Ceisteanna ar Sonraíodh Uain Dóibh - Priority Questions

Mental Health Services

James Browne


1. Deputy James Browne asked the Minister for Health his plans to regulate community residences which are providing care to a large cohort of vulnerable persons with long-term mental illness; and if he will make a statement on the matter. [12661/19]

I ask the Minister for Health what his plans are to regulate community residences which are providing care to a large cohort of vulnerable persons with long-term mental illness; and if he will make a statement on the matter.

The Mental Health Commission was established under the Mental Health Act 2001. The commission’s main functions are to promote, encourage and foster high standards and good practices in the delivery of mental health services and to protect the interests of patients who are involuntarily admitted. Accordingly, the Mental Health Act 2001 states that the Inspector of Mental Health Services shall visit and inspect every approved centre at least once in each year, and visit and inspect any other premises where mental health services are being provided as he or she thinks appropriate.

The expert group review of this Act was published in 2015 and work is under way on preparing the general scheme of a Bill to reflect the group's recommendations in revised mental health legislation. A number of proposed changes to the legislation will affect the operation of the commission. Included in these is the recommendation to remove the requirement to inspect each approved centre annually. Instead, there would be a requirement to inspect each approved centre at least once in every three-year period and more often according to targeted risk. This would allow, on a phased basis, the registration and inspection of all community mental health teams and other mental health facilities such as support hostels, crisis or respite houses, other residential services, day hospitals, day centres and other facilities in which mental health services are provided at the discretion of the Mental Health Commission.

Significant progress has been made in recent months with the aim of finalising the draft heads of the Bill in the coming weeks. The initial draft will then be passed on to the Mental Health Commission for its views. Notwithstanding other legislative pressures on the Oireachtas at the moment, it is anticipated that the mental health (amendment) Bill will then commence its progress through the Oireachtas later this year.

I thank the Minister of State. There continues to be great concern about 24-hour staffed community residences which are not regulated but provide care to a large cohort of vulnerable people with long-term mental illnesses. The Mental Health Commission has stated that it takes the view that these residences accommodate too many service users, are often of poor physical infrastructure, and are institutional in nature and lack individual care plans. Regulation of these residences should be prioritised. I am glad to hear it may be dealt with in the coming legislation but, nonetheless, it should have happened before now. As I understand it, the heads of this Bill have been promised every year for the last three years and we still have not seen them.

Over 1,300 vulnerable adults with mental illness were accommodated in community residences that are unregulated, mostly in institutionalised settings. We regularly hear the mantra of the Minister about decongregation but it would appear people will be decongregated from regulated settings into unregulated settings in the community. Rather than decongregation being a situation of empowerment for people with mental illness, it would appear they are being abandoned to these unregulated centres. We saw the scandal at Leas Cross in the past and I am very concerned that similar situations could be allowed to arise in these unregulated mental health services.

I share the Deputy’s concerns. I am anxious to see the Mental Health Commission roll this out as soon as possible. Obviously, we have to get the legislative piece of work done. Regarding the Deputy’s comments on the year-on-year promise of the legislation, I have committed that it will be sent to the commission within the next few weeks, and the officials in the Department are very close to finalising it. I do not know how long the commission will have but I would expect the legislative journey will begin later this year and I am very optimistic about that. I am very anxious, as is the Deputy, to ensure every single centre is regulated, is visited and comes under the auspices of the commission.

I understand the proposal in the legislation will be to reduce the inspection rate for currently regulated centres from every year to every three years. In Kilkenny recently, there was the first ever prosecution of a mental health service. A report from Mental Health Reform came out this morning which stated that patients using the services of the HSE are seeing a failure to treat patients with dignity, frequent changes of staff and a high focus on medication. I am not sure reducing the levels of inspection for current facilities is the answer to servicing the unregulated facilities. I would rather that this is done in addition and that the necessary resources are put in so that all services are regularly inspected.

The idea is that every service would be regulated. This is a debate we can have during the passage of the legislation, which will come before these Houses. At the moment, the suggestion is it would be better to have every single premises inspected at least once every three years as opposed to a select number being inspected once a year and others never being inspected. The best option is to have every premises and centre inspected every three years but that is a debate I am sure we will have as the legislation comes before the House.

Question No. 2 is in the name of Deputy O'Reilly and permission has been given to Deputy Quinlivan to take it.

