Dáil Éireann debate -
Tuesday, 16 Apr 2024

Vol. 1052 No. 4

Ceisteanna ó Cheannairí - Leaders' Questions

Deputy Mary Lou McDonald

Scoliosis is a debilitating and painful condition for a person's spine twists and curves. It can cause the ribcage to press against the lungs and internal organs making it increasingly difficult to breathe. It is especially tough on young children. Where children do not get the surgeries they need on time, the consequences are devastating. The longer they wait, the more complex the procedures they will eventually need and without timely care, children end up in wheelchairs. Some children wait so long that they become inoperable and they have run out of time. Too many children and their parents face this agonising wait. The suffering and the mental distress is just unimaginable. In 2017 the Taoiseach promised that by the end of that year no child would wait longer than four months for scoliosis surgery. That was seven years ago and that promise has been broken again and again. To be clear, the four-month target was agreed between the Taoiseach as the then Minister for Health and the HSE based on international best practice. That promise made by the Taoiseach then was broken. He failed to build the capacity needed here and in 2019 he ended the scheme through which children could travel abroad to have their operations faster.

Last night, my colleague, an Teachta Cullinane, and I again met parents of children of scoliosis and spina bifida. They are very angry, hurt and they feel completely betrayed. They asked me to relay their words to the Taoiseach directly. They said they wanted to tell Simon Harris that Government has actively consistently and comprehensively failed their children. They said to tell him that they as parents did all of the right things, everything they could do, and yet their children are subjected to serious and ongoing harm.

The Taoiseach met these families back in 2016 and many of the same children are still in the system today experiencing delays to the treatments they need so badly. Moreover, parents live every day with the fear of their child becoming inoperable. They say that many of the parents are kept in the dark by Children's Health Ireland, CHI, and they see hard-working consultants under huge pressure and without the resources they need. Parents suspect and fear that many more children may have run out of time and have become inoperable. They want the Government to fund a second opinion for their children, independent of CHI. The Taoiseach can see that their trust has been shattered by all of the empty promises. Níl aon ghá le gealltanais fholmha do pháistí le scoliosis agus spina bifida. Is é an rud atá uathu ná nósanna imeachta leighis anois.

Yesterday, the Taoiseach restated a promise to children with scoliosis and spina bifida but these children do not need any more promises. They need the operations. The Taoiseach stated that every resource possible will be provided "to make sure no child finds themselves waiting in pain and agony". These children, however, are waiting in pain and agony today and as I heard this promise from the Taoiseach seven long years ago, I have three questions for the Taoiseach. First, is the Taoiseach promising once again that children will not wait more than four months for spinal surgeries? Second, is the Taoiseach reinstating the scheme for children who can travel abroad to get their operations? Third, will Government fund that second independent opinion, independent from CHI, that parents are now demanding for their children?

Deputy Louise O'Reilly

Hear, hear.

Deputy Ruairí Ó Murchú

Hear, hear.

The Taoiseach

Gabhaim buíochas le Deputy McDonald and I thank her for raising what is an extraordinarily important, stressful, and worrying issue for many families in Ireland. As the Deputy has rightly said, I have met many of the families, there are many families that I know and many children whose faces and names I still remember. Nobody, not Deputy McDonald or me, nobody on this side of the House or on that side of the House wants to see any child waiting in pain. On that we can all absolutely agree.

The Deputy is absolutely correct in stating that when I was Minister for Health, I did place a real focus on this issue. It was said to me by the then director general of the HSE that the executive would put a plan in place to ensure that no child waited longer than four months.

That plan originated, as the Deputy correctly says, from clinical advice, and I believe similar clinical advice exists within the NHS. That was the clinical advice then and it is the clinical advice now. Of course, there can from time to time be complexities, as all of us know, as regards individual cases and multiple medical conditions and how they interact. Having said that, that is where the four months came from. What I definitely know is that by placing that focus on scoliosis, we saw a very significant reduction in the number of children waiting over four months. If we are to start Leaders' Questions by engaging in good faith, I think the Deputy will acknowledge when she looks at the figures that after I gave that commitment, the progress that was made in a short period in very significantly reducing the number of children waiting over four months was real and was felt and there were weekly reports produced. The Covid pandemic happened and waiting times worsened. Waiting times worsened for all procedures, including scoliosis.

