Dáil Éireann debate -
Wednesday, 2 Oct 2024

Vol. 1059 No. 1

Ceisteanna ó Cheannairí - Leaders' Questions

Deputy Mary Lou McDonald

The parents of children with scoliosis and spina bifida who have been waiting years for operations would have been listening intently to the Taoiseach's budget yesterday. They would have been listening in the hope that he might finally hear their calls for action and deliver the investment and change that their children so desperately need so that they might get their surgeries to end the nightmare of being stuck on a waiting list or struck off one. Although the budget book has 168 pages, there is no mention of these children with scoliosis and spina bifida, nor a single line outlining a specific solution.

Despite the hype around this budget, children with scoliosis will continue to wait in pain, to deteriorate and to run out of time. I am speaking about children like 13-year-old Darragh Higgins from Galway. Darragh was born with spina bifida and has been waiting for surgery for five years. He has been lost in a system that has failed him. His condition is ever-worsening. His spinal curve is now 120°. His mother Keara posted a video on social media last week telling Darragh's story. Darragh's scoliosis is now crushing his lungs, his bowels and his heart. Keara, his mother, tweeted "My son never had heart issues until his scoliosis was left to crush his body!" She is worried and terrified. Her big fear is that Darragh will become inoperable, just as other children have become inoperable as they waited and waited. Keara has been waiting for surgical intervention, a surgical plan and communication on her son's scoliosis treatment for far too long. He has been assessed for surgery in the United States but there is still no clarity as to if or when Darragh will have the operation and if it will go ahead. There is no clarity on travel plans, costs or length of stay. They have been given nothing in writing and are now wracked with uncertainty.

There are concerns that if Darragh and other children with spinal curvatures and complex medical needs travel, they might be asked to do so in economy seats on flights. I do not know if the Taoiseach has seen Darragh's video. He has. He could not possibly expect a young lad in that situation to be crammed into an economy seat for a transatlantic flight. Some children like Darragh have to be repositioned so they do not get pressure sores that would prevent them from getting the surgery they need when they land in America. This needs to be sorted out pronto.

As Members will know, last week, ahead of the budget, parents of children with scoliosis and spina bifida came to a briefing in the Oireachtas audiovisual room. A 14-year-old boy, a wonderful young man called Tommy Long, addressed the meeting. During his time on the waiting list, this child has been through it all. He said that it was extremely disappointing to have seen no improvement for him or for the hundreds of other children with scoliosis over the last ten years.

Mar thoradh ar an mbuiséad seo, leanfaidh leanaí le scoliosis agus spina bifida ag fulaingt agus iad ag fanacht ar obráidí. Here is my question for the Taoiseach. He made no mention of these children in his budget. Where is the funding to finally deliver on the promise that no child would wait? That promise was made a long time ago and has been broken many times. Where is the money to make sure that Darragh gets to the United States and gets the treatment he needs? Where are the funding and resources to look after all of the other children who are currently suffering in agony?

The Taoiseach

I thank the Deputy very much for raising this issue. It is very important and I am pleased that we are raising it in this House. Nobody in the House wants to see any child wait in pain. Any suggestion from the Deputy that she does not but that I am somehow or other satisfied with children being left in pain is obviously not a fair portrayal of me or of any public representative in this House. This is not an issue that divides political opinion. I assure her that, if she was in my role, she would be doing what I am doing, which is to meet the clinical lead and the head of the HSE to work through the issues with them. If she wishes, I will arrange for the Deputy to meet with the clinician in charge of this programme for scoliosis because, while I am very happy to address the issue on the floor of the House, I often find it difficult to discuss children's individual clinical care plans here. I believe the Deputy would have difficulty with me doing so because there is a role for politicians and there is a role for clinicians. That is an important thing to say.

I will be really clear at the outset. Let us not be disingenuous. The Deputy has been at Leaders' Questions a hell of a lot longer than I have been and she will know that the HSE budget is detailed in a service plan. She knows that is where the line-by-line detail is found. If she wishes, she can choose to use her time to suggest that Government does not care about an issue. That is fine. Perhaps it is even her job. It is not accurate, however. The HSE will now work through the level of funding it has received from the Government with the Minister for Health and will produce the detailed HSE service plan. That is how it has worked every year the Deputy has been in this House. It is how it will work this year as well. Let me be very clear; the agreement that the Ministers, Deputies Donohoe and Donnelly, received for health this year is very significant. It brings the total health budget to €25.6 billion. It means that health spending has doubled over the last decade and that staffing will have increased by 30%. It also means that there will be a real opportunity to make progress on all waiting lists, as we have been doing in recent years.

