Topical Issue Debate

Bus Éireann Services

I am glad the Minister is here to take this Topical Issue matter personally and I thank him for being here. I am raising issues with the 220, 220x and the 223 services on behalf of constituents. The 220 is the service from Carrigaline through Cork city and on to Ovens. The 220x is the same service with the addition of a service to Crosshaven. The 223 is the Ringaskiddy to Cork city service and some of those buses go on to CIT. The reason I am raising the issue is that I and others have been inundated with complaints about the quality of the bus service. In particular, we have received complaints about the reliability of the service and ongoing capacity issues as well. It appears that these routes are seriously under-resourced. They are popular, successful and profitable routes and there are people who want to use public transport. The types of issues that occur consistently unfortunately relate to buses running very late, buses being full or in some cases buses not turning up at all. We are talking about people who rely on a bus service to go to college, school, work, a hospital appointment or to go about their day-to-day lives. It is just not good enough. I have tried to take this issue through the regular channels. I have raised these concerns with Bus Éireann directly. It talks about traffic congestion, the need for greater investment in bus lanes and it says it is looking at increasing capacity on these routes. I do not see any improvements happening at the moment and that is why I feel the need to raise these issues here today.

The problems are both inbound and outbound and both the 220 and 223 serve communities that are rapidly expanding. Towns like Carrigaline and Passage West are expanding very rapidly and they need a quality bus service. I am not blaming the bus drivers, some of whom have provided really useful feedback on the nature of the timetable. It may well be that the timetable needs to change to reflect the reality of traffic congestion which is not getting lighter. It is not just in Dublin that there is traffic congestion; it is certainly in Cork as well. More resources are undoubtedly needed. There is no real-time information available. If one is at a bus stop in Dublin or waiting for the Luas, the sign will say when the next Luas or bus will be along, for example, in two minutes or three minutes. We do not have that service on these routes. People stand there not knowing whether or not the bus will turn up. That is the reality of the service that people are facing.

I welcome the extension of the city zone fares which both of these routes avail of. The 220 and 223 are now deemed to be within the city zone. That is a very beneficial reduction in fares, which is to be welcomed. The message from people is that it is all very good and they welcome it but it is not much good if we do not have a service we can rely on.

There is also a need to change routes and introduce new routes. The town of Carrigaline should be connected with Passage West because there is a new primary care centre in Carrigaline, which the people of Passage West need to get to. About 5,000 people work in the lower harbour area of Ringaskiddy and many of them live in Carrigaline. There is no bus connection for them to get to work or to Little Island.

There are a lot of issues. In some cases overtime is not available and is not being paid, which may explain why in some cases, buses have an out-of-service sign and are rushing back to the depot. In other cases, private buses are being brought in, which means people cannot use the Leap card and so there is a loss of revenue to Bus Éireann. The Minister is in charge. People are looking for answers and I look forward to hearing what the Minister has to say.

I thank the Deputy for raising this interesting issue. I am not one who thinks it is a bad idea to bring up certain bus routes in Cork or anywhere in Ireland in the Dáil. I do not think any problem is too small for us to address because it may be a microcosm of what is happening elsewhere. I am grateful to Deputy McGrath for bringing it up, although I may indeed wash my hands of some of the responsibility for it because of the structures the State has for dealing with these situations. If this is a reflection of what is happening elsewhere, it is a good thing the Deputy brought it up today. I hope I will give the Deputy a reasonably positive response. I appreciate the fact the Deputy has raised the issue.

As Minister for Transport, Tourism and Sport, I have responsibility for policy and overall funding of public transport. I am not involved in the day-to-day operations of public transport. Deputies will understand that the operation of Bus Éireann services is a matter for the company with oversight by the National Transport Authority, NTA. The NTA has entered into a contract with Bus Éireann for the provision of bus services in the State. In accordance with the terms of that contract, the day-to-day operation of those services is managed by Bus Éireann. The company is required to meet performance obligations on service delivery such as punctuality, services operated, vehicles in service and customer information. The NTA has invested in a significant improvement to subsidised bus services in Cork city. This has included the provision of cross-city services, increased frequency on existing services and new services linking residential areas to places of employment and education. Further investment has been made in the city bus fleet which is 100% fully accessible and an increase in capacity through the purchase and deployment of double decker buses. Passenger numbers have grown by 19.4% since 2013 to 12.6 million in 2017. However, the 2017 numbers were lower than forecast due to the period of industrial action at Bus Éireann. Further expansion of the Cork city network is planned in 2018. For example, there are improved services planned on the Ballincollig-Carrigaline corridor, including routes 216, 220, 220x and 223 and frequency improvements on routes 202, 207a, and 208. In addition, route 206 is planned to link with route 221 providing improved frequency to Glanmire via Cork Kent Station with the service also being extended to Cork Airport.

