Ceisteanna ó Cheannairí - Leaders' Questions

Roimh tús an ghnó seo, ba mhaith liom cúpla focal a rá faoi Tom Burke. Is cinnte gur chuala formhór na dTeachtaí Dála gur chuaigh Tom Burke ar shlí na fírinne inné. Ba mhaith liom comhbhrón ó chroí a dhéanamh le Mel, bean chéile Tom, leis na gasúir, Paul, Aidan, Yvonne, Derek agus Elaine, agus leis an seisear garpháistí. I am sure all Members have heard that Mr. Tom Burke died yesterday. On behalf of the House, I extend our sympathies to his wife, Mel, his five children, Paul, Aidan, Yvonne, Derek and Elaine, and his six grandchildren.

Tom's career as a photographer spanned an incredible 50 years, during which time he covered both the daily national and international news for the Irish Independent. For many of us, however, he will always be associated with Leinster House. It was his beat and he was certainly a semi-permanent fixture outside Kildare Street for decades. He was the first friendly face I saw when I was elected in February 2016. He enjoyed a unique relationship with Deputies and Senators and had a great respect for elected representatives, and that respect was mutual. He also enjoyed a cordial relationship with all staff and was a welcoming presence for many workers and visitors. Tom was also a close friend of many members of the Oireachtas press gallery. The reaction to his passing is reflective of the standing and respect he had earned and deserved. It is also important to highlight the legacy Tom leaves behind in his record of parliamentary politics, an integral part of political journalism but one not often given the value it deserves. Ba mhaith liom a rá, ar ár son go léir, ar dheis Dé go raibh a anam dílis.

I will now take Leaders' Questions under Standing Order 36. I ask for co-operation on the time in order that all Members are treated with the respect they deserve.

I will start, if I may, by offering my condolences to the family of Tom Burke, his wife and his children. He was an ever-present character, in the best possible sense, around Leinster House and he will be missed not only by his family but also by people in Leinster House.

This morning, there were 451 people on trolleys in hospital corridors and squeezed into free space. Limerick, Galway and Cork are still the worst hit hospitals, as they have been for years, with no change. Waiting lists are spiralling out of control, with more than 900,000 people on acute lists and 200,000 people more on diagnostic lists. This includes more than 100,000 children. The mind boggles when you reflect on that number of people who are on waiting lists and the length of time they have been waiting. We are back to high trolley counts, with waiting lists out of control, and the Government, it seems, has no plan to deal with them.

There are real human consequences of this crisis. Over the summer, I conducted a survey on the impact of long waiting times on patients. The results were stark. Long waiting times have severe consequences for stress and anxiety, with a major negative impact on people's quality of life. The survey found that 75% of people's conditions have got worse because of their wait. This is particularly severe for those waiting more than a year. It is clear that care delayed is care denied and that long wait times fail patients. There are severe consequences for mental health, with more than 70% of respondents reporting that their mental health has been severely or considerably affected.

We need to see a waiting list plan from the Government. It cannot be more window dressing, committees or talk. It has to be about action, capacity and resources. The Tánaiste knows we need more beds, staff and capacity in diagnostic and surgical theatre space. I know this from my experience in Waterford and I am sure he knows it from his experience as a previous Minister for Health. We also need modern IT systems.

One area severely affected by capacity has been maternity services. We need to see real investment in maternity services to ensure women in this country have the highest quality of care. The Tánaiste may have noticed the protest yesterday outside Leinster House, where pregnant women and their families, some with young babies, had no choice but to travel to Dublin for a protest to end maternity restrictions. Partners have been locked out of appointments and labour because of a lack of space and outdated buildings and, of course, because of infection control measures as well. Yesterday many Government backbenchers stood in solidarity with and gave commitments to the women affected and expectant mothers. I commend Linda Kelly and the #BetterMaternityCare campaign, who organised the protest, and the others who spoke or travelled. We have all heard the tragic and horrific stories from women abandoned in the most heartbreaking circumstances. These maternity restrictions need to be lifted now and the Tánaiste and his Government need to act on this. All parties and none that stood in solidarity now have to make sure there is action.

