Dáil Éireann debate -
Wednesday, 23 Oct 2024

Vol. 1060 No. 4

Ceisteanna ó Cheannairí - Leaders' Questions

Deputy Mary Lou McDonald

Fine Gael has been in government now for nearly 14 years, joined at the hip with Fianna Fáil for the last eight. We are on the eve of a general election and we still have a very serious crisis in our hospitals and across the wider health service. On the Taoiseach's watch, accident and emergency departments are dangerously overcrowded, the trolley crisis has become a year-round problem, more than 1 million people are waiting for treatment and care on waiting lists, while children with scoliosis and spina bifida wait and wait in agony for their operations. All the soundbites and spin in the world cannot hide that this persisting crisis is a result of bad policy and bad decisions by the Fine Gael-Fianna Fáil partnership.

One of these bad decisions was the Government's damaging recruitment embargo, or the pay and numbers strategy, as the Government now calls it. You can call it what you will but it means the same thing. In the midst of this crisis, hospitals and other services across the system cannot hire the front-line staff they so desperately need.

The story gets worse because, while the Government prevents the recruitment of permanent staff into the health service, its spending on agency staff has gone through the roof. New figures provided to my colleague David Cullinane this morning show that Government spending on agency staff has nearly doubled, ballooning from €350 million in 2019 to €650 million in 2023. Staggering stuff, Taoiseach. During that time, the Government abolished 2,000 permanent nursing and midwifery posts, and all the while the Government spends €146 million on agency nurses, money that would have, in fact, delivered more than the 2,000 permanent nurses into the system. The Government chose temporary staffing even when hiring nurses into permanent positions was cheaper. Think about that for a second because the mind boggles - more expensive temporary staff instead of less expensive permanent staffing at a time when our services desperately need permanent staff. How incompetent is that. How does the Taoiseach defend that use of public money? There is more, because this morning's figures also show that the Government's spending on outsourcing of administration and management in the HSE has trebled in the past five years, shooting up from €29 million in 2019 to €86 million.

The Government's spending on agency staff is a runaway train, making a mockery of public spending controls. It is not only a massive waste, it further destabilises our health service already in crisis. It shows again that Fine Gael and Fianna Fáil cannot be trusted to spend public money wisely, competently or in the best interests of the people.

Mar thoradh ar an méid as cuimse atá caite ag an Rialtas ar fhoirne áisíneachta sa tseirbhís sláinte, rachaidh an ghéarchéim in olcas. The Government's actions are, in fact, prolonging the crisis in our health service. How does the Taoiseach explain this ballooning in costs for agency staff? How does he defend the runaway costs for agency staff, leaving the health system with an ongoing staffing crisis and making private companies very rich?

The Taoiseach

I thank Deputy McDonald for raising important issues in our health service and recruitment into our health service. Of course, the reason we talk about numbers of people working in our health service is because we all want to see improved patient outcomes and improved patient wait times. I will dwell on that in a moment.

A bit of context that is important when we are discussing health services is health recruitment and the health budget. The Government recently announced €25.8 billion of a budget for the delivery of health services next year, the highest budget for health ever in the history of the State. It represents an increase of more than 43% from when this Government came to office. When this Government came to office, we were spending €18.1 billion on health; we are now spending €25.8 billion. It is important we have some context in terms of the huge levels of investment of public money we are putting in. As a result, as of August of this year, there are 27,901 more staff working in the Irish public health service - it has nothing to do with private - than there were at the beginning of 2020. As for what this means in reality, it means 9,375 additional nurses and midwives, 4,092 additional health and social care professionals, and 3,330 more doctors and dentists. These are factual figures. I presume the Deputy accepts them. There are now nearly 28,000 more people working in the health service than when this Government came to office. By any measure or means or any fair discussion, that is a very significant increase.

In fact, last year, despite what we hear in this House, we saw the largest recruitment ever into the HSE since its foundation. The largest level of increased recruitment ever in the history of the HSE took place last year, something that the Deputy forgot to mention in her earlier comments.

Deputy Mattie McGrath

Where are they? In offices?