Hospital Overcrowding

Louise O'Reilly


2. Deputy Louise O'Reilly asked the Minister for Health the way in which he plans to address the overcrowding at University Hospital Limerick; the reason the full capacity protocol is in use at the hospital every day; when the 96-bed extension and 60-bed modular unit will be built and operational; and if he will make a statement on the matter. [12443/19]

I assume the Minister for Health, Deputy Harris, is out of the country. Obviously, he should be here. I had thought I would have a chance to speak to him personally about the issue I am about to raise. I have put forward numerous Topical Issue matters and asked numerous priority questions and the Minister has never been in the Chamber to answer them.

How does the Government intend to address the chronic overcrowding at University Hospital Limerick? Will the Minister of State outline why the full capacity protocol, which is supposedly an emergency measure, is in use at the hospital every single day? Perhaps the Minister of State will let the citizens of Limerick and the mid-west region know when the 96-bed extension and 60-bed modular unit will be built and operational to ease the severe overcrowding that is now the norm in UHL.

I offer my apologies for the absence of the Minister for Health, Deputy Harris. I am taking this question and the remaining questions on the Minister's behalf as he is not in the country due to the week that is in it, as Deputies may understand. I will endeavour to answer the questions as best I can on his behalf.

The emergency department in University Hospital Limerick is one of the busiest in the country, with the number of patients attending growing year on year. The full capacity protocol was devised to direct hospital resources towards surges in demand for emergency care, thereby reducing emergency department waiting times. The decision to deploy the full capacity protocol is a matter for local hospital management, in line with the national escalation framework. The HSE advises that the full capacity protocol was deployed in Limerick for 336 days out of 365 in 2018. Limerick was identified as one of nine sites requiring additional investment, focus and supports as part this year’s winter plan.

The problem of overcrowding in hospitals requires a full system, patient focused response. Recognising this, the winter plan investment is targeted at both hospital and community services and supports. This includes additional home support packages and transitional care beds to support people to leave hospital and return home.

It is widely agreed that a key part of the solution for Limerick is additional beds. Over the past 18 months, an additional 23 beds have opened in Limerick, including five as part of this year’s winter plan. A capital allocation of €2 million has been granted in recent weeks and the HSE advises that this will facilitate the completion of enabling works for the 60-bed modular ward in 2019. In addition, the national development plan includes a 96-bed replacement ward block in Limerick and capital funding was provided in 2018 to progress the design phase of this project.

I have lost count of the number of times I have come into this Chamber to ask the Minister when substantial action will be taken to address the horrendous overcrowding in University Hospital Limerick, yet nothing has been done. The Minister of State indicated that five beds will be opened under the winter plan. That response sums up the lack of respect the Government has for the people of Limerick. The Minister of State is aware that the plan asks for much more than five beds. The situation has severely deteriorated. Limerick citizens are being treated as second class citizens. It is a simple fact that the desperate conditions in UHL, with 50, 60 or 70 people on trolleys every single day, would not be tolerated in other hospitals, for example, in Dublin. There are 60 people on trolleys in University Hospital Limerick as we speak. That is a national disgrace. Limerick is clearly at the bottom of the Government's list of priorities. Limerick people deserve quality healthcare facilities and our doctors and nurses deserve a safe place to work. University Hospital Limerick currently provides neither. The hospital is dangerously overcrowded. A constituent recently described the chaos in the accident and emergency department as being akin to a cattle mart. Will the Minister of State indicate when the Minister last met management of University Hospital Limerick to discuss solutions to this problem? Will he provide a reason for the delay in delivering new beds at the hospital?

I remind the Deputy that 23 new beds have been opened at the Limerick facility in the past 18 months. There was also a recent announcement of €2 million for enabling works to progress the 60-bed modular unit at the hospital. I will revert to the Deputy with information on when the Minister last met management at UHL.

The Minister of State said a number of beds had been opened at UHL. Will he indicate how many beds have been closed at the hospital? I understand a ward was closed which had a similar number of beds to the number that have been opened. As I said, a full capacity protocol is being used every single day. A total of 11,437 sick patients have spent time on trolleys in University Hospital Limerick in the last year. This is the highest figure in the State. As I stated, there are 60 people on trolleys in the hospital today, the highest number in the State, and 34,133 people are on waiting lists at the hospital. Fine Gael has been in government for eight years, during which time the situation at University Hospital Limerick has deteriorated substantially. The number of people on trolleys in University Hospital Limerick increased by 212% between 2011 and 2018.

I put it to the Minister of State that we need additional beds immediately in the form of the 60-bed modular unit and the 96-bed extension. It should not have taken this long. Will the Minister of State ask the Minister to agree to prioritise the fast-tracking of the additional beds that are urgently needed in Limerick?