What is the Government's plan to tackle waiting lists? What is its plan to inject capacity into our healthcare system? I heard in Cork on Monday, when I met the CEO of Cork University Hospital, that we are facing into an horrendous winter in acute hospitals of more overcrowding, more people on trolleys and waiting times getting longer. What is the Government's plan to ensure that this does not happen? What specific injections of capacity and resources will be put into our healthcare system? Also, what will the Government do to end maternity restrictions?

There were a lot of questions there, all very valid, and I will do my best to answer them as best I can in the time allowed.

First, however, I join the Leas-Cheann Comhairle in paying my respects to Tom Burke, who was a truly fine man. He was one of the first people I met and got to know when I became a Member of this House. He was a feature of Irish politics and photojournalism, and I was really sorry to hear yesterday that he had passed away. I extend to his family and friends the Government's condolences and those of my party.

I acknowledge the enormous distress and discomfort that overcrowded emergency hospitals cause patients and their families and also front-line staff working in very challenging conditions in hospitals throughout the country. I acknowledge also the risks involved in respect of infection control and delayed care.

The HSE reports that there were 292 patients on trolleys in our hospitals this morning. That is up from 164 this day last year, when hospitals were largely closed due to the pandemic, but substantially down on previous years, such as 2019, when the number was 451 a day around this time of year. A total of 292 is still 292 too many, however, and it is not acceptable that people should spend prolonged periods of time on hospital trolleys awaiting admission.

What is our plan to deal with this issue? It involves increasing our bed capacity, increasing staffing levels, modernising care pathways and expanding care in the community. Since the Government was formed, and since the pandemic started, we have added more than 800 beds to our acute hospital system. That is why the number of people on trolleys, while still too high, is substantially lower than it was in 2019, before we added those additional beds to the system. We need to add more and we have detailed plans to do exactly that, as spelt out in the national development plan earlier this week. We have also increased the number of staff considerably. The HSE has recruited between 7,000 and 8,000 additional staff so far this year and has authority to recruit more. That authority will carry over to next year, but we all understand the difficulties that exist, both in Ireland and around the world, in recruiting healthcare staff. The addition of 7,000 or 8,000 staff this year alone is a significant increase and it is making a difference.

We are also expanding care in the community, which is enabling more people to receive healthcare in their communities and ensuring they do not have to go to hospital in the first place. That is largely being done through building up our GP services, particularly by giving GPs greater access to diagnostics. We have also put huge resources into home care. The waiting times for home care are substantially down on what they were before, which means more patients can get out of hospital more quickly. That frees up beds, and the same thing goes for the adequate funding of the fair deal scheme. Those are the main things we are doing at the moment. Of course this is all done against the backdrop of a rising and ageing population and huge pent-up demand for healthcare as a consequence of care deferred during the pandemic. It is a difficult situation but the Government is very much acting on it.

Regarding waiting lists, as the Deputy knows, a task force is being established in the Department of Health to get waiting lists down. The reason they are high at the moment - they were high before the pandemic and they are even higher now - is the need to deliver the care that was deferred as a consequence of hospitals being closed or partially closed for the duration of the pandemic. That has built up a huge unmet need. The way it is going to be managed is similar to the operation of the vaccine task force, which was very successful in producing our vaccine programme. We want to take the same approach now to reducing waiting lists.

Of course the Tánaiste is right to accept that there is enormous distress caused by high wait times. He talked about the risks involved for patients and, yes, there are risks for staff as well, as we know. As a former Minister for Health, he knows that healthcare is, in essence, about people treating people, as well as making sure the people who work in our health services are valued but also that they have the resources.