The Taoiseach

She does not need any help. Deputy McDonald is right that there is an importance to the whole issue of safe staffing and the safe staffing framework. Indeed, I would have worked on this when I was in the Department of Health. The Minister, Deputy Donnelly, has done huge work on this. I am pleased to tell the House and, more importantly, people watching at home that the safe nursing staffing framework has now been fully funded. That involves approximately 2,000 posts. My understanding is approximately 1,500 of those people are now in place, working in our hospitals today, and the remaining 500, which are bring recruited, are fully funded. Every post, because the Deputy mentioned safe staffing, in the safe staffing framework of 2,000 is now fully funded. Fifteen hundred of them work in the health service today and the money is absolutely in place for the final 500.

When we talk about the health service on a macro level, let us look at it at a hospital by hospital level. In St. Vincent's University Hospital, which is not too far from here, there has been a 49% increase in the number of nurses and midwifes working in that hospital now than when Government came to office. Percentages can be misleading. That is 498 extra nurses working in St. Vincent's now than before this Government came to office. Tallaght Hospital, also not too far from here, has seen a 53% in nurse numbers. That is 521 more nurses. Cork University Hospital has 599 more nurses. The Mater, which is in the Deputy's constituency, has 488 more nurses working there since this Government came to office than before. In Waterford, in the south east, there has been a 51% increase or 381 more nurses. This is having a positive impact.

I accept wait times can still be too long; so does the Minister. We are driving them down.

Deputy Danny Healy-Rae

What about Kerry? The Taoiseach did not mention it at all.

The Taoiseach

I will get you a figure for Kerry but that has gone up, too, Deputy.

Deputy Danny Healy-Rae

The figure has gone down.

An Ceann Comhairle

Wait now, please.

Deputy Stephen Donnelly

No, it has not. It has gone way up.

The Taoiseach

Let me tell the Deputy this, because it is too important to shout and interrupt here. In terms of waiting times, it means that we are seeing waiting times fall. They are not falling in the North, they are not falling in the UK, they are not falling in most of Europe but they are falling here in Ireland. Wait times for outpatient services have reduced from 13.2 months in July 2021 to seven months today. We have seen huge progress in our Sláintecare targets, including 17% fewer patients waiting more than 12 months. That equates to 23,970 more people.

We have much more to do in health, of that there is no doubt, but there is really increased investment and increased levels of staff.

Deputy Mary Lou McDonald

Here is the context for you, Taoiseach. When the Government came to office there was a crisis in healthcare, and as it leaves office there is a crisis in healthcare, and everybody knows it. Those are the facts.

The Taoiseach

Says you.

Deputy Mary Lou McDonald

According to yourself, staffing is safe and sufficient. Why then are people waiting for care? How is it then that cardiac rehabilitation equipment lies idle? How is that can cancer patients are left waiting for treatment - 120 per day, it is reckoned by SIPTU - due to a lack of radiation therapists? How is it that you cannot walk the length of yourself anywhere without meeting people who are frantic with worry waiting because of staffing shortages?

The Taoiseach quoted his budgetary figures there. It is not only a question of the money; it is how it is spent. Notably, the Taoiseach did not address the core of my question, which is a runaway train on agency spending, which is inefficient and which means the permanent need within the system is never properly addressed, even though it is more cost-effective to take on permanent staff. When you take to your feet, Taoiseach, defend for us, if you can, how it is that €650 million is the figure on agency spend, and agency temporary staff are hired instead of permanent staff, even though that is a more cost-effective option.

The Taoiseach

It is simply not true to say we are not hiring permanent staff.

Deputy Danny Healy-Rae

It is true.

The Taoiseach

I just went through in quite a lot of detail the fact that there are 27,901 more people working in the Irish public health service now than when this Government came into office.

Deputy Mattie McGrath

Pen pushers.

The Taoiseach

With the cacophony of noise it is hard to concentrate. Including in respect of the Deputy's own local hospital, the Mater Hospital, I went through the material difference that has made in terms of hundreds of additional nurses working on the ground, thousands of extra doctors, thousands of extra healthcare professionals. The Deputy can say all that and she can acknowledge that to be true, while also saying that there are still pinch-points and there is still more to do.

Deputy Mary Lou McDonald

Agency.

