Saincheisteanna Tráthúla - Topical Issue Debate

Pharmacy Services

I welcome the opportunity to raise this issue with the Minister for Health, Deputy Harris. Every pharmacist in the country has been up in arms since it first came to light last week. I will cut to the chase. In recent years, I have interacted with the Minister and his Department in this Chamber and in committee, both privately and publicly. The Minister, in his interactions with the Irish Pharmacy Union, IPU, gave strong indications that he was willing to engage with the pharmacy sector to make headway in rolling out what is now an underutilised service, getting better value from pharmacists, negotiating a new contract and commencing the reversal of the financial emergency measures in the public interest, FEMPI, in 2020.

I should point out at this stage that, as a pharmacist and owner of a pharmacy, I have an obvious conflict of interest, but I am here representing the pharmacists of the country. The announcement last week of a further three potential cuts to payments made to pharmacists flies in the face of every discussion the Minister and I have had. I have always taken the Minister as a man of his word and an honourable person. I simply cannot believe what happened last week. What is being proposed will take a minimum of €25,000 from the bottom line of every pharmacy in the country. That is on foot of cut after cut. There has not been an increase in fees for more than ten years. Pharmacists are working night and day trying to keep our businesses viable and this is the straw that will break the camel's back. As the Minister knows, pharmacists as a group are non-antagonistic and non-confrontational. They are co-operative and willing, as is their representative organisation, the IPU. On this occasion, however, things have gone too far.

Regarding the reversal of FEMPI, the Minister has often stated that changed practices are needed. In the previous three years, pharmacists have taken 12 different actions that have saved the system money. We have done that without getting one cent extra in payment. For example, non-oral anticoagulants are provided to hundreds of thousands of patients every week in our pharmacies. We do all of the associated administration work and when patients come in with unsanctioned prescriptions, we do all of the work and give them their medication. In many such cases, we do not even get reimbursed for the first month until the patient gets sanctioned. There would be chaos if we sent those patients back to their consultants and doctors.

Dealing with the high-tech ordering, monitoring and management hub and sanctioning high-tech and critical medication for thousands of patients takes hours of pharmacists' time every week. All this additional work has been taken on by pharmacists free of charge. The Department now proposes to cut the high-tech fee for medications such as Entresto, Fampyra, Fumaderm and Prolia. Three months ago, there was a major cut in what is allowed in the area of oral nutritional supplements. We have been working with patients and their doctors and consultants to let them know what is reimbursable so that patients can go out the door with their vital medication.

This is not the way to commence negotiations on reversing FEMPI or agreeing a new contract for pharmacists. The Minister addressed the IPU annual conference and gave a firm assurance, which he also gave me at a committee meeting, that he wants to work with pharmacists and wants to roll out a new contract that will bring about a better system and fairer payments. The Minister cannot allow this proposal to proceed. I do not want to hear from him that the Department is doing this. He is the Minister and this is his Government. We have put our faith in him and I expect him to honour his commitments.

I always endeavour to honour my commitments. I thank Deputy Brassil for raising this important matter. I genuinely note his keen interest in this area, not just as a pharmacist but as an advocate regarding the role pharmacy has to play from a public health policy point of view in delivering Sláintecare. I have had good and sincere engagements with the Deputy during my time in office and I genuinely acknowledge that and thank him for it.

As the Minister for Health, I value the role pharmacists play in the health service in the delivery of patient care. Community pharmacy is rightly recognised as the most accessible element of our health service, with an unequalled reach in terms of patient contact and access. That is why, as Deputy Brassil correctly states, I have given a clear commitment to commencing a thorough review of the pharmacy contract in 2020. In broad terms, the review will address the role to be played by community pharmacy in the context of Sláintecare and in delivering a multidisciplinary model of service delivery for patients, ensuring clarity of roles, avoidance of duplication and achieving optimum value for money. I recognise already that the IPU has brought forward ideas, proposals and suggestions that it has concerning how pharmacy can do even more in helping to shift services from the acute setting to the community setting, and perhaps ensuring that pharmacists can do more in respect of their scope of practice.

