Topical Issue Debate

Planning Issues

I am grateful to be able to raise the Airbnb subject under Topical Issues today. It is a highly topical issue that has been commanding attention for the last number of days.

We need to have a conversation in this House about Airbnb. It is well past time. Airbnb has featured as a topic on the airwaves and in newspapers, both nationally and internationally, for the past year or so. For travellers, websites such as that of Airbnb offer affordable rooms to travellers and tourists, as well as an insight into and a taste of local living throughout the world. Airbnb's European headquarters are, as we know, based in Dublin, providing 300 jobs in the capital. I recognise that for those who rent rooms or properties, it can represent a financial lifeline. In the Irish context, being in negative equity has often been cited as a reason for availing of such a lifeline, as well as, perhaps, supplementing a modest income. A recent article in the Financial Times stated:

...the creation of this huge new marketplace should be welcome. But to some city authorities, the explosive growth of home-sharing represents a threat to the regulated hotel sector, a nuisance to other residents and an incentive for landlords to convert long-term lets into more profitable holiday rentals, exacerbating housing shortages.

It can be argued that those landlords who let full properties to Airbnb guests would not let them to social housing tenants to the same extent, but at a time of an acute housing shortage surely some of them would or could so let. Equally, because of the shortage of hotel rooms in Dublin, with only one additional hotel coming on stream at the end of 2016 and only another half dozen to be delivered before the end of 2019, the argument in favour of Airbnb supplementing and augmenting the tourism room offering in the capital is compelling. However, we have no statistics or hard information, except that from Airbnb or monitoring websites. The website, for example, gives the following statistics for Dublin. In the capital there are a total of 6,225 listings of properties for sharing or renting. In the Dublin city area there is the largest number of properties available, almost 5,000, for an average of 119 nights per year. Furthermore, 48% of the listed properties are either apartments or houses which are available for full letting. In other local authority areas there are smaller, proportional numbers. According to the statistics, the average cost of an Airbnb room in Dublin is €102 per night, which compares with the cost of €129 for a hotel room. There are more than 2,000 properties listed in Dublin. These are not rooms or sharing opportunities but either homes or apartments which are available on Airbnb for full-time letting for 80% of the year.

What started out as a novel concept offering individuals who owned their own homes the opportunity to offer to travellers a room, rooms or their home to share or rent has exploded into a market impacting service with few ground rules, in which there is a lack of regulation, while there are issues around registration, tax compliance and planning laws. The evidence of landlords with multiple properties or individuals renting multiple properties and sub-letting them to Airbnb tenants, while undoubtedly entrepreneurial, has placed Airbnb very much on the radar of the hotel industry, housing and homelessness organisations, the Revenue Commissioners and, more recently, the independent planning authorities but not the legislators in these Houses. That is my purpose in raising the issue. As I stated, it is well past time we had this conversation about Airbnb. As the Financial Times puts it in its editorial:

[It] is not a reason to restrict home-sharing. It is rather an occasion for authorities around the world to look again at the regulation of overnight accommodation, consider which rules still make sense and ensure they apply to all businesses offering equivalent services.

I thank the Deputy for raising this important issue. He is right; it is time we had this conversation in the House. I will give some background information and put the issue in context, but it is a conversation we need to have, not just tonight. It is one we are examining and will be discussing it further.

Article 10(4) of the Planning and Development Regulations, 2001 to 2015, which deals with change of use exemptions for planning purposes provides that development consisting of the use of not more than four bedrooms in a house, where each bedroom is used for the accommodation of not more than four persons as overnight guest accommodation, shall be exempt from the requirement to obtain planning permission under the Planning and Development Act 2000, as amended, provided that such development would not contravene a condition attached to a permission under the Act or be inconsistent with any use specified or included in such a permission.

The interpretation and application of enactments relating to exempted development in any particular case are, in the first instance, matters for the local planning authority concerned or An Bord Pleanála on appeal or referral. Similarly, an enforcement action for any breach of the planning code is a matter for individual planning authorities under Part VIII of the Act of 2000. Section 30 of the Act specifically precludes the Minister from exercising any power or control in any particular case, including enforcement, with which a planning authority is or may be concerned.