The Taoiseach

In relation to agency, I guarantee you if the Minister for Health said tomorrow that we are not doing any more agency, despite all this recruitment, your Deputies would be writing to me saying "what about this?" and "what about that?".

Deputies

Hear, hear.

The Taoiseach

There is always a need for flexibility and agility when it is hard to fill posts. We are recruiting record levels, more than ever. We have set a target of a two-thirds reduction in agency staff in 2025. The Deputy made a very important point that I ant to deal with directly about radiation therapists and cancer treatment. This is a real issue and I thank her for raising it. There are vacancies when it comes to radiation therapists in our radiation oncology centres. These vacant posts are still available to be recruited; in other words, they are funded posts. There has been a recent independent review of radiation therapy professionals which published recommendations. We are working very closely because these posts are funded and we want to fill them quickly.

Deputy Ivana Bacik

Education is the great liberator, but that is if you can get an education. In Ireland in 2024, as we have learned today, 44 pupils across the country are being taught at home because there is no school place available for them. A further 150 young people are receiving home tuition because of anxiety or mental health issues but also in many cases because there are just not enough staff in their school to look after them during the day. Those figures, awful though they are, only scratch the surface and do not take account of the immense disruption caused to children with additional needs who have no clear routine because they are forced to travel to get an education. The figures do not take account of the immense stress and financial cost to the parents of those children and their families. One parent in my own community wrote to me about the situation facing his son. He is one of the many thousands of children who are being taken out of their home area in buses and taxis every day, bussed out just to go to school. On the lack of resources for children with additional needs, the parent said this has transformed some special schools into nothing more than containment facilities to try to manage behaviours of children, not educational spaces. There just are not enough staff in schools and that is failing our children.

It is not just those children who are without a special school place or without SNA support in the classroom who are at risk. Our schooling system is facing a crisis of teacher supply more generally. I hear this from teachers, principals and parents in Dublin, Meath, Kildare, Louth, Galway, Cork and other places too. We are all hearing it. The Taoiseach insists that all children who need a school place will get one but I cannot see how he can guarantee that. The facts speak for themselves. Already I am dealing with parents on the housing list who are terrified they will be unable to take up an offer of a home in a particular area because it will mean their child cannot find a school. We all know of teaching staff who cannot find accommodation near their schools due to the housing crisis. The INTO tells us that nearly 1,000 posts are vacant in our primary schools. The Department of Education reports that nearly half of all secondary schools across the commuter belt will be oversubscribed in the coming school year. Demographic changes signal an enormous crisis in secondary education coming down the tracks. Our schools are already understaffed, principals are telling us they are struggling to recruit qualified teachers and new graduates cannot afford to live where we need them to live. Special education teachers are being forced to plug personnel gaps. Shockingly, unqualified teaching staff are being recruited to keep classrooms open while many subjects are being taken off the curriculum in individual second level schools due to lack of teachers. The effect is that our children's education is being undermined. Teachers' unions and parents have highlighted the problems schools are facing, including a shortage of teachers, the working conditions for new and junior teachers and the double whammy of the cost-of-living and housing crises.

We need a commitment to address these issues. We in the Labour Party are calling for a task force to address this crisis. What is the Government putting in place now to stem the exodus of teachers from our schools?

Deputy Michael Healy-Rae

She is not looking for a second bike shed any more.

Deputy Ivana Bacik

Oh shut up.

Deputy Michael Healy-Rae

She gave up on the second bike shed.

Deputy Danny Healy-Rae

She is not very good at building anything.

An Ceann Comhairle

We have had enough of the Waldorf and Statler, please.

Deputy Ivana Bacik

Apologies, a Cheann Comhairle, but I have really had enough of that.

Deputy Danny Healy-Rae

We will tell you the truth oftentimes.

An Ceann Comhairle

Deputies, please. I call the Taoiseach.

The Taoiseach

Thank you, a Cheann Comhairle. I thank Deputy Bacik who is clearly raising an important issue here----

Deputy Brendan Howlin

A serious issue.