My colleague, the Minister for Health, has been putting a real focus on this issue, continuing that work and trying to re-engage and refresh on it, including with new clinical leadership. I very much welcome the fact that he has appointed Mr. David Moore, a consultant surgeon in this area, to be a clinical lead, which all of us should welcome because I think that clinical expertise will make a real difference.

We have seen a very significant increase again in the number of spinal procedures now carried out. For example, in 2022, 509 spinal procedures were carried out. This compares with 380 in 2019. It represents a 34% increase in the number of procedures and a 22% increase for the year 2023. We now have the paediatric spinal surgery management unit in place, and so far this year, in 2024, we have seen over 120 spinal procedures take place. The Government remains absolutely committed, as I know everyone in this House does, to doing everything we humanly can to assist children with wait times and to assist their parents, who go through such a stressful and worrying time as well.

The Deputy has asked me three questions, so let me endeavour to answer them. As I have said as regards the first one, the four months remains the clinical advice and the clinical target and, therefore, that is what the Government here and governments around the world must work towards.

Second, yes, my understanding is that Mr. Moore, the consultant surgeon, is now looking at the issue the Deputy has raised as regards treatment abroad options. It is important that that is considered, and I welcome the fact that the Deputy, on behalf of parents, I think, makes that suggestion here today.

Third, I will engage with the Minister and the HSE on the idea of an independent opinion because it sounds like a suggestion made in good faith.

The Deputy should know this. This is an issue which will continue to receive extraordinary levels of care, investment and attention from the Government. I know also that the Minister for Health is convening a dedicated paediatric spinal task force with an independent chair. I know the idea of an independent chair was seen as essential by many of the advocacy groups. That independent chair is Mark Connaughton, who is a senior counsel, and the chair is now meeting with stakeholders and patient groups and finalising the terms of reference, which is another important step forward.

Deputy Mary Lou McDonald

The Taoiseach says that nobody wants to see children in agony and pain, but that is exactly what we see. I spoke last night to one mother whose child is now no longer a child. They are now 19 and inoperable. Why are they inoperable? They are inoperable because they waited and waited and waited. The mother said directly that they followed all the right protocols and all the care paths - and for what? Words and rhetoric are of no value to them. The only good faith that matters on this subject is the good faith of the Government. That is the issue. The issue here is that we have 4,000 children awaiting their first consultation. That is the length of the list. We have 270 children on the surgery waiting list, 78 of whom have waited and waited far longer than four months. Here is perhaps the worst feature of all: the most complex and the most desperate of cases in many instances have the longest waits. These families - these children, these young adults, these parents - are now in a state of absolute panic.

I want a concrete commitment from the Taoiseach that he will not simply engage but deliver on the independent opinion and on the travel abroad.

More broadly than that-----

An Ceann Comhairle

Please, Deputy, time is up.

Deputy Mary Lou McDonald

-----the parents want to know that now he is Taoiseach, he will finally honour a promise he made many years ago.

Deputy Pearse Doherty

Hear, hear.

The Taoiseach

I thank Deputy McDonald. First, I answered her three questions sequentially and clearly. I will continue to engage with her on the three answers I gave her. Second, it is a little dismissive to suggest words and rhetoric when 120 procedures this year is not rhetoric and massive levels of investment in theatres and hiring more nurses and doctors are not words; they are real actions. I know it suits the Deputy to suggest these are just words and rhetoric but they are real things we are doing to make a real difference. There is no monopoly on concern. Even in the past fortnight, the Minister for Health has received requests from Mr. Moore, the new clinical lead, in relation to further additional staff and posts and has provided the green light. I will engage with the Deputy in good faith on these exchanges but it is not words or rhetoric; it is real solid action which we are taking to address an extraordinarily difficult thing. She can shake her head if she wishes but that is what it is.

I hope that when Sinn Féin meets and engages with these families and positions itself as having all the solutions to all of the issues, it has the good grace to tell them that when it had an opportunity to put an alternative health budget to this House, it provided €500 million less to the health service than this Government provided.

Deputy Pearse Doherty

That is not true.

The Taoiseach

How do you square that circle in terms of extra staff and extra investment?

Deputy David Cullinane

That is blatantly not true.

Deputy Louise O'Reilly

That is nonsense.