I understand the recent determination by the board on the use of an apartment for short-term, commercial letting purposes through a dedicated website was based on a number of considerations related to the particular circumstances of the case. They included, for example, the exclusive use of the apartment in question on a year-round basis for short-term commercial lettings, the absence of any permanent resident from any portion of the apartment and submissions made by the letting company, as well as those made by other residents of the area. Accordingly, the board concluded that the use of the particular apartment in question constituted a material change of use and was, therefore, not an exempted development under the planning code.

The effect of the determination which is in line with the earlier decision of Dublin City Council is that the letting company or apartment owner will need to apply to Dublin City Council for planning permission for a material change of use. Continued operation of the apartment in question without such planning permission could be considered to be unauthorised development and subject to enforcement proceedings by Dublin City Council under the planning Acts. It is also important to note that the role of the Minister in the planning system is primarily to provide the supporting policy and legislative framework which the Deputy addressed and which comprise the Planning and Development Act, the planning and development regulations and statutory planning guidelines, to which planning authorities and An Bord Pleanála are required to have regard in the exercise of their statutory planning functions. The day-to-day operation of the planning system is a matter for the individual planning authorities and the board. However, in the context of the recent determination by the board, as referred to by the Deputy, the Minister for Housing, Planning, Community and Local Government, Deputy Simon Coveney, has asked the Department to examine the decision and consider the appropriate steps that might need to be taken, including the provision of statutory planning guidelines, with a view to providing clarity and ensuring consistency of approach by all planning authorities in terms of the planning requirements for such commercial lettings. As part of that work, we will have this conversation to see where we are going in this matter. The Deputy has raised valid points and we will have an opportunity to address and discuss them further in the House after the Department has prepared a briefing note for the Minister.

There are a number of other issues that have been highlighted by commentators and to which the Minister of State has not referred, including the impact Airbnb properties have on the social environment. Given that the majority of its properties are residential in character or setting, the ability of Airbnb to impact on neighbourhoods, residential areas, particularly apartment and privately managed complexes, is considerable. There is sufficient anecdotal evidence available on this point in terms of a public narrative for it to be at least a cause for concern. This is before mentioning the legal complexities of renting properties with shared management fees, common areas, parking and public access issues and so on, never mind the impact on residents of a residential development which was granted planning permission morphing into a commercial and, possibly, rateable enterprise. More than 6,000 units in Dublin are listed with Airbnb. The An Bord Pleanála decision allows for a wider conversation to take place and the Minister of State suggests he is open to having it. Airbnb has to begin to engage in an Irish context, but it needs an agency to engage with before that discussion can begin. However, there is no such agency or vehicle to allow it ot take place.

Until recently, Airbnb properties were not in breach of any law or regulation. The Minister of State will be aware of the wider international context. Berlin has banned tourists from renting entire apartments on Airbnb to protect the availability of affordable housing. Other cities have banned the renting of full, multiple properties because of its impact across a range of factors such as housing supply, neighbourhoods and residential settings. In New York the governor may give effect to a law which provides for fines of $7,500 for the owners of short-term lets on Airbnb. I recognise that an association which represents Irish landlords states there should not be an outright ban.

As I stated, what started out as a novel idea has exploded and I guess Airbnb is a victim of its its own success. The House and the Government needs to discuss the issue. There is a balance to be struck. I look forward to seeing the report the Department is to bring to the Minister and hope it will enable us to have a wider debate on the regulatory framework.

We will examine all of the issues raised by the Deputy in the review of the decision made last week. I agree that it would be worthwhile having the conversation, but we will be forced to have it now, which is fair enough. It is something that was on the cards for a while. The Department will review the decision and examine all of the various concerns raised by the Deputy. We will also examine the international context and decide on the best step by step approach to take. I assure the Deputy that we will have a chance to discuss the matter in the House before that will happen. It is something the relevant committee might decide to examine.