The Taoiseach

---- which deserves to be treated with the seriousness with which the question is asked. Of course education is a vitally important issue. The Deputy is right to highlight that there are some challenges and pinch points in respect of recruitment that I want to deal with directly. We need to remind ourselves again that the vast majority of allocated teaching posts are of course filled. There are more teachers than ever before working in the Irish education system. In March of this year, there were 78,646 teachers employed. We see on average in teaching less than 1% resignations and less than 2% of retirements annually. The teacher allocation ratio in primary schools, which I know we all view as really important, is now at the lowest it has ever been. That certainly makes a difference for our youngest kids as they start their formal education journey. There was an increase of 30.3% in the number of teaching posts allocated to primary schools between the 2017-18 and 2023-24 school years. Enrolments at primary level are projected to decline until 2036. That is the way the demographic bubble is moving in Ireland. A teacher projections report is due to be published quite shortly.

The Deputy is right, though, and we cannot wish away some of the challenges that exist here. There are areas of high demand. Indeed, I live in an area where there has been significant growth in population. As a result, we have been working really hard to try to expand school capacity. Since this Government came into office in 2020, we have invested about €4.5 billion in schools throughout the country and have seen around 800 school building projects completed and 300 other projects under construction. When it comes to special educational needs, it is not just a question of resources. I can stand here and tell the Deputy quite honestly that it is the largest special needs education budget ever. That is true. The Minister of State, Deputy Naughton, is working really hard on this. As she knows and as I agree, it also requires reform. It requires much better and more advanced planning, particularly when it comes to second level education for children with special educational needs. Only in the last week or so, the Minister has sanctioned five additional special schools for next year, one in Cork, I think, two in Dublin, one in Monaghan and one in Tipperary. We have given funding for 120 additional special educational needs organisers, SENOs, to have them on the ground. These are the eyes and ears who can often feed back and bring people together. They should also be the contact point for the parent, instead of a parent having to go around lots of different schools to try to find a place. There is now a forward planning structure in place in the Department of Education. There could well be merit in the Deputy's suggestion of a task force. The Minister of State, Deputy Naughton, has just established a task force for special educational needs in Dublin 15. I think it has its first meeting today. Perhaps that could be a model we could build on in terms of the rest of the country. I am happy to work constructively with the Deputy on this. I am conscious of the anxiety it causes. We generally get to a place where a place is found for every child but that is not to take away from the stress and strain of a child not knowing which school they are going to, or if their friends are going somewhere else. We need to do better on the forward planning piece and the task force idea could be a constructive suggestion in relation to that.

Deputy Ivana Bacik

I thank the Taoiseach for his constructive response. A Cheann Comhairle, I apologise for my language earlier but I am sick of taking insults and abuse on cycling from Deputies who believe that God above is in charge of the weather and who have no record of taking the climate crisis seriously. I have no time for that nonsense.

Deputy Danny Healy-Rae

You would want to be sure you are not going to the pumps for diesel. You will not build a million houses either. We have enough of that now.

Deputy Ivana Bacik

I have no time for that nonsense when we are----

An Ceann Comhairle

Please, can we stop bickering?

Deputy Danny Healy-Rae

She referred to me.

An Ceann Comhairle

Stop bickering, please.

Deputy Ivana Bacik

A Cheann Comhairle, I want to address the Taoiseach's response to me. Government policy is taking teachers for granted, notwithstanding his response. We still have some of the highest pupil-teacher ratios in Europe. The Government promised a citizens' assembly on the future of education which seems to have been quietly dropped. We want to know when the Taoiseach will address the teacher shortage crisis that is causing such seriously negative knock-on impacts for children's education across the country. As we reach the last few weeks of this Government, what is the plan for the citizens' assembly on education and for that broader vision on the future of our education system that was promised in the programme for Government?

The Taoiseach

Very shortly we are probably going to ask the people of Ireland to elect a citizens' assembly called the Dáil. I do not want to mislead the Deputy or the House on that. It is unlikely that there will be any further citizens' assemblies proposed by this Government. I would like to say on the record of the House that I do see merit in a citizens' assembly on education. We have had quite a lot of them and my truthful view is that I am not a big fan of having many more. There are many complexities and important issues in education and it would be good to bring people together to tease through those issues.

I am sure we will all have a chance to outline our respective positions on that in the time ahead.

