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Dáil Éireann debate -
Wednesday, 28 Feb 2024

Vol. 1050 No. 4

Ceisteanna ó Cheannairí - Leaders' Questions

Before I begin, I will welcome the ruling of the High Court in Belfast this morning that the British Government's legacy Act is in breach of the European Convention on Human Rights. It would be opportune to get an update on the interstate case early next week.

In 2017, thug an Rialtas agus an tAire, an Teachta Harris, gealltanas nach mbeidh aon leanbh ag fanacht ar obráid scoliosis ar feadh níos mó ná ceithre mhí ach briseadh an gealltanas sin do na páistí, do dhaoine i mo Dháilcheantar féin cosúil le Kylie Ann Stewart agus do go leor daoine eile. Sa lá atá inniu ann, tá go leor páistí ag fanacht ní hamháin ceithre mhí, ach blianta faoi choinne na hobráide seo.

Last week, children and families came to the Dáil. Like Kylie Ann Stewart and her parents, they travelled from across the State to have their voices heard. Kylie Ann, who comes from Kilmacrennan in my own county of Donegal, is ten years old. She is a brave and beautiful young girl. I had the opportunity to speak to her outside the gates of Leinster House. She has been failed by the Government, by the State and by the commitment the Minister gave her and her family seven years ago. Kylie Ann has been waiting five years for critical scoliosis surgery. She and her parents were first told she needed scoliosis surgery when she was four years old, yet she continues to wait. Her condition is acute, her pain is great and her parents are heartbroken. Right now, Kylie Ann's back is curved at 138°. Her parents have been told that if her spine curves by a further 10°, it will not be possible to operate on her. Kylie Ann has had to be especially careful with the skin that covers the bones that protrude from her back. There is a risk that the skin could break down, increasing the chance of infection.

I say all of this because, while we will discuss numbers and so on later, this is the reality Kylie Ann and her parents have to manage every single day, and many other Kylie Anns out there. We in this House cannot contemplate what it must be like to endure that as a ten-year-old child or as a parent who has to watch as months and years pass without any sign of an operation while knowing that the clock is ticking and that, if the curvature gets worse, the operation will not happen at all.

This is life for the 288 children across our State who languish on waiting lists for critical scoliosis surgery. Last week, I had the opportunity to chat to many of them. They came here to the Dáil to make their voices heard and to say that enough is enough. Seven years ago, as Minister for Health, Deputy Harris gave a commitment that, by the end of 2017, no child would be waiting longer than four months for scoliosis-related surgery; a promise he made, a promise he broke. That promise made to Kylie Ann and a great many other children has been broken year after year. There are more than 70 children who have been waiting longer than four months for this surgery. Like Kylie Ann, many have been waiting for years. Kylie Ann has been waiting for this operation for more than half her life. Two years ago, the Minister's successor, Deputy Stephen Donnelly, made the same commitment. He announced €19 million in funding for scoliosis-related surgery. Last week, he told the Dáil that he does not know if all of this money was even spent for this purpose. At the same time, the Government is asking parents and advocates to trust the system. After years of broken promises, how could these children and their parents have any faith in the system?

There are things that can be done for the 288 children who are waiting for scoliosis-related surgery. Previously, those who were well enough to travel could access treatment abroad through a specific tailored programme. That programme was ended before the pandemic in 2019 and waiting lists started to rise again. It beggars belief that the treatment abroad scheme was stopped when children were waiting more than four months for their operations. We need to build domestic capacity for those who cannot travel. The Government needs to identify a surgeon who can perform this work, even if it means an international search or a bespoke arrangement. The Government must establish a truly independent task force to get to grips with this scandal. What is the Government's plan for Kylie Ann? Has the Government or Children's Health Ireland sourced a surgeon at home or abroad who can do this work? Will the Government establish an independent task force with the remit set out last week, which was to engage with and act on the concerns of parents and advocates to improve the health service for all of these children? In his response, will the Minister also tell us why anyone, including these children and their families, should trust anything he says given that he made that promise seven years ago and broke it?