It also means that there will be further ability to invest more in paediatric spinal waiting lists. The Minister has told families, doctors, the HSE and this House that any resources required by the dedicated spinal unit he has established will be provided, and I fully support him on that. That has been the case up to now. I have met with the Minister, the CEO of the HSE and the clinical lead of the dedicated spinal unit. This is now being led by a clinical lead, Mr. David Moore. I have also met with their teams and I know that every possible avenue and resource is being put to use.

The Minister is now chairing a monthly meeting with the HSE and Children's Health Ireland on the waiting times and ensuring everything can be done. A paediatric spinal task force has been established with an independent chair, Mark Connaughton SC. We are committing significant additional investment to help to tackle waiting lists and ease the burden. This has resulted in a significant increase in the number of paediatric spinal procedures carried out in 2022 and 2023. So far this year, more than 300 spinal procedures have taken place. It is important to acknowledge that. For every child the Deputy names, and she is absolutely right to highlight them, there are children getting these operations at a scale and a pace that was not the case in years gone by. As she knows, additional funding of €1.34 million was allocated when the new clinical lead requested it, and anything the new clinical lead requests will be provided for in the HSE's budget for the time ahead.

The Deputy raises a very important, specific issue and I welcome her raising it. I agree with her in relation to the difference between economy and business class and ensuring that Darragh or anybody travelling has the space to travel safely and appropriately. An arrangement with Morgan Stanley Children's Hospital in New York has been finalised. Consultants from New York have travelled to this country to see patients at a clinic in Dublin. Following a clinic held in Dublin with surgeons from Great Ormond Street Hospital in London, a group of patients has also been offered treatment abroad and this is now in progress. An arrangement is also being finalised with the Portland Hospital in the UK. I am assured families will be fully supported in accessing these pathways if it is the right option for their children. A support package will be put in place to support them in travelling, including flights, accommodation, transport and travel insurance for all those in the travelling party. Quite rightly, a subsistence rate for expenses will be provided as well. I am assured that two of the flights for any family travelling will be business class. I am meeting scoliosis advocacy groups next week and I am very happy and eager to discuss all these matters.

Deputy Mary Lou McDonald

The clinicians give the clinical advice. I am not asking the Taoiseach for clinical advice. Why would I?

The Taoiseach

The Deputy is suggesting-----

Deputy Mary Lou McDonald

I am suggesting nothing of the sort.

The Taoiseach

Yes, but-----

Deputy Mary Lou McDonald

I kindly ask the Taoiseach, when I raise the issue of a 13-year-old boy with a 120o curvature of his spine who has waited five years for his surgery, not to insult him or his mother, Keara - do not mind me - with smart alec, slick responses.

The Taoiseach

Excuse me-----

Deputy Mary Lou McDonald

This child has waited five years. This child is suffering. This child can be treated in the United States. The clinicians have told Keara, his mother, that four weeks of halo-gravity traction treatment, which she cannot access here, and then another four weeks will be needed, at least, for the surgery, which will be complex but those surgeons can do it. She needs clarity. She has been given the runaround by a bureaucracy in love with itself, by paper pushers and by layers and layers of unnecessary complexity when the case is very simple.

The Taoiseach

They are resolved.

Deputy Mary Lou McDonald

The child is 13. Boys who are 13 years old do not want to be mentioned on the floor of the Dáil. I know because I reared one myself. The last thing he wants is his name mentioned here. Yet his mother is so desperate now that she felt moved to put up a video of him and to ask that this matter be raised directly with the Taoiseach. He can get the treatment he needs in the United States.

An Ceann Comhairle

I thank the Deputy.

Deputy Mary Lou McDonald

She needs to know when they are travelling. The people in the United States need confirmation that the resources are available and the bill will be paid.

An Ceann Comhairle

I thank the Deputy.