When the Tánaiste talks about what the Government did last year, he needs to be a bit more straight about what was promised, on the one hand, and what was delivered. There were 1,150 additional acute beds funded and committed to in last year's budget. It was confirmed yesterday by the Secretary General of the Department of Health that some 150 of them will not be delivered. The Tánaiste talked about the 7,500 staff that came into the healthcare system, which I celebrate because they are needed. However, the promise was that there would be 14,500 new staff. The Government has managed to deliver only 7,500 of them. He talked about community services. A total of €150 million was provided last year for enhanced community services. The Tánaiste might not know this but half of that money will not be spent to deliver the community intervention teams that were promised. When people hear about task forces, they will judge the Government on its record, that is, what it committed and promised to do and what it has done.

Thank you, Deputy.

Will the Tánaiste comment in his response on the issue of the restrictions on maternity services?

The budget for the health service this year is €22 billion. It is the biggest health budget we have ever seen in the history of the State. When I was Minister for Health, it was €14 billion. It is 50% higher now than it was then, and more than double what it was when I was practising as a doctor in the public health service. Money is certainly not the issue any more when it comes to our health service. As the Deputy pointed out, some of the money will even go unspent this year. There is no lack of money and no lack of political will, but there are real constraints. The Deputy knows as well as I do that adding an additional bed is not simply buying a piece of furniture; it is a whole system and that takes time to do. Recruiting people is difficult as well. The fact that the HSE has added more than 7,000 additional, mainly clinical, staff this year is an achievement, and one we should recognise. The HSE has the authority now to continue that recruitment and take on more staff.

Yes, we did not add the 1,000 beds we aimed for, but we did add 850 and that is the equivalent of two hospitals. It is quite an achievement in the space of less than two years and we need to continue with that now. Although trolley numbers are still too high today, they are not far off half of what they were two years ago. We need to keep expanding our health service to bring those numbers down further.

I would like to be associated with the Tánaiste's remarks in regard to the late Tom Burke. "Legend" is a much-overused word but it is one that we can appropriately apply to Tom. Our sympathies go to his family and media comrades.

Back in June, I told the Financial Times that Ireland could live with a small increase in our corporation tax rate. The Tánaiste accused me then of walking into a trap with those comments. He went on to accuse me and the Labour Party of damaging the national interest. It was clear then that the writing was on the wall, when nearly every country in the world was signing up to this process. Four months on, it now seems the Government is going to follow my advice and that of the Labour Party and sign up to the 15% rate. Will the Tánaiste accept that he was wrong in June and will he have the good sense - and, indeed, the good grace - to withdraw his patronising charge? It is good leadership to be able to admit when one is wrong and to acknowledge that fact publicly.

We know there are two pillars to the OECD process. Projections we have seen from the Department of Finance suggest the cost of pillar 1 will mean a €1 billion impact in 2023, rising to €2 billion in 2025. Ireland has already signed up to pillar 1 but there has been a change in scope under that pillar and significant movement on pillar 2 since those figures entered the public domain. We are all working off old figures. Does the Tánaiste accept that what Ireland may lose on the pillar 1 swings, we could gain on the 15% roundabout? Corporation tax is expected to come in at €12 billion this year. A simple straight-line increase to take it up to 15% would potentially bring in an extra €2.5 billion. This would clearly cancel out any losses under pillar 1. However, we have not been able to get access to any costings on this. There is a huge information vacuum for those of us trying responsibly to interpret the Government position. Will the Tánaiste confirm that updated figures will be published today? Will he further confirm that when the Cabinet meets today, the financial impact of these proposals will be presented to Ministers to help them to make an informed decision on this extremely momentous shift? Will he also confirm that the 12.5% rate will continue to apply to indigenous firms?

In summation, does the Tánaiste still believe that I and the Labour Party are damaging the national interest? Is it not the case that we could gain revenue and be quids in here because we will regain on the swings what we lose on the roundabouts? Will the 12.5% corporation rate still apply to indigenous firms operating here and, indeed, to smaller multinational corporations located here, because pillar 2 applies only to firms with a global turnover in excess of €750 million?