The committee is doing great work in analysing policy statements and future policy formation. We do not yet have a timeline setting out when we will be ready to proceed but we are working on the issue and I will keep the Deputy posted.

School Closures

I thank the Ceann Comhairle for allowing me to speak on this Topical Issue, which is of great concern to many of my constituents in Dublin-Rathdown. The announcement of the closure of the Notre Dame schools in Churchtown came as a great shock to parents of students in the schools who were not given any notification that the school was to close. The Notre Dame secondary school has 150 pupils, while the junior school has 100 pupils. Although the junior school is a fee-paying private school, the Department has some oversight in respect of the secondary school.

Parents learned from media reports that the schools were to close. I understand the junior school will close in June 2017 and the senior school will close in summer 2019. Some allowance has been made, therefore, but the parents I met last Sunday are devastated by the decision. One particular woman lost her husband two weeks ago and her five year old child has been crying every day because the child must move school.

When did the Department learn that the schools were to close? What steps were taken to address the lack of funds in the schools, which were clearly not viable? Why were parents not informed that this would happen?

I am aware that a trust was established which is not subject to the oversight of the Department. Members of the trust also have questions to answer when I and a number of parents meet the chair this evening.

This is extremely stressful for all those involved. I ask the Minister to clarify whether a competition to have other schools open on the site will be expedited. I am aware that ownership of the site has transferred to the Department. The possibility of a Gaelscoil or Educate Together school opening on the site has been mooted. I would like the process to be expedited and I ask the Minister to provide clarity on when this will happen.

The announcement of the closure of the Notre Dame schools has caused great distress. We are all aware of the significant waiting times for schools in all localities. What action is the Department taking on the issue? Will the Minister communicate directly with the parents to find a resolution?

I thank the Deputy for raising this matter. I can fully understand the dismay caused by the decision of any school to close. I will clarify the Department’s position on the closure by Notre Dame Schools Trust of the fee-paying primary and post-primary schools which it operates on Churchtown Road Upper in Dublin. I understand the concerns that have been raised by staff, parents and students regarding the recent announcement of this closure.

Last week, the Notre Dame Schools Trust made a formal announcement regarding its decision to begin winding down the Notre Dame junior and secondary schools. The parents of pupils have been informed that the decision to close the school was made by the trustees on the basis that there was insufficient income to support the schools' financial commitments and operating costs and the need for significant investment in the infrastructure.

Officials from the Department of Education and Skills had been in contact with the school trustees prior to the closure to provide the required supports to assist them in facilitating an orderly wind-down and phased closure of the schools. Notre Dame Schools Trust has at all times indicated its commitment to ensure appropriate arrangements are put in place to facilitate the current cohort of students during the schools' phased closure. The Notre Dame junior school will continue operating until the end of the current academic year in June 2017 and will then close. The Notre Dame secondary school will continue to operate until June 2019 to ensure that all pupils currently attending the school can complete their current junior and senior cycles uninterrupted.

As part of its liaison with Notre Dame Schools Trust, my Department agreed the acquisition of the school property and grounds, with a view to using them for school purposes in the future. This acquisition was finalised recently. While the proposed school to be accommodated has not been determined at this point, there are several school needs in the area and the future use of the property is being considered in that context. My Department is awaiting clarification pertaining to the feasibility of development of alternative sites and the timelines for acquisition, planning permission and development, which will inform the decision with regard to the future use of the Notre Dame site. The Department will not take over the current schools. As part of the discussions on the acquisition, it was agreed the current schools will remain in situ until the wind-down period has been completed.

I thank the Deputy for giving me the opportunity to outline the position regarding the closure of two schools in Dublin 14.

I thank the Minister for his statement. I appreciate the sentiments expressed and will convey them to the parents when I meet them this evening.

The Minister stated the Department is "awaiting clarification pertaining to the feasibility of development of alternative sites and the timelines for acquisition". Whatever happened in the past has happened and separate questions arise with regard to the Notre Dame Schools Trust. I would appreciate, however, if I could give the parents some indication as to timelines for the future of the site. It may not be feasible to open a new school by September 2017, which will require parents to re-school their children or find alternative schools for them. Their preference is to have their children to continue their schooling at the Notre Dame schools' site. I would appreciate if the Minister could provide definitive timelines and give me an idea as to when the feasibility study will be completed.

