Order of Business

The Order of Business is No. 1, Health (Miscellaneous Provisions) Bill 2016 - Committee and Remaining Stages, to be taken at 4.45 p.m.

Like many others, last night I watched "RTE Investigates: Living on the List" and was shocked and horrified by the programme's content. It is unbelievable that, in this day and age, people are left to suffer on hospital waiting lists to the extent that they contemplate suicide. The programme unveiled that waiting lists might be significantly longer than those published by the National Treatment Purchase Fund, NTPF, with a pre-admit list comprising 23,000 patients and a pre-planned list of approximately 60,000 patients not included in the NTPF's monthly reports.

Last year Deputy Billy Kelleher of my party raised his concerns about waiting times for children suffering from scoliosis. I share his concern and believe this situation highlights the need to have the new national children's hospital constructed without further delay. Obviously, there are concerns about costings, but they must be ironed out in order that children have an efficient and state-of-the-art facility to attend. They deserve nothing less. I have voiced my support numerous times for the national children's hospital, as it is a necessity in easing the waiting lists facing children with scoliosis and those suffering from other ailments.

The new orthopaedic unit has opened at Crumlin children's hospital. One would imagine that it would be fully operational and ready to help ease the suffering of children with scoliosis on waiting lists. However, the theatre is not open because of a scarcity of theatre nurses due to the Government's bad planning. This must be remedied immediately. Issues surrounding staff shortages, the cost of implants and other bottlenecks in the health system must be addressed and the recruitment of new nurses must be a priority. Bad planning must be rectified immediately and those suffering on waiting lists, including children, must be given an opportunity to attend consultants and have their surgery scheduled.

Yesterday was international day of zero tolerance for female genital mutilation, FGM. It is estimated that more than 2,500 women and girls living in Ireland have undergone FGM according to research conducted in 2008 by the national network of African women living in Ireland. It is a major issue that I must raise in the Chamber.

It involves the mutilation of female genitalia for non-medical reasons and is a serious violation of the human rights of females. FGM has been inflicted on approximately 200 million females and the horrific procedure is generally performed on young girls between infancy and the age of 15 years. I reiterate the calls made by numerous non-governmental organisations for its elimination. Awareness of the practice is key. As such, it is necessary to raise the issue today.

On the issue I highlighted last week about children and their mental health, it is important that the House take a moment to reflect on last night's RTE programme, "RTE Investigates: Living on the List". It illustrated the physical and emotional burden on sufferers waiting for long periods for life-altering operations and the impact of the waiting periods on their families and friends as they watched them suffer. It also documented how, as time passed, the condition of patients worsened. The long-term impact can be far-reaching. One of the most disturbing findings of the investigation was that there were two unpublished waiting lists for health treatment in Ireland. I second the words of the Minister for Health, Deputy Simon Harris, when he stated this was wrong and something over which the Government could not stand. He also added that he was ashamed. What shames me as a Senator is that there are very sick children on waiting lists for mental health treatment, inlcuding for early onset psychosis, anorexia, bulimia, self-harm and addiction. They are equally vulnerable, but not once was the waiting list of these children mentioned last night. What shames me even more is that not only did they not get a look in last night, or this morning when the Government spoke about the need for extra beds and staff in the health service, but there was no mention that last year in Ireland 17,794 children had been referred to the CAMHS and that 5,379 children had not been dealt with at all. The waiting lists for mental health treatment are extremely serious and equally as critical as the devastating interviews we saw last night. Each month, approximately 2,500 children await assessments. Almost half of these children will not be seen during the first year, while some of them will not be seen after a year. What strikes me as bizarre is that the national service plan published in December 2016 warned us that the number of children on the waiting list would increase in the coming 12 months. Why are mental health sufferers second-class citizens? Why is the same urgency not given to dealing with their situation? It appears that this and previous Governments have operated a two-tier system of health care which ignores and neglects children and adolescents suffering from a mental health illness. In the 1990s the then Government got rid of the asylums. We opened up the doors of our Victorian hospitals and integrated those with mental health issues into society. I am beginning to wonder whether this institutional deconstruction had any effect on our attitudes and ideas about mental health services. Is anyone becoming a little exhausted with the talk about reform and the absence of a discussion on delivery? Is it not a source of outrage that the administration is not giving the public a full and frank image of waiting lists? Is it not a source of disappointment that once again mental health service waiting lists are completely ignored?

I refer to last night's programme on RTE. I commend RTE for the service it has done in highlighting the problem of waiting lists. It is not a new phenomenon to us as we deal with it every day, as we have for the past few years. It is deplorable that Minister for Health after Minister for Health, including Deputy Micheál Martin, Mary Harney, Senator James Reilly and the current incumbent, has presided over a situation where thousands and thousands of people throughout the country wait in pain without being able to obtain treatment.

The crux of the matter is if I need an MRI scan tomorrow morning and produce €250 or €300, I will have the same MRI scan on the same equipment with the same consultant within ten days, but if I do not have the money, I will have to wait in pain. The people who have been responsible for delivering that health service should hang their heads in shame.

