Dáil Éireann debate -
Thursday, 14 Jun 2018

Vol. 970 No. 3

Leaders' Questions

Deputy Darragh O'Brien

In April, the country was shocked and appalled by the revelations made by Vicky Phelan about her cervical smear test and how she had to go to the High Court to fight for justice, even though she had been diagnosed with terminal cancer. Vicky agreed to waive her right to privacy and also refused to sign a confidentiality clause, as she wanted other women to be made fully aware of her experiences. We then heard the heart-rending radio interview given by Emma Mhic Mhathúna, a young mother of four from Kerry who had also been diagnosed with terminal cancer. Both of these women, and many hundreds of others, were unaware that an audit had taken place which showed that they had false negatives. Some 209 women who were diagnosed with cervical cancer were not told about subsequent audits showing that previous smear tests could have brought about a different outcome. The Government committed to introducing mandatory disclosure in 2015, and it has indeed been HSE policy since 2013. Yet it was exposed at the Committee of Public Accounts that CervicalCheck, the HSE and the Department of Health were informed and the audit results were knowingly withheld from the women affected.

As we know, the head of CervicalCheck immediately resigned her post and the CEO of the HSE left. It was and still is a national scandal. It has been an intense and emotional few weeks for the women and their families. It still continues. Even this morning at the Committee of Public Accounts, CervicalCheck and the HSE had to apologise to members and to the State Claims Agency for giving them incorrect information to the effect that all women affected had been told. The fact that Dr. Gabriel Scally, who was appointed by this Dáil to carry out the scoping inquiry on 8 May, has not been given all the information he requires to do what the Government and the Dáil asked him to do is absolutely outrageous. I agree with Dr. Scally when he says that it is unacceptable.

He has rightly said that he will not be stonewalled. Yet there are agencies of this State willing to drag their feet, put up obstructions and continue to behave in an inexcusable defensive manner to the Government, the Dáil and most importantly the women involved, on the basis that they believe their actions are defensible. These women, who want to get their records to examine exactly what happened, unfortunately do not have the luxury of time. The scoping inquiry was to be completed at the end of June. It has now been delayed until approximately the end of summer. I know that the Government wants the scoping inquiry completed as soon as possible, but now it looks as though that will not happen. In the scoping inquiry, information is being denied and delayed unacceptably for various administrative, medical, legal and other reasons.

Does the Minister believe it is acceptable that it has taken a full month to send documents to the scoping inquiry, and that these documents were not sent in an accessible form to the inquiry team, particularly when a deadline of the end of June was set? Does the Minister accept that the scoping inquiry is being buried under a mountain of paperwork and that the women affected deserve better? Finally, does he not agree that at this stage it would be more prudent to set up a commission of inquiry now, so that information can be sought rather than dragged from the agencies involved and so that a resolution can be found sooner rather than later?

Minister for Education and Skills (Deputy Richard Bruton)

I thank the Deputy for raising this issue. It is an extraordinarily serious matter and the Government is taking it very seriously. As the Deputy knows, this was something that was never brought to the attention of the Minister or any previous Minister. The Government has set up a serious incident management team to address this, and as the Deputy acknowledged, a number of changes at senior level have been made. The scoping inquiry has been put in place and yesterday the Minister was absolutely clear, as was the Taoiseach, that full co-operation with the Scally inquiry is demanded of every agency. Moreover, serious unhappiness was expressed by the Minister with the fact that the documentation provided was not in searchable form, which made it difficult for Dr. Scally to do his work. The Minister has made it categorically clear to Dr. Scally that no such interruption in his work will be tolerated, and the Minister has been in touch with the HSE to confirm that.

As the Deputy knows, the Government sanctioned the Royal College of Obstetricians and Gynaecologists to work with the women affected. They are working with them case by case and meeting them on an individual basis so their concerns can be fully addressed. In the interim period, Dr. Scally has made some very worthwhile proposals. He has made it very clear that guarantees should be given to women in the consent form that they will receive the information and that full disclosure will occur if any change in information from those smear tests is discovered. New guarantees will be put into the consent form and the HSE has indicated that will happen immediately.

In addition, new information notices are being provided to anyone doing these tests, so that it is very clear to women that there is a possibility of a smear test not being accurate. That is categorically provided. In addition he recommended that women's expenses should be provided for. A payment of €2,000 has been provided immediately, so that no woman has any difficulty in accessing the services that are being made available. The Government has also provided a care package. This is being rolled out to women who need it so that they can have access to care and to support for any expenses that arise.