I am aware Bus Éireann has been experiencing some operational issues in the Cork area recently and that there have been some complaints regarding the non-arrival and late arrival of some services. This apparent degradation of services for the customer is not acceptable and it is a matter for the company to resolve the issues promptly. I take note of what the Deputy has said and presume the company will do the same.

I am advised the NTA is currently liaising with Bus Éireann regarding a number of complaints from Bus Éireann customers regarding problems with services in Cork that it has received recently and no doubt some of them are from Deputy McGrath. I understand the NTA wrote to Bus Éireann last week asking that the company revert to the authority as a matter of urgency with the steps being taken by it to resolve the underlying issues and mitigate the effects of them in the short term until permanent solutions are put in place. I assure the Deputy the NTA is continuing to monitor developments closely and has reminded Bus Éireann of its performance obligations under its contract. I look forward to this issue being resolved as soon as possible.

I thank the Minister for his reply. People locally hold me accountable politically and I have to hold the Minister accountable politically as the one in charge of this issue. I ask him not to wash his hands of any aspect of it and make sure the fact that it has had to be raised on the floor of Dáil Éireann will work its way through the system and result in a better quality of service for the people I represent. He can be sure these issues are not unique to the area I represent, but it is a matter for other Deputies to raise them on behalf of their constituents. I would like the Minister to follow up on these problems with the NTA and Bus Éireann. It is welcome that there are plans to expand services, including the 220, 220X and 223, but will the resources be provided to back up the intention to expand these services because lack of capacity is a problem? Lack of resources is, undoubtedly, a problem.

People want to know whether the position is going to change. I invite the Minister to read the community noticeboards on Facebook. Local newspapers such as The Carrigdhoun also provide a Facebook platform. They have been inundated with complaints and people are utterly frustrated about buses running so late and, in some cases, not even turning up and being full that it is having a detrimental impact on their daily lives. The fact that I have had to raise the issue in the House is born out of frustration and I am demanding action. I respect the fact that the Minister takes the matter seriously and it is welcome that the NTA has engaged with Bus Éireann and is aware of the operational problems which I agree are not acceptable. If the NTA measures the performance obligations, service delivery, punctuality, services and so on, it will find, unfortunately, that on these routes the quality of service has not been up to standard. Will the Minister follow through on this issue and please engage with the NTA in order that it will engage with Bus Éireann and put pressure on in in order that these services can be improved? There are people who want to avail of public transport which the Minister wants to encourage, but let us make it possible for them to do so by being able to rely on the provision of a decent service.

What the Deputy raises is fair and I have no doubt that what he says is true. The NTA acknowledges there has been an increase in the number of complaints about Bus Éireann services in Cork, particularly since implementation of what it calls the optimisation scheme in early December 2017. It continues to implement measures to further improve service levels and in recent days there have only been a few cancellations. I will not wash my hands of this issue. It is useful to hear the complaints on the floor of the House, particularly if there is an avalanche coming the Deputy's way. Whereas the NTA has operational responsibility for everything that happens, the buck stops here and it is good that the Minister is made aware of such problems which, if they were to recur throughout the country, would become far more serious. I acknowledge what is happening in Cork. I will be in touch with the NTA on the Deputy's behalf and thank him for raising the subject.

Aviation Industry Regulations

Unlike the previous small local issue in which the Minister said he had limited direct involvement, this is a major issue for which he has sole responsibility. To say his decision to appoint Fingal County Council as the competent authority under EU Regulation 598/2014 has caused consternation is probably an understatement. There is uproar in the community. People certainly did not see this one coming because of the very obvious conflict of interest.