Deputy Pearse Doherty

That is misinformation.

The Taoiseach

It is true. It is in Sinn Féin's alternative budget available on sinnfein.ie.

Deputy David Cullinane

We will fact-check that for the Taoiseach.

Deputy Pearse Doherty

Can we get a fact-check?

An Ceann Comhairle

Please. It is Leaders' Questions, not anybody else. I call Deputy Cairns.

Deputy Holly Cairns

Stop the clock. I am just waiting for them to leave. The "RTÉ Investigates" programme about our abortion services that aired last night was harrowing. It was also infuriating because everybody in this Chamber is already aware of all of the problems with these services. The Government has been sitting on the expert report that pointed out these problems for 12 months. Instead of action, we have had a game of political pass-the-parcel. The expert report was kicked to the health committee before being kicked back to the Government, where it has been since December. Last night, we saw clearly the people who are paying the price for that inaction, namely, women across the State who are traumatised, stigmatised and penalised. The Taoiseach has previously spoken about how he came to support repeal. He said one reason was a briefing he attended by the group Terminations for Medical Reasons. These are women and their partners who received a devastating diagnosis of foetal abnormality and were forced to leave the country for a termination. The Taoiseach stated, "I have never before left a briefing so moved by it ... I was really ashamed at how these people were treated", That quote is seven years old. Despite the repeal vote, nothing has changed for these women. Irish law still forces them abroad for care because often doctors either cannot definitively say complex foetal abnormalities will lead to death within 21 days of birth, as the law demands, or they interpret the law conservatively because of the threat of criminal sanction, that is, up to 14 years of a prison sentence. The result is devastated women like Alison Gibney, who are forced to travel at the most traumatic time of their lives. Then, heartbroken, they are forced to smuggle their much-loved stillborn baby back into the country, as she said, hidden underneath coats in the boot of her car. Or women like Allison Lynch and Christine Monaghan who were forced to leave their stillborn babies in the UK and travel back without them. Why are we allowing this terrible suffering to continue? We are the legislators. We are the only ones with the power to change this. We have a duty to do it. The Taoiseach was the Minister for Health when we had the repeal vote. As Taoiseach, he can take the advice of his own expert report and reform the law before more women and families experience even more trauma. I recognise the importance of operational reform and that more maternity hospitals are now providing the abortion services but I am asking him about something else today.

In his reply, I ask him to specifically answer these three questions. Will the Government remove the mandatory three-day waiting period, end the criminalisation of healthcare workers and provide more clarity when it comes to providing abortion in cases of foetal abnormalities?

The Taoiseach

I will specifically answer those three questions, but I am conscious that people follow these debates and discussions at home and in the time available to me I want to say a few things.

First, six years ago abortion was constitutionally banned in this country, so a lot has changed. We had a referendum, the result of which was decisive. Since then we have steered legislation through this House. Draft legislation was published in advance of the referendum so that people would know what the law would look like if they voted "Yes". We introduced it in this House and in the other House and we passed it. Since then, despite a global pandemic that had a very significant impact on the delivery of health services, we have seen the expansion and embedding of those services. From a relatively small number of our hospitals, it got up to 12, then 17 and it is the hope and expectation of the Minister for Health that it will get to all 19 hospitals by the end of the year. Safe access zones was another legislative issue that came at us in terms of wanting women and health professionals to be able access services unimpeded. We passed the legislation in this House and I expect it will pass Committee Stage in the Seanad this evening. We continue to see a small increase in the number of GPs, community providers. I think there has been an additional 20 providers in the course of the past 12 months and that matters with respect to geographic access across the country.

The Deputy is correct that we commissioned an independent review, which we have received. The Oireachtas health committee considered it. It was sent back to the Department and Minister for Health in December. As the Deputy acknowledged, the bulk of the recommendations are in the operational space, which she also acknowledged are important. They have largely been put in place and are being embedded across the health service. There are some recommendations that are not in the operational space, but rather the legislative space and it does fall to these Houses to decide how to act on them.

