Topical Issue Debate

Treatment Abroad Scheme

I thank the Minister of State, Deputy Finian McGrath, for taking my Topical Issue matter. Fianna Fáil has been contacted by Children’s Liver Disease Ireland, a voluntary organisation, the aim of which is to support families who have a child with liver disease. It is a small group as liver disease in children is uncommon. Nonetheless, for those affected, it is a serious issue for them and their families. Children have to travel to the United Kingdom for treatment for serious liver disease, with liver transplantation and Kasai procedures the main treatments. All families know the worries that go with the transplantation process, but they have been compounded by other factors recently.

In early January staff shortages in the Air Corps resulted in serious pressure being exerted on the ability of combined services that compromised emergency medical transport services. The impact of this pressure means that, despite a professional and dedicated team, the air ambulance service cannot guarantee that a child will be transported to the United Kingdom in the six-hour window period allowed for the donor of a liver. Parents of children affected had this explained to them and, understandably, some of them have taken the decision to move to London while their children await a transplant. Children’s Liver Disease Ireland believes the Health Service Executive, HSE, has made decisions about the air ambulance service which will impact on children's plans. It does not believe a reliable service will be available to children awaiting a transplant for many months. One mother who lived through having a child on a transplant list told us how she knew how those who did faced many dilemmas and risk factors. It is not unreasonable that the system should represent their decision about a risky transport system as their opinions are respected in medical decisions about their children.

Obviously, the cost of living in a different city, as well as absence from work and home, are significant. A child can be on a transplant list for many months, even up to a year, but may not require hospitalisation. I understand the Department of Health has instructed the HSE to provide these families with financial support on a case-by-case basis. However, I understand the families that have moved to London have been informed they do not meet the criteria for the provision of this financial support. I also understand that initially all liver transplant children were told they did not meet the criteria. Following queries to Our Lady’s Children Hospital, Crumlin, some but not all liver transplant children were granted financial support. There was no explanation given of the criteria used. The families need clarity at this stressful time. Will the Minister of State respond to the questions I have raised?

I thank the Deputy for raising this important matter. I know that she has a good record on health and disability issues. It gives me the opportunity to inform the House about air ambulance services and the supports available to families of children receiving medical treatment abroad.

The United Kingdom and Ireland share a common organ pool base. When donor organs become available, they are submitted to the common pool for transplant to the most appropriate patient on the waiting list. The United Kingdom provides paediatric transplant services on behalf of Ireland and they are organised through the treatment abroad scheme. In 2016 nine paediatric liver transplant and eight cardiac patients were treated under the scheme.

Responsibility for the co-ordination of transport logistics for paediatric transplant transfers rests with the National Ambulance Service, NAS.

The NAS uses three providers for these transfers: the Irish Air Corps, the Irish Coast Guard and private air ambulance companies. The NAS prepares an individualised transport logistics plan for each patient and keeps the plan updated. This logistics plan takes into account the patient's location, medical requirements and the time window available in which to complete the transport. The timeframe to transfer a liver patient is six hours, whereas a shorter timeframe of four hours is available for cardiac transplant patients.

As the Deputy will be aware, the Air Corps is currently experiencing manpower challenges and has been unable to sustain the level of service previously provided for the transfer of priority paediatric transplant patients. While there is significant work under way in the Department of Defence to increase the capacity of the Air Corps, this reduction in the availability of the Air Corps resource is problematic. I accept the Deputy's point in this regard. I can assure the Deputy that the NAS has taken every step possible to ensure that contingency arrangements are in place in light of the reduced Air Corps availability. In that regard, the NAS is working closely with the Irish Coast Guard and private providers in an effort to mitigate the risks associated with the transport of patients. However, the NAS medical director is of the view that, given the current difficulties, all cardiac transplant patients should relocate to the UK in order to guarantee access to transplant surgery. He has also recommended that decisions regarding the relocation of liver transplant patients be made on a case-by-case basis, considering the location of the child. I understand the decision to relocate is a very difficult one for any family, not least the family of a sick child. Given the exceptional circumstances with regard to air ambulance transfers, the Minister, Deputy Harris, has asked the HSE, through the treatment abroad scheme, to make a financial contribution to families who are advised to and who choose to relocate.