I want to raise an industrial dispute issue in my area. Hastings Garage in Westport recently imposed compulsory redundancies on three members of staff. Ex gratia payments were recommended by the Labour Court for all three, with one employee to be given the option of returning to employment at the garage. The company has made it clear that it will not abide by the second ruling concerning payments. No explanation was given as to how the redundancies were chosen. The Government’s industrial relations strategy is contradictory and utterly useless. These industrial disputes can often be viewed as legal proceedings ongoing in the background. In reality, they have led to great hardship for families, many of whom are already struggling. The Government has been at pains to instruct Bus Éireann workers and others to go to the Labour Court and abide by its recommendations. Here we have a case in which a ruling has been made but one party refuses to abide by the decision. The Government cannot hide behind the excuse of urging engagement with the Labour Court, yet in other circumstances remain completely silent. I would like to have the Minister for Jobs, Enterprise and Innovation explain to us in the House exactly what the Government's strategy is to deal with industrial unrest. It does not, however, have to be that Minister. I know that the Taoiseach is acutely aware of this dispute within his constituency. There is a basic need to stand up for fairness and to be seen to do so. We have enough problems in creating and keeping jobs in the west. It is vital that fair play be seen to prevail in this situation. I urge the Government to intervene to ensure the right thing will be done for the workers and that the company will be made to adhere to the Labour Court's ruling.

The Sunday Independent stated a leaked report from the Department of Public Expenditure and Reform emphasised a number of pressures on the State's income and expenditure. However, it made no mention of 600,000 people with disabilities and mental health needs, even though it is acknowledged that the people concerned are in the throes of a long-term crisis. There are public service pay pressures and a deep housing crisis, which also affects people with disabilities. We have the health issues that have been exposed again today and the Brexit challenges. The glaring fact is that there is an ongoing crisis for the 600,000 people mentioned and their families, a crisis long acknowledged by successive Governments.

The troika left town at the end of 2013 and the recession ended that year. People with disabilities are now, in the fourth year following the recession, still feeling its worst effects, with little or no hope the situation will change. Last week the CSO confirmed that the modest recovery had not extended to people with disabilities, for whom poverty rates are increasing, while, thankfully, they are decreasing for the general population. Four years after the troika left Ireland, more than half of the people living with disabilities are not able to afford four essential items: adequate heating; two pairs of strong shoes; a warm coat; and meat a few times a week. These are the facts in Ireland today. The SILC figures released last week show that people with disabilities are at twice the risk of living in poverty, at just under 35%, as opposed to 19% for the general population. These are stark facts. The incidence of people with disabilities in consistent poverty has increased by 8%, while the deprivation rate has increased by just under 2%. The number at risk of poverty has increased by almost 10%. While, thankfully, the rate is falling for the general population, it is going the wrong way for too many.

This crisis is absolutely out of control. It is going the wrong way. It needs to be acknowledged and tackled.

I pressed the Taoiseach in September last year, just before the budget, to prioritise the welcome but modest funding then available in the budget for people with disabilities, but that did not happen. There are real pressures in other areas, but this, too, is a real issue and if the Government is honest and honourable about its commitments to people with disabilities, the upcoming budget in October will have to have a real, meaningful, cross-Government package for people with disabilities. Will the Leader ask the Taoiseach to come to the House to set out what he and his Government intend to do to make this a reality for the coming year?

I welcome the announcement that the Government is establishing a commission of inquiry to investigate the allegations of a campaign within the Garda to discredit whistleblowers within the force. I know that announcement has been made following a Cabinet meeting today. It is in keeping with the recommendation made by Mr. Justice Iarfhlaith O'Neill in his inquiry earlier last year.

I call on the Leader to arrange a debate on US immigration policy in the light of the restrictions announced by US President Trump last week. I was among many people who protested outside the US embassy on Thursday evening. The numbers present in the lashing rain showed the immense concern among Irish people about the nature of the new restrictions President Trump had announced, notably the restrictions on citizens of seven predominantly Muslim countries. This is not just about that restriction. We saw the chairman of Ornua, formerly the Irish Dairy Board, talking about difficulties that he had had since President Trump took office in getting Irish graduates into the United States for the first time. The new immigration policy in the United States is a much bigger issue than just that restriction. It is welcome that over the weekend the US courts effectively brought about the suspension of the ban. I am conscious that the ninth US Circuit Court of Appeals is hearing the appeal being brought by the US Department of Justice this afternoon. I hope the US justice system will be robust enough to withstand the dreadful critiques we have seen from President Trump and the attacks he has made on members of the judiciary. I hope we will see the most recent immigration restrictions lifted or indefinitely suspended. If the restrictions remain in place, I will join the leader of the Labour Party, Deputy Brendan Howlin, in calling on the Taoiseach to stay away from the White House on St. Patrick's Day. There is immense concern among Irish people about the nature of these restrictions and the Taoiseach would do well to note their concerns.

It is not a decision for any one man to make.

Please allow Senator Ivana Bacik to continue, without interruption.