The Deputy is a former trade union negotiator and he understands negotiations, as do I. It is deeply unhelpful when someone on one's side - we were team Ireland on an issue like this - makes concessions on one's behalf. It is exactly the same thing for a shop steward or trade union official going in to negotiate with an employer and somebody from his or her team starts making concessions before they are agreed. It is deeply unhelpful and it was damaging. That is my assessment of the situation and I stand over it. That is if the Deputy sees himself as being part of team Ireland.

There will be a Cabinet meeting this afternoon at which we will discuss this matter. No decision has yet been made. Our existing projections are that any change of this nature will reduce our revenue by approximately €2 billion a year, but that is only an estimate. Nobody can know that for sure. It is based on certain assumptions that may or may not be correct and may well be updated. I do not know if there will be any financials published today but I will get back to the Deputy on that.

Our 12.5% corporate profit tax has been a huge success. It is a really important part of our industrial policy and has, not entire but strong, cross-party support in this House. More than a quarter of a million people work in multinational companies in Ireland. We want to keep those jobs and the 100,000 or so indirect jobs that arise from the direct employment.

We take in approximately €12 billion a year in corporation profit tax. That is roughly double what the average European country takes in on a per head basis and it is evidence that in a world where capital, labour, talent, investment and money are mobile, lower taxes can mean higher revenues. It is proof positive of that.

What we have always tried to maintain are two things - competitiveness and certainty. Competitiveness in knowing that our rate will be substantially lower than that of our competitors, and certainty, so that we can say to companies thinking of making a 30-year investment in Ireland and employing tens of thousands of people that the rate will not change even if the Government or the economic cycle changes. That is something we have to consider today because if we agree to a new global minimum rate, there is the advantage of no country being able to undercut us. Some countries have actually undercut us in recent years and that is something we would avoid if we were to sign up to a global minimum rate.

In terms of our concerns, they relate to the issue of the rate being "at least" the relevant figure. We want to make sure that whatever rate is agreed is certain and will not ratchet up over time. There is the issue relating to SMEs and mid-caps. We want to ensure that for smaller and middle-sized companies we can continue to charge the lower rate of 12.5%. We want to make sure that our research and development tax credit is protected. We also want to make sure that if countries sign up to this, they actually implement it. We do not want to be the country to implement it but for our competitors then not to do so. That would be a disadvantage to us. Those are the issues that are currently in play.

I certainly will not be patronised by the Tánaiste or anybody else in Fine Gael regarding what represents the national interest. The Labour Party has always put the national interest first, as history shows. The truth is that we could have boxed off the 15% condition very early on and it was the Tánaiste and his Government that created the kind of uncertainty that has dominated this process in recent months. I have asked him the very simple question of how much extra or less it is forecast that Ireland will raise in corporation tax if we adopt the 15% rate for multinationals. Is he telling me seriously that this has not been worked out or presented to his Cabinet colleagues who are about to make a momentous decision today that will affect Ireland's national industrial strategy? The decision today will have far-reaching consequences for the economy, jobs and business. Will the Tánaiste commit to those figures being published and shared with Members of this House later today after they have been presented to Cabinet members, if he is prepared to do so?

The Minister, Deputy Donohoe, both as finance minister and as head of the Eurogroup, handled these negotiations very well and has made sure that we got the concessions and protections we wanted. Had we folded earlier, as Deputy Nash perhaps would have done were he in government-----

Committed earlier.

-----I do not think the Minister would have been able to secure the reassurances he has secured in the past couple of weeks because significant efforts were made by other countries to get us into the tent and we had our price for that.

As regards the Cabinet meeting today, the most recent projections I have seen - they may have changed - estimate, and it is only an estimate, that we would lose in the region of €2 billion a year in revenue. However, nobody knows that for sure. Nobody predicted that after the most recent range of changes we made, corporation profit tax receipts would soar. There are so many variables that it is very difficult to know but if it is possible - it is a matter for the Minister for Finance to publish that information - I see no reason we would not publish the figures.