We are certainly not taking teachers for granted. I understand that teachers are not immune to the challenges that are faced by many young people in our country in respect of housing, and housing supply is an important part of improving teacher recruitment. I know that, in my constituency and around the country. We have a new pay deal, though, for teachers and it will mean a teacher's starting salary will now increase to €46,000, rising to a maximum of €85,000. This does compare well internationally, but I know the cost-of-living pressures in Ireland are real too. We have seen over 3,700 newly qualified teachers registered with the Teaching Council in 2024 and we now have over 123,000 on the register. I think that when it comes to enrolments and admissions, better planning with centralised planning processes and forward planning on special educational needs is the way to go. I also think that the D15 task force, as established by the Minister of State, Deputy Naughton, has an important role to play.

Deputy Richard Boyd Barrett

I believe the Government is deceiving the public about what is actually happening in the health service. While it claims it is trying to recruit people to the health service to fill the staff shortages to address the ever-growing waiting lists, which have now reached nearly 1 million people in various hospitals, or the 10,000 children waiting for assessments of need, the 110,000 children waiting for therapies or the hundreds of people waiting for hours on trolleys in emergency departments, in actuality it is imposing a recruitment embargo by another name. I refer to the pay and numbers strategy, which is restricting the ability of hospitals and the health services to recruit the people they need. The Government is gaslighting the public about the truth of this.

The Taoiseach

Come on.

Deputy Richard Boyd Barrett

It absolutely is.

I was talking to radiation therapists who will be in here later today. They say that despite capital investment in, for example, linear accelerators and scanners in Cork, Galway and St. Luke's, the machines are sitting idle because they do not have enough staff, and that if people leave, there is no guarantee at all that they will be replaced and there is no effort to recruit the people who are necessary. In respect of my own hospital, I was informed, and I have to hand figures from the HSE that show, that it has 21 fewer staff than are required. After we had a protest and a meeting, I got a letter saying it was going to try to recruit the 21 staff. That was a month ago, and two jobs have been advertised for St. Michael's Hospital.

The same picture appears everywhere else. Lourdes hospital in Kilkenny has only 75% of its posts filled. Twenty-seven jobs are needed and one has been advertised for. The Government is not trying to recruit the people. That is what is actually happening. It has suppressed jobs and created an artificial ceiling or quota for staff, based on whoever happened to be in post in December 2023 - completely arbitrary - if those posts were not filled. According to the Irish Nurses and Midwives Organisation, INMO, 2,000 nursing posts have been suppressed.

It is very simple for me. Do I believe the Government or the INMO nurses who are balloting for industrial action? Do I believe the health workers who are protesting outside University Hospital Kerry at the moment? Do I believe hospital consultants who are saying the waiting lists are getting longer and will be longer this year than they were last year?

The Taoiseach

They are not.

Deputy Richard Boyd Barrett

I believe the health workers. I do not believe the Government. The workers are saying that they are stressed and overworked, that staffing levels are not safe, that patient safety is being endangered and that they are utterly demoralised. The Taoiseach should tell the truth about what is happening in the health service and scrap the pay and numbers strategy.

The Taoiseach

We will not scrap the pay and numbers strategy because that is how you run the country. You run Government Departments and public services by providing a budget that is voted through this House. That budget then translates into a number of positions in any public service agency and then the agency or the Minister responsible ensures those positions are filled. If it is the position of the Deputy that there should not be any budget at all linked to employment, that is radical but maybe-----

Deputy Richard Boyd Barrett

We are getting nearer to the truth now.

The Taoiseach

Excuse me, sorry.

Deputy Mick Barry

They are out to save safe staffing.

An Ceann Comhairle

Please, will you let the Taoiseach answer?

The Taoiseach

I thank the Ceann Comhairle. We do not need to use language in this House about "deceiving" and "gaslighting". I have facts, which I have outlined. The Deputy can tell me-----

(Interruptions).

The Taoiseach

The Deputy can wave his sheet of paper, but-----

Deputy Richard Boyd Barrett

I have my facts from the HSE.