I hope we will see the US justice system, in which I have great faith, as I am sure everyone does, upholding the decisions of the lower courts, having seen the joyful scenes at the weekend in which people were reunited and able to travel. We would love to see those scenes replicated, not the absolute chaos, confusion, distress and trauma caused for so many people as a result of the restrictions.

There is huge human trauma caused by such a chaotic announcement of restrictions, apart from their content.

I renew a call I made to the Leader for a debate on the situation Syria. Perhaps in all of the international news about President Trump the focus has moved from the situation in Syria. This week Amnesty International accused the Syrian regime of hanging 13,000 people at an infamous prison, Saydnaya, near Damascus. This appalling report was yesterday utterly dismissed by the President of Syria, Bashar al-Assad, in a comment to Belgian media. The English translation refers to Mr. al-Assad being utterly dismissive of the United Nations, international tribunals and any attempt to make his regime accountable for war crimes committed. I again call on the Leader to arrange a debate on the situation in Syria.

I concur with Senator Ivana Bacik and others in commending the Government for finally implementing the recommendations of Mr. Justice Iarfhlaith O'Neill's committee and actually going ahead with the establishment of a commission of investigation into the suggested ill-treatment of whistleblowers. Whistleblowers are the primary source of a lot of the reforms we are seeing and this issue needs to be dealt with once and for all.

Like others and the Minister, we were all horrified by what was unveiled last night on the "RTE Investigates" programme. It is outrageous that successive Ministers have been given information that is not accurate and that figures, waiting lists and reports are not accurate. That is not good enough. It is not good that a Minister should receive the wrong information. Effectively, it is a case of somebody lying. We need a serious investigation in the HSE into why the Minister and previous Ministers were given the wrong information. Heads should roll. How can a Minister make a case to the Government for extra funding if he or she does not have the full facts? On the money required to get the health service up to a standard over which people can stand, a significant increase in funding is required. We need a debate about having no tax cuts for the next number of years. The extra resources that would become available as a result of not having tax cuts should be ring-fenced for capital expenditure in health services. Most decent human beings and taxpayers would be quite happy to see their taxes increased by a percentage point or two in order to solve this problem once and for all. Every year since I have been elected, Senators have stood up prior to the budget and looked for tax and universal social charge reductions and tax breaks. That day must be gone. We need to see a significant increase in health spending to deal with what we saw last night on television.

I agree with Senator Martin Conway about the information being provided for Ministers. Mark Twain said "facts are stubborn, but statistics are more pliable," but when someone does not have the facts, there is nothing he or she can do about it. While heads should roll, in a modern democracy, the fact that the lists are not accurate means that the HSE has a lot to answer for, but that does not mean that the Minister is not the person in charge. The former Minister, Deputy Leo Varadkar, appeared here many times and one would have sworn that he was a commentator on the health service instead of Minister for Health. Nobody can point to any reforms he made when he was Minister.

The leader of the DUP is also a person who seems to be unable to grasp facts as they apply to the real world. She is not, as we know, a woman of detail because even though she was in charge of the Department that promoted and signed off on the renewable energy scheme, she said she did not realise the devil was in the detail and that, in reality, she was giving away hundreds of millions of pounds to people to literally burn. She was not very good on facts when she said yesterday that more people in Northern Ireland-----


Senator Paul Coghlan is interrupting a lot today and in interrupting he is delaying the entire process.

I will start again for the benefit-----

That is not allowed.

On the ability of the leader of the DUP to grasp facts, she does not seem to understand her Department was in charge of signing off on the renewable energy scheme and that she has burned £500 million on the scheme to the point where I am informed by people in Northern Ireland that they are not even burning the pellets they are being paid to burn. They are actually taking the pellets south and reselling them. That is enterprising and I am sure the DUP would love that type of enterprise. The leader of the DUP also said something yesterday that was not a fact either. She said more people in Northern Ireland spoke Polish than Irish. That is not true. There are 30,000 Polish speakers and 105,000 people who speak Irish. She did not seem to understand the most important fact of all when she announced the DUP's policies and said she did not support an Irish language Act and would not see one implemented. It is part of an international agreement.

That is a fact. It is the St. Andrew's Agreement which should be implemented. However, it seems the DUP wants to roll back on an agreement to which it signed up. Ms Foster does not seem to have much of a grasp of the facts. It is deplorable that the DUP is rolling back on its commitment to the Good Friday Agreement and the St. Andrew's Agreement.


The Senator is one minute over the limit. He has five seconds.

The state of Israel is taking over Palestinian land and building houses on it. It is a deplorable act by a democracy. We do not expect much of Syria or Iraq, but we expect a lot more of the state of Israel.

The Senator makes four minutes out of two.

If only my colleague would leave me alone.

He only took five seconds.

I said one word.

No interruptions, please. The Senator has interrupted three times. All he is doing is inciting the Senator sitting opposite him to continue. He is not helping the Chair.