The regulation was intended to be the mechanism for the independent regulation of aviation noise designed to protect communities from that intrusion. In order to transpose it, a competent authority had to be established to monitor such levels. It is important because the Dublin Airport Authority, DAA, has made it abundantly clear that once the body is established, it will use it in order to try to overturn the two restrictions in place on the new runway and night time flights. This is of vital importance to the surrounding community which does not resist construction of the runway per se but is asking that the terms and conditions on which permission was granted all those years ago when we were not as knowledgeable as we are now about the damage caused by aviation noise to the health and well-being of surrounding residents be upheld. Even then, almost ten years ago, these conditions were imposed and the DAA has made no secret of the fact that it wants the restrictions to be lifted. The local community thinks the idea of appointing Fingal County Council which gave the DAA the original permission without restrictions is absurd. Not only that but 20% of the rates income of Fingal County Council comes from the DAA. The council is renowned for its deferential relationship with the DAA, given the enormous value of the DAA to the surrounding community. The idea of the council being able to be impartial against that backdrop seems crazy to residents.

It is ironic that the original choice, the Irish Aviation Authority, IAA, was broadly accepted by the community. It has an international reputation for excellence and is highly technical in its assessment of this issue. While it manages air traffic at Irish airports, there is no profit in it for it. Its money comes from overflights, not use of the runway. There is much less of a conflict of interest with the IAA which has the required experience.

I think I speak for the representatives from all of the parties who attended the briefing the Minister organised last week on this decision when I say we could not get our heads around the justification given by the Department, that the Minister was looking for an organisation that had expertise in making environmental impact assessments and dealing with noise and aviation issues. With no disrespect to anybody in Fingal County Council, at a stretch, we might grant it the first one, but there is certainly no basis for the idea that it has expertise in dealing with noise and aviation issues, yet it has a clear conflict of interest. The Minister needs to revisit this issue, go back to the drawing board and reconsider the IAA as the competent authority under the regulation.

I thank the Deputy for raising this question and I am glad that it is being raised in the House, particularly after the briefing given to all of the spokespersons last week. I know that the Deputy will understand it has been a very difficult journey dogged by legal problems for nearly two years which has led us to this conclusion, with which I am happy. It was not easy because there will be people who, no matter who is appointed as the competent authority, will say this is the wrong one and that we should have appointed a different one, not least the lawyers, certainly Deputies and others. That is understandable, which is why this is a useful debate. I am happy now, having listened to the Attorney General, the IAA and others, that this is the correct appointment.

I have made several contributions in the House on this matter over the course of the past 12 months or so, particularly in response to questions posed by Deputies Clare Daly and Robert Troy. As the Deputy knows, the EU noise regulation, Regulation 598/2014, establishes a set of common rules and procedures to deal with noise issues at major airports within all EU member states. We do not have any option but to appoint a competent authority because of the EU regulation. As the Deputy mentioned, it was previously proposed that the IAA would be designated noise regulator for the purposes of Regulation 598/2014. However, as I explained in the Dáil before Christmas, when this approach was subject to final legal review, it was found to be impracticable in the light of emerging EU case law. It was as much a surprise for us as it was for the Deputy. Specifically, the advices were that the IAA would be conflicted, given its direct commercial interests in traffic growth at Dublin Airport. Offseting these conflicts would have required the establishment of a noise regulation unit within the IAA that would have had to be wholly separate from the parent organisation in terms of resourcing, recruitment, performance management and human resources management.

This was considered wholly unworkable and clearly against corporate governance best practice. Having re-examined the matter as to how best to implement the EU Regulation fully, Fingal County Council, with An Bord Pleanála as an independent appeals body, was considered the best way forward. Fingal already has responsibilities under an EU noise directive, which covers non-airport noise, and it has experience and expertise in environmental impact assessments and in managing extensive public consultations. There are quite a lot of synergies already and so it makes sense to give it responsibility for airport noise regulation.