The Taoiseach

The Deputy will get another chance in a minute, so it would be appreciated if he could give me a little opportunity to respond. Does he accept that 9,375 additional nurses and midwives are now working in the health service compared with 2020, that there are 4,092 health and social care professionals additional to 2020 or that there are an additional 3,330 doctors and dentists? Those are facts I am putting on the record of the House. They are not numbers. They are real people who get up out of bed every day and go to work in our hospitals and health service. They work damn hard and make good progress for our patients. That is the first thing.

There is a real issue, which I have acknowledged clearly and the Deputy is right to highlight, when it comes to radiation therapy. I have had a number of meetings specifically about this, including with the Irish Cancer Society. There are radiation therapist vacancies in radiation oncology centres. There are vacant posts and they are still available to be recruited. They are funded. Measures have been taken to address international recruitment of radiation therapists, including a recent change to CORU's requirements for practice hours to bring Ireland into line with international practice. Additional training places were introduced for radiation therapists during the past academic year. There are plans to further expand courses in Trinity College Dublin and UCC to meet expected future demand. Funding for advanced practice posts for radiation therapists was recently announced in budget 2025. I accept fully that there are real challenges when it comes to radiation therapy. The Deputy's point about equipment that is there and could be further utilised if we filled these posts is true. That is something the Minister for Health and the Government are working on and I have outlined what we are trying to do in respect of that.

When it comes to waiting lists, though, the Deputy is not acknowledging facts about them either. Countries across Europe are reporting increased pressure on waiting lists. In England, waiting lists had climbed to 7.6 million by June 2024. That means inpatient day case hospital waiting lists have climbed by 80% in England since the start of the pandemic. In Northern Ireland, on a per capita basis the figure is effectively double the comparable figure for Ireland. In Scotland, waiting lists have increased by 96%. Here in Ireland, waiting lists have now fallen for two years in a row, as have waiting times. That is what doctors will tell the Deputy. They will also tell him they are too high, and we agree with that and we want to continue to make progress on that.

If the Deputy wants to talk about truth, he has to have an honest debate. Waiting times are falling. Staff numbers are increasing. Budgets are increasing. More people are working in the public health service than ever before and we want to continue that journey, but this idea that we are not hiring anyone does not stand up to scrutiny.

Deputy Richard Boyd Barrett

Of course the numbers are growing. Our population is growing and the need is growing. Baffling people with figures that are out of context does not tell the real truth. Waiting lists are not falling, according to the hospital consultants the Taoiseach mentioned. They are saying they are going to increase by 11% this year, so we will have 746,000 people waiting for outpatient appointments and just under 1 million waiting for hospital appointments. I suppose the Taoiseach thinks the waiting lists for assessments of need or for therapies are not facts either, does he? They are facts and we have evidence all over the place of them.

On the understaffing of our hospitals, as I mentioned, I got the figures. In the Ireland East Hospital Group, the figure is -12 for Wexford General Hospital; -21 for St. Michael's Hospital, -4 for Loughlinstown hospital; and -27 for Lourdes hospital. We can go on through the list. The figures are -41 in south Tipperary hospital and -57 in St. Luke's in Kilkenny. In all of those cases, the jobs are not being advertised, or only a fraction of the number that even the HSE acknowledges are needed are being advertised because there is a de facto embargo. That is what the pay and numbers strategy is. The Taoiseach admitted the truth when he mentioned budgets. The Government is setting staff ceilings even when we need staff in vital areas to address the needs.

The Taoiseach

I am kind of baffled by the fact the Deputy thinks it is breaking news - hold the front page - that organisations are given a budget and can employ people within that budget. The budget we have given for the health service allows it to hire 7,500 more people between the end of this year and the end of next year. Last year saw the highest number of staff ever recruited in the history of the HSE. It seems that when I quote facts, I am bamboozling people or spinning, but when the Deputy quotes them, they are absolute gospel. Let us actually have an informed debate here-----

Deputy Richard Boyd Barrett

I got the figures from the Government. I got them from the Taoiseach's Minister for Health.

An Ceann Comhairle

Please, Deputy, will you stop interrupting?

The Taoiseach

The faux outrage must be utterly exhausting. In St. Michael's Hospital, the Deputy's hospital, as he calls it-----

Deputy Richard Boyd Barrett

The Taoiseach called it that.

