of Ireland when they need it and where they need it. For the fourth year in a row, Ireland has the highest self-perceived health status in the EU, with 80.4% of males and 79.9% of females rating their health as good or very good. Our life expectancy is continuing to increase and is above international averages. Life expectancy in Ireland has increased by two years for males and one year for females since 2015. We are treating more people, with better outcomes than ever before. We continue to reduce mortality rates from cancer, circulatory system diseases and respiratory system diseases, and report positive trends in preventative health. Our overall mortality rate has fallen by 16.1% since 2015. The Government will continue to invest and reform, changing the way health services are delivered this year and into the future.

The Waiting Time Action Plan 2026, published on 30 January, represents the Government's continued commitment to improving access to hospital care. Since the commencement of the multi-annual action plan approach, significant progress has been made in reducing the length of time hospital patients are waiting.

The new regional structures within the HSE have been established, with six new health regions and 20 integrated healthcare areas, IHAs. Health and social care services are planned and delivered around the specific needs of local populations, leading to better co-ordination of care and access to services.

The public-only consultant contract, POCC, is central to the transition towards a more consultant-led public health service and represents a significant structural reform in the delivery of public hospital services. The POCC was introduced to strengthen clinical decision-making capacity within the public system and to improve patient access to timely care. It also aims to ensure access to treatment is based on medical need, not ability to pay, in line with the Sláintecare vision.

I will read the rest of the reply into the record.

One of the biggest health issues that arose in this country related to Children's Health Ireland, CHI, scoliosis and child surgery. Now we find that four out of the eight groups have withdrawn from the scoping exercise that was to draw up the terms of reference for the inquiry.

It includes the spina bifida and hydrocephalus paediatric advocacy group and many others. Another group has also reportedly left but not yet publicly. The reason for this is 12 unpublished reports to do with CHI since 2017, including the Dixon report. The groups are afraid that the issues in these reports will not be investigated by the inquiry. Parents are being asked to participate in these groups but they are not being given all of the information in order to allow them to participate. How will the inquiry function when half of the groups involved are having nothing to do with it? When will they get the information they are asking for?

Once again I want to ask about Roscommon University Hospital and the promised neurorehabilitation unit. It was promised in 2015 with an attached budget of €8 million. It was twice removed from the HSE's capital plan without any discussion and twice put back on after lobbying by me and my office. Now there is a real lack of urgency about providing those places. Neurorehabilitation looks after acquired brain injuries, stroke, traumatic Parkinson's disease, multiple sclerosis, motor neurone disease, spinal injuries and a host of other things. There is a dearth of beds in the HSE west and north-west region and this is recognised. It is something that is needed and desired and has been promised with a budget but there seems to be lack of urgency by HSE to progress this unit.

I want to raise again the chronic shortage of respite for children with profound disabilities in County Kerry. Families are waiting seven or eight months for one or two nights' break and they are at breaking point. The same applies with regard to adults with profound disabilities in Kerry. The issue of respite for these individuals and their families must be of the very highest priority. There is a wonderful centre at St. Mary's of the Angels in Beaufort that should be developed into a centre of excellence for respite. There is also the excellent St. Francis Special School along with many services located there. I wish to avail of this opportunity to invite the Taoiseach to visit the centre, which is just outside Killarney.

I want to raise with the Taoiseach once again the issue of rare diseases. It is something on which we have made considerable progress in recent months. We had the very effective campaign run by Senator Costello and others on the reimbursement of givinostat. On foot of this, the Minister has also ordered an end-to-end review on drug reimbursement as a whole. These are very much welcome. In relation to comments made by a member of the NCPE over a week ago on RTÉ radio, does the Taoiseach think is appropriate that a member of the NCPE was on the airwaves disagreeing with the Minister's direction, insofar as he admitted he was against an early access scheme? Is there an update on the next drugs group meeting? Ordinarily it is on the second Tuesday of every month. Is there any possibility of bringing the meeting forward?

There is still no PET scanner operating in the public system in Galway or across the wider western region. We are being told it will be at least 2033 before a PET scanner will be provided for University Hospital Galway. This is completely unacceptable because this imaging technology is vital for monitoring cancer patients for cancer diagnosis. Patients are being forced to travel long distances to access these scans. They are often referred to private operators at significant cost to the State. They cost millions of euro each year. Patients in the west should not have to travel for essential diagnostic services that are available on-site in other major hospitals. We should have equal access to care across the country. We need a PET scanner, and we need the promised new cancer centre at UHG as well as other infrastructural improvements. Will the Taoiseach intervene to expedite the delivery of this critical infrastructure and equipment for the west to ensure there is equality of care for cancer patients across the State?