A contractual agreement that is fit for purpose in a health care system that is increasingly seeking to tilt the balance of care towards a strengthened primary care system is now much required. The vision and approach which underpin Sláintecare need to be mapped out for community pharmacy. A primary care model, integrated with other health policies, will require the expansion of both the scope of practice and the range of public services provided in community pharmacy. I am thinking specifically of the successful pilot we had for a minor ailments scheme. That could well be an area of expansion.

In May of this year, as the Deputy rightly reminded me, although I certainly have not forgotten, I addressed the Irish Pharmaceutical Union at the national pharmacy conference in Galway. In my keynote speech, I made a clear commitment to move beyond the arrangements underpinned by the Financial Emergency Measures in the Public Interest, FEMPI, Acts 2009 to 2015, as I have done for other professions, with a view to optimising the role of pharmacists in the years ahead. I stand by that commitment, not to move back to pre-FEMPI arrangements but to move on "to a higher terrain", as I said at the time. I am satisfied that we can agree a new contract next year that will do precisely that. However, in the meantime I am obliged, under law, before the end of this year, to put in place a new framework to maintain a statutory basis for contractor fees as the existing regulations will be revoked from the end of this year, in accordance with the Public Service Pay and Pensions Act 2017.

That is not new information. It is a statement of fact based on an Act that this House passed.

Prior to the making of the new regulations, I am required to consult the representative body for pharmacy contractors, the IPU. In that respect this statutory consultation is under way. My officials wrote to the IPU on 10 October inviting it to attend discussions on the making of the new regulations. Meetings were subsequently held in my Department at an official level on 24 October and 7 November, following which a detailed and welcome submission was received from the IPU. That submission is being considered by my Department and I have agreed to a request from the IPU that I would meet it directly in the coming weeks. I assure Deputy Brassil that no decision has yet been made in this regard. The Deputy will, I hope, understand and appreciate that while a statutory consultation process is under way I am somewhat limited in terms of what I can say. However, we have received the detailed submission from the IPU. It is being given the most serious consideration. I am conscious of the fact that we will be entering contract negotiations at the start of 2020 and that the sequencing of these issues needs to be considered.

I expect to see discussions on a new contract begin early in the new year. I fully believe that community pharmacy contractors have an important contribution to make in realising my future vision - indeed, it is the Deputy's also - for community care which needs to be enabled by a modern fit-for-purpose contractual relationship with the HSE.

I thank the Minister. I am aware that a statutory framework needs to be put in place. The Minister should leave it as it stands and commence the negotiations for the new contract and new fees under the existing arrangement, which, I would add, has already taken 33% from payments from pharmacies over the past ten years. We carried more than our fair share of the burden in the difficult times. There is also the additional work we have taken on outside of our contract.

I am trying to express to the Minister, in as calm a way as I can, the anger that is out there among pharmacists. I would not be surprised if they withdrew their co-operation in the high-tech hub, withdrew their co-operation for the National Oversight and Audit Commission and brought about chaos in a system that is already overburdened. That is coming from a group of people who have never been antagonistic. They have never been confrontational, they have always been co-operative and willing.

Dentists are moving into 2020 with the same framework. There will be no change for them. The Minister is reversing the financial emergency measures in the public interests, FEMPI, for GPs, which we welcome. They are not being asked to accept further cuts. As a matter of fact, payments they received previously are beginning to be restored to them. I ask the Minister not to treat pharmacists differently. We do not deserve it. We are honourable and hardworking of people who provide a fantastic service to communities. The one thing the Minister will not hear about in the context of the health service is the pharmacy system being in chaos. We do a good job and we do not deserve this.

I will take the Minister at his word to the effect that when he meets the IPU in the negotiations in the coming weeks, the first thing that will happen is that what was put on the table last week will be taken off it. I also take it that we will sign what we have already and that in 2020 we will renegotiate for a new contract and for the reversal of FEMPI.