I also refer to the "RTE Investigates" programme, for which I thank RTE, as previous speakers have done. It has done a great service to the State. We need to deal with the facts. I ask the Minister for Health ti come to the House to explain the relationships between him, the HSE, the National Treatment Purchase Fund and the Department of Health. It is a complex web. We cannot lay blame without all of the facts. We need to see what is the role of the National Treatment Purchase Fund. While I note and welcome the Government's commitment to provide additional funds and resources for the fund both this year and next year, as set out clearly in the budget and programme for Government, it is important to have a statement on the issue. Who actually validates lists and how does the system work? We need more information than we heard last night. It was an appalling story and an appalling vista. Not one of us would like to be on one of the waiting lists or have any family member on one. Will the Leader ask the Minister attend at some point to make a statement on the interrelationships between the HSE, the National Treatment Purchase Fund and the Department?

Last month I highlighted a report released by CyberSafeIreland on childhood safety and cyber issues. The report set out that 84% of the teachers surveyed had said they did not cover online safety on the curriculum, while 64% had said they did not have sufficient resources. We need to have a debate in the House on this very serious issue which is only getting worse, given the extent to which technology and online developments are so far ahead of those who make policy in this area. A new survey conducted by the national anti-bullying centre at DCU and released yesterday emphasises the need for additional measures to combat this scourge as a matter of priority. Only one in three parents feels confident that he or she can protect children online. Parental concerns revolve around risks of cyberbullying, access to pornographic content, online grooming and generally spending too much time on the Internet. When it comes to lifestyle issues, the last mentioned is the biggest of them all. Children are going online at an increasingly younger age. Combined with the exponential growth in the use of mobile phones, this presents an immense challenge for parents. The latest study highlighted how new apps and social media platforms are coming onto the market all of the time and being targeted at children as young as nine years. A second report out today also confirms that one in ten children in Ireland says he or she has been cyberbullied. Both reports are being released to highlight Safer Internet Day which is tomorrow. They call for parental education on digital technologies and their use.

Meanwhile, the survey of parental attitudes conducted last month among parents of children aged zero to 18 years found that they employed a range of strategies to try to protect their children, the most common being limiting screen time. As most children are now accessing the Internet on tablets and mobile phones, it is very difficult for parents to have any control. Certainly, they cannot watch their children on a 24/7 basis. Of parents, 53% are happy with how they monitor their children's usage of the Internet, but 40% admit that it is easy for their children to use the Internet without their knowledge. I ask the Leader to arrange a debate on this issue and suggest to the relevant Minister that we create a one-stop-shop to deal with this issue nationally. There should be strategic campaigns for parents and a backup service to help them to deal with the issue of cyberbullying.

We were all so affected by the "RTE Investigates" programme last night. The Minister for Health needs to direct the National Treatment Purchase Fund to obtain accurate and real figures for waiting lists. There are two waiting lists, one of which involves massaging the figures. Waiting lists are already shockingly high, with the number of scheduled procedures having risen from 50,000 in 2013 to 80,000 in 2016. The saddest point is that public patients are suffering most. Since Christmas, the number of patients on trolleys in corridors of hospitals has been the highest. The numbers waiting for appointments and procedures have rocketed. There is no accountability in the health system and no leadership. I heard the Minister say last night that this was unacceptable. It is unacceptable and not good enough.

Another urgent case the Minister is not addressing - I have asked that he appear in the House next week - concerns the unacceptably large number of cancer patients fighting for medical cards. A large number of cancer patients have been waiting for months while further information is sought. They need-----

A Senator

That is not true.

I can provide the figures and statistics. All I can say is that it is unacceptable. We need to ensure the health service and the people will not suffer any more.

The nation was shocked by the harrowing stories exposed on the "RTE Investigates" programme last night. It is shocking and a shame that it takes a television programme for notice to be taken, rather than calling out these issues long in advance of the broadcasting of such programmes. Patricia Connolly told her story of how she was waiting for over a year for a gynaecological appointment in Cork. She is condemned to a life of pain on painkillers. She is one of at least 4,265 women, if not more, in Cork who are waiting for a gynaecological assessment. It is nothing new. I raised this matter with the Minister in September, but nothing has happened since. There are more women living in pain on the list. We need to know what needs to be done to resolve the issues in Cork. We need the Minister to ensure the doctors' four-point plan will be put in place. The four recommendations the doctors made to him some weeks ago are to employ additional gynaecology theatre staff to increase theatre capacity from 30% to 100%; to develop a gynaecology day unit; to build and staff the gynaecology one-stop shop which was part of the cancer plan in 2014; and to employ a minimum of four additional consultant gynaecologists.

To end the misery for women in Cork and the region, we need concrete action beyond the Minister's genuine emotion and warm words. I want to know what specific actions he will take. What is the timeframe for the taking of these actions? On 25 January, the last time the Minister addressed this matter in the Seanad, he told us he had requested a report from the HSE on both inpatient and outpatient waiting lists. Is the report ready? Will it address the practical issues in CUMH, which issues are the outliers? Can we see the report? The Minister said on the occasion in question that the situation was not acceptable. What does this actually mean for women waiting to receive the treatment they need? What action will the Minister take to provide a sustainable solution to build real capacity and not fund something that will just rely on the National Treatment Purchase Fund? In January he promised to meet the consultants and management in February to agree the actions and promises. Has a date been set? The consultants have sent their proposals to the Minister. It would take him just under 30 minutes to consider their practical proposals. I would like the Leader to bring the Minister to the House to answer these questions for all of those on the waiting lists.