Deputy Mary Lou McDonald

I am challenging the Taoiseach because if I were the Taoiseach, I would sort this out.

Deputy Pearse Doherty

Hear, hear.

(Interruptions).

Deputy Mary Lou McDonald

Sort it out today for that family.

The Taoiseach

The Ceann Comhairle will understand why I am finding it hard to take a moralistic lecture on child protection from the leader of the Opposition today of all days.

Deputy Pearse Doherty

For goodness' sake.

(Interruptions).

The Taoiseach

She might come back to us on that. I cannot ask her a question in this House but there is a function available to her and she should use it because she should apply the same standards to herself as she applies to everybody else.

Deputy Pauline Tully

Answer the question.

The Taoiseach

I will answer the question. The Deputy is trying to do this thing. She stands up and talks about being slick and soundbites. She has obviously decided that I am now living rent-free in her head. That is fine.

(Interruptions).

The Taoiseach

The reality of the situation here, Deputy McDonald, is that I will work with this family, but I will not have her wrongly represent who I am, my values or the work I do. I will work every day to help every child who needs access.

Deputy Matt Carthy

The Taoiseach made promises to this family.

The Taoiseach

We delivered a budget yesterday that will make substantial progress. I have already outlined to the Deputy that I will be meeting directly with the family advocacy groups next week. I do not need the Deputy as an intermediary.

Deputy Thomas Gould

Why are you here?

Deputy Mary Lou McDonald

It has been-----

(Interruptions).

The Taoiseach

I will be meeting them directly and I will be working with them, the Minister of Health and the clinician who carries out the surgeries, and is now the clinical lead, to do the best thing possible. We will put every support in place. I assure the Deputy of that.

Deputy Pearse Doherty

That was promised before.

Deputy David Cullinane

Another promise.

Deputy Ivana Bacik

Before I start, I acknowledge the distressing escalation of conflict in the Middle East. Our thoughts and, I am sure, all our thoughts are with all those affected, with our Defence Forces in south Lebanon, their families and our citizens trapped in the region, who must be brought home. We need to see all diplomatic means exhausted to bring about peace in the region.

I wish to raise with the Taoiseach today the question of child protection and how his Government will stand by survivors of child abuse in Irish schools and institutions. It is an issue that has been brought into light recently. Over recent years, we have gained a new understanding of the scale of the abuse perpetrated against children, in particular, across so many religious and State-run institutions through disclosures of abuse in industrial schools, orphanages, mother and baby homes and Magdalen laundries. Most recently, thanks to the immense bravery of survivors like the Ryan brothers, we have learned of the awful abuse of students and young children in a significant number of religious-run schools. We have also heard new revelations about abuse perpetrated by Bishop Eamonn Casey, among others.

Each time we hear about abuse perpetrated upon children in religious-run institutions, there are calls for religious orders to step up and pay their share of redress. When the dust settles, however, the State has never really stepped up to make sure those religious organisations do pay up. I have seen this myself. As a legal practitioner previously representing survivors of abuse, I saw how many were often retraumatised by a flawed redress process, in some cases, and by religious orders’ refusal to engage. The Government and the Taoiseach have called, as have I, on religious orders to pay their share of redress. The problem is that many are hiding behind what I have called the "developer’s wife syndrome" - I think we are all aware of this - where orders transfer their assets to lay-run trusts, meaning the orders may be legally liable to pay redress but no longer have the means or assets to do so. Of course, the lay-run trusts have no legal liability. What makes this troubling ethically is that the assets involved are so extensive. I have seen an investigation by Noteworthy for The Journal showing that religious orders involved in historic abuse sold over 75 properties, worth more than €90 million, between 2016 and 2022 alone.

As legislators, we must go beyond condemnation of abuse and appealing to the moral duty of orders. We have to review the broader issue of why we still have the bulk of schools under religious patronage and why we do not have a true separation of church and State. On the practical issue of redress, just three weeks ago, I shared with the Taoiseach a Bill that we in the Labour Party drafted to ensure religious orders would be compelled to contribute in full to redress schemes and could not hide behind any legal mechanisms or lay-run trusts. The Taoiseach said he will work with the Opposition parties on this crucial issue. Indeed, I previously welcomed the engagement of the Minister, Deputy Foley, with Opposition parties on the scoping inquiry and the commitment to statutory redress. What the Taoiseach has not confirmed is whether he will ensure that organisations that facilitated or even covered up abuse will now be compelled to pay redress. Will the Taoiseach legislate to make the orders pay their share before a general election?