This inquiry is really important. I believe the Deputy's question was addressed yesterday by the Taoiseach. He pointed out that a commission of inquiry results in longer delays. Each person will have to be lawyered up. We have seen these commissions' record of running for a very long time. Many of these women do not have such long periods to wait. It is really important that Dr. Scally, who we appointed, is allowed to do the work effectively, as he will do. He has already proved his effectiveness in the interim report he has given.

Deputy Darragh O'Brien

My party and I believe that it is actually the women and their families who need to be put front and centre. That is why my party leader raised the matter earlier in the week. It is as though some of our State agencies cannot help themselves. They are dragging their feet on this. I asked the Minister earlier if he thought it was acceptable that it has taken more than a month for incomplete information to be sent to the scoping inquiry. All the Members of this House want to make sure that we find out the truth in a very timely fashion and most importantly that the women and their families find out the truth.

However, a change of culture is needed. I actually believe that some of our agencies, the HSE and others, are still acting in a very defensive manner and defending the indefensible. That is why we firmly believe that a commission of inquiry needs to be set up, with powers to compel. I do not want us to come back in the autumn still discussing the problem of the scoping inquiry not getting the information that it needs. Can the Minister give us assurances and tell us what the end of the summer means in the context of the scoping inquiry? Will this be completed by the end of June? Will it be July? Will it be August? These women do not have the luxury of time, as the Minister himself has said.

Deputy Richard Bruton

As Members will know, it is Dr. Scally himself who has requested the extension of time until the end of summer.

Deputy Mattie McGrath

He could not get the information.

Deputy Richard Bruton

It is at his request that this has occurred.

Deputy Darragh O'Brien

The Minister knows why, though.

Deputy Richard Bruton

The Deputy will also be aware that in answering questions, Dr. Scally said that while he did not have the power to compel, he expected full co-operation and was getting co-operation from those he had approached. There is no evidence that people are refusing to appear before Dr. Scally. I think if there was any suggestion that he was being interfered with, the Minister and the Government would take immediate action. However, we are confident that he will have the opportunity to complete his work. As the Taoiseach indicated yesterday, it is the Government's intention to have a full commission of inquiry in due course. However, the reason all parties in this House believed that the scoping approach was appropriate is that we needed to get quick access to certain important information. We needed to ensure that the system was changed. Already as a result of his recommendations there are changes in the guarantees that are written in to the consent form.

There are new information packages and new supports. This has come about almost immediately - within weeks - as a result of his work.

Deputy Darragh O'Brien

What about the timeframe?

Deputy Richard Bruton

The timeframe has been set by Dr. Scally. He has indicated that he intends to have his work completed by the end of the summer.

Deputy Pearse Doherty

Today marks the first anniversary of the Taoiseach, Deputy Varadkar, assuming responsibility for leading the Government. Like previous Governments before it, its record on health has been absolutely abysmal. Nowhere is this more evident than in the context of hospital waiting lists. Since the Government came to office, hardly a month passes without the number of people on waiting lists increasing. The figures have risen every month since last autumn, with the exception of a small reduction in February. The figures released by the National Treatment Purchase Fund, NTPF, this morning are totally shocking. The figures for May are up 6,200 on the previous month and the overall number has increased by more than 20,000 patients for the year. This brings the total number of people on waiting lists in the State to more than 707,000. That is the highest number ever recorded in the history of the State.

When he came to office, the Taoiseach said he would be taking a special interest in the issue of health. That special interest has amounted to overseeing an increase in hospital waiting lists to record highs. Such failure has not been confined to the issue of hospital waiting lists alone. Since Deputy Varadkar became Taoiseach, more than 106,000 patients have spent time on hospital trolleys. He has presided over a recruitment and retention crisis in our hospitals and, as we heard again this week, there is chronic underinvestment in our mental health services. There has been a significant increase in those over the age of 75 who have spent 24 hours or more in accident and emergency wards. If this is the Taoiseach taking a special interest in health, I am loath to think what it would be like if he did not take that interest.

I do not want to absolve the Government's partner, Fianna Fáil, from its role in all of this. When it cobbled together its deal to put the Government in office in 2016, Fianna Fáil stated that it would ensure that a plan was put in place to tackle waiting lists. Look at the situation now. We have record levels, with 707,000 patients on hospital waiting lists.