Today nurses and midwives are protesting at University Maternity Hospital Limerick. The HSE pay and numbers strategy cut approximately 30 to 35 front-line nursing and midwifery posts, imposing new staff ceilings, recruitment limits and pay spend caps. Many areas of the hospital are running rosters at 50% below safe levels. The neonatal unit is beyond safe capacity while awaiting HSE approval for service expansion. The labour ward has a daily deficit of midwives. This has been raised repeatedly with management. A HIQA review found the situation to be unsustainable. The HSE must uphold the agreement on staffing from 2015. The neonatal unit expansion must be funded. Safe staffing is needed and the hospital needs to be protected from the HSE pay and numbers strategy.

Endometriosis impacts more than 300,000 women in Ireland, with 30,000 of them being very complex cases. This is a condition that is absolutely crippling for any woman who has it. There have been efforts by the Government to bring in a new framework to deal with endometriosis but access is still very difficult. A treatment abroad scheme was set up but a number of countries are not included in it, namely, Greece, Romania, the UK and France. There were plans to look into expanding it to these countries. I also want to raise the fact that in many instances women have to fund this treatment upfront. This would exclude an awful lot of women from accessing the treatment abroad scheme for endometriosis because it is a considerable amount of money. Will the Taoiseach and the Minister look into this?

For people living with Friedreich's ataxia time is something they simply do not have. Every delay means more mobility lost, more speech lost and more independence taken away. Families such as Emily Felix and her family in Kilkenny, Oisín Pollard and his family in Carlow and many others have campaigned with huge dignity and courage for access to Skyclarys, the first treatment approved for this condition but unfortunately they continue to face delay and uncertainty while the disease continues to progress. Will the Taoiseach update the House on what the Government's position is on reimbursing Skyclarys? What message does he have for the young people and families who feel they are being asked to wait while an irreversible disease takes more and more from them every day?

In the past there was a system of phased dispensing that was paid for by the State. It evolved into patients getting blister packs. In disadvantaged areas and areas of low income many people who had blister packs had the cost covered by the Government. The Government recently brought in changes to the way this is to be paid for. It did this without discussing it with pharmacists on the ground and there was no consultation with doctors or patients. Now there are no payments for phased dispensing or blister packs for those receiving one on a weekly basis. A lot of home help providers do not deal with medication unless it is in a blister pack. All of this adds to the massive increase in the cost of living that families are enduring at the moment. It means people coming into the system will pay between €20 and €30 extra on a monthly basis for this. Will the Taoiseach delay the process that is costing so much money? Will he ensure the process is reviewed? Will he listen to doctors, pharmacists and patients on the ground?

I thank all Deputies for raising the various issues they have raised. Deputy Coppinger raised the issue of the Children's Health Ireland inquiry. This is a scoping inquiry in the first instance, essentially to scope out the terms of reference and what will be covered by an inquiry, and to look at the statutory format the inquiry will take. I would encourage all groups to participate and engage with Remy Farrell.

In terms of the issues raised concerning unpublished reports, it would be my assessment that any statutory inquiry would get any report it would need. Given the powers that would be given to a statutory inquiry, it would obviously have the power to procure documents in the possession of CHI. In the context of this scoping inquiry, the independent facilitator, Remy Farrell, has written to all involved. He wrote to the Minister for Health last week requesting an extension to conduct his scoping exercise and, in particular, to attempt to further re-engage with stakeholders. The Minister has granted this request until 18 August.

I understand that the facilitator will be engaging with the advocacy groups over the coming days regarding this extension of time and seeking to re-engage with them. He has also been engaging with CHI in respect of those unpublished reports or any particular material that might be in those reports. It is very important that engagement would continue to enable us to get to a position where the Government can have a decision presented to it to establish a statutory inquiry. Otherwise, it could get delayed unnecessarily, in my view. Having had a lot of experience of establishing various inquiries, I urge everyone to engage with the facilitator.

Deputy Martin Daly raised, not for the first time, the issue of the promised rehab unit in Roscommon University Hospital and the lack of urgency attending to it. I will talk to the Minister again and to HSE estates to see if we can progress this, and I will come back to the Deputy. One of the values of Roscommon University Hospital has been the degree to which it can provide a range of services outside of the acute tertiary centres. That makes life far easier for people in the region to access these services. Rehab is so important, particularly for neurological issues or accidents and so on. It can do an awful lot in enabling a person to get back into participating in society and work, depending on the circumstances governing an individual who requires access to a rehab unit of that kind.

Deputy Cahill spoke about the chronic shortage of respite, which is more of a national issue but is an issue in Kerry. We have placed this very high on the agenda of the Cabinet subcommittee on disability. There has been good development of late between the Minister for housing and the Minister for disability, who have come together. The Minister for housing has undertaken to build housing for people with disabilities. This is so we will not be dependent on waiting for the HSE but can get on and instruct every local authority to build a quota of units and to reserve a quota of any new builds in local authority housing to be made available for people generally with disabilities and particularly for those adults with disabilities. Respite is perhaps a separate issue to some degree although we believe housing can have a role there, too, with provisions. I will take the Deputy up on the offer to visit St. Mary of the Angels. I would be interested in doing that. I do think there is an issue with how we are progressing what is called decongregation. We are trying to get new places and allocate resources for new respite and residential places, yet a lot of resources have gone to decongregation, which takes resources from new places. I think there needs to be a more balanced approach about that, particularly where people are satisfied with the level and quality of care. I made this point to the HSE already at the Cabinet subcommittee, and we are working on that issue.