I, too, wish to pass on my condolences to the friends and family of Tom Burke. Tom was a bright presence outside the gates of Leinster House and just a very nice person. He will be sadly missed here, although more so, obviously, by his family and friends.

I was going to address my question to the Taoiseach. I meant the Tánaiste. The co-Taoiseach, perhaps. People Before Profit is not a late convert to questioning the 12.5% corporate tax rate. We have done so from the very beginning. How does the Tánaiste morally justify the fact that for many months now, the Government has put, and continues to put, enormous energy and resources into preventing international efforts to have a minimal increase in the rate of tax on the absolutely staggering profits of some of the largest and wealthiest corporations in the world and make them pay just a little bit more tax? It seems to be willing to die in a ditch on this issue, in effect. We know that corporations are involved in aggressive tax avoidance and do not pay anything even close to the 12.5% rate but in reality pay approximately 5.5% collectively. Some of them pay far less.

Why does the Tánaiste think it is okay to try to prevent a little bit of extra tax being imposed on these staggeringly profitable corporations, but to trenchantly oppose efforts to reduce the tax burden on ordinary working people in this country? We pleaded with him last night not to impose a further tax hike through carbon taxes on ordinary working people, some of whom, such as the elderly, the vulnerable and the sick, will have to choose between food and heating their homes after the raft of energy price hikes. Now the Government is proposing to worsen that situation by imposing carbon tax hikes in the budget. Does the Tánaiste think Jeff Bezos is going to be worried about whether he should heat his home or have food? These people are making billions of euro. How does the Tánaiste think it is morally justifiable that workers in this country pay a minimum of 20% tax on their income but he does not think it is acceptable that corporations would pay the same amount in tax? Does he know, for example, that workers earned €130 billion last year and paid €27 billion in tax?

I thank the Deputy.

Corporations earned €200 billion and paid €11 billion in tax. In other words, workers paid 20%, on average, in tax and corporations paid 5%. Why does the Tánaiste defend the corporations instead of looking after working people?

I thank the Deputy. I believe taxes should be low, simple and fair. That goes for workers and companies. I am not sure if the Deputy believes taxes should be low, simple and fair. Perhaps simple and fair but not low. I believe that should apply to companies and workers alike. I hope that when it comes to budget day the Deputy will vote in favour of tax indexation, for example, where we raise the credits and bands so that people are protected from the effect of inflation on their pay packets.

Our position is one of defending our national interest. Some 250,000 people work in multinational companies in Ireland and that spins off another 100,000 jobs or so. That is 350,000 jobs. We want to retain those jobs in Ireland and we want more of them all over the country. We also want to protect our revenue base. We take in between €10 billion and €12 billion a year in corporation profit tax, double what the average European country does on a per head basis, precisely because we have a low tax rate. In the modern world that we live in, labour, capital, investment and money - all those things - are internationally mobile. If taxes are too high, the companies leave. If taxes are low, they come in. That is why the 12.5% rate has worked so well for Ireland and that it what this is about for us - trying to protect jobs and our revenue stream. The €10 billion or €12 billion we take in every year from corporations is roughly the cost of running our entire education system. It is that large an amount of money and we want to retain that coming in.

I know this can be characterised in a very simple way as corporations not paying their fair share of tax. They should pay their fair share of tax, whether it is here or somewhere else, but, in reality, these negotiations have been about other things. They have been about larger countries trying to get a bigger share of the pie and taking that share of the pie from us. It has not been about ensuring that countries in the developing world get a fairer share of the taxation; it has been about big and wealthy countries that think we are getting too much and want to take some of that off us. That is what we have to protect and push back against.

Those are scare tactics in order to justify the pitifully low levels of tax these corporations are asked to pay. As even the US Chamber of Commerce and representatives of many of these multinationals have said, the reason they are here is not primarily or exclusively the tax rate.

It is to do with the fact that we are an English-speaking country, we are within the European market, we have an educated workforce, and we used to have - not now, because of the lack of public investment - a decent water infrastructure and a proper energy infrastructure. The Government would be doing far better collecting some taxes off these corporations at a reasonable rate, comparable with what ordinary workers pay, in order to fund the investment in education, higher education, water and energy infrastructure and all of the things that can sustain investment and develop the economy in the mean time.