In the meantime, I understand that every effort is being made to address the shortages in personnel faced by the Air Corps, and a plan is in place to allow it to return to full strength. The Deputy may wish to note that following a recent notification from the Irish Coast Guard of reduced availability for inter-hospital transfer services due to scheduled fleet maintenance, the Air Corps rosters were changed at very short notice to provide additional cover, in case an organ became available for a transplant patient. This arrangement, at very short notice, illustrates the strong interdepartmental co-operation evident in the provision of the air ambulance services.

I thank the Minister of State for his positive response, which was very welcome. From what I hear, funds will be made available to families through the treatment abroad fund. The cardiac cases are approved but the liver patient decisions will be made on a case-by-case basis, depending on the location of the patient. Will there be two different approaches for those in the west and in Louth?

Both liver and heart conditions are very serious. Regardless of whether a heart or liver is to be transplanted, the child has to get from Ireland to England. Regrettably, air transport is currently provided only between 9 a.m. and 5 p.m. and there is no weekend service. The Minister of State reassured me there is a private air ambulance company employed. I am sure he can guarantee me it is available 24-7, when requested. When Crumlin hospital states a liver or heart is available in the United Kingdom for a child, are we in a position to provide the transport and meet all the standards of delivery, even if the child is living at home? Many of the liver patients are in the home setting and do not need to be in hospital at all. One can totally understand the concerns of the families. They are very concerned over the fact the air ambulance service is not the service that existed last June or July and they are concerned given what came to light last January. The families need to know they have support, including financial support. It is a huge commitment to uproot a parent and child and leave half a family behind. Some people must walk away from their job to do what is necessary until such time as we have a full air ambulance service again.

Of course I understand the dilemma of the families, in particular those dealing with liver disease. They are very worried. I accept the Deputy's point that they need clarity. On the funds, the assessment and the point the Deputy made about Galway and Louth, I will raise the matter with the Minister, Deputy Harris, because we need total clarity on this issue to reassure the families.

May I make four other points that are important for families to know? First, where a family is experiencing undue hardship, it may, of course, apply to the Department of Social Protection for an exceptional needs payment. It is understood that, in general, exceptional needs payments are approved when the applicant is already in receipt of some sort of income support. Second, owing to the air ambulance difficulties, we have asked the HSE to provide financial assistance to the families required to relocate. It is a difficult situation. Where a child is in hospital and the hospital cannot provide accommodation for a parent, or where the child is not hospitalised, the family will be offered a subsistence payment of €169.22 per night per family.

Third, while the financial contribution is generally directed at the families of cardiac patients, the HSE has also been directed to consider the requests for financial assistance for the liver transplant patients, and this is very important. Fourth, the Irish Coast Guard provides capacity for the inter-hospital transfers on an as-available basis from Dublin, Waterford, Shannon and Sligo. This is where the private providers come it. They are used regularly to supplement both emergency transfer patients, who are a priority, and scheduled transfer patients. The HSE acute hospital division has identified a comprehensive list of private air ambulance providers. This is updated continuously. The Deputy can reassure the families that lists of reliable people have been drawn up and that the service is being given.

I will bring the other concerns raised by Deputy Rabbitte back to the Minister, Deputy Harris, to obtain further clarity.

Respite Care Services

There has been a misunderstanding. Deputies Breathnach and O'Dowd will be aware that if both had submitted this matter, then we could have allocated time as desired but in these exceptional circumstances I ask Deputy Breathnach, who has three minutes, to go ahead.

I wish to bring the disgraceful lack of respite places in County Louth to the Minister of State's attention today. Last year, the acute lack of proper respite facilities in Louth reached a crisis point. Families in my area are suffering from ongoing unacceptable distress as the crisis continues to escalate. I am aware that the Minister of State has been contacted by many of the families and care groups. Let me outline some of the severe hardship cases that my office and other Deputies in Louth are dealing with. Most importantly, I ask the Minister of State to provide the funding for a facility that has been identified to provide care for 30 people. It would cost €800,000 to provide care for 30 people per annum. The service provider Praxis Care is ready to provide the service, and a premises has been identified. It just needs confirmation from the HSE that the funding will be provided. The facility could be operational within three to four months. The service would provide respite to young adults in Louth, Meath, the north midlands and north Dublin. The premises identified is just off the M1 in Drogheda.