Deputy Pádraig O’Sullivan spoke about rare diseases. Generally speaking, I am not comfortable with people disagreeing with the Minister in respect of decisions that ultimately get taken in respect of an end-to-end review. Personally, I think it was long required and not before its time. We do need a more fundamental look at rare diseases generally, because more and more companies are producing orphan drugs, as they were once called, to meet the needs of rare diseases. That will create challenges for funding for for health services - there is no question about that - but we need to look at this issue in its entirety in terms of how we provide for rare diseases in future.

Much of this is positive. There was a time when companies were not producing drugs for rare diseases. They were going for the blockbuster drugs. Now that they are producing drugs for rare diseases, it is positive for the patients and cohorts involved. It is giving them hope that there is some prospect of moderating the disease or even ultimately getting to a cure. It is only when you are on a journey of medical discovery that you can get medicines that ultimately can achieve significant and transformative results. On the next drugs meeting, it is due in July, but I know the Minister was trying to bring it forward a bit, in particular in consideration of key drugs such as Skyclarys and so forth.

I will raise with the Minister the issue Deputy O’Hara brought up in respect of a PET scanner for University Hospital Galway. I do not have the specifics behind that. A PET scanner is about more than just a machine, of course. It is about the entire team needed to support that machine. That is a critical issue there. These are substantial investments in people, technology and so on. I will get the background to this issue and see where we are in respect of access to it in terms of University Hospital Galway.

Deputy Sheehan raised nurses and midwives and the particular issue in University Maternity Hospital Limerick and the neonatal unit there as well. Again, we have been through a period of significant workforce growth in the health service, with the addition of about 30,257 staff from January 2020 to the end of May 2026. That is about a 30% increase in the number of staff. It includes over 11,000 extra nurses and midwives, which is an increase of over 32%. There are over 5,100 more health and social care professionals, which is an increase of over 40%. Over 4,400 doctors and dentists have been added, which is an increase of over 40% in the last six years. It is quite substantial. We do have to ask questions in terms of how people are being deployed. There is an issue with the use of agencies. The Deputy raised that. There is no question about it. The Minister is very focused on that issue as well, regarding the use of full-time employees instead of agency staff.

Turning to Deputy Whitmore on endometriosis and the new framework, to be fair to the Ministers, previously Stephen Donnelly and now Deputy Carroll MacNeill, there has been progress on this issue but we are not there yet, of course. Is the Deputy talking about the cross-border directive or the treatment abroad service?

It is the treatment abroad service. There are a number of countries that are-----

We do not really do this.

On treatment abroad, that applies to the entirety of the European Union. It is meant to.

No. No.

Again, I will talk to the Minister in respect of that. Generally speaking, across the board, treatment abroad has not had an issue in terms of its funding. That has never proved to be a problem in the past.

There are three more Deputies to go.

This is a specific treatment scheme for endometriosis.

I will come back to the Deputy on it.

Deputy Cleere's question was on Friedreich’s ataxia. I think I referenced this earlier. I fully appreciate what the Deputy said. I think he mentioned Emily Felix and Oisín Pollard. I have met quite a number of people as well. It is very distressing, difficult and challenging for the families and for Emily, Oisín and their contemporaries who want access to Skyclarys as quickly as possible. Early on, there were issues in getting the material from the company and so on, but all that has been overcome. I would hope that we will get a decision on that. Obviously, the Minister is trying to progress it as quickly as possible. I will come back to the Deputy after I talk to the Minister on this issue.

I do not think the way Deputy Tóibín presented the issue regarding blister packs was probably as accurate as the real story behind it. I think the Minister has been quite robust and has revealed a lot in terms of her own work on this issue. I will put it this way. There was a different practice in many different areas. There were different patterns of behaviour and different things being done by different pharmacists in that respect. It is not all as the Deputy articulated. We want to help those who need help, and the Minister will continue to target resources. The Minister already had an agreement with the Irish Pharmacy Union, IPU, in respect of this issue.

Regarding Deputy Lawless's question, I had a very good day in Mayo. It is a great hotel. Two pharmaceutical companies are doing very well in Mayo, namely, Vantive and AbbVie in Westport. Huge investment is under way over the next while in Castlebar further education and training college. In terms of the hospital, I do not have the specifics on that individual surgical experience of the person who broke their leg. That three-day period is not good, but I do not know what the background to it is.

I thank the Taoiseach.