The Taoiseach

I thank Deputy Bacik for raising this important issue around child protection and child abuse and making sure we have a zero-tolerance approach to this matter in all organisations, including in State agencies, political parties and everywhere else. I could not agree more with the Deputy. The issue of child protection is the most important one. Child abuse is something that sickens everybody to the very gut of their stomach. It absolutely does. I thank the Deputy for her constructive engagement and suggestions. I assure her we will work with her and all of the Opposition in relation to getting this matter right. I think the Deputy's critique of successive governments is fair. Many of us have been in them over the years. The people in good faith try to establish inquiries and get to the bottom of things, and then it seems we are always one report away. We have had so many reports into sexual abuse. Let us be really honest. It is such a stain on our country. The pain caused by the sins of the past is destroying lives today.

We have had engagement over decades, if we think about it, with religious orders on whether people will do the right thing. Let us be honest, they have not or certainly the overwhelming majority of them have not. The short answer is "Yes". We will work with the Opposition and engage with the Labour Party's legislation. An interdepartmental group was set up after the scoping inquiry into sexual abuse in schools. As part of that work, the Attorney General has been asked to consider the whole issue of how to ensure that if a redress scheme is put in place - and there needs to be a redress scheme - there will be mechanisms not just to ask nicely but to make sure that if people do not do the right thing, they will need to contribute to the scheme.

In the first instance, while I know Deputy Bacik would not do so, I do not want to be misrepresented as suggesting that it is just about asking nicely or appealing to people's better nature. When people issue statements, and the religious orders did issue statements of profound regret and the likes, one would hope that they would now do the right thing. I want the Government's position to be clear, and I expect it is also the position across parties in this House, that if people do not do the right thing, we need to find legislative mechanisms to ensure that the correct thing is done.

The Deputy is asking me to give a timeline which is not unreasonable but I want to be honest. I want to get this right and I know the Minister, Deputy Foley, wants to get it right. She has handled the issue very well and sensitively. Deputy Bacik acknowledged the engagement she has had with the Opposition. She has also had great and meaningful engagement with survivors. Making sure that the structures and mechanisms we put in place produce answers, healing, justice, accountability and appropriate redress is important. We will continue to work on this. I have no doubt, and I think I can speak for the House on this, that regardless of when there is a general election, this is something to which we will all commit to getting right and working on together.

Deputy Ivana Bacik

I thank the Taoiseach for his acknowledgement that the religious orders have not done the right thing to date. I had hoped for more in terms of a timeline. I ask the Taoiseach to refer our Bill to the Attorney General for advice. Our Bill would facilitate civil proceedings against unincorporated bodies such as, but not confined to, religious orders and would provide for the recovery of any damages awarded from associated trusts of such bodies. It is critical legislation and is needed to ensure that we do right by survivors of abuse. Again, I commend the immense bravery of those survivors who have come forward and condemn perpetrators of abuse. We are all conscious that abuse was not confined to religious-run organisations. Abuse, unfortunately, against children has happened in all sorts of settings and we must all condemn it outright wherever it occurs and do right by survivors. There are some specific actions we can adopt, like the Bill we have proposed and like, for example, honouring those survivors of abuse by Bishop Casey who have called for the removal of his remains from the crypt in Galway Cathedral. These are significant actions that can be taken to do justice by survivors and all of us, in government and opposition, should be committing to do so.

The Taoiseach

I will ask that the Deputy's party's Bill is referred to the Attorney General as part of his consideration. That is a sensible thing to do. We will continue and I want the Deputy to know, as she probably does from her engagement with the Minister, Deputy Foley, that there is an intense degree of work going on in relation to this. We have seen in the past when we have got mechanisms correct that we have provided people with answers and a degree of healing. However, we have also seen that when we have got mechanisms wrong we have provided people with meeting more senior counsel than one could fit in here, often paid for by the State, and have retraumatised survivors. That is the bit that we want to get right.