I join with the Deputy in acknowledging the ruling from the High Court in Belfast issued earlier today by Mr. Justice Colton. It is a long ruling of approximately 200 pages but it seems positive from the perspective of the Irish Government, which wants to work to ensure that all families get justice, which is what they deserve. Officials from the Department of Foreign Affairs are in close contact with organisations assisting the plaintiffs in this case. Many families in Northern Ireland stand to be impacted by the legacy Act and they will be studying today's judgment carefully. I have no doubt there will be an opportunity to provide an update on that in due course.

I thank the Deputy for raising an extraordinarily important issue that everybody in this House and in this country wants to see resolved. He referenced Kylie Ann and he is right; nobody in this House can imagine the pain that she and her family are going through. When I was Minister for Health, I met many families whose children were awaiting scoliosis procedures. I remember them; I remember their names and their faces. I know something of what they were going through, although none of us can fully imagine it. As a result, I decided to place an unrelenting focus on reducing scoliosis waiting times in 2017.

The Deputy is correct; the HSE told me and mentioned in its strategic corporate plan that it wanted to reach a point at which no child was waiting longer than four months and to bring scoliosis surgery waiting times in line with those under the National Health Service in the UK. With hand on heart, I can say that, as a result of that commitment, we saw very significant progress in achieving that target. The Deputy does not have to take my word for it, although I am sure he would not. However, I am sure he will accept the word of the Ombudsman for Children. A report published by that ombudsman has shown that, by the end of 2017, the number of children waiting longer than four months was down to 29. The report also states that the ombudsman met with many people and that, in meetings with the Department of Health, the children's hospital group, consultants, hospital staff and management and myself, he noted an absolute commitment from all involved to addressing this matter in the best interests of children. People worked tirelessly and we saw waiting times reduce very significantly. We opened an additional theatre in Crumlin and hired additional theatre nurses. Many more surgeries were carried out in those years than had been carried out before and many children got access to life-transforming surgeries. All of that is true.

The Deputy referenced the pandemic. He again does not need to take my word in that regard. An article from the Irish Examiner of 8 September 2020 mentioned that the closure of theatres and reduction of certain health services during the pandemic had a real impact and led to progress reversing. As a result, we have seen the health service working night and day to try to build on that progress. My successor, the Minister, Deputy Donnelly, is extraordinarily committed to getting where we need to get to and to getting this thing back on track because the Deputy is right; we are not talking about numbers but about real children and no one wants to see them suffering.

It is important for parents to know that there are extra theatres opened and additional theatre staff in place. Some €19 million has been allocated and that funding has done real tangible things. It has resulted in an additional 193 staff working in the health service. These are doctors, nurses and radiographers working on spinal surgery in Cappagh, Crumlin and Temple Street. As the Minister for Health told the House last week, another wave of capacity is now due to come onstream. There is another theatre due to open in Temple Street and another MRI scanner due to open in Crumlin, along with 24 additional beds. From memory, I know that beds are a core component of the delivery of these surgeries. I believe 20 of these are already open.

The Deputy raised two specific questions. One related to the issue of a task force. The Government and I believe that is a sensible suggestion. A task force will be established and it will include all stakeholders, including patient representatives and clinicians, whose inclusion is also important. The Minister for Health met with a number of advocacy groups last week to discuss the terms of reference for that task force and patient advocates were very clear about what they want that task force to do. In collaboration with the advocacy groups, work is now progressing on addressing the terms of reference. The task force will have an independent chair and, contrary to some of the misinformation that is out there, it will not report to Children's Health Ireland.

I asked the Minister what his plan was for these children and for Kylie Ann? I used Kylie Ann as an example but we could name many other children. She has been waiting for five years. The curvature of her spine is 138°. If it increases by a further 10°, it will be inoperable. During this five-year period, the Minister, Deputy Harris, has been in Government, including as Minister for Health. Over two years ago, his successor, the current Minister for Health, Deputy Stephen Donnelly, made a commitment, just as the Minister did seven years ago on the basis of a plan, that by the end of that year, nobody would be waiting more than four months. It still has not happened. Kylie Ann and many others like her are not waiting for four months or even four years; some of them have been waiting longer than that. I will ask the question again. What is the plan for these individuals? The Minister, Deputy Harris, spoke of money being invested. The Minister for Health, standing where the Minister is now standing, said he was carrying out an audit because he did not even know if all the money he allocated went to scoliosis treatment. That was two years after he announced that allocation and on the day we brought forward a Private Members' motion because the issue is not receiving the attention it needs.