It is hoped the matter will be dealt with in a matter of weeks, rather than over a longer period. I hope we can identify what is the best use of the site that recently came into the ownership of the Department. I understand a number of stakeholders could use the site. The Department wants to make a decision based on what alternatives are open to the schools in question and whether they would represent the best use of the site to accommodate needs in the local area. We do not envisage a drawn-out process because we expect an existing school to operate from the site, which would mean a new patronage process would not be necessary. Establishing a brand new school with a new patron would require a much longer planning horizon.

Deputy Madigan asked what role the Department will play. When a patron decides it can no longer continue to operate a school, it is entirely a matter for the patron. However, the Department will support the continuing operation of the school to allow students in certificate classes to complete their cycle and sit their examinations. I hope we will be in a position within a reasonably short period to give parents some indication as to the future use of the site in order that we can assist them in making plans.

Garda Industrial Relations

I ask the Tánaiste to provide an update on the ongoing negotiations with Garda representative organisations. While I fully understand she cannot provide details of the discussions, I ask her to provide information on the number of meetings that have taken place and so forth. I am aware that representatives of the Association of Garda Sergeants and Inspectors, AGSI, are due to meet departmental officials again tomorrow to try to find a resolution before Friday's industrial action. I also note the AGSI stated today that it did not have any progress to report. While I understand the Tánaiste is limited in terms of providing details of the ongoing discussions, I ask her to provide information on the nature of the discussions, the number of meetings held and at what level and whether she is hopeful of finding a resolution to the problem.

I thank the Deputy for raising this important matter. As he stated, the negotiations are at a sensitive stage. For the moment, we must concentrate on securing a satisfactory resolution to the ongoing talks. I assure the House that every effort is being made to resolve the dispute in the only way that it can be resolved, namely, through negotiation.

Intensive discussions are taking place. I know the House will understand that I am anxious not to say anything publicly which would make the resolution of the issues involved any more difficult. Everything that can be done is being done. The resolution of outstanding concerns lies in further engagement and I will continue to facilitate that.

I do not want to mislead the House by pretending there is some easy solution to hand. On the one hand, the Garda associations feel a genuine sense of grievance about their pay and conditions, a grievance felt by many public service workers and others as a result of the great sacrifices which had to be made, given the dire economic circumstances this country faced. While it is easy to understand and sympathise with this, what this Government cannot do is take measures which could only have the effect of endangering the progress we have made in leaving those dark days of economic ruin behind us.

We all have great admiration for the difficult job which members of An Garda Síochána do, day in, day out, in protecting our community. However, we cannot let that admiration and respect blind us to the consequences of trying to resolve this dispute outside general policy in regard to public service pay. Against that background, we need the discussions to continue to see whether we can reach agreement on measures which are possible within the context of the Lansdowne Road agreement. Of course, they have to be fair to gardaí, to other public sector workers and to the wider community, which has to pay for these measures.

As Deputies are aware, the agreements reached between the Department of Justice and Equality and the GRA and the AGSI addressed in a very positive way the issues raised by them in the course of the negotiations which took place over a number of months. In particular, the agreement sought to address the concerns they have articulated in regard to the pay of new recruits, the additional hours that gardaí are required to work, their access to pay determination and dispute resolution bodies and the completion of the review of An Garda Síochána - the Horgan review - which will be available in a number of weeks. The agreement included very significant benefits, including the restoration of the rent allowance worth over €4,000, or 17%, annually to new recruits and also, in the case of the GRA, the lifting of the increment freeze from 1 January.

It is very disappointing that these terms have been rejected and that the announcement has been made in regard to industrial action and withdrawal of service. The reality of any negotiations is that both sides do not get everything they want. However, we must continue in the coming days to work with great intensity to map a way forward, which we will. While our focus is on achieving that, work is ongoing in the background in regard to contingency planning and indeed I met with the Garda Commissioner to discuss issues relating to the dispute, including contingency plans.