The scale of this is alarming. The scoping inquiry was told of 2,395 allegations of sexual abuse involving 884 alleged abusers in 308 schools. The allegations were contained in the records of 42 religious orders which currently run or previously ran schools and include 590 allegations of sexual abuse in special schools. That section of the report is particularly harrowing and horrifying to read. Let us continue to engage on this. I will seek legal advice on the Deputy's legislation.

Deputy Richard Boyd Barrett

Israel's ongoing genocidal, year-long massacre in Gaza and now its savage assault on Lebanon have triggered a terrifying escalation of conflict and violence that threatens to engulf the entire Middle East. It is worth saying that the state that is guilty of this massacre in Gaza and that is attacking Lebanon has nuclear weapons and has refused to sign the nuclear non-proliferation treaty. This is a state for which there is no atrocity it is unwilling to commit, no butchery or massacre that it is not willing to perpetrate and no red line it is not willing to cross. It has nuclear weapons and does not believe in international efforts to contain the proliferation of same. This is a scary situation. There are 379 Irish troops and over 100 Irish citizens in Lebanon. Equally important, more than 1,000 Lebanese men, women and children - the count is going up - have been butchered with missiles. We had a James Bond-like explosion of thousands of pagers, indiscriminately killing dozens of people and injuring hundreds more and 41,689 people have been killed in Gaza over the last year since Israel began this onslaught. There were 60 people killed in Gaza last night and more than 200 Lebanese people have been killed in the last few days. The International Court of Justice has ruled that Israel is guilty of illegal occupation of Gaza, the West Bank and East Jerusalem. It is, by its own admission, committing crimes under international law, war crimes.

What is the Taoiseach and the world going to do about it? In particular, is the Government speaking out of both sides of its mouth on this issue? The Government says it is concerned about what Israel is doing and about the crimes it is committing but then we get a report that the Minister, Deputy Donohoe, had a conversation with the Israelis back in 2019 and gave assurances that the Control of Economic Activity (Occupied Territories) Bill, which the Government still refuses to pass-----

The Taoiseach

He had no such conversation.

Deputy Heather Humphreys

No.

Deputy Richard Boyd Barrett

We will see. Why does the Government still refuse to pass that Bill? Why does it not ban all overflights of weapons being carried by Israel? The Government denied that such flights were happening but now we know that they were happening in Irish airspace. Why does it not ban all flights carrying weapons through Shannon Airport? Why does it refuse to condemn the United States for continuing to provide the missiles and weapons that Israel is using in Lebanon and has used against the people of Gaza? Why does the Government continue to allow-----

An Ceann Comhairle

You have made your point, Deputy.

Deputy Richard Boyd Barrett

-----the US military to use Shannon when it is up to its neck in the crimes that Israel is committing in Gaza and Lebanon and which are now threatening to escalate into an all-out regional war?

The Taoiseach

Last week, I was at the United Nations and I met the President of the Palestinian Authority, Mr. Mahmoud Abbas. I also met the Prime Minister of the Palestinian Government. Both the President and the Prime Minister of Palestine thanked me, our Government and the people of Ireland for what we are doing in relation to Palestine. I come back here and I come into this Dáil and the Deputy's distortion of what the Government is doing is actually breathtaking, in terms of how he distorts the record of this Government. It is breathtaking. President Abbas thanks the Government and people of Ireland for our position but Deputy Boyd Barrett comes in here and constantly endeavours to misrepresent it. The Government's position is clear and the people of Ireland's position is clear in relation to the humanitarian catastrophe that is happening in Gaza. We are very clear in relation to the breaches of international law. We are very clear in relation to the ICJ ruling and in relation to the actions we took arising from that ruling in the context of defence equipment. Please do not attempt to misrepresent the Government of the people of Ireland in terms of our position in relation to this. The President of the Palestinian Authority understands it and, quite frankly, what he thinks of our record on Palestine matters to me a hell of a lot more than what Deputy Boyd Barrett thinks and how he wishes to misrepresent our record.