Unquestionably, Fingal will have to build some additional expert capacity and so the draft legislation will provide for additional funding to provide for this. The Government has endorsed this proposed course of action and I now intend to get on with implementing it. There are challenges. This regulation has already proven quite a complex provision to transfer and align with existing Irish planning and development arrangements. Indeed, on my instruction, as the Deputy has already alluded to, departmental officials met the Deputy and a number of other Members of this House last week to hear their views, concerns and also to talk over the complexities and challenges. It is so important that the runway goes ahead, that we have a competent authority and that we involve anybody in this House and others outside in the decision-making process. As I understand it, that engagement was constructive and it has been agreed to have follow-up engagement with the Members. I hope the Deputy will attend those follow-up engagements. My Department and I are sensitive to concerns raised and are willing to find an agreed way through these if at all possible. It is my intention to publish a draft Bill as soon as possible. Doing so is a priority. It will set out precisely how the new regulator will operate in accordance with Regulation 598/2014. There will be plenty of opportunity for examination of the proposals as the Bill comes through the House. I welcome them starting with pre-legislative scrutiny at the Oireachtas Committee on Transport, Tourism and Sport, which will be attended by many Members and which can also be attended by others, including the Deputy.

I acknowledge that it has been a difficult journey, not least for the Minister because he is in a very difficult position. The reality is that a previous Attorney General gave a diametrically opposed view on this issue to the one we currently have. Previously, we were told that the Irish Aviation Authority, IAA, was the best organisation for the job and that a statutory instrument was sufficient to bring it into law. Now we hear that there is a conflict of interest in the IAA and we need primary legislation. We welcome the fact that there will be primary legislation but one of the purposes of this discussion is to tell the Minister in no uncertain terms that he will never sell Fingal County Council as an independent competent authority on these issues and it is best that we address those issues now rather than wasting even more time in dealing with this in the future. Fingal Organised Residents United Movement, a community organisation that has been very vocal on this issue, has said that it wants to see Dublin Airport prosper and increased connectivity and has no wish to stop the development of the northern runway but it believes there needs to be a totally independent body. The problem with the Minister's response is that it does not stack up to analysis because an independent body within the IAA is not wholly unworkable. It already exists in terms of other areas like safety. There are two independent bodies operating under the umbrella of the IAA. It is entirely possible to set this up. The IAA does not benefit financially from planes landing at the airport. It mainly makes its profits from overflights so the conflict of interest is far less than it would be for Fingal County Council, which gets 20% of its rates from the DAA which has a disproportionate influence on development in that county and to which the council gave the go-ahead years ago without the conditions on night-time restricted flights, the retention of which is so important for the local community so that the airport can be a good neighbour.

I think it is unfair, or most unusual, of the Deputy to suggest that a local authority is conflicted in its role with regard to its statutory environmental protection and enforcement responsibilities and wider economic and physical development roles. As the Deputy knows, local authorities already have a wide range of statutorily based regulatory and enforcement functions relating to environmental quality, planning enforcement and other areas which necessarily sit alongside their rateable income and property tax collection functions. This is how local authorities operate. Assigning Fingal County Council as the airport noise regulator is wholly aligned with that very long-established multifunctional role played by all local authorities. Importantly, it will also be subject to independent appeal. We must not forget that it will not be acting completely on its own. An Bord Pleanála will be sitting there to hear appeals in all cases of noise regulation and it cannot be considered to have a conflict of interest. I understand the Deputy's point of view. I know that whoever we appoint will come under scrutiny, particularly from the lawyers. Obviously, the IAA came across legal problems. I know that this one will rightly come under scrutiny from Deputies and other Members. This is why we have involved and will involve Deputies in as wide an engagement as possible on this and why we will do everything to ensure that their wishes are listened to and indeed adhered to and consented to by the Government so that we get the best possible result.

Defence Forces Representative Organisations

First, I record congratulations to PDFORRA and EUROMIL on winning their case against the State in the European Committee of Social Rights. The committee ruled by 11 votes to two that Defence Forces personnel were having their right to organise breached and that the Government should recognise their right to affiliate to the Irish Congress of Trade Unions. The committee also ruled unanimously - by 13 votes to zero - that the right of Defence Forces personnel to bargain collectively was being breached and that they should be able to participate in pay negotiations, so congratulations and hats off to PDFORRA and EUROMIL. I also want to record here the historic role of the wives and partners of members of the Defence Forces whose protest movement in the 1980s paved the way for the creation of PDFORRA and whose recent work has helped raise general awareness of the dire working conditions endured by Defence Forces personnel and the consequences for their families in terms of living standards. I have no doubt that this has been a source of pressure on this Government.