I again thank Deputy Brassil for raising this important matter. I share his view that pharmacists are always honourable and constructive in their engagement with the State. I referred on previous to our Brexit preparedness, an matter in respect of which there has been significant leadership shown by Darragh O'Loughlin, CEO of the IPU, in particular but also by pharmacists in general. Perhaps we are better prepared than other jurisdictions as a result of that constructive engagement and collaboration.

I want pharmacists to do more. Pharmacists want to do more. In order for them to do more, I accept that we need to provide more resources to them. That is why I want to start contract negotiations similar to those that led to a successful agreement with GPs. Some 95% of GPs voted in favour of the new agreement.

The law of the land revokes the existing regulations at the end of this year. The law of the land obliges me to put a new framework in place. The law of the land obligates me to consult representative bodies before doing that. That consultation is well under way. Letters have issued and meetings have taken place. A meeting with me will take place. A detailed and constructive submission has been received from the IPU and is being actively considered. We believe that there are efficiencies to be made. Pharmacists do not disagree with that. However, I am conscious of the fact that we will hopefully be sitting down in a few weeks' time to discuss a new contract. How those two interact is something to which I am giving a great deal of careful consideration.

The document submitted by the IPU is being actively considered at the most senior levels within my Department and by me. I will meet the IPU and we will decide how best to proceed in due course. It would not be constructive to go further than that today, particularly as the consultation process is ongoing, but I hear Deputy Brassil's compelling arguments clearly.

Waste Management

This is a critical issue. What is at stake is that the polluter pays principle would apply. One could see in these documents which have been released, uncovered by Mr. Juno McEnroe in the Irish Examiner, Ms Lynn Boylan, a former MEP, and indeed Mr. Daniel Murray from The Sunday Business Post, that rather than the polluter pays, what we have had in the management of plastics in recent years is that the polluter sets the policy. Through this cache of over 100 emails, we can see a Department that is operating hand in glove with the industry representative group, Repak. In the drafting of the plastics directive in the European Union, which was only passed earlier this year and which is critical legislation, and in the debate on my party's Waste Reduction Bill 2017, which has been killed by the Government by its failure to issue a money message, at every stage of the process, the Department was turning to Repak for a steer on what was the best approach to take. In the European context, that was going right through most aspects of the legislation. The Government, effectively representing the industry, looked to weaken the provisions of the directive and reduce the category of items that might be included in restrictions to weaken timelines and constantly feed back to industry the latest developments. Reading the emails, as reported in the Irish Examiner, someone asks whether the recipient can telephone in the next half an hour. Indeed, in the emails published in The Sunday Business Post the same system applied in the context of the processing of my party's legislation. It is not only email correspondence but, according to the articles, meetings were also held on a regular basis.

It is not right that, in the context of this country seeking to go green and wanting to gain public confidence in how public policy is managed, industry interests and the public interest are so entwined. In this area, the public interest is very real. This is not a minor or side issue for most people. I refer to single-use plastics, the problem of plastic waste pollution and the need for us to be stringent, ambitious and bold in terms of telling companies such as Coca-Cola and Britvic that we will run this consumer area not on the basis of their interests but, first and foremost, with environmental and consumer protection interests in mind.

That is why it is a significant and worrying development that the Department appears to be closely dependent on the industry representative group. I am keen to know what the Minister thinks of what was stated in these emails. I am keen to know whether he thinks this is acceptable practice. If he does not, I am keen to know what the Department will do to change its working procedures so that this type of lobbying on behalf of industry groups will not happen in Brussels or here.

This relates to the ongoing debate we have had in this House as to how Opposition legislation is treated. We never got a satisfactory answer. My party's legislation was in tune with the European legislation, even the version that was finally passed. All we heard at the committee was that we could not do it and, effectively, the industry reasons as to why it could not be done. That is not good enough.

I thank the Deputy for raising his concerns about this. My Department seeks to promote wide stakeholder participation in policy development and is always open to improving those consultations and to suggestions from the Deputy or others. The Bill to which the Deputy refers was first published in mid-2017, which was before my time in this office. It provided for prohibiting the sale or free distribution of disposable plastic cups, glasses, plates and other tableware from 1 January 2020, except for items which can be disposed of by composting in an ordinary domestic compost facility, and the mandatory introduction of a deposit and return scheme, DRS, for all beverage containers by 1 July 2019.