The reason I have put this into the life experience of the child is that we have to be children centred here. What is the Government going to do? For the last seven years the Minister, has been in this Government, including as Minister for Health when he made this commitment, which is drastically failing these children. It is simply not good enough.

Your time is up, Deputy.

What we will do for Kylie Ann, children right across the country, parents and families is get this back on track. We saw the progress that could be made in 2017. We saw the fall in wait times, the extra children getting their services and the Ombudsman for Children's report welcoming some of that. We now have an extra €19 million. There are additional staff. I am very clear on that. There are 193 more staff and a new theatre due to open. New diagnostic equipment, an MRI, is due to come on stream in Our Lady's Hospital in Crumlin. Let us not suggest that any of us has greater concern than anyone else because I could equally ask the Deputy what he is going to do. While he has rightly raised the issue over the last while-----

Let us in there.

Hang on a second. I am not planning on doing that at all, to be honest.

At least I would not break my promise to these children, as you did.

With respect, as Deputy Cairns said in a reminder to the House yesterday, "Show me your budget and I will tell you your priorities". I have here Sinn Féin's alternative budget. I ask the Deputy to direct me to the page that references scoliosis, spinal surgeries or any additional funding. This Government is absolutely determined to deliver for these children. It is working night and day. There is a task force in place and engagement with the advocacy groups. Consultant surgeon David Moore has been appointed to head up a paediatric spinal surgery management unit. There is no lack of compassion and there will be more delivery.

That was seven years ago.

We are running out of time to stop the climate crisis becoming a catastrophe. Every day, every equivocation and every cowardly U-turn makes that work so much harder. We know that people in Ireland are especially worried about the impact of climate change. We only need to look at the recent flooding events in Midleton to get a glimpse of what the future holds. According to new research from the Environmental Protection Agency today, three quarters of people believe that extreme weather poses a risk to their communities. Much of our population lives by the coast or by rivers and they see that rising sea levels and flooding pose risks to their homes, farms and futures. This is why a large majority of people, 79%, say that climate should be a high priority for the Government.

This Government claims that climate is a high priority but time and again we see that the Government's climate rhetoric far exceeds climate action. Government MEPs voted for the nature restoration law in the EU this week. Simultaneously, we have had two separate reports in the past week alone that confirm the Government is nowhere near meeting its targets. The European Commission says Ireland will only reach one quarter of the emissions cuts we need. The Climate Change Advisory Council states the Government is nowhere near meeting the targets it set out for its first carbon budget. When we inevitably miss those legally binding targets in 2030 the country faces the prospect of up to €8 billion in fines from the EU. Imagine what €8 billion could do to improve our biodiversity, expand public transport systems across the country and protect the future of Irish agriculture.

We are so far behind where we need to be now that making up ground will be extremely difficult. At the pace this Government is moving, it will be impossible. Climate action requires more than plans laid out in glossy brochures and watered down legislation. It requires actually implementing measures that will make a real difference and it means doing so quickly. We cannot wait until next month or next year to start this work. We need climate action yesterday. Instead, this Government is knowingly setting us up for failure. We all know that doing nothing is not an option but equally not doing enough is not an option either. Will the Minister outline what changes the Government will make to avoid this impending disaster and meet our climate targets?

I thank Deputy Cairns for raising this important issue. I will begin by paying tribute to my colleague, the Minister of State, Deputy Malcolm Noonan, for the leadership he has shown within Government throughout this process. This deserves to be commended. Yesterday was a significant day. The Deputy rightly acknowledged that Government MEPs voted in favour of the nature restoration law in the European Parliament. I am sure she noticed that the main Opposition party's MEP voted against it. That is of particular importance to the Social Democrats considering they are keeping their mind open after the election. I am sure the Social Democrats will want to discuss with Sinn Féin the reason it wishes to remain a climate laggard at a time when the rest of us are trying to pull together and are taking hard political decisions. This particularly the case in an era of misinformation and disinformation about what this nature restoration law does and does not do. It was disappointing yesterday that some Irish MEPs voted against the proposed nature restoration law but I am pleased that the overwhelming majority voted in favour of it.