However, what I asked the Tánaiste was how he thinks it is justified to try to minimise international efforts to make these corporations to pay a little bit more tax. He has put huge energy into that but he thinks it is okay to whack a carbon tax on the elderly, sick and vulnerable, some of whom will suffer needless death this winter because of the cold and because of the energy price hikes and carbon tax, and he thinks it is okay that ordinary workers in this country pay three times the proportion of their incomes in taxes that these corporations pay.

The reality of these negotiations, and I have been following them closely for a long time now, is not how the Deputy has presented them or sees them. Large and wealthy countries are looking for more revenue and they want to take it from smaller countries like ours. In the negotiations, the UK made sure that the City of London was protected and would not see some of these applications applied to it. Some of these countries had their research and development tax credit system protected.

They have a 19% rate.

The US ensured that the EU dropped its digital tax proposals. That is the reality of what has been happening. As a small country that relies a lot on multinational investment, we had to protect our interests and seek guarantees and protections. We did exactly that. It is what any right-thinking Government should do.

I agree with the Deputy on one point. The offering from multinationals is, and always has been, about more than tax. It is about talent, infrastructure, and access to the European Single Market and the eurozone, to which I believe the Deputy is opposed. It is about commitment to free trade, which I believe the Deputy also is opposed to. Let us not forget one thing-----

The estimate not from me, but from the Department of Finance, is that increasing corporation profit tax in Ireland will result in a reduction in revenues. That is because investment, capital and wealth are mobile in the international world that we live in.

Where are they going to go?

I have been contacted by numerous people across County Tipperary regarding concerns about diabetic services in University Hospital Limerick, UHL. These concerns were highlighted in an article in The Irish Times, which concluded that diabetics in the mid-west region are offered a disgraceful service. There are 20,000 registered patients between counties Tipperary, Limerick and Clare. There are 225,000 people with diabetes in Ireland. Of this figure, between 10% and 15% have type 1 diabetes. People of any age can be diagnosed with type 1 diabetes, however, it is much more likely to be diagnosed in young people. Up to five children and teenagers are diagnosed with type 1 diabetes every week in Ireland. According to medical reports, the number of older people being diagnosed with the condition is steadily rising. Early intervention and specialised medical support structures are key to averting an influx of adult patients with type 1 diabetes.

In addition to being given the proper medication to treat and stabilise type 1 diabetes, the condition requires expert instruction on managing both the administration of insulin and the effective control of diet. In University Hospital Limerick, the needs of paediatric type 1 diabetics are being met by a specialist dietician. There is no specialist dietician in the hospital to attend to the needs of long-term or newly-diagnosed adult type 1 diabetic patients. If they are hospitalised, they can receive dietary advice and support from a ward dietician. There is no specialist care or outpatient appointments available for adult diabetics at University Hospital Limerick. This is not the quality of service we expect from a centre of excellence.

It is discriminatory and disgraceful that UHL does not provide pumps that deliver insulin subcutaneously 24 hours a day. These pumps offer diabetics the benefit of the latest technology. It is a simpler, and much less invasive, means of controlling the condition. These devices are efficient and effective and give the patient peace of mind and a release from regular injections.

In December 2020, UHL received confirmation of funding to recruit for three new additional dietetic posts for the treatment of adult diabetes. Nine months later, and those posts have not been filled. The HSE, in a typical bureaucratic flourish, tells us that the recruitment process for two of these posts is at an advanced stage, while the process for the third remains ongoing.

The UHL staff currently working with diabetics are providing exemplary care to patients. They are delivering a service under immense pressure. They need additional support.

Adults need and deserve access to dietary services and the provision of insulin pumps from UHL, which is deemed to be the centre of excellence for the Limerick, Clare and Tipperary area.