I want to give some examples of the extreme hardship the families are going through without access to respite care for their loved ones. A family with a severely disabled 26-year-old daughter has been looking for respite care for three years now. Her mother rang up giving four months' notice to get four nights' respite for a trip planned for her wedding anniversary. The family was told immediately there was none available even though ample notice had been given. She was not able to get respite in May to enable her to attend her granddaughter's Holy Communion. Recently, the family was granted two nights, which was not enough time in which to plan anything meaningful. Two nights is not enough of a break for the family. The mother said she was too exhausted to do anything with the time.

She is distraught. There is another mother who has an 18-year-old son and she is very conscious that as yet there are no specific plans in place for how adult respite will be delivered to her son. She is aware of many other families in the same predicament. Her son continues to display high-risk and challenging behaviour. Respite is a complete lifeline to them and they are extremely worried and worn out.

Go raibh maith agat. I call Deputy O'Dowd.

I would like Deputy O'Dowd to expand further on the issue because we are ad idem in Louth on this issue.

I thank Deputy Breathnach for agreeing to allow me to speak on this. I appreciate his commitment, which we share, as does Deputy Adams. We have met regularly with the HSE and with Drumcar and St. John of God to try to get a solution to the problem that continues. It will continue until adequate and proper funding is provided. I welcome the commitment of the Minister of State and the Taoiseach to deal with this issue, but the scale of it is huge. There has been no increased investment by the HSE into respite care since 2008. The estimated number of new places required nationally by 2020 is 2,133. In our own HSE area, that number is 316. There is no sign of any of these places at this moment in time. There is huge distress, upset and concern. There are people crying on the phone, elderly people breaking down at meetings and parents in their 80s distraught and terribly upset. People are listening and Ministers are listening, but we need the action and we need it now.

I thank Deputies Breathnach and O'Dowd for raising this very important issue because it gives me the opportunity to outline the position on the need for respite care for children, young adults, and ageing adults in the community in Louth. I want to make it very clear that this Government’s ongoing priority is the safeguarding of vulnerable people in the care of the health service. We are committed to providing services and supports for people with disabilities that will empower them to live independent lives, provide them with greater independence in accessing the services they choose and enhance their ability to tailor the supports required to meet their needs and plan their lives.

The provision of respite services has come under additional pressure in the past number of years. I accept that point. An increasing number of children and adults are now seeking access to respite, and the changing needs of people with a disability are also having an impact as they, along with the rest of the population, are living longer lives. The HSE acknowledges, as do I, the need for additional respite for adults and children with intellectual disabilities and the difficulty experienced by families with regard to the lack of respite places available. The HSE is working with agencies to explore various ways of responding to this need in line with the budget available.

To support these alternative ways of providing respite, funding has been provided to the HSE to provide 185 new emergency residential places and new home support and in-home respite for 210 additional people who require emergency supports has been allocated. The HSE’s social care operational plan for 2017 aims to provide 182,000 overnight stays in centre-based respite services, in addition to 41,000 day respite sessions.

HSE Louth disability services have recently received a draft costing proposal submitted by a local service provider. The nature of the proposal is for the provision of a residential respite service for young adults with complex needs and challenging behaviour. No discussion has been had with the service provider regarding the costings as received for the proposed provision of a respite house that the service provider is considering developing in the Louth area. The HSE has confirmed in local discussions with the service provider that it is not in a position to give assurances to any provider regarding the independent commissioning of such a service outside procurement. The service provider was advised that if the organisation were to proceed to develop same, it would be the organisation's decision to do so.

I emphasise that further discussion is ongoing at CHO 8 level regarding the emerging need for additional respite services and the options to be developed to meet these needs. The HSE has advised that additional funding would be required for the development of respite services in Louth, but there is a problem with regard to that. As Minister of State, I intend to seek additional funding for residential and respite services as part of the 2018 Estimates process.

Only yesterday, I had a meeting with the Taoiseach on the social service plan for 2018. This item was at the top of our agenda.

I am disappointed with the Minister of State's response as deeds and actions are needed, not words. I could go on for the next hour about cases that have come to the attention of my office. The Minister of State has been written to about many of those cases. For example, two social workers left Drumcar last December and since then no social worker had been there at all until last week. Just one social worker was appointed to facilitate the needs of these families. If the Minister of State cannot give a commitment to give the money needed to solve the problem in Louth immediately, I want to make a suggestion to him and I ask him to consider it. In the short term, could he not allow retired accredited intellectual disability nurses provide respite for these families in their homes? While it is not an ideal solution, that would alleviate the distress and worry of these families. Most importantly, I call on the Minister of State to get the funding to which I have referred to provide the facility that has been identified. Let us get action on this. Words are no good.