Is the Minister of State prepared to give a commitment in the House tonight that he will now arrange to meet Ms Patricia King of the Irish Congress of Trade Unions to discuss putting in place the necessary arrangements in the wake of this important judgement? I also ask him to give a commitment not to go down the road of obstruction, denial of rights and foot dragging, which this Government has attempted to do in recent years. From the moment the Garda organisations won their equivalent case at the European Committee of Social Rights in the autumn of 2016, we put the argument to the Minister of State's office that the Government should short-circuit the EUROMIL case rather than force a rehash of the same arguments in Brussels. The fact the Government persevered and contested this case all the way to the bitter end is shameful. Even since the ruling in favour of the Garda organisations, there has been more foot dragging with a promise of a Bill to give effect to the Garda ruling only listed for this Dáil session a full year and a half after the ruling. A Bill of mine entitled the Industrial Relations (Defence Forces) Amendment Bill 2017, which grants trade union rights to the Defence Forces in anticipation of yesterday's ruling, passed First Stage last year. The Government could easily progress this Bill to Committee Stage in this term. The Minister of State might comment.

The denial of union rights to the ranks of the Defence Forces has facilitated many abuses in terms of pay and working conditions.

The number of Defence Forces personnel on family income supplement alone is testament to this as is the exodus of technically skilled personnel in recent weeks and months. There are issues still outstanding in respect of the Organisation of Working Time Act and the loss of annual leave, Lariam, hazardous working conditions in the Air Corps paint shop in Baldonnel and so on. These issues have been argued out ad nauseam behind the closed doors of the conciliation and arbitration scheme run by the Department of Defence. This is a sham process.

The Taoiseach holds the portfolio of Minister for Defence. Some class of statement from him today regardless of this Topical Issue debate was warranted. I call on him now to make a statement on this ruling and to commit to bring forward legislation immediately to give effect to it in this session. I look forward to the Minister of State's reply with interest.

The European Committee of Social Rights has considered a complaint submitted by EUROMIL, a European umbrella body for military associations, on behalf of PDFORRA, concerning the lack of certain rights for military representative associations in Ireland.

In a non-binding ruling, the committee has concluded that prohibiting military personnel from the right to strike was not in breach of the European Social Charter, but that the charter was breached by prohibiting the representative associations from affiliating with a national employee organisation, such as ICTU, and in respect of the right to bargain collectively.

The Government welcomes the conclusion of the European Committee of Social Rights that the prohibition on the right to strike for members of the Defence Forces is not a violation of the European Social Charter.

It should be noted that the complaint predates a number of significant Government initiatives. Regarding collective bargaining, the Government established an independent Public Service Pay Commission in 2016 to provide objective analysis and advice on the most appropriate pay levels for the public service, including the Defence Forces. The Permanent Defence Force representative associations took the opportunity afforded to them to make submissions to the commission. Following the publication of the report of the public service pay commission, the Government initiated negotiations on an extension to the Lansdowne Road agreement.

The Permanent Defence Force representative associations were subsequently invited to the negotiations on the agreement, which were held under the auspices of the Workplace Relations Commission. They were afforded equal standing with other public sector trade unions and representative associations during the negotiations.

I am happy to acknowledge once again that in mid-December, both PDFORRA and RACO accepted the terms of the Public Service Stability Agreement 2018-2020. This provides for increases in pay ranging from 6.2% to 7.4% over the lifetime of the agreement, with the focus on the lower paid.

Members of the Defence Forces have a range of parallel complaint and adjudication mechanisms in law to compensate for the limitations on their access to the normal industrial relations machinery which applies in wider society. This includes a redress of wrongs, a Defence Forces Ombudsman and a conciliation and arbitration scheme for members of the Permanent Defence Force.

The conciliation and arbitration scheme, since its inception in the early 1990s, has provided the framework to progress many successful negotiated agreements between Defence Forces management and the PDF representative associations. However, there have been many changes in the industrial relations landscape in the intervening period. In this regard I have initiated a fundamental review of the scheme to ensure that it remains efficient and effective for all parties. I have appointed Mr. Gerard Barry to conduct the review. While the focus of the review will be primarily on the operation of the Permanent Defence Force conciliation and arbitration scheme, on my instruction the terms of reference of the review require that the findings of the European Committee of Social Rights are considered as part of that process.