I note that in his comments - unless I missed it - that the Deputy did not condemn Iran and did not condemn what happened last night. A civilian is a civilian. International law is international law. We cannot just pick and choose if we like this country or do not like that country. What Iran did last night should be condemned by Deputy Boyd Barrett when he rises to his feet again and should be condemned by this House because we condemn other acts of aggression on a regular basis. Presumably, we wish to apply international law regardless of the country or our political stance on an issue. What Iran did last night was a despicable act that should be condemned by all. Had the air dome failed, we would be dealing with mass civilian deaths in Tel Aviv and in Jerusalem-----

Deputy Mary Lou McDonald

Just like in Gaza.

The Taoiseach

Yes. Deputy McDonald is exactly right and I hope she will condemn Iran too-----

Deputy Paul Murphy

The Taoiseach has not condemned Israel-----

The Taoiseach

Sorry, hold your horses. Hold your horses-----

Deputy Paul Murphy

He has not.

The Taoiseach

I condemn the actions of the Government of Israel, the incursion into Lebanon and what it is doing in Gaza, on a daily basis. The difference between the Deputy and me is that I am consistent. I believe breaches of international law are wrong no matter who carries them out, whereas the Deputy believes they are wrong if it suits his political agenda. What would he have said if those Iranian missiles had landed last night? What would he have done? Would he have engaged in a bit of whataboutery? What Iran did last night is dangerous and should be condemned. What Israel has done in relation to Lebanon should be condemned. I am clear on that. It is an incursion in breach of the UN Charter but it is really easy when one applies international law consistently.

We are very worried about this.

The Deputy is quite right. We have a significant number of peacekeepers, with whom I have been in contact, on the ground in Lebanon. I met the UN Secretary General, António Guterres, specifically on this issue and I spoke to the Lebanese Prime Minister directly on this matter last night. I can assure the House, because I am sure this is to the fore of the Deputy's mind and it certainly is to mine, that the safety of those troops is the absolute paramount concern for this Government and for the people of Ireland. We have been assured of their safety and have a contingency plan in place and for all eventualities. We continue to monitor that closely.

We believe very clearly there needs to be de-escalation, full implementation of the UN Security Council resolution and an immediate ceasefire. That is the position we say in public and private regardless of who breaks international law.

Deputy Richard Boyd Barrett

I am not in favour of military escalation of this by any side but I will not engage in "on the one hand, on the other hand."

The Taoiseach

Just condemn them now.

Deputy Heather Humphreys

Condemn them.

Deputy Richard Boyd Barrett

No.

Deputy Heather Humphreys

No, he will not.

Deputy Richard Boyd Barrett

I am not.

The Taoiseach

The Deputy is not condemning them.

Deputy Richard Boyd Barrett

Somebody is responsible for all of this.

A Deputy

Iran.

Deputy Richard Boyd Barrett

Somebody is responsible for all of this.

The Taoiseach

Condemn Iran.

Deputy Richard Boyd Barrett

I will tell the Taoiseach who is responsible. It is the State of Israel that invaded Lebanon in 1982, invaded it in 1996, invaded it in 2006 and invaded it again in 2024.

Deputy James Lawless

What about the Six-Day War?

Deputy Richard Boyd Barrett

Does the Taoiseach remember Shatila and Sabra where they collaborated with the Christian Phalange to kill hundreds of people in Palestinian refugee camps in 1982, the decades-long ethnic cleansing of Palestinians, an illegal occupation now under international law, the illegal occupation of Gaza and the 17-year siege of Gaza, which is a war crime? These are the roots of the conflict. We can condemn all we like, but we need to say that is the problem and this is a rogue state guilty of these criminal actions. The Taoiseach never condemns the United States for giving Israel the weapons to carry out these crimes-----

An Ceann Comhairle

The Deputy's time is up.

Deputy Richard Boyd Barrett

-----or its complicity in those crimes-----

Deputy Paul Murphy

Just condemn it.

Deputy Richard Boyd Barrett

-----in giving it impunity for genocide, illegal occupation and apartheid.

I will finish by saying there is a national demonstration at 1 o'clock this Saturday-----

(Interruptions).

Deputy Richard Boyd Barrett

-----in solidarity with Palestine.

An Ceann Comhairle

The Deputy's time is up.

Deputy Richard Boyd Barrett

Believe me, they are very critical of this Government.