I absolutely agree with everything Deputy Breathnach has said. It is universally true in every home in Louth where there are people with disabilities. There is an absolute lack of clarity, support and services. Yet, at the same time, more than €30 million is spent on the services of St. John of God. It is reducing its services but is not giving the funding back to the HSE or to other groups that want to provide the services. It is not doing its job.

I appreciate the Minister of State's commitment to increased funding for Louth. What the Minister of State needs to do is attend the meeting with us, the HSE and Drumcar to sort it out once and for all. These families deserve better. No later than this afternoon, I got a call from a constituent who has a 21-year-old disabled son who never got respite. Despite applying for it, they got no answer this year - no answer at all. It is a disgrace and is unacceptable. I appreciate the Minister of State's hands-on involvement in all the issues we bring to his attention. I ask him to please deal with this issue. We will talk to him after this debate to get action and commitments.

I accept the points raised by Deputies Breathnach and O'Dowd about needing action and deeds. Even in the last couple of days, I have written to the CEO of and people directly involved in St. John of God about the management of money. That is a separate debate but, at the same time, I am not happy with the way some of the money is being spent on services. It is unacceptable to hear that a family has told Deputy O'Dowd it received no respite.

The management of money in services is very important. I take Deputy Breathnach's point about the retired nurses. That is a good idea. There are 101,000 families claiming the carer's grant, which is worth €1,700 and was restored recently to those families. They could use some of that money to pay for respite while we get the long-term issue resolved. However, I accept the point that we need action on respite services. We need good management of the resources. We do not need all the money going to senior managers in St. John of God's services, because the people on the front line deserve the respite services. That is the direction I want to go in.

I also appreciate sensible ideas. We could use some of the nursing support hours. In this year's budget, I got an extra €16.2 million to support 395 people through funding for the new home support, which is in-home respite for emergency cases. Perhaps some of that money could be used for those ideas. I saw a group of nurses in north Dublin recently who have retired from St. Joseph's intellectual disability service in Portrane and are doing an excellent job of helping out the services that are in crisis.

I will talk to Deputies O'Dowd and Breathnach about meeting those directly involved, in particular parents who have not received the services. I would like to hear from them first hand.

Insurance Costs

Táim buíoch don Leas-Cheann Comhairle as ucht an t-am a thabhairt dom an t-ábhar tábhachtach seo a phlé leis an Aire Stáit. Cuirim fáilte roimh an Aire Stáit. Táim ag cur an cheist árachas margaidh os comhair an Tí. Early this morning, it was confirmed that the Competition and Consumer Protection Commission carried out a series of raids on insurance companies and brokers and their representative body, Insurance Ireland. The raids are part of an ongoing investigation regarding suspicions of the existence of price signalling or price fixing within the insurance sector in this State. This suspicion is most evident in motor insurance prices, which most of us have had to put up with over the past number of years. However, it is far from being limited to car insurance.

I am sure the Minister of State is very well aware that Donegal has a very long and proud farming and agricultural heritage. The diversity of land use within the sector reflects the physical diversity of our landscape. From largely dairy farming in the north to crop growing in the east and throughout the Finn valley to cattle rearing in the south and grazing lands in the west, few counties can boast such a mix and range of farm types. As a rural county, this tradition is not only widely known but widely celebrated because even to this day, the industry remains at the heart of the local economy in many of our smallest villages and towns. The local farmer's mart is at the centre of this industry. Many of our biggest towns such as Letterkenny, the twin towns, Raphoe, Milford, Donegal town, Ballyshannon and others owe much of their success down through the years to the influence of the local livestock co-op or mart. In fact, many of them remain open for business today. They are local trading hubs - institutions in their own right - where farmers and traders come to do business, to socialise and, in most instances, to continue a long and lasting family farming tradition.