Clearly, the reality is that very significant challenges will be faced in this country if there is a widespread withdrawal of labour by a substantial number of gardaí. I believe the Garda commitment to serve our community will inform the discussions that are taking place. I believe all sides must wholeheartedly focus on those discussions in an effort to resolve the dispute. I appreciate the support of this House.

The AGSI is due to have another round of discussions tomorrow. The Minister might inform us when the GRA is due to meet Department officials. While we do not want to say anything that may jeopardise those ongoing negotiations, it is important for the general public to know what is happening. That is why I put down this Topical Issue in that it gives the Minister the opportunity to reiterate that every opportunity to try to resolve this will be explored. This is not just about pay, as the Minister knows. There are other issues on the table and the AGSI in particular is, for example, seeking the recognition of the European Social Charter, which was ruled on in 2014. I am sure all of that is part of the negotiations.

The Minister said she has met the Garda Commissioner in regard to the contingency plans. Although I am sure she is not going to go into what those contingency plans are, again, it is an opportunity to put on the public record that if the industrial action does go ahead, there are very robust contingency plans being worked on at the moment that will be implemented if necessary.

I want to wish the Department officials, the Minister and the Garda representative bodies every success in trying to resolve this. As the Minister said, no side is going to come out a winner or a loser in this and the only way it is going to be resolved is around the negotiating table. I hope the negotiations bear fruit, hopefully before this Friday but, if not, certainly before the following Friday.

I thank the Deputy for the approach he has taken. The Government understands the very real anger that is out there which, as I said, is shared by many in the public sector and the public at large because of the very tough decisions that had to be taken in recent years and the impact that has been felt so deeply by many people, including gardaí, who feel it very deeply. However, it is important to be clear that withdrawal of service, industrial action or threats of industrial action will not achieve something in contravention of wider public pay policy. Nonetheless, I believe there is scope for an agreement, which is what we want to focus on.

Intensive work is ongoing. The Deputy asked about meetings with the GRA. There have been meetings today and there is a meeting with the AGSI again tomorrow. I assume these meetings will continue. Detailed discussions are ongoing which I hope can lead to satisfactory outcomes, with goodwill all round.

In regard to the contingency planning, as I said, I have met with the Garda Commissioner in this regard and we are liaising very closely with the Garda authorities about all aspects of the dispute, as the Deputy would expect. The Garda associations have already stated that some emergency cover would be provided. The extent and nature of that cover is very important in terms of managing the situation. The Garda Commissioner will have to take any and all actions available to her to mitigate the impact and effects of any withdrawal of labour.

There is no point pretending the planned action, if it goes ahead, will not constitute a very significant challenge to this country. Given the scale of the work the 12,800 gardaí do, day in, day out, whether in regard to cash in transit escorts, preventing burglaries, gathering intelligence, dealing with fatal road traffic accidents and the whole range of other work they do, it is a hugely significant issue if that labour is withdrawn and would have a huge impact. I make no apology for repeating that the focus of the Government remains on engagement, negotiations and, ultimately, finding a pathway to resolution and agreement in the coming days. We want all sides to keep talking, discussing and trying to find a solution. That is what is happening at present and I hope we will have a positive outcome.

Hospital Procedures

I am grateful for the opportunity to raise this matter. Two weeks ago a surgeon requested to meet me and my colleagues, Deputies Lahart and Troy, regarding his concern for his patients due to the current unacceptable delays in adult spinal surgery at Tallaght Hospital. Grave concerns exist regarding the growing outpatient waiting list and there is currently no dedicated spinal theatre in Tallaght. While five surgeons are attached to Tallaght, three are jointly appointed to Crumlin children's hospital, one is working half-time on a temporary basis and one is a recent appointee. I met the consultant who carries out spinal surgery as a result of the seriousness of the issue and the impact it is having.