We are fast-tracking beds through the allocation in recent weeks of €2 million to facilitate the 60-bed modular unit. The Deputy will be aware there has been a significant increase in the number of presentations at the accident and emergency department in University Hospital Limerick which compounds the difficulties. We have to plan ahead to try to deal with those increases. A whole suite of issues and solutions have to be taken into consideration. It is not simply a matter of providing more beds and capacity, although that is one element. We must also address delayed discharges. We had a report done on that issue at the end of last year and we now have an implementation team set up within the HSE. The terms of reference for the team are being drafted in order that it will address the issue of delayed discharges and ensure more timely discharge from hospitals. Delayed discharges contribute significantly to overcrowding at University Hospital Limerick and many other hospitals. We also have more proactive measures in Sláintecare to ensure people are treated in their communities and to reduce the numbers of presentations to accident and emergency departments. These protocols, when implemented, will impact on the University Hospital Limerick and other sites throughout the country.

Hospital Consultant Contracts

Stephen Donnelly


3. Deputy Stephen Donnelly asked the Minister for Health his plans to address the new entrant pay disparity for consultant doctors; the status of new contracts for hospital consultants; the number of meetings he has had on these topics with consultant representative groups (details supplied) in the past 12 months; and if he will make a statement on the matter. [12662/19]

We have a chronic and urgent issue with the low levels of doctor and consultant numbers. It is leading to the longest waiting lists in the history of the State. More than 500,000 people are waiting to see a consultant and 1 million people are waiting for diagnostic tests, consultant appointments, special needs services and so on. One of the biggest drivers of this is the massive pay disparity between existing consultants and new entrants. Will the Minister of State outline the status for new contracts for hospital consultants? How many meetings has the Minister for Health, Deputy Harris, had on this issue with representatives of doctors and hospital consultants?

The difference in pay between established consultants and new entrants - those who joined the public health service from 1 October 2012 - has been highlighted extensively by the consultants’ representative bodies. My colleague, the Minister for Health, Deputy Harris, met the Irish Medical Organisation, IMO, at its annual general meeting last year when he addressed the issue of new entrant pay. He also met the Irish Hospital Consultant Association, IHCA, last week when the issue was discussed. The Minister has also met members of the representative bodies at various engagements at which the issue was raised. The matter has also been highlighted in meetings involving Department officials, including in the past year.

An increase in the gap between the pay of existing consultants and new entrants was a product of the settlement of the legal dispute surrounding the consultant contract under which it was argued that existing contract holders were due certain pay increases. The Public Service Pay Commission, in its report published on 4 September 2018, identified difficulties in attracting consultant applications for advertised posts and acknowledged that the pay rates for new entrants had been highlighted as a factor in this. Given its analysis, the commission proposed that the parties to the public service stability agreement jointly consider what further measures could be taken, over time, to address the pay differential between pre-existing consultants and new entrant consultants. The Departments of Public Expenditure and Reform and Health have noted the commission's views and consideration will need to be given to potential solutions which are in line with public sector pay policy and available budgets. This will be a significant challenge given the amounts involved.

With regard to the new contracts for hospital consultants, no engagement has taken place with the representative bodies to date. The contract currently available to new entrants is the common 2008 consultant contract.

That is an appalling situation, for which I blame not the Minister of State, Deputy Daly, but the absentee Minister for Health. Less than one week from St. Patrick's Day, the Minister is active on Twitter but he is not in the Dáil to answer questions. He was not in the Chamber last night for a Private Members' motion on the national children's hospital, nor was he before the Select Committee on Health to take Committee Stage of legislation on the HSE board. The Minister seems to be missing in action, except when it comes to Twitter.

Essentially, the Minister of State has just said there has been no engagement. Ireland is running out of doctors. We have the lowest level of hospital consultants in the OECD. At the same time, we have the highest waiting lists for patients - men, women and children - to see these doctors. These issues are linked. Any doctor thinking of returning from Australia, America or elsewhere will end up earning between €60,000 and €90,000 less than colleagues who have the same experience and may have graduated from the same medical schools. As a result, doctors are not coming back and the Government does not seem to be doing anything about it.

Does the Minister of State accept that we now face an urgent crisis in respect of the low number of doctors and consultants in the country? Does he accept that one of the key drivers of that is the massive discrepancy in new-entrant pay? If he accepts those things, why has there been no engagement whatsoever with representative groups to do something about it?