The Taoiseach

When the national Chamber is reduced to some kind of community notice board, it tells us everything. While the Deputy is continuing to misrepresent the position of this Government, we are actually trying to do things. We are actually trying to do things like working with the international community to keep our troops safe. When speaking directly to the Lebanese Prime Minister-----

Deputy Bríd Smith

Pass the occupied territories Bill.

An Ceann Comhairle

Deputy-----

The Taoiseach

I ask the Deputy to have a little respect for the process here. This is quite a serious issue-----

Deputy Bríd Smith

So is the occupied territories Bill

The Taoiseach

-----and should not involve shouting and roaring. When speaking to the Lebanese Prime Minister-----

Deputy Bríd Smith

The Government's not passing it is very serious.

Deputy Thomas Gould

Why not?

The Taoiseach

It is because of the legal advice.

Deputy Bríd Smith

The legal advice-----

The Taoiseach

May I just have a minute to answer the question?

An Ceann Comhairle

Please-----

The Taoiseach

It is a serious matter and I am trying to give it the serious answer that it deserves. The reality of the situation is we are engaging on a frequent basis, often hourly, on these matters. We are providing increased humanitarian aid. We speak up and speak out outlining our position on a constant basis. I have said consistently that I believe what is happening in Gaza is a war on children. It is a humanitarian catastrophe and the EU is not doing enough. The US has not been effective in bringing about a ceasefire. I believe the US and the EU desperately want a ceasefire but the levers that have been pulled have been ineffective to date and have not brought it about. That is what people will ultimately be judged on. I am very clear on this. I can stand up and I can condemn the Iranian attacks-----

Deputy Richard Boyd Barrett

Not the United States which gives-----

The Taoiseach

-----and the Deputies will not condemn Iran. I do not understand why they will not do it.

Deputy Paul Murphy

Just condemn the US.

The Taoiseach

It is because they do not believe that the State-----

Deputy Paul Murphy

Go on, say it. Just condemn it.

The Taoiseach

I would like to speak. I believe the State of Israel alongside the State of Palestine both have a right to live in security and peace. The problem is the Deputies do not believe that about the State of Israel.

Deputy Bríd Smith

Do they both have the right to defend themselves?

The Taoiseach

They do not believe-----

Deputy Paul Murphy

Say it, Taoiseach.

An Ceann Comhairle

Please-----

Deputy Paul Murphy

Say it and be consistent. Condemn the US.

An Ceann Comhairle

If this racket is going to continue, I will suspend the House. I ask Members to please respect the normal procedures and have a bit of manners.

Deputy Bríd Smith

In abnormal times.

Deputy Matt Shanahan

In 2020, the people of Waterford placed their trust me, many driven by a single issue, namely, the undelivered promise of 24-7 cardiac care in University Hospital Waterford. This is a critical service and a matter of life and death for the 600,000 people in the south east who rely on University Hospital Waterford. We have seen the tragic consequences of this unmet need through stories like that of Tom Power and Una McDermott, and the data exposed by the "RTÉ Investigates" team. An entire community marched in protest. Some 22,000 people took to the streets of Waterford in 2013. The issue is not new nor is the frustration.

The Taoiseach has a legacy here. As Minister for Health in 2016, he commissioned the Herity report, a document so riddled with errors that the word "clinical" was misspelled on the front page. It was hastily thrown together, deliberately misinformed, marred by dodgy and incorrect data and is still used to shield inaction. When the flaws of that report became apparent, as Minister for Health in 2016 he commissioned the national review of specialist cardiac care services led by Philip Nolan. For the past six years we have been told to wait for that review. The report remains buried on the desk of the Minister for Health. Promises have been made and recycled. The Taoiseach's colleague the Tánaiste, Micheál Martin, stood for a photo in Waterford in 2016 promising 24-7 cardiac care for the south east, a promise that played a role in his party's regaining a seat in the region. Standing beside him was the now Minister of State at the Department of Health, the main beneficiary of that promise. Last November on WLR's Damien Tiernan show, the Minister of State assured us that recruitment for a seven-day service would begin in January. In March, she had to return to assure us that recruitment would start in June. Again she returned and again nothing has happened. The promises are repeated but the people of Waterford wait.