The problem can be addressed but it is a matter of priorities and choice, and of making the right choices. It can be done by removing private health care from public hospitals and ensuring proper oversight of private practice limits, by stopping State funds going into private interests through the NTPF, and by ensuring there is adequate public investment in funding of public hospitals so they do not have to raise their own funds. All of this can help to bring down waiting lists.

It is long past time that the Government got serious about tackling this issue. It might be late in the day and one year on, but it is time for the Taoiseach to take a special interest in health and fulfil the commitment he made to the people and make meaningful changes that will result in these waiting lists coming down.

Deputy Richard Bruton

I thank the Deputy for raising this matter. The investment in health is now at unprecedented levels. It is encouraging that 22,000 operations are conducted each week in our hospitals. That is a very high number. Admittedly, there is a waiting list of 79,000. When we think of the 22,000 being treated every week, however, it shows significant progress is being made. The number of 22,000 per week has increased, and it has risen in each of the past five years. We are progressively making progress on tackling the waiting lists.

The outpatient waiting list is down. The number of patients waiting longer than nine months, which is the target for an inpatient or day-case procedure, is now down 5,800, so it is significantly down in comparison to the figures previously provided. We are making significant progress. The number of outpatients treated in our hospitals each week is 64,200. Again, this is a figure that is increasing all the time. There is a waiting list of more than 500,000 outpatients but the Minister is introducing a new outpatient action plan to address this.

The Deputy is aware the NTPF has been reinstated. It has already very successfully treated 7,500 people so far this year, taking them directly off waiting lists. The Minister will now address the outpatient waiting lists, which do present a challenge. It is well known that there is duplication on those lists. We need to properly verify the lists. A strategy is being put in place - it is close to being finalised by the Minister - to address the specific issue of outpatient waiting.

We have to bear in mind that this is also in the context of significant improvements being made in the broader health service. There is a strategy to increase investment in primary care centres and we see that throughout the country almost 100 additional primary care centres have been put in place. For the first time in 25 years we have new investment in hospital infrastructure. It is hard to believe no new hospital capacity was put in place in our health system for almost 25 years but, as the Deputy knows, the Minister is investing in a new children's hospital, a new maternity hospital and a new forensic hospital. He has indicated in his ten-year plan that significant investments are coming in order to address needs, with almost 3,000 additional beds - some of them exclusively in hospitals dealing solely with elective procedures - being provided. This will be a significant addition to the investment and the range of resources to address needs.

Deputy Pearse Doherty

I do not know what planet the Minister lives on, coming in here and making a statement to the effect that the Government is making progress on waiting lists despite the evidence. That evidence is not just coming from me or the Sinn Féin benches, it is contained in the report published this morning, which states very clearly that the numbers on waiting lists in the State have increased by 6,200 in the past month. Since the Taoiseach assumed office, the overall number has increased by 20,000. The report is very clear that we have the largest number of patients on waiting lists ever recorded in the history of the State.

The Government tries to slice and dice the figures and present them in a way that makes it seem that great improvements are being made. The only thing that can be relied on is the NTPF, but we know that is a privatisation of the system and it will never work. What we need is investment in the public service. What we need is proper value for money. What the Government is doing with regard to the NTPF is siphoning off taxpayers' money into private health care that provides for routine and simple procedures which should be carried out in public hospitals. These are procedures that cost three times more than if they were carried out in a public hospital, but there is an ideological blind spot whereby the Government believes that underinvestment in public services and dishing it out to private services is okay.

An Ceann Comhairle

I thank the Deputy. The time is up.

Deputy Pearse Doherty

I will finish on this point. Sarah Burke of the centre for health policy and management in Trinity College nailed it when she said that over a decade of pouring hundreds of millions into the NTPF is proof it does not address the underlying causes and the long waits for public patients. Will the Government accept this reality and bring forward a proper programme which, at its core, has investment in the public service so we can end the shameful episode of having 707,000 patients on hospital waiting lists?

Deputy Richard Bruton

To address the issue of waiting lists, the Deputy is right that 162,000 people joined the outpatient waiting list in the past three months, but in that time 832,000 outpatients were treated in our hospitals. We are delivering care. Of course, any system will have people who are joining the waiting list as it is not an immediate service, but most of these patients are there less than six months and 75% are treated within 12 months. There is a system and a pipeline for dealing with them.