On the three specific questions, they are about issues the Government has not yet considered. However, the Minister for Health will engage at the Cabinet committee on health about them shortly. They deserve serious consideration though. The way the Deputy framed them is quite responsible regarding wanting to tease through some of the nuances of how the legislation is operating. That is different from some of the views presented in this House, which suggest that the draft legislation we put before the people stating this would be the law if they voted "Yes" should not count for something. I take as constructive the points the Deputy made about the three-day waiting period, the issue of how doctors feel with respect to the criminal justice system and the issue of - the Deputy used the phrase "clarification around" - fatal foetal abnormalities. The Government will give consideration to the legislative proposals, but I am also struck, as is the Minister for Health, as the Deputy rightly said, that in politics your word matters and when you publish draft legislation-----

(Interruptions).

The Taoiseach

Gabh mo leithscéal.

It does matter because when you publish draft legislation alongside a referendum, stating that it will be the law if people vote "Yes", it has to count for something. I welcome the constructive way in which the Deputy engaged on the matters. I am not being coy about the three matters. I am being honest. The Government has yet to consider them, but we intend to discuss them at a Cabinet committee on health shortly.

Deputy Holly Cairns

To hear that a year after a report was given to the Government it has not been considered is extremely worrying. I heard the Minister for Health say yesterday that we have to be cognisant of what people voted for in the repeal referendum and in any plan to reform the law and the Taoiseach referenced it now too. I do not know if they are suggesting that they think the majority of people who voted to repeal the eighth amendment wanted to continue to force women who need terminations for medical reasons to travel abroad. I have to say that the very brave women who spoke out about needing a termination for medical reasons during the repeal referendum campaign won more hearts, minds and "Yes" votes than the Government's heads of Bill.

However, for argument's sake let us say it is about the heads of the Bill and the Government wants to honour that, the heads of Bill committed to having a review to see whether there were any serious issues with the current legislation. Some very serious issues have arisen. The fact is that people are still being forced to travel abroad and that women are being forced to wait three days to access medical care. The latter is something we do not see in any other kind of provision for care. It has no place in our law or in modern medicine and it needs to go.

On those three issues, does the Taoiseach think they need to be changed? Will he outline to the House, when considering them, what position he is coming from? Does he understand why these things need to be changed and why considering it now, a year later, is far too long for the women who have been forced to travel and for the ongoing suffering? Every day women are still travelling.

The Taoiseach

I, too, pay tribute to those who spoke out. As the Deputy correctly said, I was very influenced and informed in my own views. I am also very conscious, as the Deputy said, that they played a much larger role than any politician in this House, most particularly myself, in bringing about a successful "Yes" vote because they spoke to the people of Ireland and the people of Ireland responded compassionately. I also participated in debates, however, as did the Deputy's party and other parties, when we told people that a "Yes" vote was a vote for this and not for that. We have to reflect on that. Within that context, some of the things the Deputy said have merit. We put in place a review clause because we want to make sure the legislation is operating as intended. The perspective I come from on this is very straightforward. It is about wanting to provide healthcare to women. It is about wanting to be non-judgmental and compassionate. It is the same approach I brought when I campaigned for repeal and worked across party lines in a minority Government to pass the legislation.

It is not that the Government has a report and has not been doing anything. A very significant amount of work has been done with that report in the operational space. Also, from a legislative point of view, the priority has been safe access zones. I will continue to keep the Deputy and the House informed on our thinking on this.

Deputy Bríd Smith

On the Taoiseach's first day of Leaders' Questions, it is quite a coincidence that he is being questioned by both the previous speaker and me on the abortion legislation. Last night's programme exposed the ongoing denial of abortion rights to a significant number of women in this country six years after repeal. It was interesting that it opened with a clip of the Taoiseach in Dublin Castle on that historic day when the massive "Yes" vote was announced. He told the crowd, “Under the eighth amendment, [we said to] women in crisis ... take the boat [or take the plane], today we ... [say], take our hand." The programme then showed how women today are still being forced to take the boat or the plane. It has happened to hundreds of women since repeal.

Three brave women told their very moving, sad and tragic stories last night. I commend them for doing what they did and their courage because it has implications for the future for all women with crisis pregnancies in this country. Having been given the devastating news that their much-wanted babies will not survive, women are then told they cannot access abortion care here and will have to travel. Then, they have the tragedy of having to leave the remains of their babies behind to come back and collect them later or hide them under a blanket in the back of a car in case customs interrogate them. Women are still being treated as criminals for accessing basic reproductive healthcare. As Ms Marie O'Shea pointed out on the show and to members when she appeared before the Joint Committee on Health, doctors are being intimidated by a 14-year prison sentence hanging over them like a chill factor in case they fall outside the terms of the legislation.