Now that the current text has been adopted by the European Parliament without amendment, which is not a small task, with 329 MEPs in favour, we will move forward to the member state approval process. This is expected to take place on 25 March when member states, including the Government on behalf of Ireland, will have a chance to formally adopt this measure as law. It is my understanding that the compromise text is currently going through the various legal processes. The text sees the retention of flexibility gained in the general approach, including an alignment of the marine targets with the marine strategy framework directive, and a move from absolute area targets to increasing trend-based targets for urban ecosystems.

There is a lot of misinformation around the nature restoration law. There is a lot of fearmongering and a lot of people attempting to use it to worry the agricultural community in a way that is inappropriate. What will now happen is that each State will have to come up with its own national plan for how it intends to act on the nature restoration law. We will have time to do that and we will each have to develop a national restoration plan and show how we intend to implement that plan and monitor and report against implementation.

Let us be clear. This is going to require the Government to provide funding mechanisms to help people transition. That is why we made a specific decision in the last budget to set aside some of our economic and financial surplus for a specific fund for climate. This will be required as we begin to develop the financial schemes that will be needed to help people transition.

I am very proud of the record of this Government when it comes to climate. We have taken a number of very important decisions. There has been a 135% increase in funding for wildlife and parklands. We have seen our new national biodiversity plan. There is now a huge increase in the number of homes being retrofitted and the number of people seeking to drive electric vehicles.

There is no denying science in relation to this and there was some worrying commentary today. I heard the director of the Environmental Protection Agency speaking on RTÉ radio this morning about the number of people who still seek to equivocate around climate. There is a climate emergency. It is real and the science is real. The Social Democrats are not doing it but we in this House should not lecture farmers and others and tell them they must do this or that. We need to help people transition. The Government has put a number of measures in place already to do this and will introduce more. Yesterday's adoption of the nature restoration law is a very significant step for Ireland, the bulk of our MEPs and the European Union.

The Minister either did not hear my contribution or questions or he just did not have a defence for our climate targets, which are what I am asking about. While I obviously welcomed the Government MEPs voting for the nature restoration law, I did not ask the Minister about that issue, which is the only one he replied on. The reality is that independent expert groups believe Ireland is on course to massively miss our climate targets. If the Government cannot accept that reality, it is quite worrying. There is no denying the science. Continuing with an incomplete and inadequate climate action plan guarantees failure. Expecting the nature restoration law to change that course is guaranteed failure. If we do not act now, it will devastate the country. The people who will feel the impact first are our farmers, our rural communities and people living in poverty.

Will the Minister tell me what all of the experts who say we will miss our targets are missing if he does not agree? He did not reference our targets. The most recent offshore wind project is 20 years old. The Government promised that a low-interest loan scheme for retrofitting would be in place by 2020 but almost two years later, we still do not have it. A total of 85% of our protected habitats are in poor condition, with 46% in active decline. The list goes on. Does the Minister accept the reality that the Government will not meet its climate targets? He does not accept the science.

Thank you, Deputy. The time is up.

What will the Minister do about it?

Just because someone does not agree with you it does not mean they do not accept the science. I am a Minister for science, for the record.

It is not agreeing with us; it is agreeing with the independent advice.

I very much accept the science and we very much accept the advisory structures we have set up. We very much accept that the challenges and targets which have been set are really difficult. I very much accept that every day, every week and every month it requires the Government to do new things. If we take agriculture, for example, as an area that has a significant focus on it-----

Does the Minister accept the Government will not meet the targets?

No, I accept-----

Please, Deputy. You have asked the question and let us hear the answer.