When it comes to investment, the Deputy will have read the recent investment plan. From memory, €10 billion is being invested in our health services and, as I said, this is the first series of investments in almost 25 years in expanding the capacity, not just of our hospital system but also of our primary care system, to address the needs of a growing population and an ageing population. We freewheeled through the so-called Celtic tiger years and did not make those investments, but they are now being made because the hard earned recovery we have achieved will be used in a prudent way and we will invest it in elective-only beds and additional capacity throughout the country.

That is the way we invest. We will support the Sláintecare policy, which I understood had broad party support across the House, as a consistent strategy to address health in the long term.

Deputy Alan Kelly

I have just come from a rather extraordinary meeting of the Committee of Public Accounts where we were joined by representatives of the Health Service Executive, CervicalCheck and the State Claims Agency to discuss contradictions in evidence. Those contradictions have not been cleared up. The evidence given to us leads me to one of two conclusions. Either the Minister is not being told everything or is being misled or else he is simply not on top of this matter. It could be one or the other. The Government must immediately find out what is going on.

CervicalCheck is run out of Limerick and I have spoken to the people who work there. They are good people. I am sure there are issues at a management level but the ordinary workers are good people. Dr. Scally has never set foot in the place and has not met those workers. The head of the HSE met them once and has now acknowledged that he must meet them more often. Dr. Scally has never spoken to the man who is over CervicalCheck. This is the biggest healthcare crisis in this country in decades, but after this length of time he has not sat down with the director of the programme. How is that acceptable?

I do not have a great deal of time for Dr. Scally's report but he was very clear that the provision of documentation was not acceptable. Does the Minister know what we found out in the past hour? The head of CervicalCheck offered full remote and electronic access to the programme's records but the head of the HSE, who was sitting beside the programme director, had never heard of that offer. He thanked him for the offer and said he would take it up. What is going on? All of this information is available but we are four weeks on and Dr. Scally has received a dump of information that is not readable or searchable. Nevertheless, the head of CervicalCheck, whom Dr. Scally has never met, offered electronic access to all this information through the HSE but it was turned down. Some people might say "cover-up" but I wonder what is going on.

Will the Minister and his Government instruct Dr. Scally to visit Limerick and the programme manager immediately? Will the Minister for Health visit Limerick and the programme manager immediately? We now know there will be more than 209 women affected so will the Minister outline to the House the likely number of cases? Will he guarantee in this House that the Scally report will come back in time and the Dáil will be recalled at the end of August to discuss it and commence the commission of investigation? Without a Dáil sitting, it cannot begin. The Taoiseach has given much detail and many commitments in saying there will be no further court cases, but what work has been done by the Taoiseach and this Government with the State Claims Agency to ensure this? I am not seeing it.

Deputy Richard Bruton

I reiterate the point that the Government acted very swiftly to address what is an appalling issue. We have worked hard with the affected women to get them immediate support and ensure they can have access to professional services to advise them. We have brought in outside experts and not relied on internal experts. We have brought in UK gynaecology services for advice and each person is being treated respectfully.

The State Claims Agency has indicated it will work with those who make claims and seek to facilitate mediation wherever it occurs. Of course, there is another party involved, namely, the testing services. The State Claims Agency represents the State and that has implications. It is very clear that the approach being taken is one of supporting those women and minimising the trauma in pursuing a case if that is what they seek.

The Houses sought an independent outside expert and we did not seek to appoint someone perceived as somebody already within the system. We sought somebody from outside with the necessary expertise. For the Deputy to suggest that this person should have already met a range of individuals-----

Deputy Alan Kelly

Surely the person who runs the programme-----

Deputy Richard Bruton

It is up to Dr. Scally to order his own work. We have provided terms of reference for him. There has already been an interim report and in my experience - I am a long time around this House - it is not often we have an independent expert appointed to do an investigation of this nature who has come back within weeks with very concrete proposals that will support the affected women with financial support and provide guarantees on consent forms. They will be provided with far more information than they have been getting. It demonstrates that Dr. Scally is reviewing processes. Of course, in ordering his work he will meet all those whom he needs to meet.

Dr. Scally spoke about the difficulty he has experienced getting the records he needed promptly and in a readable format. I understand the HSE has stated it provided as much as was available in an electronic format-----

Deputy Alan Kelly

That has been proven to be wrong.