The Taoiseach made his political name as Minister for Health during the repeal campaign. During the Dáil debate on the abortion legislation, he repeatedly said how important it was that the legislation be kept under review. He stated:

I am purposely seeking a review clause in the legislation as a result of looking at other jurisdictions where legislators thought all they needed to do was pass a Bill and that they had dealt with the issue forever. For us ... that would be a dereliction of our duty. It is appropriate that we return to the issue and make sure the legislation continues to be in line with best international practice. That is what a review clause will accomplish.

Yet, six years after repeal and well over a year since Ms O'Shea's report, we are still waiting for the Government to stop sitting on its hands. It is almost one year since People Before Profit had a Private Members' Bill passed in this House by a majority of Deputies, using the Marie O'Shea report to show how a Bill could be passed to abolish the three-day wait, 12-week limit and 14-year prison sentence for doctors and ensure that no one else is told to take the boat or plane ever again. However, it remains sitting in committee. TDs were given a free vote and they voted for that amendment, so it is not true to say that we are all laggards in terms of trying to make progress.

It is not good enough that the Government is sitting on its hands and refusing to allow the Bill to progress in committee. I wrote to the health committee this morning, having written many times previously, asking it, yet again, to progress the Bill through the committee. Will the Taoiseach do what his predecessor, Deputy Varadkar, did and continue to tell women with fatal foetal anomaly and with those diagnoses that they must take the boat or the plane, or will he show a bit of courage?

An Ceann Comhairle

The Deputy's time is up.

Deputy Bríd Smith

Marie O'Shea has said courage is needed. Will the Taoiseach use his famous slogan about new energy to implement a review immediately?

The Taoiseach

I thank the Deputy. I accept the sincerity of her view. Whether people agree or disagree with her view, it is well known in this House. We should not engage in revisionism. An awful lot has happened. We had a constitutional ban on abortion. We had the eighth amendment. This House was not empowered to legislate at all. We all went out, across party lines, and campaigned. It is kind of amazing now to think that actually happened, given there was a minority Government. People pulled together and we brought about good societal change.

Since then, we have managed to see the services embed. We have managed to see many thousands of women who previously would have travelled or been denied access to healthcare be able to access healthcare in this country. The statistics are published and laid before this House each and every year. We have established My Options. It is a really important, free, non-judgmental service that provides people with information and access to counselling, as well as advice on how they can access the services that are legal within this country. We have seen the number of hospitals providing the service significantly increase. We have seen the number of community providers increase and geographic access across the country thereby improve. From a legislative point of view, we have prioritised safe access zones. There was a view in this House that we needed to move on that issue. This House passed the legislation. It is on Committee Stage in the Seanad and it is hoped to conclude that Stage this evening.

We put in place a review clause. Yes, I did that. I remember being in the committee with the Deputy when we put in place that review clause. There was a view in the committee, across party lines, that we should do so. The review has come back with many recommendations. A lot of them have already been enacted in the operational space. They have been good recommendations to help to improve the clinical delivery of the service. Some of the recommendations are legislative in nature. The Government will give them due consideration, as I am sure will the Opposition parties.

I note the Deputy's comment regarding her own Bill. She has every right to bring it forward. I do not recall the figures but my memory is that it passed because a majority, or certainly a large number of Deputies, abstained out of respect for wanting the review to be carried out. Factually, the Bill passed Second Stage in the House. That is true. Without speaking for the Deputy, I think it is fair to say her Bill would go significantly further than the review. She is very clear about wanting to abolish the 12-week limit altogether. That is her position. It is not mine and it is not the position we set out when we went before the people. The Deputy has interacted with the health committee, as is her right. It is a matter for the committee to decide how it wishes to proceed with that request. I have outlined very clearly what the Government intends to do, which is to pass the safe access zones legislation, ensure the services are provided in the 19 hospitals, implement the operational recommendations and engage with the Minister for Health and the Cabinet committee on health on the legislative recommendations.

Deputy Bríd Smith

I do not think it is fair to frame the history of what happened to the Bill as there somehow being a minority voting for it. Only approximately nine Deputies abstained that day. There was not a huge number of Deputies abstaining.