I confirmed in my reply that the Minister, Deputy Harris, met the representatives of the Irish Hospital Consultants Association last week. It has been accepted that there is a disparity in new-entrant pay for consultants and the Government would like to see it addressed. It has been acknowledged by the Public Service Pay Commission that the disparity is contributing to recruitment issues in the sector. As the Deputy is well aware, however, there is no pot of endless money there. There is also a public sector pay agreement within which we have to keep. We have already addressed the significant issues affecting the pay of consultants, notwithstanding the issue of new entrant consultants. That was an issue the Deputy was rightly making a great deal of noise about in the past. It has been addressed. Nursing pay is a very significant pay bill also. There is no endless pot of money and there is a sectoral agreement that has to be respected and worked within as we advance the issue. We have addressed issues for consultants and nurses and, over time, we will also address this issue. However, it cannot be done as one would flick a light switch. We must continue to work within the parameters of available budgets and the public sector pay agreement. In fact, we are continuing to do so and engaging to achieve it.

The Minister of State says there is no endless pot of money and I agree. Is it not then extraordinary that €1 billion can be found to build the same hospital? When it comes to certain things, there is an endless pot of money. My calculation is that the switch can be flipped. When our healthcare system is about to explode and half a million people are waiting to see a consultant, it can be done. Flipping that switch would cost approximately €25 million a year by comparison to an additional €1 billion for the children's hospital. The Minister has met the Irish Hospital Consultants Association once. That was last week and after the association had waited a year for the meeting. I am sure the Minister of State saw The Irish Times today which featured new research that half of hospital doctors in Ireland are emotionally exhausted and overwhelmed by work. One third are experiencing burnout. We are mistreating, disrespecting, overworking and ignoring our hospital consultants, doctors and nurses. Today is about hospital consultants, of whom we need more. We need them to be able to do the best job they can do. We do not have enough of them and they are becoming burned out, are leaving the country and are not coming back. If the Minister of State does not believe a switch can be flipped, albeit I do, when does the Government expect to see actual movement to close the gap for new-entrant consultants?

I am not going to argue with the Deputy but we cannot flip a switch. The Deputy is comparing apples and oranges when he refers to capital and revenue budgets. He says it is €25 million, although I am not certain his figure is correct, to bridge the gap but that is each and every year. The other budget to which he referred is a capital budget for a build which is a one-off cost. They are very different. Further, we have not spent an additional €1 billion on any children's hospital. The Deputy makes the point that we found €1 billion but we have not spent that yet. Be that as it may, while it may not be politically opportune to bring the children's hospital into this, it is also the case that it is not relevant factually. I have explained already to the Deputy that we have made very significant progress on the issues of pay in very challenging times. We have come out of the deepest, most difficult and darkest recession the country has endured in the history of the State and we are only starting to get back on our feet economically. We do not have a magic wand to fix everything. The Deputy can take a sectoral approach and progress and campaign for matters piece by piece. We have to take a helicopter view. That comes with the responsibility of Government. We have to do it within the confines of the public sector pay agreement which we cannot jeopardise. There is only so much capacity within the agreement to deal with these issues. We also have only a finite budget. We are engaging with the relevant people and intend to address the matter when we can.

Cannabis for Medicinal Use

Gino Kenny


4. Deputy Gino Kenny asked the Minister for Health the steps he will take to address the issue of those with a licence to use cannabis medicinally having to travel to the Netherlands regularly to obtain their prescription; if the establishment of a distributive system similar to that in the UK and Northern Ireland (details supplied) will be considered; and if he will make a statement on the matter. [12082/19]

I am disappointed the Minister for Health, Deputy Harris, is not here. He seems to be the Scarlet Pimpernel of the Dáil these days. My question relates to the families who have to leave the jurisdiction to fill a medical cannabis prescription in Holland. It is an onerous and unworkable imposition. I await the reply.

I have already addressed the absence of the Minister for Health who is out of the country. The Minister is working towards the introduction shortly of a cannabis for medical use access programme. While the arrangements to enable this programme to begin are being finalised, it is open to a registered medical practitioner to apply for a ministerial licence under the Misuse of Drugs Act 1977. Such a licence, if granted, enables a practitioner legally to prescribe medical cannabis for a named patient. It is important to note that the decision to prescribe such treatment is a clinical decision for the prescribing doctor. Until acceptable medical cannabis products are available for use in Ireland, patients who are the subject of a licence are obtaining their cannabis products from a pharmacy in the Hague. Under the policy of the Government of the Netherlands, cannabis oil products are not permitted to be commercially exported from that country. Notwithstanding the fact that such cannabis products might eventually be listed as products that may be accessed under an Irish programme, anyone who is prescribed these products will have to travel to the Hague to obtain them, unless the Dutch export barrier is removed.