It would be lovely to answer it. The Government is absolutely bound by the targets and is working to achieve them. Do I accept the targets are extraordinarily challenging? I do but I am pointing out that in this House it has been said, for example, that farming will never reach its targets. This is not true. We are seeing emissions from farming and agriculture drop. We are seeing farmers do their bit and make the difference. We are seeing investment in technology through Science Foundation Ireland to help farms in the Deputy's part of the world in west Cork become carbon neutral in terms of how they deliver. We are seeing a real increase in the investment we are making in the retrofitting of our homes to get 500,000 done by 2030. This is a core part of our plan. We are seeing incentives to help people convert to electric vehicles. We are making the investments and we will make more. I do agree that the climate emergency is real. The science is clear and meeting our targets is absolutely required. We will continue to work across parties to make this happen.

Last week a disturbing article appeared in our local newspaper regarding South East Technological University, SETU. The article discusses a conversation that took place at a meeting of Wexford County Council between the now retired chief executive and a local councillor, in which it was alleged that SETU and the Department of higher education are dragging their heels. I am a graduate of what is now South East Technological University. We have a very limiting campus whereby we cannot expand and certainly not into STEM courses. We do have more than 1,100 students on the campus. We very much look forward to a new state-of-the-art campus, which the Minister has heavily endorsed. We also have devolved Departments of environment and agriculture in Wexford. I see the future of education in Wexford as very much in STEM courses when the new campus is brought there.

I very much hope that what is alleged in the article is not true for the families who are contacting me about whether their children will be able to start their third-level education in a Wexford campus of SETU. They are looking for timelines; they are not looking for stories that will result in non-delivery. This is the big issue for people. Stories and photo opportunities are all well and good. Headlines for councillors, chief executives, TDs and Ministers are all very good but delivery is what is key. It is paramount that we understand that Wexford had been left behind prior to and until the setting up of SETU. I could not have furthered my education were not for the campus in Wexford of the then Carlow Institute of Technology. I undertook my course at night time. I could not have done it in any other way. As a result I have a law degree. I am very proud of this but there are many parents who envisage not being able to send their children to third-level education because of the cost-of-living increases they are experiencing, the exponential cost of accommodation they are experiencing and what they expect to pay for accommodation in Dublin, Galway and Limerick and other university cities. It is paramount to the people of Wexford and the surrounding south east counties that we get our state-of-the-art campus and that it encompasses STEM courses as well as utilising the Departments that are devolved in Wexford. A huge expansion of Rosslare Europort is ongoing. We have offshore wind development. The campus and what we foresee in education will only complement this. This is what we need to plan for and what we need to see. I ask the Minister whether these allegations are correct and why he is dragging his heels.

I thank the Deputy. I hope she is asking a question to which she knows the answer is that we are not dragging our heels. The commitment we have given to the people of Wexford, to the Deputy and to the people of the south east is real. It is very real because we have invested an awful lot of money in it already. To be absolutely crystal clear, it is our intention to develop a state-of-the-art campus in Wexford. As the Deputy knows, we, and specifically SETU, have been working very closely with the local authority to try to secure a permanent home for the Wexford campus. I should pause and make the point that Deputy referenced in passing. There are already approximately 1,000 students studying third education through SETU, and she was once one of them, in County Wexford. We already have 1,000 students studying in a university in Wexford. They are not in a state-of-the-art campus and this is the problem. There is an ability to do a hell of a lot more if we can give them modern facilities.

The Deputy knows we have identified the preferred site. There had been a lengthy negotiation process that did not reach agreement. Wexford County Council has since progressed the acquisition of a site totalling 48.5 acres by way of compulsory purchase order. The intention is that a proportion of this site will now be used to facilitate a new Wexford campus for SETU, with the remainder of the site being developed by the local authority and the Murphy will have more information on this than I do. I was delighted to announce on 9 November 2023 that the acquisition of the Wexford town site has progressed significantly. What I mean by this is it had issued the notice to treat. My legal advice is that once this notice is issued it marks a significant milestone because it legally obligates the local authority to acquire the property. It also legally obligates the owner to surrender same.