I want to pick up on a few things the Taoiseach said. The 28-day limit is really the crucial thing in terms of how fatal foetal anomalies are treated and in stopping the harrowing and tragic testimonies we saw last night. The 28-day limit on when doctors can say there is need of a termination in a case of fatal foetal anomaly was added only after the referendum. It was not in the heads of Bill. People did not vote for it. The requirement for a three-day wait and a repeat visit was never discussed by the citizens' assembly or the joint Oireachtas committee. It was put in by the Government afterwards to try to bring some of its leading members on a journey. It was never discussed by us.

The programme last night also raised the question of rogue agencies. Will the Taoiseach address that in his response? In 2016, after a similar investigation was revealed in the Ireland edition of The Times, he said he was sickened by those claims and vowed to regulate rogue agencies. Eight years later, they are still free to operate.

An Ceann Comhairle

The Deputy's time is up.

Deputy Bríd Smith

I repeat my contention that the Government is sitting on its hands.

The Taoiseach

I thank the Deputy for repeating her contention. Obviously, I do not agree with her. Even the three-day wait period has seen clarification on how it operates since the Covid pandemic.

That used to involve two in-person visits but that is now not the case. That was something that came about during Covid that was deemed to work clinically well in the health service and was therefore embedded. I am not dismissing many of the points that have been made in this House but outlining the process the Government will go through.

On rogue crisis pregnancy agencies, I was and am sickened. The Deputy tried to imply that I did nothing about the matter but we set up My Options. For the first time in the history of the State, we now have a State freephone service. I encourage people to make this known. It is a non-judgmental service that is available to people, provides massive support and directs people to appropriate and safe services.

Deputy Bríd Smith

I did not accuse the Taoiseach of not doing anything. He failed to regulate-----

An Ceann Comhairle

The Deputy should please let the Taoiseach respond.

The Taoiseach

I also went further. Elections sometimes interrupt people's tenure of service but in 2019 I also brought about regulations to designate the professions of counsellor and psychotherapist under the Health and Social Care Professionals Act. I established the Counsellors and Psychotherapists Registration Board. I appointed its members in February 2019 and they held their first meeting in May 2019. Everybody knows the pressure the Department of Health has been under with the Covid pandemic and the like since. A lot has happened.

Deputy Joan Collins

I agree with the last two speakers on the documentary last night on the O'Shea report but I want to raise the following issue. Earlier this month, we learned that health and social care staff with community and voluntary bodies are still awaiting pay increases agreed last October. I am referring to section 10, section 39 and section 56 workers. There was an agreement for an 8% pay increase and a commitment from the Government to work towards pay parity with public sector workers. Many workers have not received any increase at all. I am well aware of this because I sit on the board of the Canal Communities Local Drug and Alcohol Task Force. In general, funding for task force projects and posts has not increased since 2009. Many salaries were subject to cuts after the crash until 2021, when pay was restored to pre-2009 levels for some workers. I am told this is reflected across most HSE-funded organisations, where pay scales have fallen well behind those of the HSE that they were originally linked to. Pay scales and funding frozen at 2009 austerity levels, or even pre-2009 cut levels, are a disaster for workers and those relying on the services. There are no pay protections, no pay parity, no pay equality, no job security and no pensions or other benefits that their public sector counterparts receive. It is an absolute disgrace. Kevin Figgis of SIPTU stated, "The night we agreed the deal [in October 2023], the Government side were saying it would apply to in excess of 2,000 organisations." He added:

They are now saying they are engaging with a little over 1,000 agencies and we are going: 'What's happened to the rest of them?'

[...]

And what we have now is people who weren't even in the room that night telling us what was intended, which is unacceptable. We are not going to have the deal reimagined by people who weren't even there when it was agreed.

He added that there is an ongoing attempt to minimise the number of people who benefit from the deal and any future restoration of the pay link with equivalent public sector staff. From everything I have seen, I agree with him. This is a broken system. These workers are essential to the communities and people who rely on them. Many of the services in question should be provided by the public sector but are instead left to the voluntary sector, which is woefully underfunded.