Deputy Richard Bruton

It is working to ensure the other documents will be searchable for Dr. Scally. We have assured Dr. Scally that he will have the support of all agencies of Government in getting access to the records he needs. It would be inappropriate for us to be issuing instructions to someone when we have decided for him to come here to do an independent scoping report. If we did so, the Deputy would be back here, rightly, saying that the Minister was interfering with the independent work of somebody appointed to investigate this matter. It is exactly what would happen.

Deputy Alan Kelly

The Minister has refused to answer my questions. I asked very specific questions but he has not answered them. I will say it straight that if the Government does not deal with this matter soon, the lifetime of this Dáil will be shortened considerably. This is a scandal and the Government is not on top of it in any way, shape or form. Members of this House have more knowledge of some of these matters than members of the Government who are responsible for this.

The decision of the Dáil was to give Dr. Scally this inquiry and that he would report by the end of June. That has unilaterally been changed by the Government and not the Dáil. We really need something that is scoped, with key decisions and terms of reference needed by a commission of inquiry. What is being outlined here will go on for an inordinate amount of time and, unfortunately, women will pass away while that is happening. They want answers and guidance. They want to know the facts. This will not come back by the end of August. It will hardly come back by the end of this year if it continues going this way. It has gone beyond what was the idea of this Dáil. I can see that. Women will need to tell their stories but first they need the facts to come out. It is not what will happen. I ask the Minister, who has refused to answer my questions, to go back to the Minister for Health and put my questions to him.

Deputy Richard Bruton

If the Deputy comes in and wants to change from week to week the instructions issued to Dr. Scally, who is conducting an independent inquiry-----

Deputy Alan Kelly

It was supposed to be finished at the end of June.

Deputy Richard Bruton

-----we will never have proper responses as the Deputy will want to change from week to week what he is seeking.

Deputy Alan Kelly

Rubbish.

Deputy Richard Bruton

We have provided Dr. Scally with resources to investigate this.

Deputy Alan Kelly

And timelines.

Deputy Richard Bruton

We know there are parallel discussions going on in the House, as they should. We cannot come back seeking to instruct Dr. Scally in a different way every week. The Deputy asked if there are cases other than the 209 we know of. I do not have that information available to me. Part of the response was to examine cases that did not come to the attention of CervicalCheck and have an audit.

There were, as I recollect, 3,000 such cases. A process was being put in place to identify whether there were additional cases that would have emerged from those. I am sure that process is ongoing and that the Deputy can get information in the usual way from the responsible Minister to find out how that approach is developing.

Deputy Mattie McGrath

I am sure the Minister is aware that this is national carers week. It is our annual opportunity to express our profound admiration for the work that carers provide day in, day out. I am sure the Minister will join me in that sentiment. In my county of Tipperary, 7,041 people provide regular unpaid personal help to a friend or family member with a long-term illness, health problem or disability. This amounts to 4.4% of the county's population. According to the Central Statistics Office, CSO, a total of 195,000 persons were providing unpaid assistance to others on the last count, with the largest percentage increase seen among those aged 85 and over, where the number rose from 1,318 to 1,776, a rise of 34%, which is huge.

I want to focus, however, on the very disturbing revelation that 3,800 children under 15 years of age are engaged in providing care to others, accounting for almost 2% of all carers in the State. That is almost 4,000 children, a shocking figure, spending their childhoods looking after their sick and disabled loved ones and family members. We have spoken in this House recently about the harsh and cruel way in which children were treated. Such actions were disgraceful, and it is right that we condemn them wholeheartedly and without reservation. It is my belief, however, that in a few years we will look back and be appalled at how we could have allowed or indeed forced these young carers to bear such an extraordinary emotional burden. How can it be right that children as young as 12, 13 or 14 are left to meet the physical and sometimes medical needs of their adult loved ones? How can we stand over this? We cannot.

All of us in this House are aware of the challenges adult carers face, and how difficult it is for them to find even a moment for themselves because of a lack of home care supports or other care packages that will give them some semblance of respite. If this is the case for adult carers, can we even imagine what it is like for the thousands of child carers in this State who must juggle school life, full-time care of their loved ones and trying to see a friend for some fun or games or whatever else young children should be doing?

I want the Minister to make a commitment to me today that this Government will put as much energy into addressing the scandal of child carers in this State as it has put into other child welfare issues. It would represent an appalling vista for us to allow this to go on. But for these children, many of their adult family members or loved ones would not have any care provided to them, and this is unacceptable.