I have been informed, as I was not in the Department at the time, that the Department engaged with the Deputy and certain environmental groups shortly after the publication of the Bill. The Minister at the time supported the intent of the Bill, which aims to reduce the amount of plastic waste in the environment. However, he referred the Bill for detailed scrutiny to the Oireachtas Joint Committee on Communications, Climate Action and the Environment citing concerns about its compatibility with EU legislation and the cost implications for the Exchequer of the introduction of this provision. The resulting committee report acknowledged the incompatibility of the Bill with EU legislation and outlined potentially significant costs in establishing and operating a deposit and return scheme. Cost estimates considered in the course of the committee's deliberations identified costs of over €76 million in the first year of establishing the scheme with up to €72 million in costs for the second year.

The Government is not opposed to the possible introduction of a deposit and return scheme in Ireland. However, given the potential costs involved in its introduction, it believes that a proper study of the costs, impacts and effectiveness is necessary. The Department is currently undertaking such a review.

It is normal practice to seek the views of affected parties when considering a response to proposals. I am informed that in consideration of the above proposal the Irish Business and Employers Confederation, IBEC, and Repak were consulted as the need arose. The Environmental Protection Agency, EPA, was also consulted. It does not seem unreasonable to consult with Repak, which co-ordinates the delivery of the obligations of industry in this area. Repak operates under an approval from the Minister to act as a national compliance scheme for packaging. Producers of packaging have obligations under the EU packaging directive, as transposed in Ireland by the European Communities (Packaging) Regulations 2014. Repak is a not-for-profit organisation which carries out these regulatory obligations on behalf of its members. Under the terms of its approval, it is tasked with ensuring that Ireland meets its EU targets under the packaging directive and to report to the Minister annually on progress. It is also obliged to keep updated on relevant regulatory developments at national level.

I recognise that all stakeholders should have a fair opportunity to participate so all views can be fully taken into account. In terms of policy development, my Department will evaluate the analysis being undertaken on a deposit return scheme. Incidentally, the scheme is strongly opposed by Repak, so it has not been a slam dunk for whatever view is coming from industry. The Department held a major stakeholder forum in September on a new waste strategy embodying the circular economy plan adopted by all member states of the European Union. All stakeholders were invited to participate.

The approach I have taken since I was appointed to this office is to consult widely. I consulted widely before the adoption of the climate action plan and I am consulting widely at present before the adoption of a waste and circular economy strategy. I hold regular meetings. I have held ten town hall style meetings to ensure I am getting access not just to national interest groups but also to the views of people in the regions. The approach I seek to take is to receive all views fairly.

I understand that a Department, Ministers and politicians must engage with stakeholders and be informed. However, that is not what we see in the emails released under a freedom of information request. I can give an example. There is an email from 8 May 2018 from the Department to Seamus Clancy of Repak. It states: "As you know the Minister is before the Oireachtas joint committee today to discuss the draft report on the Waste Reduction Bill" and then puts a "quick question" about Repak. On the day it was being debated it was to ask if he could ring that day about what the Minister was going to say. This applied not just to how our Waste Reduction Bill 2017 was handled. It was the iterative in the circle. It was informing and being centrally involved, such as asking for a call in the next half hour and, further to a discussion earlier, asking what should be done in the European Council on the plastics directive.

The problem is that the Department was repeating Repak's line that our Bill was in contravention of European policy when, in fact, it was bang in line with European policy presented by the Commission and subsequently in the directive, despite all the efforts of the Government to weaken it. The Opposition had a correct legislative measure that was perfectly formed to meet what the European Commission was telling governments to do to comply with the new directive. While the Government was trying to water down the directive in Europe, it was saying here that it could not be done because it would upset industry and would not suit it. That is what happened and that is why Members on this side of the House are increasingly angered at how a legislative measure that was absolutely appropriate and bang in line with European legislation was turned down for industry interests and not on the basis of a policy approach formed by the Department.