It is critical that the Defence Forces are fully operational at all times. The taking of any form of industrial action is irreconcilable with military service. The right to affiliate with ICTU poses complex questions for the Defence Forces from a legal, operational and management perspective.

In accordance with the Defence Acts 1954 to 2015, military personnel are subject to military law at all times. By association with a trade union or similar body, such as the Irish Congress of Trade Unions, members of the Defence Forces would have to comply with certain obligations and rules of that body. This could have implications having regard to the roles assigned to the Defence Forces.

The Defence Forces have in the past and may again in the future, be called on by the Government to contribute to maintaining vital services. Serious difficulties and conflict of interest for Defence Forces personnel would arise if the Government were to direct the Defence Forces to undertake a task to ensure the maintenance of essential services in an area where the trade union umbrella organisation has authorised any form of industrial action.

It would be unfortunate for any question to arise over the authority of the Government to require military personnel to serve in such circumstances and to observe the commands given by their military superiors.

The findings of the Report of the European Committee of Social Rights are receiving consideration. There are a number of stakeholders involved who will also have input to the review of the PDF conciliation and arbitration scheme. It would not be appropriate at this stage to pre-empt any conclusions arising from the review.

I asked if the Minister of State would give a commitment to make arrangements to meet Ms Patricia King of the ICTU to put in place arrangements in the wake of this judgment. The reply the Minister of State gave me is that the recommendation from the European committee is receiving consideration. I note that reply. I express disappointment at it. I also take the opportunity to ask the Minister of State how long this consideration will take. Is it consideration that will play out over days, weeks, months or years? It will not be acceptable to the men and women of the Defence Forces and will not be acceptable to those who sit in these benches here and, I hope, others in this House, if the Minister of State attempts to kick to touch and do with the soldiers what the Government has done with gardaí, which is to drag its feet for a long period of time.

The one area where the European committee ruled unfavourably was in the area of the right to strike. Basically its ruling leaves it to member states to uphold a ban and the point was made by the EUROMIL representative that the right to strike exists in the Austrian and Swedish armed forces. The Minister of State said it was irreconcilable, but it exists in Austria and Sweden.

I want to put on record my support for the right to strike for members of the Defence Forces notwithstanding the fact that this right is not being actively sought by PDFORRA. The arguments against the right to strike are quite ridiculous. No worker or group of workers embarks on a strike in a light-minded way. Besides the financial hardship that comes with industrial action, public service workers weigh up the impact of their action on the service they provide to the public. The best that the Government and others in the establishment can come up with is the laughable notion that the Defence Forces might take action in the midst of an invasion or attack. Whether it is our Bill or the Bill that the Government must produce eventually, we will introduce Committee Stage amendments upholding the right to strike.

Deputy Barry would love everyone to strike; all he wants is anarchy in here and outside here. He would have a smile on his face every day if that was to happen.

As I said, the conclusions arising from the report of the European Committee of Social Rights raise complex questions for the Defence Forces from a legal, operational and management perspective. While the findings of the report are non-binding, the Government is fully aware of the context to take action to address some of the concerns of the Permanent Defence Force representative associations.

As I advised in my earlier reply, the Permanent Defence Force representative associations were afforded equal standing with other public service trade unions and representative associations at the 2017 public service stability negotiations. I have also stated that I have commissioned a full review of the conciliation and arbitration scheme. I am on the record of this House as saying that I want a full report back within six months. I expect this to be back by no later than the end of June or early July.

I note in his first contribution that Deputy Barry talked about the high number of Defence Forces members who receive family income supplement. Maybe the Deputy does not want to hear the truth and maybe he just does not listen, but there are 175 persons in receipt of family income supplement as of today. If the Deputy wants to check that out, that is a reply I received directly from the Department of Employment Affairs and Social Protection. I know that I repeat that figure every time the Deputy raises that issue in this House but maybe he just does not want to remember it. I will repeat it for him again in case he did not hear it. Some 175 members of the Irish Defence Forces are in receipt of family income supplement.