This system is failing on its own merits as the funding streams struggle to see the implementation of a pay deal agreed last October. We need immediate action from the Government to ensure pay increases are passed on. The long-term effects throughout services and the risk of further strike action – action diverted last October as a result of Government inaction – are a disaster for workers and service users. These workers are central to the most vulnerable in our society. They do invaluable work and the Government is treating them like dirt. I refer in particular to community prison links workers paid through the Department of Justice, workers in the youth projects paid by City of Dublin ETB, Dublin City Council-funded workers and the HSE grant aid project staff, who have not even received the 2021 pay restoration payments. What action is the Government taking to ensure the workers of all 2,000 organisations covered by the 2023 deal will receive the pay increases they are entitled to with immediate effect?

The Taoiseach

I thank Deputy Collins. I appreciate the passion with which she discussed the issue. I just do not believe phrases like "treating them like dirt" add much to the debate, though. That is the Deputy's view.

Deputy Joan Collins

It is their view.

The Taoiseach

It is the Deputy's view and their view. Here is my view: this Government, which I am proud to lead, very much respects and values the work carried out by these workers. The Deputy is right that there are many aspects of our public services, including health and social services, that rely on people who have been traditionally outside the public sector. We are the better for it as a country. Indeed, many of our services working with some of the most vulnerable in society are reliant on those individuals. They provide services that all of us, as constituency Deputies, know of in our communities and very much value.

This Government has done significant work over a sustained period to try to improve, regularise and come to agreement on a variety of issues within the spectrum of matters the Deputy raised. The hospice movement is one example. Transferring it from section 39 to section 38 was a big body of work but it has shown real good faith on the part of Government and will make a big difference to both the staff there and to the sustainability of those services into the future.

Regarding some of the specific issues the Deputy raised, an 8% pay increase was agreed in October 2024 on the eve of strike action. I was pleased that was agreed. A lot of hard work was done by many, including the Minister, Deputy O'Gorman. My understanding is that Tusla has provided those payments and that the HSE is in the process of finalising those arrangements. The Minister for Health and I will seek an update for the Deputy for the people from the HSE who have contacted her about where that is. Following the new public sector pay deal, there will be engagement with both the section 39 and section 56 organisations on further pay issues that arise from that pay deal. I would like to think we are in a better space as a result of the agreement that was reached last October and as a result of the public sector pay deal and the engagement that will flow from that. If the Deputy wants to send me specifics, I am happy to come back on them as well.

Deputy Joan Collins

I thank the Taoiseach. It has been 15 years since the crash. Until 2021, many of these workers had not even received a pay increase. The staffing community of voluntary organisations who are awarded the pay increase of 8% have not received it and have not been paid to date. That is outrageous. Why has it not been paid and when will it be paid? This needs to happen urgently. It undermines and makes a complete mockery of our system of industrial relations and collective bargaining. When agreements are made, they must be honoured. It must be noted that the agreement is applicable only to sections 10, 39 and 56 bodies. Projects and initiatives that have service-level agreements with the HSE are included. Those that have grant-aid agreement are not. Many other services are excluded from the agreement.

Will the Taoiseach and the Minister for Health, who is sitting beside him, seriously consider setting up an implementation body with the unions, those involved in the different organisations and the Government to actually look at this? It is a very complicated system. The funding goes astray. The HSE and Department of Health have the funding, which is given to the HSE. The HSE gives it to the Department of Justice, the ETBs, Dublin City Council and all these areas. This has to be looked at in detail and implemented as quickly as possible for these workers and those services.

The Taoiseach

I thank the Deputy. I will undertake to engage with my Government colleagues. As she has rightly indicated, this cuts across a number of Departments. Many of the organisations fall within the Department of children. I have outlined on behalf of the Minister, Deputy O'Gorman, that Tusla has made payments. Some fall within the Department of Health or the health agency family. Some are within the Department of housing and its agencies. We have two things to do arising from this question. The first thing we need to do is to ensure that all of the agencies move forward as quickly as possible with regard to the agreement that was reached in October. The Government wants to see that happen. I will get the Deputy an update, following on from this, on that.

Secondly, as I referenced in my earlier answer, as a result of the new public sector pay deal, we have an opportunity and obligation to engage with the representative bodies of those staff working in the sections 10, 39 and 56 bodies. That is probably the best way to proceed. I am not sure we need a new implementation structure. I think there is a mechanism in place for engagement as a result of that. If the Deputy wants to correspond with me, I am happy to come back to her on that.