Despite this, all is not well at the local livestock mart. It is a business which finds itself coming under increasing financial pressures as a direct result of what is fast becoming the cross-sectoral problem of insurance costs. In my view, the same core issues that have caused the rip off for drivers are driving these increases. In recent weeks, I have been contacted by representatives from the sector who have stated in no uncertain terms that the crippling costs associated with rising mart insurance premiums over recent years are forcing mart operators to consider their own futures seriously as well as affecting the future survival of the wider institution itself. Marts are reporting to me that they are coming under heightened demands from their insurers - demands with which they complied in the past and that are still there. Those demands are to introduce costly structural adaptations and changes to existing practice which it is claimed will help keep the cost of cover down. However, even though some marts have already carried out those works, they are seeing dramatic increases in their premiums. Even though they are open for fewer hours than previously, they are seeing the premiums increase year on year. What will the Minister of State do at this stage of the insurance review to ensure that the plight of marts are brought into the terms of reference? I have written to the Minister requesting that. Can the Minister of State comment on the Competition and Consumer Protection Commission investigation? Will he write to the Competition and Consumer Protection Commission and ask it to look not only at motor insurance but at wider issues, including mart insurance?

I am well aware of Donegal's farming background, which is one of the most mixed and varied in the country. Given Donegal's size in an area where there are challenges, we must do what we can about them. I have been advised by Insurance Ireland that livestock marts have significant exposure to injuries to employees and members of the public. This has resulted in claims occurring with a level of frequency which has led to a reduction in market capacity due to the hazardous nature of the risk.

In response, insurers have developed active risk management programmes in order to try to reduce the level of accidents and injuries. In addition, I understand that insurers have been working with marts with a view to implementing improvements in management practices and facilities to reduce claims as this is the key area in terms of managing claim costs.

Insurance Ireland has advised that it is not aware of any recent major increases in the cost of insurance for agricultural mart owners. However, if the Deputy is aware of a specific issue facing an individual mart owner, I recommend that he or the mart owner raise it with Insurance Ireland, which I understand is happy to discuss the issue as part of its free insurance information service for those with queries, complaints or difficulties regarding obtaining insurance.

The Deputy should note that the Minister for Finance is responsible for the development of the legal framework governing financial regulation. Neither the Minister nor the Central Bank of Ireland can interfere in the provision or pricing of insurance products as these matters are of a commercial nature and are determined by insurance companies based on an assessment of the risks they are willing to accept. This position is reinforced by the EU framework for insurance, which expressly prohibits member states from adopting rules which require insurance companies to obtain prior approval of the pricing or terms and conditions of insurance products. Consequently, the Minister is not in a position to review individual cases nor to direct insurance companies as to the pricing level or terms or conditions that they should apply in particular cases.

Nevertheless, it is possible for the State to play a role in helping to stabilise the market and deal with factors contributing to the availability and cost of insurance. In terms of measures being taken to tackle the cost of employer and public liability, the Deputy will be aware that this is being examined as part of the second phase of the cost of insurance working group. The working group is building upon the previous work done in the motor phase in order to determine how it can be applied in the employer and public liability insurance claims areas. The working group is also considering the impact of the cost of insurance on the competitiveness of particular business sectors, the impact of health and safety issues on the cost of insurance and other market issues. The working group has held extensive consultations with a range of stakeholders, including the Irish Farmers' Association, IFA, which provided a submission to the working group. This issue was not raised in its submission.

It is envisaged that the final results of the second phase will take the form of an addendum to the existing report. As with the first phase, the aim is for all relevant bodies and stakeholders to work together in order to deliver fairer premiums for businesses without unnecessary delay. As it is likely that employer and public liability risks are factors in the cost of insurance for marts, any recommendations emerging from this review should be of relevance to the mart sector. I met with the IFA in Wexford yesterday and raised this issue with it. There are two marts in Wexford and two marts that are very close to the border of Wexford so there are four marts in direct proximity to Wexford but the matter has not been raised with me. However, if there is a specific issue in a specific area, I will certainly take it up to improve matters so that premiums are not unreasonable and unfair.

I appreciate the Minister of State's comments. I will raise this matter with Insurance Ireland and ask the mart owners to do likewise. However, given that he is the Minister of State with responsibility for examining the cost of businesses, and I note his comments about the IFA, I can tell him that the businesses in Donegal with which I have spoken are seeing dramatic increases in their insurance premiums. The Minister of State said the insurance industry is working with the sector to ensure that measures can be taken to reduce the premiums. Many marts have carried out those measures. They have carried out the costly structural adaptations and changes to existing practices but lo and behold, they see their premiums go up when they are due for renewal. For example, despite having spent over €12,000 on introducing such changes, operators of one local mart saw their premiums rise from €8,000 in 2015 to a whopping €15,000 for the period 2017 to 2018. This is an increase of nearly 100% in 24 months.