Drugs Payment Scheme Coverage

I thank the Ceann Comhairle for giving us the opportunity to raise this. There comes a time when official replies do not always tally with what is happening in broader community and society. This is an occasion where we have to address an underlying problem, the fact that the withdrawal of the Versatis patch has left many people with pain thresholds they can no longer tolerate, anxiety and concerns. There is no doubt that there has been a huge escalation in the prescribing of the patch and in the demands on the budget. At the same time, we have to accept that many people claim that this has had a major impact on their lives with regard to their ability to deal with pain. Some of the longest waiting lists in the country include very long waits in the area of neurological illnesses and diseases and waiting for outpatient and inpatient appointments with neurological consultants and neurosurgeons. That was only alluded to last week in the context of parliamentary replies in this Chamber last Thursday. Huge numbers of people need this patch to function on a daily basis because they are waiting for a long time to see consultants or to get treatment for a neurological condition. At the same time, we now have a situation where there is withdrawal of reimbursement and a change of what it can be prescribed for. When a huge cohort of people are saying things, highlighting them on "Liveline" and in many other fora, and are contacting our offices, it reminds me of the time of the medical card debacle of 2014 when officialdom told us that there was no change of policy but at the same time it was evident that the change was having a profound impact on people's lives. Those decisions had to be reversed subsequently because they were wrong in the first instance.

The withdrawal of Versatis patches from the drugs payment scheme and the medical card has been a debacle. Somebody should put his or her hand up and say that he or she has got it very wrong. Those who benefit from the patches, numbering tens of thousands, are being denied this medication that gives them relief. I know the HSE has said it is based on clinical grounds but most people listening in or who have been on radio or television think it is a monetary decision. A number of people contacted our office about this, and to say they are distraught is an understatement. They are going through life with a condition that has chosen them. They have not chosen the condition of chronic pain or neuropathic pain. The patches give them some sort of relief. The decision by the HSE has put those people outside of the reach of these patches. The HSE might save money in the short term but it will cost the HSE much more money in the long term and hardship, particularly for the people benefitting. I know the Minister remarked this morning that a radio station should not make decisions. I think that is a flippant remark and I do not know if the Minister meant anything by it. I know clinicians make these decisions but I ask for the HSE to repeal this decision.

I thank the Deputies for raising this issue, which I recognise is causing significant concern for a number of people. I welcome the opportunity to put some facts on the record of the House and to try to provide some guidance and information into how best patients might be able to proceed with regard to this important issue. I am conscious of the impact of changes on individual patients and I would like to use this opportunity to set out the background to the decisions made by the HSE's medicines management programme and the process by which patients can apply for continued access to the patches. I am concerned that I have heard many patients worried and upset about this and it is important that they hear how they can have their case reviewed. Lidocaine 5% medicated plasters are licensed to treat neuropathic pain from previous shingles infection, or post-herpetic neuralgia, PHN, in adults. They have been reimbursed in the community drugs schemes since 2010. When the patch was first introduced, its projected budget impact was low because of the very specific licensed indication. It was clearly a clinical cause of concern when the reimbursement cost increased from €9.4 million in 2012 to over €30 million in 2016, mostly from unlicensed use of the patch. When one has clinicians in a medicines management programme seeing that a patch which was expected to be used for a small cohort of patients is now being used for a large cohort, and in many cases for indications for which it was never meant to be used, it is important and appropriate for clinicians in the HSE to review it.

In 2016, the HSE's medicines management programme reviewed the use of this product. The National Centre for Pharmacoeconomics estimated that only 5% to 10% of prescribing of the patch has been for the condition it was licensed for. In light of this clinical review, the HSE introduced a new reimbursement system for lidocaine patches from 1 September 2017, as has been done for other medication, including Entresto, a heart failure drug. This process supports its appropriate use and ensures that post-shingles patients continue to receive this treatment. I heard accusations in this House earlier which led to my response about this being a Government decision. It is not a Government decision. This was a clinical decision made within the HSE. Under this protocol, all patients who were receiving antiviral drugs for shingles were automatically registered on the HSE's primary care reimbursement service, PCRS, system. These patients continue to receive this treatment under the community schemes. However, since 1 December 2017, non-shingles patients no longer automatically - which is the important word - receive this item. The HSE advised GPs and pharmacies in August 2017 of these changes and of treatment alternatives for non-shingles patients.