The point of consultation is to get both sides of the argument and bring them to bear. It is not to hear only one side of the argument. There is an obligation on us to make massive changes in the way we manage resources, but we must also take their cost implications into account. The Deputy was keen to have a deposit and return scheme established, but there was evidence which the Oireachtas committee believed to be a realistic consideration that had to be taken into account with regard to whether one should impose that. When legislation is introduced by the Government, a regulatory impact assessment is conducted in the normal way. What tends to happen with Private Members' Bills in my experience is that all of that gets compacted and there may be hurried consultations. I can understand how the Deputy might construe them as being only hearing one view because there was a need to respond quickly, but it is the Department's policy and my view that everybody's voice must be heard and that we must try to achieve what we must achieve in a way that imposes the least burden and offers the most opportunity for us to succeed in our environmental objectives while also being compatible with other needs of the community. That is what I seek to do. If there are flaws in the way this is done, I will certainly seek to correct them. The approach I have taken in the consultations I have held is to be fair to all concerned. That does not mean, of course, that people will always be happy with the position I ultimately take, but that is the nature of decisions. It can be portrayed as only hearing one side of the argument. As this is so important, we seek to hear from all sides and make appropriate policies.

Family Support Services

I welcome the children and teachers of Our Lady of Lourdes national school in Ballinlough who are in the Visitors Gallery. It is pure coincidence that I happen to be in Chamber at this time. It is appropriate that the Minister for Children and Youth Affairs is also here to welcome them.

This important issue involves the Bessborough Centre, previously the Bessborough Mother and Baby Home. That was controversial in itself, but I am not dealing with that aspect today. The trustees of the Sisters of the Sacred Hearts of Jesus and Mary have decided to sell the land. On that land are vital family services for vulnerable families and children. What has developed there over recent years is an extraordinarily high quality intervention service funded by Tusla on a current basis. The family assessment and treatment services include a parent and infant residential unit. It is an 11-bed facility that provides a continuum of assessment and parenting capacity building, a therapeutic intervention for high risk parent-infant families.

The parenting capacity provision is very significant, as is the acute residential unit, as has been well recognised. Post discharge, the Lime Tree project comprises community-based family support service and supervised access service. That is exclusively commissioned for families involved in the South Lee social work department. There is a very extensive community crèche and preschool with Pobal subvention. I understand the nuns wish to sell this as a going concern. This has a capacity of 139 with a staff team of 34, including an administrative manager and childcare manager.

There is a secondary school for second-chance education provided by the education and training board to some of the mothers who avail of this facility. Vulnerable adult students are intensively supported to achieve a leaving certificate to enter further education or vocational opportunities. That school works in harmony with all other Bessborough services, particularly providing parents opportunities to consolidate positive life change whilst using clinical family services. The centre's ethos of inclusion and unconditional respect engages pupils typically resistant to formal education or statutory involvement. There are comprehensive employment support services on the Bessborough lands, again facilitating vocational training and experiences for individuals to return to the workplace or seek employment. That is critical in facilitating the therapeutic and trauma-informed physical environment of the Bessborough centres. There are tremendous synergies between all these different strands of provision. On the wider campus, Eist Linn, an inpatient mental health facility operated by the HSE, is also on these lands. An 11-year lease is left on that facility and €2 million extra capital investment has been added to the premises in recent years.

In one parliamentary answer, the Minister said she had no role to play in intervening in the sale. I put it to her straight that the Government should buy it on behalf of the people. The Minister should work with other Ministers - Health, Education and Skills, and Housing, Planning and Local Government - along with the local city council and combine to buy this entire facility. A master plan could be developed for its extensive lands, which would add to its existing synergies. The sod was turned for the event centre in Cork four years ago and nothing has happened. The developer said he could not complete the project for €10 million or whatever, and I reckon €20 million is now going into it. Why is it that the most vulnerable and most needy of families and children are always at the bottom of the queue? There is a real danger that these services will dissipate as a result of this sale.