I join those who have rightly referred to the "RTE Investigates" programme last night. It is quite shocking that we have figures such as those aired and that there are two sets of figures. The CEO of the HSE, Mr. Tony O'Brien, has many questions to answer in that regard. People want to hear more than statements of shock from us. The HSE is charged with delivering a health care service. There are children with scoliosis who need a timely intervention and surgery, but it does not seem to matter.

The list goes on and I know that the Minister has been deeply affected. However, we have seen this with Minister after Minister and need to get to the bottom of it. What is shocking and shameful needs to be pointed out. I support the suggestion that the Minister come back into the House. I raised a very important concern about how the health care groups were operating. I am reliably informed that, since they have been set up, there have been 122 new general manager grade A posts at St. Stephens Hospital central administration but that there are 120 consultant vacancies nationwide. We need front-line staff, but these new managers cost in excess of €100 million per year. What is going on? I raised this issue during statements on the health service and have not received any answer. I would like an answer because it is very peculiar that, with vacancies a problem in the health service, there is no problem in filling managerial posts centrally.

There is a crisis in an industry which is estimated to employ 10,000 people in this country, namely, the greyhound industry. Last Saturday there was to be a picket placed at Shelbourne Park to highlight the difficulties within the industry. On Friday evening the interim CEO of the Irish Greyhound Board called off the race meeting due to be held in Shelbourne Park on Saturday night. Among other things, he claimed he was concerned that racegoers might be intimidated. The hard facts are that the people who attend race meetings on a weekly basis are the same people who were supporting the placing of the picket. The claim made by the interim CEO was unfounded and extremely unfair. The actions taken by owners and trainers have not been taken lightly but out of years of frustration at the lack of action in dealing with problems within the industry. I ask the Leader to invite the Minister for Agriculture, Food and the Marine to the Seanad for a debate on this issue and to find out why the legislation which has been promised since last year and which I am informed is ready is not being brought forward. I also want to know the circumstances around the departure of the former CEO before Christmas and its implications for the Irish Greyhound Board in terms of contractual obligations, given that the person in question only served two years of a three-year contract. I also want to ask about the procedures used in appointing the interim CEO to the Irish Greyhound Board, how long the appointment is for and when the position will be advertised. The Leader referred to a meeting held last Wednesday in Naas between the Dublin Greyhound Owners and Breeders Association and the interim CEO. The meeting was a non-event and completely unsuccessful. One of the issues raised by the group was the closing of the race track at Harold's Cross, one of the most profitable tracks in the country. The interim CEO said he did not want to discuss it. The track was being closed - end of. Another picket will be placed at Shelbourne Park next Saturday at 3 p.m. The national awards ceremony is taking place there at 4 p.m., but this is not the action of people who want to disrupt the industry. They are frustrated at the lack of action on the part of the Government to clean up an industry they all love and to which many of them have given their lives.

I say, "Well done," to RTE for its programme last night. I did not see it, but I do not need to see such a programme to find out what is going on. I call on the Minister for Health to come before the House to report on the overall situation in medicine and the health service.

There is, as we know, a crisis in emergency departments. Trolleys are being counted. I had reason to visit University College Hospital Galway, UCHG, over four days, from 26 to 31 January, as a visitor, friend and relation. I must commend the excellent work being done. Because of the chaos - organised chaos, perhaps - it was like a scene from Martha Mitchell's "Gone With The Wind" in Atlanta, Georgia. Once one gets into that situation the medical team moves very quickly, but there were only two recovery cubicles in the emergency department. There is a need for a reconfiguration of the hospital system in order that emergency departments will become mini hospitals and that beds will be allocated to ensure patients will not be on trolleys. The fact is that once someone gets into the system, he or she can be cured.

I send best wishes to the Minister for Communications, Climate Action and Environment, Deputy Denis Naughten, for a speedy recovery. On 2 January he was involved in an accident six minutes from the closest emergency department in County Roscommon, but he was brought to Portiuncula hospital and then UCHG. It is disgraceful. The former Minister, Senator James Reilly, is present. He proposed the closure and the Minister, Deputy Denis Naughten, voted against it. He was carted from the scene of the car crash but could not be taken to Roscommon.

Roscommon County Hospital has never been busier.

He could have died in the interim.

Will the Senator, please, conclude?

I am calling for the reopening of the emergency department. I will put it further-----


I call on the Minister, Deputy Denis Naughten, to put the gun to the Government's head and demand that the emergency department be reopened and if it brings down the Government, so be it. I would welcome it collapsing on the basis of his commitment. He voted to retain the emergency department in the hospital. Now he has an opportunity to say to the Taoiseach-----

The Senator's point has been well made.