I stress that it is possible for non-shingles patients to be approved for the patch through the community schemes. The patient's GP should apply to the medicines management programme through the online system. That medicines programme will review the application and inform the GP of its decision. I am not talking about some abstract thing. I am informed that, as of today, over 450 such applications from GPs have been approved. That represents 450 people whose GPs have applied, saying that their patients do not have post-shingles but have a condition and need this patch. Where a GP's application is rejected, it can be appealed. I am informed that, as of today, over 220 appeals have been granted, which represents over 61% of appeals being accepted on clinical grounds. Nearly 700 patients are receiving these patches despite that it is beyond the shingles indication. While this is a clinical decision for the HSE and its medical experts, a process is in place for appeals. I want to see that process applying the maximum compassion, which I have conveyed in the clearest possible terms to the HSE. This needs to be done in a compassionate way where, if a GP highlights to the HSE's medicines management programme that a person needs these patches, that application and appeal would be looked upon compassionately. I am encouraged to see the successful rate of appeals increasing from 50% in recent days to 61% today.

We had discretionary medical cards in previous times and the word "compassion" was invoked on numerous occasions. It was not a compassionate programme in the sense that it became very bureaucratic and inflexible and discretionary medical cards were effectively withdrawn in their thousands even though the Government and HSE at the time were saying that was not the case. I am concerned that we have a situation again where people depend on these patches for pain relief and will now be in a position where they simply cannot access them.

It is creating huge anxiety. "Liveline" is only a sounding board but it has been a very loud sounding board over the past week. The programme has received numerous calls from people who are very agitated, anxious and concerned. The Minister said that a compassionate programme is in place, but he will have to be more specific on how people can access the lidocaine patch for pain relief in the first instance. We need more specifics so that GPs will be able to prescribe and people will be able to get it.

The system is overly bureaucratic and compassion gets lost in bureaucracy. I acknowledge that there is an appeals mechanism and that appeals are dealt with on a case-by-case basis, but surely this is putting people through unnecessary suffering and bureaucracy. One in eight people suffer from chronic pain and a huge volume of opiates would be required to treat those patients. Versatis patches are less harmful to such patients in the short and long term. I listened to "Liveline" last Friday and I heard one caller say that they were real people with real evidence and real pain. That says it all. The HSE should listen to people rather than make bureaucratic decisions that will have a huge impact on them.

It is important that the process is not bureaucratic and that is the reason the appeals process is online and done by a general practitioner. Applications are turned around very quickly. Hundreds of people are now accessing this patch above and beyond the post-shingles indication as a result of the appeals process. Deputy Kenny is right that the process needs to be compassionate and I want to see that happen. I am encouraged by the fact that the number of successful appeals has increased from 50% in recent days to over 60% today. People can try if they wish for political reasons to liken this to previous issues in the health service but is not at all comparable. This is a clinical decision. This is about medication that, if used incorrectly or long-term, can have adverse consequences. It is important that the medical experts in the HSE have a role in this area. They are doctors too.

I hope that the answer I gave here earlier did not give anyone the wrong impression. I am very concerned about the worry and upset I have heard from patients. I want them to know that I am listening and I want them to receive the compassion and treatment they need. The point I was making is that there is an application and appeals process in place that doctors can use to gain access to these patches for patients. Almost 700 patients in this country have gained access to these patches as a result of that process. I did not mean to be dismissive of people feeling that they had no option but to call a radio programme that is rightly highlighting an issue that is concerning people, but I have always been clear that when it comes to our citizens accessing medication, I want them to be able to do that through engaging with their doctors and in this case their doctor engaging with the medicines management programme.

I am listening. I believe those patients who need these patches can and must continue to receive them through the process that has been put in place. Doctors can make a case to the medical experts on behalf of their patients. These applications are being turned around quickly and, as I said, the success rate for these applications is increasing significantly because of the compassionate approach being taken. I want to see the HSE continue to take that compassionate approach so that anyone who needs these patches on the advice of their GP should be able to receive them.