That is not sustainable for a mart in a rural area. This is a business which is important and which supports an agricultural sector. Another mart has advised that the costs of its renewal is now a staggering €30,000. This cost is among its biggest overheads for the year and the figure is now unsustainable. It is telling us that it is unsustainable. It has scaled back its operating times and cannot scale back any further. The next step is whether to close the mart. This is particularly the case for smaller marts and co-operatives which operate only a limited number of days. Mart owners simply cannot afford to pay such inordinate insurance premiums and many fear that if the issue is not remedied shortly, it will result in their likely demise and closure. What they are reporting is what we know of, but those in the agriculture sector are at the mercy of a highly concentrated insurance industry which is dominated by a relatively small number of big insurance firms that can charge what they want.

What can the Minister of State do? He is carrying out the business sector review. His predecessor took on board some of our comments when he appeared before a committee. Independently of what I have said, I ask the Minister of State to take a sample of perhaps 20 marts across the country to see if insurance premiums have increased dramatically and to look at that when engaging with the sector.

I did that earlier. I telephoned two of the marts in the area closest to me. The cost for one of the largest marts in the country is approximately €12,500 and its owner said its premium had not increased. I anticipated the question would be about why premiums had increased. The owner said its premium had not increased because he had not had a claim for 12 years. That is the primary issue I see. When I pushed him about his knowledge of other marts, he said from what he has been told, the cost to insure a moderate-sized mart is between €20,000 to €25,000. I take on board the Deputy's assertion that there is probably a bigger issue where premiums for smaller marts, which operate on a smaller number of days and which have a smaller turnover, go from €8,000 to €15,000, thus experiencing a really significant jump. It is concerning in the extreme if they have done the work required to insure there are no claims or where they have done the work if there were issues to be resolved. I have a real problem with that.

If the Deputy supplies me with the details, I will pursue the matter. I will also take it to the next phase of insurance analysis. The marts are crucial and are an essential part of rural Ireland in terms of trade. It is not just the marts because there are shops and other services attached to them. I am from rural Ireland and an agricultural background and do not want to see any further slippage in this sector.

Road Projects

I thank the Minister for making himself available to take this issue. Will he seriously consider, as part of the capital programme, which I presume will be announced when we come back after the summer recess, funding the N24 to motorway standard? This road connects Limerick and Waterford. This is a very valid proposal and given where we are with regard to the national spatial strategy and the national planning framework, which, coincidentally, I kicked off myself a couple of years ago, this would fit right into the plans and requirements set out in them. It also fits into the plans set out in the submission from County Tipperary as part of that and also submissions and plans from the south east. The local authorities of Tipperary, Waterford and Kilkenny have written to the Minister and made a submission on this motorway proposal.

We need the motorway in order to open up the south of the country. Not only would it link Cork, Limerick, Waterford and all the towns in between, it would link the ports of Rosslare, Waterford, Limerick, Foynes and Cork. Based on my knowledge as a former MEP, I think there is potential for funding from the Trans-European Transport Networks, TEN-T, programme because this would link up all the ports and in doing so, meet all its requirements.

The current N24 is substandard. It links many towns in Tipperary, including Clonmel, Carrick-on-Suir and Tipperary town, with many others. It has slow journey times. It would be a game-changer because it would link up the whole southern region. It would also open up Shannon Airport as an access point. Furthermore, it would create the possibility of opening the M8 and linking it with the M7.

The Minister has decisions to make on capital funding which will be tight. He will be under pressure in regard to requirements in Dublin, which are also all valid. I was in his Department a number of years ago when similar decisions had to be made and when our envelope was much smaller.

Will the Minister consider doing this motorway? If he cannot do the whole motorway, will he consider doing a component of it? The cost associated with linking up Limerick with the M8, for example, would come in at €500 million or thereabouts. The cost associated with doing the Cork to Limerick road would be much higher and that is a very worthy project in its own right, but the Minister is obviously going to have to fit the projects within the envelope he has.

This is a fantastic project that would tick all the boxes in regard to the Action Plan for Jobs, the plans for opening up rural Ireland and regionality. IDA Ireland and those looking to bring investment into this country would be very excited if the Minister could go some way to funding this road to bring it to motorway standard, whether by upgrading the road or, probably more likely, building a new road. In the coming months will the Minister consider this favourably, if at all possible?