The Taoiseach

In the hospital in the Deputy's constituency, there has been a 5% increase in staffing levels since this Government came to office. That is the truth. More people are working in that hospital. Despite the Deputy's constant talking-down of the Government's recruitment efforts-----

Deputy Richard Boyd Barrett

It is understaffed.

The Taoiseach

-----more people are working in that hospital.

When it comes to safe staffing, which is the agreed staffing structure we have for safe nursing levels in the Irish health service, every single post in the safe staffing structure is now funded. Of the 2,000 posts, 1,500 are filled; 500 are fully funded. These are the facts.

An Ceann Comhairle

We go now to the Regional Group and Deputy Peadar Tóibín.

Deputy Peadar Tóibín

The Kyran Durnin case has shocked the country to the core. This is a tragic and dark case that asks serious questions of the State. How can a vulnerable child go missing for two years? How can a vulnerable child just disappear for two years? How broken is the State care system that we are not talking about an intervention here but we are talking about the potential murder of a child. The political establishment has expressed shock and disbelief over what has happened to Kyran but the truth is he is only one of 227 children who have died in State care, or known to State care, just in the last ten years. Of that 227, we know 11 were murdered. Another child died as a result of a suspected non-accidental injury and a further child lost his life due to a suspected homicide. Forty children died because of suicide, eight because of drug overdose, 16 because of road traffic accidents and 18 by other accidents. I wish to reference some of the National Review Panel reports because I feel these speak for themselves. I have ascribed pseudonyms to the children who have died.

The report on the death of Hugh, published in 2018, highlights how he was referred to CAMHS but was left without treatment due to CAMHS policy where young people who are using drugs or alcohol are not eligible for service. Hugh died at the age of 16 from a drug overdose. Niamh, whose report was published in 2019, died at the age of 15 by suicide. She too was deemed ineligible by CAMHS. I wish to mention Ava also. She was a victim of child sexual abuse. The abuse occurred in one Tusla area and she lived in a different area. Area 1 believed that area 2 was speaking to Ava about the allegation and area 2 believed that area 1 was doing it. I quote from the report: "This ultimately meant that nobody in Tusla spoke to Ava about her alleged experience of sexual abuse". CAMHS discharged her after the second appointment as it had no evidence of mental illness. She went missing at the age of 14 and her body was found a few days later. The report on the death of Luke is heartbreaking. He experienced sexual abuse as a child. His father died when Luke was nine and he found his father's body. His mother died shortly after that and Luke was put into foster care. In foster care, he was robbed and assaulted. He then went to a homeless hostel. He faced threats in the hostel and he moved onto the streets. He then went to prison. There are no details of the circumstances of his death, only that his body was found two weeks after he was released from prison. He was a child.

The 1916 Proclamation states that we will cherish all the children of the nation equally. The report on the death of Luke notes he never received a birthday present and that Santa Claus never came to him. Will the Taoiseach demand that the Minister for children, Tusla and CAMHS are brought to the children's committee in light of the shocking case of Kyran Durnin and the hundreds of other children who have lost their lives in this State in the last ten years?

The Taoiseach

I do not think there is a person on any side of this House, or in Ireland, who is not both utterly horrified and heartbroken at what is emerging in relation to the case of young Kyran Durnin. This is nothing to do with political establishment or any sort of rhetoric. This is just to do with basic humanity. An eight-year-old boy effectively went missing for two years and the saddest and most painful thing is that nobody asked why or where he was for that period of time. Any one of us thinking that this could happen to any child is deeply upsetting. Let me say at the outset that this is absolutely going to require a structure to get to the exact bottom of this; of that there is no doubt. However, right now, we have to be very conscious of the fact that An Garda Síochána is very actively investigating this. To say there is a live investigation under way would capture it. An Garda Síochána has appealed to the public for information. I echoed that appeal today. A murder investigation has been commenced. While no arrests have been made at this point, the investigation is ongoing. It is being led by a senior investigation officer based out of an incident room established at Drogheda Garda station. An Garda Síochána is appealing to anyone who has any information in connection with the disappearance of Kyran to contact Drogheda Garda station, the Garda confidential line or, indeed, any Garda station. I know vigils were held in both Drogheda and Dundalk over the weekend and it is clear the whole community in Louth has been deeply affected. We are very conscious that this is ongoing. I am also conscious that An Garda is current investigating this case and liaising with Tusla as part of that investigation. The Minister, Deputy O'Gorman, has confirmed that he has asked Tusla to send this case to the National Review Panel. Just as the Deputy quoted from some of its reports, the role of the National Review Panel is to examine the circumstances surrounding the death of any child who has links to the caring structure of the State. This is not in relation to Deputy Tóibín but I am conscious when any case such as this comes to public view obviously people speculate and discuss it, sometimes from a place of good. It is important though that we afford the State agencies the space they need to investigate the matter fully. Tusla, the Child and Family Agency, is the statutory body with responsibility for child protection in Ireland. Under Children First, everyone has a role to play in ensuring the welfare and the safety of children. Information on how to report any concern about any child, whether as a mandated report or a concerned neighbour, family member or member of the public, can be found on Tusla's website.