I welcome the opportunity to respond to the issue raised by Deputy Micheál Martin. As he outlined, the Bessborough Centre in Cork is a not-for-profit organisation that works with children and families. The centre is based on a large site that is in excess of 40 acres. The property is owned by a congregation of nuns who have operated child and family services on the premises for many decades. The congregation that owns the property is now based in the UK, and I understand that the site was advertised for sale in 2018. It appears that the Bessborough site has a mix of considerable undeveloped lands and a range of buildings. A range of services are provided on the Bessborough site, and funding is provided by a number of public bodies, including the Department of Employment Affairs and Social Protection and the Health Service Executive as well as my Department and Tusla.

In 2018, Tusla, the Child and Family Agency, allocated €1.5 million in funding to family and community services provided by the Bessborough Centre. This was established under the trusteeship of the order of nuns who own the land. Tusla is also a tenant on the site and has a short-term lease for its fostering office. The CEO of Tusla visited the site last week. I am informed that the Health Service Executive also operates services on the campus.

The Bessborough Centre is currently considered a leading national centre for therapeutic assessment and interventions for vulnerable families. The centre aims to keep families together where it is in the best interests of the child. My Department provides funding to the Bessborough Centre to run a range of early learning and care and school age childcare programmes for young children. I recognise the challenges that can be faced by community not-for-profit childcare services. That is why my Department has developed a strong case management system operated by Pobal, and through which a dedicated team, in partnership with local city and county childcare committees, assists childcare providers facing challenges.

I understand that Cork City Childcare Committee and Pobal are engaging with the service in question on this matter, and they will continue to support the service as and when required. This is a fluid situation. There appears to be much uncertainty regarding the future of the site and the services provided there. It is important that all factors are taken into consideration before any decisions are made. I know that many people who work for the Bessborough Centre, or who engage with its services, will be anxious to know what the sale of the property means for them. There are also many others who use HSE or Tusla services on the site who will be concerned.

What is clear is that the property is scheduled to be sold, and that there is a potential risk to services as a result of that sale. I know that this is the issue that concerns the Deputy most. Both the CEO of Tusla and I are keen to secure the future of the services that are located on the site. The owners of the Bessborough property have nominated a representative to engage with Tusla. An initial meeting took place between all parties on 4 November and further engagements are to take place shortly. I emphasise that these discussions are in their early stages.

I know that the Deputy will appreciate the sensitivities around engagement on this matter. We are at one on the need to ensure continuity of these necessary services and I appreciate his support and that of other public representatives in Cork in achieving this. I will continue to take an active interest in this matter, and will continue to liaise with Tusla.

I accept that the Minister's Department specifically will not have the capital funding required to purchase the 40-acre site. The State has invested hugely in the area with capital investment over the years and ongoing current funding. If the land is sold to a private entity, to a developer, these services will break up. Huge work has gone into building up the family therapeutic service. In her former role as rapporteur, Dr. Carol Coulter said this is one of the best in the country. It is nationally recognised and is a national service.

Such facilities do not come easily. I know that as a former Minister. This is a wonderful site with tremendous potential. I understand there was interest in the site by a particular developer who has left the scene due to other issues. Some of it is zoned amenity and so on. I ask the Minister to give a commitment to talk to other Ministers and raise this at Cabinet level. While I am supportive of the event centre, we can find €20 million very quickly for that project, which has taken five or six years to develop. We can find that no problem because of political imperatives. It has to be done for politics as the election is coming, the Government promised it, and its attitude is that if it is a case that it cannot deliver it, it had better find another €8 million or €10 million to do so. Here is an incredible range of services for the most vulnerable in the country, the most vulnerable women, families and children. A good model has been developed. There is a mental health inpatient facility for teenagers and children. Why is it that the State cannot be as proactive as it is in other areas, do the right thing for the future, and develop even greater synergies in future? This is possible and doable, bringing together all the State agencies and Departments and using them to get the right result for all concerned. Will the Minister make the commitment to engage with her colleagues to endeavour to achieve that outcome?