I thank the Deputy for raising this very important subject. He will be aware that I cannot make any commitment at this stage and that he is putting a case which is competing with many others in what is not a bottomless pit. I acknowledge the fact he has made a very good case for upgrading the N24, in particular when he mentioned the spatial strategy, which is important, and the fact the road is undoubtedly substandard. I point out to him, because I do not want to raise expectations and I have had a multitude of requests about roads, that we really have not been able to do anything to even keep up with the steady state in recent years and that will not happen until 2019 or 2020. We are coming from behind but, as the Deputy said, the capital review will I hope release capital.

The N24 services the cities of Limerick and Waterford. The route originates at the junction of the N24 and the N7 at Henry Street in the city of Limerick and terminates at the junction of the N9 and N25 at the Brother Ignatius Rice Bridge in Waterford city. The overall route length of the N24 is approximately 120 km. An approximate breakdown of the route length by local authority means that the largest stretch of the route is in the Deputy's home county of Tipperary. A number of significant upgrades to the N24 were being planned before the financial crisis but were, unfortunately, suspended at route selection stage due to lack of funding. These included the Bansha-Tipperary-Oola bypass, the Cahir-Bansha road, the Carrick-on-Suir bypass, the Clonmel-Cahir bypass and the Mooncoin bypass. The Government's capital investment plan, building on recovery, infrastructure and capital investment, provides the financial and strategic framework for Transport Infrastructure Ireland's, TII, activities during the period from 2016 to 2021. The N24 was not included among those projects which were identified for development during the period of the plan. However, as the Deputy is aware, mid-term review of the capital investment plan is being undertaken by the Government and the position on the development of the route will be reviewed in the light of the outcome of the review and any additional funding priorities that may be identified by the Government for the national roads programme.

The Department's submission, as part of the capital plan review, includes provision for the development of a project pipeline for national roads. Among the projects included in the pipeline is an upgrade of one section of the N24, from Cahir to Limerick Junction, which is 27 km. The capital review process is under way and decisions on the outcome will be made before budget 2018.

The Minister and I have had our differences in the past on a range of issues. One matter on which I have great sympathy for him is the issue of roads and capital spending because there will never be enough funding. Obviously, he has other competing capital public transport projects across Dublin and other cities. I was in that Department and have sympathy for him.

I will ventilate some issues for the Minister to put into the mix. This opens up together all the ports across the south of Ireland. Given our issues in regard to a range of other areas, including climate change, that should be considered. Second, it opens up Shannon Airport. It meets our spatial strategy plans. We cannot continue developing this country based on the conurbation around Dublin. We need to open up other parts of the country and I believe turning this into an motorway, even if we have to do it in stages, is critical in order to achieve it.

I very much welcome what the Minister said. I am taking it as a move in the right direction that, in consideration of upgrading the road from the Cahir on the M8 to Limerick Junction, which is a road desperately in need of being upgraded, it allows a continuation of the M8 motorway on to Limerick Junction and then from a road from Limerick Junction into Limerick, which is not as bad as the other area. I implore the Minister. Even if he could countenance doing that component of it, that would be welcome. It would open up that part of the country and allow for continuation of the work when more funding is available. I encourage the Minister to do that. I believe it would open up the whole area, particularly a part of the country that has not had infrastructural investment. There are serious issues, for instance, in Tipperary town and the surrounding areas. We need to allow for greater investment in that whole area and this would do so. Even if the Minister were to look on it favourably, it would be welcomed by all sides of the House.

I will, of course, look on it as favourably as I possibly can. I am glad the Deputy, who has been in this position, realises that the competing considerations are overwhelming in this case, particularly as the capital plan looms and decisions have to be made in the autumn. I will certainly bear in mind what he said about the ports and Shannon Airport. They are strong points.

The plan provides for a gradual build up of capital funding towards the levels needed to support maintenance and improvement works. It will, however, take some years yet to restore the steady State funding levels for land transport. There will be a significant increase in funding from 2020 which will facilitate the construction of the national road improvement projects included in the plan. While available funding is not sufficient to address all the demands for improvement schemes, including schemes such as the upgrade of the N24, by the end of the plan period I expect that capital funding for the road network will be back up to the levels needed to support maintenance and improvement works in the future.

As regards the possibility of additional funding within the plan period for national road projects, the capital plan review process is under way and my Department is making a strong case for extra funding to the Department of Public Expenditure and Reform, including the development of a project pipeline for national road schemes. The final decisions on allocations are, however, matters for the Minister for Public Expenditure and Reform and the Government as a whole.