Tallaght Hospital currently services hospitals such as Naas, in my constituency of Kildare North, Tullamore, Portlaoise and St. James's, among others. It is a wide catchment area, given that my constituency has a population in excess of 100,000 people. As far as I am aware, the only hospitals that have theatres equipped to carry out spinal surgery and are dedicated as such are Beaumont Hospital and Cork University Hospital.

In response to the front-line staff - the surgeons and all of their teams - and the patients on these excessive waiting lists, can the Minister and the Department give a commitment that they will invest in one, and ideally two, spinal surgery theatres in Tallaght and provide the required staff?

I am told the cost of a theatre is approximately €4 million and the cost of staffing to carry out operations adequately is approximately €300,000 per annum. Those are the figures I have been given but the Minister of State, Deputy Finian McGrath, may correct me on them. I am being told there is now an urgent requirement to have one theatre but that, given the waiting list, the service would operate very effectively and efficiently with two.

Statistically, our population is ageing. The demands for spinal surgery will increase as the population ages and the service will become more critical. Therefore, it is imperative to have in place the necessary infrastructure, such as the dedicated theatres.

The total number of patients currently on the waiting list for outpatient surgery in Tallaght is approximately 412. One hundred and ninety of those are waiting for between 12 and 24 months. One hundred and seven are waiting for between six and 12 months. The lists are becoming longer all the time, for the reasons we have outlined. This is because the facilities are not in place. The service is covering such a wide catchment that it is just not able to keep up and deal with the number of people referred to it for various types of surgery.

The adult waiting list to see a spinal consultant is currently in excess of 400. Most of these people will need surgery. The spinal surgeon I met made this known to me purely out of concern for his patients. The waiting lists are getting completely out of control, with no end in sight. The surgeon said the target waiting time for urgent cases is approximately one to two months, but the actual waiting time is 13 months. For a routine procedure, the next available appointment is the target, but the actual waiting time is in excess of 23 months. Currently, there are 93 patients awaiting urgent surgery. It is very important to address this and I would appreciate the feedback of the Minister of State on ascertaining how this issue can be dealt with. It is important that the Department takes this on board and consider an investment plan and policy so we can deal with this issue.

I thank Deputy Frank O'Rourke for raising this important issue and giving me an opportunity to outline to the House the current position on this matter. Tallaght Hospital adult service is part of the Dublin Midlands Hospital Group and Tallaght is the principal provider of elective orthopaedics in the group. The hospital's spinal orthopaedic service provides emergency and elective access for varying acute and degenerative spinal conditions with a tertiary referral base.

The hospital service for chronic degenerative disorders includes surgery for conditions such as sciatica resulting from spinal degeneration, degenerative spinal deformity, bone fragility-related disorders of the vertebral column and spinal fractures. Patients with abnormal curvature or deformities of the spine may also require corrective surgery. Approximately 30% of spinal patients operated on in Tallaght Hospital are patients who transition from Crumlin children's hospital. In cases involving the severely disabled, complex reconstructive surgery provides real capacity for improvement in life quality, pain and spinal function. The service at Tallaght Hospital includes a pioneering physiotherapy-led back pain clinic screening, which ensures that only 20% of the GP referrals require onward referral to a consultant-led clinic. There are also linkages with pain management services so that patients have access to pain management clinics.

It is acknowledged that spinal orthopaedic activity levels at Tallaght Hospital have fallen in recent years. There has been a reduction in consultant staffing numbers in this sub-specialty area due to consultant departures and difficulty in recruiting replacements. This is an important issue. In an effort to address inpatient and outpatient spinal orthopaedic waiting lists, an additional half-time consultant was appointed in late 2014. This appointment has assisted in managing emergency admissions and in running additional waiting list clinics. In 2015, €1 million was provided by the HSE to fund 100 degenerate spinal surgeries. An additional consultant is due to start work at the hospital in July 2017 and it is expected that this appointment will assist in addressing the hospital's capacity deficit in the long term, particularly in respect of the issues the Deputy raised today.