I will answer some of the issues the Deputy raised before I answer his question directly. I do not think it is necessarily the case, certainly in my Ministry, that the most vulnerable are at the bottom of the queue. I agree with the Deputy that should not be the case. I think I have done a lot in my own work, and I only have responsibility for certain things, to ensure that is not the case, particularly in the area of early childcare and school-age childcare.

I have outlined to the Deputy our willingness to step up to the plate with the not-for-profit services provided there and ensure they continue.

The Deputy has outlined the fantastic synergies that happen in the Bessborough Centre and I am absolutely a firm believer in that process. It is visionary and the centre was clearly way ahead of its time in establishing that process. I acknowledge this and thank the Deputy for outlining it in such an eloquent manner. He is right to say that the capital investment has been made but it could also give us a substantial return, particularly a social return, which is what the Deputy is asking for. The services are clearly top class, and I have looked into this since the Deputy and other colleagues have raised the matter. I am very impressed with what I have heard about the centre, so I acknowledge that a good model has developed and there is potential for more.

Tusla and other representatives are engaging with the religious order. I accept the Deputy's comment that it would be good to speak to other Ministers about this and I will do so.

Air Ambulance Service Operations

The emergency aeromedical service, EAS, is an air ambulance service that helicopters from the Air Corps have been providing since 2012. We heard only this week that the service is being curtailed for safety reasons, which we acknowledge. It is being curtailed because of a failure by the Government to address a resourcing issue, as the most valuable resource in the Defence Forces and Air Corps is its personnel. The fact that the personnel have not been there for a period and are not likely to be there in future concerns me. In press releases this week, the Department has stated the service has been curtailed by four days each month until February next year, but no guarantee has been offered by the Department, military authorities or the Minister - the Taoiseach, Deputy Varadkar - that the crisis in manning levels for the Air Corps is at an end.

The Taoiseach stated that this position was "not ideal", and this is the understatement of the year. This is a service that provides for those who are critically ill in the main, accident victims or medical emergency cases that may be transferred to a hospital for appropriate care. It is used daily, such is the success of the service to date. We should praise the charity that is stepping into the breach to save the blushes of the State. It is great that the Irish Community Rapid Response organisation has the expertise and facilities to step in and deliver the service or at least cover the service for those days that the Air Corps cannot do it.

It is a sad state of affairs that we have reached a point where the Defence Forces must be backed up by a charity. This comes after many years of representative organisations for the Defence Forces and Members in this House, including me, continually raising the issue of the failure of the Government to address the retention problem in the Defence Forces and Air Corps in particular. Specialist personnel are required. These are not just pilots but also back-up and maintenance crews. Currently there are only three full crews available for the service despite the fact that there is a need for ten crews.

I hope the Minister of State will be able to reassure me in his comments that come the end of February next year, we will have ten full crews in place. I do not believe it will happen but it is what we have been told. The statement indicates that this curtailment will only last for a number of months.

We acknowledge the energy and enthusiasm of the men and women in the Air Corps and their ability thus far, despite reduced numbers, to deliver a service. It has got to the stage now where they cannot deliver this because it would put their lives at risk or the lives of those at risk they are sent to help. I hope the Minister of State can reassure us on this.

I thank the Deputy for raising the matter. I apologise on behalf of the Minister of State with responsibility for defence, who cannot be here today, unfortunately.

As Deputy Ó Snodaigh indicated, the EAS based in Custume Barracks in Athlone is an important service provided by the Air Corps. Notwithstanding the well-documented ongoing human resources challenges in the Air Corps, particularly with the recruitment and retention of pilots, the EAS has been delivered without interruption since 2012, as Deputy Ó Snodaigh, in fairness, has acknowledged. The Minister of State, Deputy Kehoe, has prioritised this service and will continue to do so in future.

The Minister of State received military advice that the Air Corps will not be in a position to accept EAS taskings from the National Ambulance Service for four days per month for a period of four months from November 2019 to February 2020. That is regrettable but necessary for safety and governance reasons. During this time there will be a training surge to produce a new cohort of aircraft commanders for the EAS, and this will ensure the long-term viability of the service provided by the Air Corps. The safety of serving personnel, HSE staff and patients is the shared number one priority and our whole focus is returning the EAS service to full capacity.