SETU is now engaging with the Higher Education Authority to develop its case on what it wants to develop on the site. The project will be progressed through the technological sector strategic projects fund framework. That is how we intend to fund the development on the site. I spoke with the president of the South East Technological University, Professor Veronica Campbell as recently as yesterday. I am very confident following the conversation that she, her team and the governing authority have a very clear vision for the site. It is a vision that reflects on the strengths of the region and builds on links with employers in the region. It is not for me to speak for the autonomous institution but a number of the areas referenced by the Deputy around playing to Wexford's geographic strength make an awful lot of sense. Offshore wind is an obvious area of great potential.

I am absolutely confident that Professor Campbell, SETU and the Department not only are not dragging our heels on this but are enthusiastic proponents of having a clear plan as to what can go on the site. Of course it goes without saying, but I best say it for the record, the president of the university does have to follow the various approval processes and the public spending code. She does obviously need to seek governing authority approval. Once that happens, it will feed into the overall master plan.

I have heard a little bit of misinformation too and let me correct it. It was not from the Deputy. It was a little bit of misinformation around SETU holding up the master plan. This is not true. Wexford County Council should progress as it intend to do with its master plan. I am absolutely confident that the work SETU is undertaking will complement it and fit perfectly within it. I understand it intends to put the draft master plan out to consultation in June with responses due back by October.

I thank the Minister. I am glad to hear him reaffirming the endorsement of a new campus for Wexford and the people of Wexford will be very glad to hear it. These allegations made at a public meeting of the county council are not helpful. The article also states that while the CPO process was invoked in January, it was completed in March. Intelligent people will know this was not the case. The notice to treat was served but the process is anything but complete. I do believe that what people want is a timeline. I ask the Minister to ensure the president of SETU engages with the county council so that we do not have the retired chief executive making allegations that it is holding it up. This is exactly what the article says, which is exactly what was said at the meeting. It is the same for county councillors trying to make political capital. People are very concerned about this and they want a timeline more than anything so that their children will be afforded the opportunity of a third level education. For some this means in Wexford and Wexford only.

I am a firm believer that having access to a university in your county and community makes a real difference.

I met a number of the students at the Wexford campus. Similarly to the Deputy, they told me that they could not have accessed third level education were it not for the provision of a campus in Wexford. We must now ask what more we can do in Wexford and what the benefits would be in terms of foreign direct investment, job creation and playing into the strengths of the south east, complementing the work in Waterford and at the Waterford Crystal site. I see Deputy Shanahan sitting beside Deputy Murphy.

I would be happy to go to Wexford again and meet all of the stakeholders. The Government and the president of SETU are clear that a state-of-the-art Wexford campus is key – it is in SETU’s published strategic plan, which has been passed by the governing authority – but everyone needs to understand that the president has a process that she must follow, and she is correct in how she is following it. We must follow the various approval processes as well. This does not in any way, shape or form mean that SETU does not intend to slot this into the master plan. It does, and I look forward to that plan going out for public consultation in June and getting the feedback in October. I look forward to visiting Wexford and having engagement on this shortly.

Information supplied to me in response to a parliamentary question to the Minister for Health revealed that, since 2010, the total cost to the State of defending medical negligence litigation against the HSE and Department of Health, including court settlements, had exceeded €3 billion. In fact, there had been a 400% increase in costs from 2010 to 2023, rising from €74 million to just over €350 million. The Minister will agree that these are staggering costs and a clear indication that there is something profoundly broken when a health system for such a small a country can generate these kinds of costs and settlements.

These costs relate to claims against all HSE locations, namely, acute and community settings, section 38 service providers and the national services and disability sector locations. Behind them, however, are traumatised patients, devastated families left with life-long care needs, and doctors and medical professionals who have been broken by the adversarial and lengthy nature of the litigation process. We know that doctors are leaving our system because of this. As Professor Gabrielle Colleran, vice-president of the Irish Hospital Consultants Association, pointed out on RTÉ on Monday in response to my parliamentary question, Ireland and the United States were top of the table internationally in terms of medical negligence litigation. As Professor Colleran pointed out, some of the major reasons for this had to do with the ongoing failure to optimise care, treatment delays, unfilled medical posts and overcrowding in emergency departments, which generates its own kinds of adverse outcomes, including death.