The Minister for Health is aware that a UK company may provide a service which involves it collecting cannabis products from the Netherlands for persons authorised to use it under the UK's medical cannabis regime. While this company can import medical cannabis products into the UK from the Netherlands, the UK authorities do not currently allow re-export from the UK to other countries, including Ireland. I have been informed that the UK company may be acting as patients' nominated representative in the collection of their personally-prescribed medical cannabis products. No similar Irish entity is known to provide this service, but it is certainly open to any patient to engage a representative to act on his or her behalf.

I am sure the Minister of State will agree that this situation which requires people to leave the jurisdiction to obtain a prescription is ludicrous. I cannot think of any other medicine in respect of which a patient or nominated person must travel to another jurisdiction to bring a filled prescription back. It becomes even more ludicrous. A family in Newtonards in County Down who have given me permission to speak today do not have to go to Holland as a distribution company brings the medicine to a named pharmacy for them. In the case of Vera Twomey, however, her husband Paul has travelled to Holland in the last two months. The pharmacy there told him the prescription could not be filled for the next six months. It is a completely unworkable scenario in both the short and long term.

I appreciate the Deputy's consistency on the issue and his diligence in raising the difficulties families are experiencing. We want to introduce a medicinal cannabis access programme to address those difficulties. In the meantime, however, we must deal with the difficulties and challenges presented by the law of the Netherlands on exports. We recognise the difficulty that presents to families, but until we get our own programme up and running, we have to operate in that context.

Most people listening to this discussion will not understand this. Given that 16 licences have been granted to 16 individuals in the State, one would think the State would intervene to provide a distribution company to go to Holland and bring the product to those 16 individuals' pharmacies. That would be the logical thing to do. Currently, the cost of reimbursing the travel and the inconvenience are very stressful for the families. The substantive issue is the cannabis access programme which has been mooted for the last two years but is still not up and running. Individuals continue to have to go their specialists who will say in the majority of cases that they do not know enough about the product and situation to prescribe it. It is an unsustainable situation. The access programme must be implemented so that people do not have to leave the jurisdiction but can get the medication in their local pharmacies while being reimbursed by the HSE.

I agree wholeheartedly with the Deputy. We share the same desire to have our own medical access programme implemented in its entirety, not in a piecemeal way. We can divert our attention to address the issue in a piecemeal way or we can implement our own programme in full, which is a much more sustainable solution. The latter is where we are putting our energies, focus, time and effort.

When will the programme be up and running?

We do not have an end date. As the Deputy will appreciate, there are a lot of issues to address to bring the programme about. It is not that it is not being done. It is mentioned every month at our management meeting in the Department of Health.

We get updates on progress but I do not have a timeline for when we hope to have the programme established. The Deputy will appreciate the number of issues and challenges involved in establishing it for this country.

Trade Union Recognition

Joan Collins


5. Deputy Joan Collins asked the Minister for Health if he will instruct the HSE to accept the invitation from the Workplace Relations Commission, WRC, in relation to the ongoing dispute between the HSE and unions (details supplied); and if he will ensure that he has read and examined the health sector national staff surveys of 2016 and 2018. [12599/19]

Will the Minister for Health instruct the HSE to accept the invitation from the Workplace Relations Commission, WRC, on the ongoing dispute between the HSE and Psychiatric Nurses Association, PNA, which represents the National Ambulance Service Representative Association, NASRA, branch? Will he ensure that he has read and examined the health sector national staff surveys of 2016 and 2018, which I believe hold the ingredients for the present dispute?

As the Deputy is aware, a branch of the Psychiatric Nurses Association, PNA, called the National Ambulance Service Representative Association, NASRA, has been engaged in industrial action. The PNA states that its industrial action is in connection with two substantive issues. The first is the automated deduction of union subscriptions. The second is the refusal by the HSE to engage in negotiations with the PNA or to recognise the PNA as representing ambulance personnel.

To be clear, NASRA, which is affiliated with the PNA, is a group which is not recognised by the HSE and, therefore, does not have negotiating rights. The PNA does not have negotiating rights for ambulance personnel.

It should be noted that the HSE deducts subscriptions at source for those ambulance staff who are members of a number of trade unions, namely, SIPTU, Fórsa and Unite. The deduction of subscriptions is not a legal right but rather a concession granted to recognised unions.