I am not suggesting Deputy Tóibín conflated the issue but he quite rightly brought up a broader issue in respect of children in care and what happens when a child in care goes missing. Tusla has advised it prepares an absence management plan for each child in care and this plan is a tool to manage the risk in the event of a child going missing. Perhaps I can come back in on that in my second answer. I am sure the Oireachtas children's committee will, in due course, wish to discuss this issue.

Deputy Peadar Tóibín

The Taoiseach has not addressed the question I asked regarding this case-----

The Taoiseach

I ran out of time.

Deputy Peadar Tóibín

Many of these deaths are as a result of a failure of State care. I will give him other examples. The Government is using special emergency arrangements at the moment to accommodate children. These are often unregulated, rented accommodations provided by third-parties with questionable vetting standards. Children are going missing every month and these children are being exposed to sexual exploitation. I have raised these cases practically every month for the last five years in this House, as have other organisations across the country. Shockingly, Judge Simms sent a report to the Minister for children which details cases. The Minister for children shredded these reports stating GDPR reasons. The Government actually reported Judge Simms to his superiors for raising his head above the parapet on this situation. The Minister, Deputy O'Gorman, cut funding for the Child Law Project just recently. It provides transparency on the operation of the childcare system in the courts. The Taoiseach has said he wants to make this country the best country in Europe in which to be a child. For thousands of children across this country----

An Ceann Comhairle

Thank you, Deputy. Your time is up.

Deputy Peadar Tóibín

-----it is the polar opposite of that. It is really important that we get to the heart of the fatal dysfunction that exists in our childcare system currently in this country.

An Ceann Comhairle

Thank you.

Deputy Peadar Tóibín

Will the Taoiseach ask for the Minister, Tusla and CAMHS to be brought before the children's committee to focus on this fatal dysfunction?

The Taoiseach

It is not my job to order the business of an Oireachtas committee. I am sure the Deputy is well-----

Deputy Peadar Tóibín

The Taoiseach can ask, like any TD here can.

An Ceann Comhairle

Please, Deputy.

The Taoiseach

The Deputy is asking me a question as the Taoiseach. I will respond to it, if that is alright. First, the Minister, Deputy O'Gorman, is a good person who works hard and does a good job. I do not like the aspersion cast on him in the constant framing of the Deputy's questions quite frankly. Of course, I am going to use the time available to me, when the Deputy raised the case of Kyran Durnin, to put on the record of this House the extreme concern of Government and, I think, this House. That is an appropriate thing to do.

The Deputy is right regarding the need to reduce our reliance on the special emergency arrangements for the accommodation for children in care. I agree with that. Tusla's strategic plan on residential care outlines plans to increase residential care capacity and Tusla continues to progress a number of measures to secure residential care capacity. We have seen an increase to the foster care allowance in 2024. We have seen a further increase in that allowance scheduled to take effect in November. The Minister, Deputy O'Gorman, has secured an increase of 14% in Tusla's total budget for 2025. That is an extra €145 million. These are extraordinarily difficult cases. Every child deserves their voice to be heard, including vulnerable children; in fact, vulnerable children most particularly who do not have others to raise their voice for them. The Deputy is right to highlight that. However, we do not yet know the facts. We need to know the facts of the horrific situation that is now emerging and the heartbreaking situation regarding Kyran Durnin.