In response to queries from a journalist, Mr. John Drennan, on this issue, the Private Hospitals Association of Ireland also expressed concerns about Ireland’s outlier status when it came to the cost of medical negligence. The PHA stated: "The human and financial cost of the current clinical negligence claims system reveals a system that is not fit for purpose and has not been fit for purpose for some time."

What are the possible solutions? According to Professor Colleran, the first thing we need to do is be ambitious about the introduction of pre-action protocols, which emphasise a less adversarial mediation process. As I understand it, when such pre-action protocols were introduced in Australia, the cost of claims fell by 50% and the average cost of litigation fell by 20%.

Given the costs involved and the high likelihood that we will face €500 million in costs in 2024, will the Minister commit to establishing a high-level HSE and Department of Health working group to examine options such as those put forward by Professor Colleran around pre-action protocols?

At the outset, I will call out and condemn what happened to the Deputy’s constituency office. I am thinking of her and her staff and would encourage anyone with information to come forward to the Garda in Offaly. It was an utterly despicable act that should be called out and condemned by all.

I thank the Deputy for raising this important issue. She has made a number of constructive suggestions and interventions on it. The first action we need to take is to make our health service as safe as it can be. That requires additional capacity, as reducing overcrowding in EDs plays a part in helping us have a safe environment. It also requires putting structures in place so that, when something goes wrong, all of the facts are shared with patients in an up-front and frank manner and a safe environment for the sharing of that information can be provided. A great deal of work has been ongoing in health in recent years in terms of the establishment of the National Patient Safety Office and the passing by the Oireachtas of the landmark patient safety Act and the relevant provisions around open disclosure. From meeting many patients in my time as Minister for Health, I know that the failure to disclose often caused significant pain and people to feel like they had been forced into the legal system when all they wanted was answers and for someone to be up front and talk to them. Equally, or perhaps not equally, the clinicians said that they did not know how to interact in that regard and there needed to be clear policies and laws.

The patient safety Act was an important step, but the Deputy is right about there being actions that need to be taken to reduce the costs arising from medical negligence. Of course, we need to reduce medical negligence as well, and to address Professor Colleran’s points, steps are being taken. Speaking from memory, the Government appointed in January of last year Dr. Rhona Mahony, an eminent individual, the former master of one of our maternity hospitals and a leading clinician, to chair a group to do exactly as the Deputy suggested, that being, to consider how to reduce the cost of health-related legal cases, with a particular focus on some of the higher cost cases as examples. My understanding is that that work is nearing conclusion. When it is concluded, its report will be considered by the Minister for Health and relevant Government colleagues, published and, I expect, brought to the Cabinet. We need a roadmap. It is important that we consider how to reduce the patient safety incidents in our health service that the Deputy referenced. It is also important that, when things go wrong, we have a system in place that is not an outlier in terms of legal costs and timelines compared with neighbouring jurisdictions.

I thank the Minister for his comments of support. They are appreciated.

There needs to be more accountability. While I acknowledge that there are patient safety measures in place, the model is failing and patients and medical professionals are getting caught up in a system that is not fit for purpose. The establishment of a working group between the HSE and the Department of Health would be a good approach. Along with other steps, I hope that such a measure can be put in place to ensure that Ireland is not an outlier, we can address the issues and, most importantly, there is accountability within our health system.

I assure the Deputy that the HSE, the Department, the State Claims Agency and, I believe, the Department of Finance are represented on the group chaired by Dr. Mahony. I have the terms of reference with me. The group will assess why the costs of claims are continuing to rise, develop a plan to implement risk management, recommend measures to address patient concerns, and receive updates on the implementation of recommendations that were set out in previous reviews of the law of tort. Fundamentally, the group needs to consider suggestions for what practical measures we can take to help reduce costs. I am pleased that there is a wide variety of expertise from government and outside of government in the group and my understanding is that it is due to report shortly. The Government can reflect on the Deputy’s suggestion at that stage in terms of what we need to do to consider and implement those recommendations. We are looking forward to the report and are grateful to Dr. Mahony for agreeing to chair the group and bring her significant healthcare experience to it and to the many other people sitting on it.

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