We must salute the carers, young and old, but young carers should not be forced to do this. I salute in Tipperary Councillor Richie Molloy, who is the manager of the carers in Tipperary, and all the carers who give of such valuable time. Will the Minister give me a commitment that he will rectify this situation?

Deputy Richard Bruton

I thank the Deputy for raising this issue and for acknowledging the extraordinary work that carers do in our community. There is no doubt that a huge number of families have very active family carers way beyond the 60,000 who receive carer's allowance or carer's benefit. A huge level of voluntary support is willingly given to support loved ones within the family.

The State has over many years provided good but not adequate services in this area. I have always been impressed by the community services in our health areas, the public health nurse on the front line, the gateway to many services, and the home help services that are provided and are increasingly being delivered. The Deputy will be aware that the Minister of State, Deputy Jim Daly, has recently recognised that there are gaps in access to home care packages and that he has had a recent consultation, to which I am sure the Deputy contributed, whereby he has invited all people who have an interest in this to make submissions as to how we should develop a statutory home care service for the long term to support carers, be they adult carers or child carers. The Minister of State is well advanced in this work.

There is an obligation on us in this House to recognise that home care is as important as, for example, nursing home care, in respect of which we have had for many years now, under fair deal, a reasonable certainty for families as to how they will be supported if one of their loved ones enters a nursing home. We have not had the same certainty in respect of home caring. We have had a mixture of tax breaks, respite grants, carer's allowance and access to home help. The Minister has recognised, however, that we need to integrate that into a more coherent service in order that carers, be they children, as Deputy Mattie McGrath said, or adults, have a sustainable support on which they can depend. This is clearly a priority. We spoke earlier about hospitals and their needs, but often the unsung heroes in our health system are the carers who silently provide care 24-7. The State must recognise them in a much more tangible way. I am very hopeful, therefore, that the initiatives that the Minister of State is taking in this area will be very valuable.

The Minister of State has also taken steps to provide immediate access to general practice care services free of charge to people on carer's allowance or carer's benefit in order that some of their concerns and pressures are addressed. This is an area where public policy clearly needs to evolve, and the Minister of State, Deputy Jim Daly, is working hard to ensure this.

Deputy Mattie McGrath

We have had enough consultation. It is obvious - the Minister himself admits it - that carers need support for the valuable work they do. The provision of care by children, however, surely cannot be acceptable, and I am worried about the Minister's comments in this regard.

On a related matter, in December of last year, the Minister, Deputy Harris, in response to a prominent "Carers in Crisis" special on RTÉ's "Prime Time", for which I thank RTÉ, announced legislation to ensure that all carers in receipt of carer's allowance could access GP services without charge. While Family Carers Ireland reads this as a step in the right direction, it believes it should be applied more broadly in order that all full-time carers, not just those in receipt of carer's allowance, would be prioritised in the roll-out of GP visit cards. Therefore, will the Government consider using the non-means-tested carer's support grant, rather than the carer's allowance, to validate those providing full-time care for a loved one for the purpose of allocating a GP visit card? Will the Minister incorporate this into his forthcoming legislation?

Consultation time is over. The needs are obvious. We all appreciate the work carers do alongside the district nurses and home helps, but we need to have it recognised and we need the scheme proposed by the Minister to be expanded to include all carers.

Deputy Richard Bruton

The Deputy is right that the period of consultation is over. The Minister must still evolve a set of proposals, however, and I think most people would not regard simply adjusting the respite grant, or the carer's support grant, as that €1,700 is now called, as an adequate response.

Deputy Mattie McGrath

I did not say that.

Deputy Richard Bruton

It was one of the suggestions the Deputy made. Regarding his other suggestion of expanding eligibility for the GP card, there is clearly an ambition on the part of the Government to extend primary care to a greater number in order that they are not charged to visit a GP. All these issues, however, would have to be considered in a budgetary context. What the Government has clearly signalled through the work of the Minister of State, Deputy Jim Daly, is that we need to develop a more coherent policy in this area which would embrace access not only to medical care, as Deputy Mattie McGrath says, but also to the kinds of supports carers need. This is a range of supports, and they have not been adequately delivered through the existing services, good as they have been for many years. This is why the Minister of State took the time and effort to ensure that the input of people such as the associations Deputy Mattie McGrath represents, but also individual carers, would be brought to bear on designing a long-term system which would be statutorily based, so it would be an entitlement set out in law.