Today I ask for clarity and accountability. When will the Government deliver 24-7 emergency cardiac care in Waterford? In his response, I ask the Taoiseach to limit his comments to the issue of 24-7 cardiac care. This is not about political point scoring. It is about fulfilling commitments made to a community. The Taoiseach now holds the levers of power and has the legacy on the issue. I ask him to expunge this wrong and show the people of the south east that politics can work for them.

The Taoiseach

In this democracy, the Deputy gets to ask the question but he does not get to tell people what they can say in response. I think it is quite important that I have a right to speak freely in this Chamber to which I am also democratically elected.

The Minister of State, Deputy Mary Butler, Deputy Marc Ó Cathasaigh and Senator John Cummins have been working on this, as has Deputy Shanahan and Deputy Cullinane. We should not doubt the bona fides of all people in Waterford in trying to improve the services for people in University Hospital Waterford and improve the cardiac services. While we have our political spats from time to time, I do not doubt the Deputy's bona fides on this. I acknowledge that.

We have seen a significant level of investment to improve and expand cardiac services. The second cath lab opened on 4 September 2023. By any fair measurement that was an important milestone. It has been operating five days per week, Monday to Friday, from 8 a.m. to 6 p.m. We have seen 24 whole-time equivalents provided to open the second cath lab. The hospital is using a combination of day beds and recovery spaces for the operation of the second cath lab. The medium- to long-term options for recovery beds are now being discussed with the HSE, involving the relocation of the on-call residents and refurbishment of this area. The opening hours for the first cath lab were also extended in September 2022. Permission has now been granted to recruit a specific group of staff for the initial tranche for 2024. It is now an operational issue for the HSE to do so. The Minister of State, Deputy Butler, has assured me that permission has been granted by the Department of Health to recruit a specific number of staff for the initial tranche of new developments for this year. The HSE is now charged and getting on with doing that.

In light of the Deputy's raising the issue today, which is a fair and important issue for people of Waterford, I will engage directly with the CEO of the HSE to seek an urgent update on this matter. All of us in this House want to see an expansion of those services. We need to do it in a way that is clinically advised and clinically safe. I will seek an urgent update from the CEO of the HSE for the Deputy on the matter.

Deputy Matt Shanahan

Yesterday, the Government announced a budget of €10.1 billion and yet in the south east at this time, we can only treat heart-attack patients in a cath lab for 60 hours per week. I remind the Taoiseach that Katie Hannon's RTÉ report showed that only 3% of heart-attack patients were getting out of the region when the Waterford lab was closed. That report was from five years ago and I hardly imagine that ambulances transfer times have improved since then. Four families living within a five-mile radius of me have had members who have suffered a heart attack.

One of those is Jennifer Pheasey, whose father Willie Doyle started the first cardiac care group in Waterford. That is more than a decade ago. These families worry every night, and go to bed apprehensively waiting for the dawn, because they know there is no service available to them. Many times in the House I have heard the Taoiseach mention and reference that the Government wants to leave nobody behind. We are leaving a whole region behind. We do not need a report to tell us what is needed in the south east. We have the testimony of the McDermott family and the Power family. We have many other testimonies of people who had delayed cardiac care and are suffering as a result. I ask the Taoiseach please to implement this. I remind him that the HSE recruitment embargo stopped the recruitment of the seven-day service by not bringing those people forward. They were emergency personnel. Why were they included in the embargo? I ask the Taoiseach to get the Department and the Government to stop dragging their feet and deliver this equality issue to the south east.

The Taoiseach

I thank Deputy Shanahan. There has been a significant level of investment in University Hospital Waterford. I know Deputy Shanahan does not want me to broaden the issue too much but I want to say for the people of Waterford, who no doubt will follow the debate, that we have seen staffing at the hospital grow by 866 people from the end of 2019 to today. There are 49 more consultant doctors, 114 more NCHDs, 378 more nurses and midwives, as well as 118 more health and social care professionals. In 2019 the hospital in Waterford had a budget of €201 million. In 2024 the budget is more than €309 million. The budget has grown during the lifetime of the Government by €108 million. I accept there is work to do, I really do, but I do want people to know there has been more than €100 million of additional investment, significant extra staff increases and the expansion of our cardiac services. In light of Deputy Shanahan raising the issue today I will seek an update from HSE chief executive and come back to him directly on it.