-----"My vote will not be there anymore, unless I see the restoration of the emergency department in Roscommon, or I am resigning from this discredited Government. I do not care how long it lasts. If I get back the emergency department, so be it." He has to call for this to happen now.

That is a matter for the Minister, Deputy Denis Naughten, to decide.

It is very disappointing to hear an experienced Senator like Senator Terry Leyden use the health service as a political pawn. If he wants to talk about the history of politics and the state in which the country was left after the Government led by his party, he should mention that the then Minister for Health left not only the health service but also the economy in a terrible state. Whatever we say about the last Government, it was up to the mark in the oast five years in repairing the economy and putting funding back into the health service. If we look at the facts, Ireland has the second highest expenditure figure in health services among OECD countries. It is not just about funding. It is also about accountability. I ask the Leader to bring the Minister for Health to the House because we need political accountability. We also need administrative accountability for the manner in which funds are being spent in the health service. I point the finger of blame at the HSE which is not managing to the best of its ability the funding provided by the taxpayer to provide essential health services for communities. My colleague, Senator James Reilly, the former Minister for Health, was mentioned. In 2013 he reconfigured the acute hospital network, but the problem has been that four years down the road the governing boards of the hospitals have not been appointed. Without accountability structures, the HSE is not going to be held to account for the harrowing scenes we saw on "RTE Investigates" last night, about which we are all concerned and expressing our outrage. I ask the Leader to bring the Minister for Health to the House to explain why the hospital boards have still not been appointed to govern the hospital network that was reconfigured in 2013. Without accountability and governance structures, we are not going to see the improvements and efficiencies planned at the time. We all need to work together, across parties, if necessary, to ensure we will get to the fundamental problems in the health service because arguing about parochial issues, as our colleague, Senator Terry Leyden, has done, will not help to solve the problems. We need to stand up and be counted on a national level.

I echo the sentiments expressed about the report on "RTE Investigates" last night.

It is shocking to think 81,000 people are on waiting lists and that 34,000 are awaiting endoscopy procedures which are vital in the diagnosis of gastrointestinal cancers.

I call for an urgent debate on a separate issue, namely, the plans the Minister has in place to safeguard the 50,000 or more employees who work in the pharmaceutical industry in Ireland. They need safeguarding because of the policies of the President of the United States, Donald Trump. During his first press conference the then President-elect decided to target the pharmaceutical and medical technology sectors. In so doing stock prices for major US pharmaceuticals dropped by more than $25 billion in 20 minutes. It is the longer term impact which can be more profound and about which we must be concerned. At the time my party colleague, Deputy Niall Collins, expressed his unease at President Trump's comments and also questioned the failure of the Government to spell out any plan to respond to the emerging threats to jobs in US owned companies in Ireland. One month on, the Minister for Jobs, Enterprise and Innovation, Deputy Mary Mitchell O'Connor, has yet to adequately respond to these threats or illustrate any plan to deal with them. President Trump wants the US pharmaceutical companies to which Ireland is home to close up shop and return to the United States. He has spoken forcefully about getting US pharmaceutical companies to make a return and imposing sanctions on those which do not. It is worth remembering that Pfizer employs 3,200 people at six sites across the country. AbbVie's Irish operation employs more than 500 people at five locations across the country, while Boston Scientific which was founded in Galway in 1994 employs more than 4,000. These are just a few of the companies that are providing jobs and benefiting the economy. If we have learned anything from the first 18 days of the reign of President Trump, it is that he was not simply paying lip-service throughout his campaign and his plans for the pharmaceutical industry are no exception. He is a populist President and pharmaceutical companies are a popular villain. We cannot allow his comments which are very likely to become actions to rock a recovering country and one of our most fruitful industries.

I would also like to comment on the waiting lists issue covered on the television programme. It has been an ongoing problem for many years. We want waiting times for patients to be diminished, but it is not and never has been just about resources. I wish to correct the record for the leader of Sinn Féin. During my tenure as Minister for Health inpatient waiting times came down to eight months, despite €2.5 billion less being available. The number who had to endure long waiting times on trolleys, those most acutely ill and the seriously sick, was reduced by one third. There are still far too many waiting on trolleys and more work has to be done in that regard. The bottom line is that no part of the health service operates in isolation. If we want to cure what is happening in emergency departments and fix waiting lists, we must fix what is happening in primary care services. Unless there is a new GP contract and greater emphasis on prevention and early detection, people will continue to wait. As pointed out on the programme last night, if patients are left on waiting lists, they will go from being elective cases, that is, having their surgery planned, to emergency cases. All of the statistics show that the outcomes are not as good for them and that the expense on the State is greater. I commend the Minister for Health for starting negotiations on a new GP contract, but we also have to look at who is doing what within the health service. I have mentioned treating the patient at the lowest level of complexity that is safe, efficient, timely and as near to home as possible. Consultants are doing work GPs could be doing and GPs are doing work nurses could be doing. We are all doing work other paramedics could be doing. This must change.