While it is regrettable that the PNA has taken this industrial action, it is not possible to negotiate with a union which is not recognised as having negotiating rights for ambulance grades. Officials from the Department have met representatives of the HSE and the management of National Ambulance Service to explore possible options. However, this is a complex, challenging situation.

Industrial relations policy has had a longstanding objective of avoiding fragmentation in worker representation in public sector employments, and the trade union movement generally, so as to facilitate the orderly conduct of bargaining and other aspects of industrial relations.

The Deputy has also raised the issue of the health sector national staff surveys of 2016 and 2018. As we know, surveys of this kind are a valuable tool used to gather information to assess employee opinion and satisfaction rates.

In relation to the National Ambulance Service, the 2016 survey contained both positive and negative results. In response, management took a range of measures, including staff health and well-being programmes, leadership development programmes for managers, the establishment of a national staff engagement forum and anti-bullying initiatives.

I understand that the results of the 2018 survey were published on the National Ambulance Service website on 11 March 2019. I have asked my officials to examine these results and engage with the HSE on further measures to address any areas for improvement.

This is not a breakaway union. The PNA has negotiated and represented members of the health service for the past 49 years. It has a long history of advocating on behalf of staff and patients to ensure the delivery of quality health and mental health care. The NASRA branch of the PNA has represented its members in a variety of industrial relations fora, including the WRC and Labour Court with which it meets. However, the HSE refused to engage with the union on grievance procedures and investigations. From 2010 the membership of NASRA has grown consistently. Since its formation, NASRA union subscriptions were deducted by the HSE at source from members' salaries and in January 2018 the HSE stopped deducting union subscriptions at source for new members. Last week, when I raised this dispute with the Tánaiste he made the point that this was an industrial relations issue for the HSE, which was very revealing. The HSE is a State employer and it should not have the authority to do that. It should allow this go to the WRC, hear its recommendations and follow them.

The reference to industrial relations policy is that there has been a longstanding objective not to have over-fragmentation of representation for workers because that does not lead to coherent representation. It is accepted across the board that it is not helpful to have disparate, fragmented groups representing one sector. Ambulance personnel have three unions that are recognised to choose from, Fórsa, SIPTU and Unite.

The deduction of the subscriptions is not prescribed by law. It is done by agreement. It is a concession to the unions. The HSE recognises the right of three unions to represent ambulance workers. The PNA has been representing psychiatric nurses but not ambulance workers for years. It wants to get into this area but the HSE believes, in line with industrial relations policy, that it is better not to further fragment this one sector of workers who have three unions to represent them.

I am disappointed that the Minister for Health is not here. He knew the questions would be taken today, even though he obviously had plans to travel for St. Patrick's Day. He should be here to answer these questions. I am not questioning the Minister of State but the Minister for Health should be accountable.

It is absolutely outrageous that the HSE has taken this decision. It has refused to go to the WRC. The PNA has said it would go to the WRC, which is the industrial relations platform and court where this matter should be teased out. It is up to the WRC to decide whether the over-fragmentation of representation is an issue. If the WRC says the PNA should be a voice for the national ambulance workers, the HSE will be taken out of the equation. If the PNA does not get recognition there, it can go to the European Court of Human Rights. The Minister is denying these workers their right to join a trade union of their choice. I and a cross-party group of Deputies asked for a meeting with the Minister on this issue and we have not heard from him. I gave him the letter last week. Maybe the Minister of State can say whether the Minister will meet us.

I have already explained the Minister's absence. I cannot keep repeating myself.

He knew the questions were being taken today.

I do not think he went abroad to avoid answering this question.

If he knew this was-----

Allow the Minister of State to continue without interruption.

We either accept or not that it is good industrial relations policy to limit the number of unions-----

Where does it say that?

It is just a point of debate. I am just putting it out there. If there were 12 different unions representing one sector, it would be very difficult for the employer. That is a fact of life. We are making many demands of the HSE to do more, to do better and to improve and we have to accept that common sense and logic must prevail. If we allow 12 individual unions to represent one sector-----

I am not asking for 12.

Twelve is an arbitrary number. My point is that we should accept that over-fragmentation of the representative bodies is either helpful or unhelpful.

The WRC should make that decision.

I believe it is unhelpful. I do not want to prescribe a number but workers in this sector already have three different unions to choose from. The Deputy says the workers are being denied their right to choose a union but they have three unions already to represent their rights.

They are not being represented.

This is a debate about whether there should be a fourth union, whether we should continue indefinitely or whether the HSE as an employer should.