During the 16 days when the Air Corps will not accept taskings, the Irish Coast Guard will provide reserve cover for the National Ambulance Service. This is in line with the Government's decision in 2015 to establish the emergency aeromedical service. The Irish Community Rapid Response, ICRR, emergency medical service, which was mentioned by the Deputy, has agreed to provide additional cover using a second helicopter, which will be based at Roscommon University Hospital on the days when the Air Corps will not be in a position to accept taskings for the EAS. The ICRR will also continue to be available in the south of the country.

The whole focus is on returning the EAS to a full service and full capacity. A number of measures are being pursued, including the reintroduction of the service commitment scheme for pilots, the recommissioning of former Air Corps pilots and the training of junior pilots during that time. The emergency aeromedical service provided by the Air Corps has completed more than 2,600 missions since it commenced operations in 2012. On behalf of the Minister of State and the Government, I pay tribute to the professional and effective service provided by Air Corps personnel, as Deputy Ó Snodaigh did as well. I acknowledge the support of the Irish Coast Guard and the ICRR during this period. The shared priority is to provide the best available service using all available resources during the four days in each month when the Air Corps will not be available for EAS taskings. This interruption is regrettable but necessary, as I stated, from a safety and governance perspective. Everybody accepts it is correct if that is the advice that has been provided. The emergency aeromedical service operated by the Air Corps will continue and it is not being wound down. The service will continue to be provided by the Air Corps.

I acknowledge that the emergency aeromedical service is continuing and it has a tremendous record since 2012. The key question is whether there will be other interruptions. If we do not have ten crews available at Custume Barracks but instead we have three crews that may be topped up by people coming from training in February, the service will have to be curtailed on other occasions. That is the case because of the crisis within the Defence Forces and the Air Corps in particular when it comes to retention.

I note the Minister of State's indication that the Irish Coast Guard will also provide cover, but it is facing other difficulties and there is no guarantee it will be able to provide any additional cover if there is further curtailment. In the House two years ago I raised the two-year contract awarded to Medflight-Air Alliance Express to transfer children undergoing organ transplant to England.

That contract was up to April 2020 and involves a cost. I do not know if it will have to be extended or if the Air Corps has the required personnel and pilots to bring such a service back into full operation. We had the tragedy of the Irish Coast Guard Rescue 116 which went down off the coast of Mayo. Accidents can happen but on the night in question, the Air Corps, either because of a lack of personnel or equipment, was not able to provide the required cover. There are major problems. Cover will be provided by the Irish Community Rapid Response helicopter for 16 days. We need a commitment that the service will not be curtailed beyond the 16 days extending to February 2020.

The Deputy raised some legitimate points. I will ask that they be brought to the attention of the Minister of State at the Department of Defence and he might reply directly to the Deputy.

The focus is on returning the service to full capacity. The loss of 16 days is regrettable but necessary from a safety and governance perspective. I know the Deputy will accept and appreciate that if advice is given on safety, it must be adhered to. At least there is a fall-back position in this case and it is being implemented. During this time there will be a training surge to produce a new cohort of commanders. Steps have been taken to ensure there is an air ambulance service available on the 16 days in question. As I indicated previously, the Irish Coast Guard, complemented by the Irish Community Rapid Response service will provide additional cover using a second helicopter which will be based at Roscommon University Hospital on those days. This necessity for short-term measures is regrettable but it will contribute to the longer-term viability of the service.

The Deputy will know as well as I do that there is no silver bullet when it comes to the provision of pilots. I am not a military aficionado but I expect that pilots are highly trained individuals who are highly sought after. There is a shortage of pilots. As I stated, the Minister of State is pursuing a number of measures, including the reintroduction of the service commitment scheme, the recommissioning of former Air Corps pilots and the training of junior pilots. These measures are being taken to ensure the service can be reintroduced. The Minister of State has been advised that a maximum of 16 days will be lost. The Deputy has sought further assurances and I will ask the Minister of State to reply to him directly in writing.