I want to comment on management. It takes six years for a student to become a doctor and approximately four years to become a GP or 12 to become a specialist. What do we spend on managers? Many of them are excellent administrators who were promoted into management positions. They cannot take study leave and do not receive extra training. They are left in place.

During our time with the special delivery unit, SDU, we set up a programme to train 30 a year and provide postgraduate training. That programme needs to continue and be amplified. The point has been made that the funds go into the system and that we have the best doctors and nurses in the world. It is management that we need to address. There is no point in Senators giving out about management unless they are prepared to train and support managers during the course of their careers in order that they can do the job we all want to see done.

There is still a need for capital investment. Members have mentioned the emergency department in Galway. The same can be said of the emergency department in Beaumont Hospital. There is a need for more primary care units and day hospitals. All of these things will help to treat patients long before they get to the position where they will need to be in an acute hospital. That is what needs to be done.

As clearly outlined by my colleague, Senator Mark Daly, it is clear from Arlene Foster's disgraceful comments yesterday on the Irish language that it is coming under attack north of the Border. From speaking to European colleagues, it has come to my attention that the Irish language may also come under attack in the European Union as a result of Brexit. As the Government has decided that the Taoiseach is the Minister for Brexit, I request his presence in the Chamber in the coming days to discuss this worrying prospect. Currently, there are 24 official languages of the European Union, Irish being the official language of Ireland. The EU institutions currently use three languages, namely, English, French and German, in conducting its everyday business. English is by far the dominant language, with 80% of documents written in it. The next most popular language is French, at 7%. When the United Kingdom exits the European Union, no country will have English as its official language. The talk is that France and Germany will push to have their languages become more prominent in EU institutions and lessen the use of English. As a result of this push, pressure may come on Ireland from other member states eager to maintain the status of English to drop Irish as our official language. Danuta Hübner, the head of the European Parliament's committee on constitutional affairs, has recently warned us of this prospect. The Wall Street Journal has reported that French and German are being used increasingly since the referendum in June. Therefore, the prospect of Ireland coming under pressure to change our official language is worrying. The Government must guarantee that it will fight to maintain the status of the Irish language in order that it will not be diminished, notwithstanding the pressure that might be exerted on us to change it to facilitate other member countries. As an Irish speaker, I find this prospect worrying. We must protect the status of the Irish language in the European Union. If we do not, it will have a knock-on effect at home.

In view of the "RTE Investigates" programme broadcast last night, it is important to recognise that a great number of staff in the HSE - the vast majority - are working extremely hard and committed and dedicated to their jobs. My colleague referred to the average spend per head of population on health. We have the second highest spend in the OECD, but the question is whether we are spending the money wisely and, if not, how that situation has arisen. When one considers the HSE's 2015 annual report, it is worrying that the number of managers went from 4,700 to 5,000, an increase of 300. The number of clerical assistants increased by 700, whereas the number of public health nurses increased by 60. This is in an area in which we should be increasing the numbers of those on the ground to ensure people receive advice and care in their homes and localities rather than having to be admitted to hospital.

Some of the figures for the health service are being lost in the process. For instance, there are 3.2 million outpatient attendances every year, or 63,000 per week. There are 23,000 attendances in emergency departments per week, which gives a total of 86,000 attendances in these two areas alone per week. This is outside the numbers in hospitals.

The figure of 86,000 per week shows the volume of work being done. We do not give credit to those who are doing this work.

Three weeks ago I wrote an article for the Evening Echo in Cork about the increase in population. In the past 30 years the population of County Cork has increased from 410,000 to 542,000, an increase of 132,000 or approximately 30%. In the same period the number of hospital beds in the county has not increased. We had plenty of money in the period between 1998 and 2008, yet not one new major hospital facility was opened in the county during that time and no real long-term planning took place. One of the major problems in health care is that planning seems to be engaged in on an annual basis, rather than long term. Time and again I have referred to the need to provide more hospital beds in response to demographic changes. We can open all of the primary care centres we like, but they will not sort out the problems of emergency departments and waiting lists. The number of beds in major hospitals must be increased. While doctors have increased the number of day procedures which reduces the number of overnight admissions, this does not solve the problem. Planning is needed in this area.

The current national development plan runs to 2020 and its successor will be in place until 2040, by which point it is predicted the population will have increased by 1 million. As Senators will be aware, the bias shown towards Dublin has created serious logistical problems. In the past 20 years an excellent road network has been constructed, which means that there is nothing to prevent major urban development outside Dublin. The Minister speaks about such development, but if he is serious about it, he should row back on the decision taken by the previous Government to put a stop to decentralisation. In Mullingar where I live more than €2 million was paid for a centrally located site that was fenced and shovel ready. It was to be used for a new office of the Department of Education and Skills in the town. Approximately 300 people accepted job offers and were ready to move to Mullingar before the plug was pulled on the project by the previous Government. I do not wish to make a party political issue of this decision, but it is now up to the Minister to press ahead with the project to advance the national development plan. The decentralisation programme was shelved for financial reasons and should be reintroduced under the national development plan. The site to which I referred in Mullingar is ready to roll and provides an ideal opportunity for a decentralisation project. I impress on the Leader the need to speak to the Minister for Education and Skills to find out whether he will roll out the 300 jobs promised in the town in a new departmental facility.