I thank Deputy Lowry for raising the issue the lack of insulin pumps and the recruitment of three additional dieticians, which was sanctioned nine months ago in UHL. I am advised that the University Limerick Hospitals Group recognises the need for additional resources within its adult diabetic service. This issue is a focus for the University Limerick Hospitals Group and it is committed to improving the service for its patients.

Developing services around insulin pump therapy and structured education requires them to fill further specialist posts, including nursing and dietician posts. While there is a specialist dietician working with the paediatric diabetes patients, there is currently no specialist dietician in post for adults with type 1 diabetes. Patients are seen by a ward dietician as inpatients, but currently, there is no specialist dietetic care or outpatient appoints available for adult diabetes patients in UHL.

In December 2020, the hospital group received confirmation of funding to recruit three additional dietetic posts for the treatment of adult diabetes. This funding has been made available through the national clinical programme for diabetes. These posts include two senior dieticians and one staff grade dietician. The recruitment process for the two senior dieticians is at an advanced stage. The recruitment process is also ongoing for the staff grade dietician post. UHL has advised that it will be able to provide a more precise timeline on when it expects the successful candidates to take up post in the the near future. A second consultant endocrinologist took up post on 1 October 2020. Two further consultant endocrinologist posts have now been approved. They are currently being progressed through the approved HR process. UHL will advise when the consultants are in place.

The adult diabetes service is also supported by a dedicated team of clinical nurse specialists and staff nurses. Four diabetic clinical nurse specialists, CNS, posts have also been approved for UHL. Of these, three have been successfully recruited and the successful candidates will commence post in the coming months, while the recruitment campaign is currently ongoing for the final CNS post. There are also two dietetic staff nurse positions within the diabetes unit at UHL, both of which have been filled.

UHL has advised that the provision of the dose adjustment for normal eating course for adults with type 1 diabetes will be dependent on the appointment of specialist dieticians and on the recruitment of additional CNSs. Currently, the adult service in UHL is unable to commence adult patients on insulin pumps due to service demands. However, it does accept patients established on pumps from elsewhere. These patients are managed under the care of a consultant endocrinologist. The largest group of these are patients who have transferred from the paediatric service in the region. All of the hospital group's insulin pump patients are seen in UHL. At present, there are 51 patients within its adult diabetes service who are using insulin pump therapy.

That information from the HSE, which is the kind of information that it has been giving us for the last nine months, is cold comfort to the patients who are waiting. They are living with a life-altering illness and need access to the services and support to which they are entitled, in keeping with other patients attending other hospitals around the country. I will quote one of the many patients who has contacted my office seeking help:

I feel, as a patient, that the HSE is letting us diabetics down as they are not providing us with the services which are very important to us to live as normal a life as possible and to avoid long-term complications. UHL is a regional hospital that covers Limerick, Clare and Tipperary, and over 20,000 diabetics live within these counties. It is a disgrace that we are being left behind, compared to similar sized hospitals that offer services to diabetics. I have to go to a private hospital to access services that UHL is not providing. I should not have to do this.

For those who cannot afford to access private services, what is the solution? As a medical doctor, the Tánaiste will be aware that diabetes, if not managed properly, is a serious illness with life-changing consequences.

It is a very common condition that can be successfully managed. Patients deserve to have access to technological advances to give them every advantage in coping with the illness.

I cannot begin to understand the frustration patients must feel if they are not able to get access to modern treatment such as this, and the anger they must feel when they see people receiving this treatment in other regions and it is not available in their own. I do understand this. What I can say from the Government's point of view is that funding has been allocated to University Hospital Limerick to hire the additional specialist staff that are needed. We are committed to getting the service up and running. I certainly encourage anyone involved in the recruitment process in the HSE and in University Hospital Limerick to expedite this and make sure the staff are hired. I understand, as is the case throughout Ireland and the world, that there is a huge shortage of people who have the specialist skills to fill these posts at a time when demand is rising but that is not an excuse. It may be a reason but it is not an excuse. The funding is there and we are determined to get the service up and running as soon as possible.