Furthermore, the winter initiative funding for 2016 and 2017 includes a €7 million fund for a targeted waiting list programme for orthopaedics and spinal and scoliosis procedures in designated sites, including patients on the Tallaght Hospital waiting list. This includes €2 million provided specifically for scoliosis patients to treat the 39 adolescent patients on the Tallaght waiting list and additional 15 to 20 paediatric patients by the year's end. I am aware that the long-term strategy for Tallaght Hospital is to provide spinal degenerative surgery, with a gradual transfer of the adolescent scoliosis surgery from Our Lady's Children's Hospital, Crumlin, to the new children's hospital.

Hospital groups must focus increasingly on networks of service provision, with smaller hospitals managing routine, urgent or planned care locally and more complex care managed in the larger hospitals, such as Tallaght Hospital.

I thank the Minister of State and welcome this reply but the difficulty is that the number of patients waiting to have surgery is still in excess of 400. The information I am getting from the surgeons and the front-line staff who must deal with the waiting lists and reduce them to a manageable size is that there ought to be a commitment to invest in delivering the theatres. I know the Minister of State understands this. We are trying to ascertain whether the commitment will be given. Ultimately, it is what will deal with the backlogs initially and have them managed thereafter.

I welcome the €15 million investment in the National Treatment Purchase Fund. I hope some of this will assist in dealing with some of the backlogs and waiting lists in this area. It is a short-term solution for dealing with waiting lists that is to be welcomed but in the longer term we must plan and strategise. The best way to deal with this for the future is to ensure we have the necessary infrastructure and appropriately staffed theatres ourselves.

The surgeon to whom I spoke highlighted that when surgeries are being carried out in private practice in Blackrock, for example, four to six can be carried out per day. In the same period in Tallaght Hospital, the maximum number carried out is two. This needs to be examined, regardless of whether it is a staffing issue or an efficiency issue. The people at the front line are doing everything they can. They are working in difficult circumstances, as we all know, but what is occurring is adding to the problem.

Those who need the procedures carried out are suffering from horrendous pain. I accept what the Minister of State said about pain management but I note, having spoken to those affected in recent days, that it is not working and it is having a serious negative impact on the patients' mental health. There are many consequences arising from having people suffering and waiting for over 24 months to have necessary procedures. I hope there will be a genuine refocusing on this issue, based on the delivery of the measures needed at the front line to deal with this unacceptable problem and the unacceptable waiting lists.

I thank the Deputy. Spinal injuries are an important issue for me, the Minister, Deputy Harris, and the Government in general. Only last week I had a very informative meeting with a group of affected patients, and they raised many of the issues raised by the Deputy today. I arranged to meet with my adviser on disabilities, Mr. Gerry Maguire, in the past couple of days. We are focusing on the issue. I totally accept the Deputy's point about there being 100,000 people in his constituency in Kildare.

The Deputy mentioned Beaumont Hospital and the unit in Cork, which do great work on these issues. As the Deputy knows, Beaumont Hospital is in my constituency. I am well aware of the work. The Deputy referred to the cost of a theatre. He is correct it is in the region of €4 million. Staffing a theatre costs in the region of €300,000 per annum. Our plan is to invest in the health service. We have started that investment. It is important that we recognise that.

I am working on the issue of investment very closely with the Minister, Deputy Simon Harris, whom I commend for his recent work, particularly on the budget, on which we also worked very closely. We are talking about actions, not just issues, for example, the provision of €3 million for an additional 570 orthopaedic procedures in the national tertiary referral centre at Cappagh; €2 million for additional orthopaedic procedures in Beaumont Hospital, Tallaght hospital and the hospitals in Tullamore, Waterford and Galway, with the objective of achieving the 18-month waiting list target by year end; and €2 million to treat the 39 scoliosis patients on the Tallaght hospital waiting list and an additional 15 to 20 paediatric patients by the end of the year.

The important message from the budget - I am standing beside the Minister for Finance, Deputy Michael Noonan - is that we are focusing on investing in health services. I hope to be able to do something about many of the issues raised by the Deputy. As I said, I am working very closely with the Minister, Deputy Simon Harris. The issues raised by the Deputy are among my priority issues in the context of the HSE service plan. I hope, therefore, that we will see some movement in dealing with them in the next few months.