I should respond to Senator Terry Leyden's timely intervention. Yesterday, while attending a conference in Boyle, a young man from Elphin thanked me for introducing an air ambulance service in County Roscommon which had saved his life. Six months ago the air ambulance service transferred him from the scene of a car accident to an emergency department in Galway within 35 minutes. There are dozens of men and women, young and old, in County Roscommon who have had similar experiences. I called into Roscommon County Hospital this morning on my way to Dublin, as I do every week. The hospital was so busy I could not find a parking space. This is a major issue and a national disgrace. The hospital has become much busier and needs more parking spaces.

The reason for my late arrival was that I was attending the 13th national health summit in Croke Park, at which I was one of the speakers. More than 300 stakeholders in the health system, including managers, consultants and doctors, attended. After I spoke, Audrey Carville who organised the summit asked whether anyone present believed the downgrading of the emergency department in Roscommon County Hospital had been a mistake or had cost lives. Not one of the 300 health professionals present raised a hand.

They were not from Roscommon.

Not one of these health professionals-----

Absolute blatant propaganda.

The Senator should look at what is happening on the ground because I have seen a huge change in the past six months. People in County Roscommon are not fools. They will not tolerate people like the Senator going up to the top of the hill, moaning and shouting, and saying lives are at risk. They know that the hospital is much safer, that they have a better hospital and that the work the last Government did secured their future and safety.

Will the Senator not ask the Minister to-----

Both Senators have had their say. Never the twain shall meet as far as the two of you are concerned.

I rarely comment here, but on the health issue, it is a problem people face at some time in their lives. Some commentators talk about mental health and disabilities in a very balanced way. We should have a full, balanced debate some time with the Minister for Health. I have been involed in politics for more than 30 years and it has been an issue for all of that time. With the way things are going, we should not have been surprised by the "RTE Investigates" programme last night. All it did was shine a spotlight. I held clinics for many years and many of the issues highlighted were raised. We tried to do the best we could and probably failed. We should have a full debate, not a one hour debate. Perhaps the Leader might invite the Minister to come to the House for four hours. Let us see who will contribute in a balanced way and get the Minister to respond, but that is only a suggestion, which I rarely make from the Chair.

Go raibh maith agat, a Chathaoirligh.

The Cathaoirleach is now like the Speaker in the House of Commons.

You have joined the club.

I thank the 22 Senators who spoke, including the Cathaoirleach, for their contributions on the Order of Business. Sixteen Members referred to the health issues raised last night on the programme "RTE Investigates: Living on the List". In our lives, families, homes and communities and as politicians we recognise that what was portrayed on the programme was unacceptable. Nobody, young or old, man or woman or young boy or young girl, should have to wait while in pain. The stories portrayed on the programme should not, as the Cathaoirleach said, be new to people. It has been an ongoing issue for far too long, despite the best efforts of many and because of the abdication of responsibility by some. If it does anything, the programme might perhaps help to focus minds. Senator Victor Boyhan was correct when he spoke about the need for synergy and a relationship between the Department of Health, the HSE and the National Treatment Purchase Fund. It is something that has been badly missing.

As Leader of the House and a former Chairman of the then Joint Committee on Health and Children, there should be one waiting list. There should be no duplicity, changing or alteration. There should be one waiting list that gives an accurate reflection of the figures which are far too high. It is about time we looked at the reality and time for accountability. Those tasked with running the health system must be held to account. While there is political accountability, there is no accountability among those asked to administer health system. It is time that happened. As someone who spent five years chairing the then Joint Committee on Health and Children and had a working relationship with many of those involved in the health system, my confidence in those tasked with running it is at an all-time low. I question their ability to lead it out of this debacle. In the budget we saw an increase in the budget allocated to the Department of Health and the HSE. When the party opposite was in government, when Deputy Micheál Martin ran out of the Department of Health, the budget was at an all-time high and there were waiting lists. It is not about apportioning blame to Ministers but to those who run the health system and manage-----

Deputy Micheál Martin allocated €10 million for the emergency department in Roscommon County Hospital.

Will the Senator, please, allow the Leader to respond?

Senator Terry Leyden's display this afternoon on the Order of Business was quite poor.

That is the Leader's opinion.

If the Senator wants to look at Deputy Micheál Martin's record, I will certainly do so with him.

I will not sit idly by-----

I will do so with the Senator, no bother, because Deputy Micheál Martin was the architect of the HSE and the person who created the organisation that now runs the health system.

He allocated €10 million.

The HSE is a failed entity. Therefore, let us have that debate.

The Deputy is in and the Senator is out.

The Leader should not take the bait; he should respect the Chair.

Senator Terry Leyden is continuing his poor judgment. I will not have that debate with him and not go to his level.

At this stage the Leader has gone below my level.

When Senator Leyden goes low, I will go high.

The Leader must be joking.

Will Senator Terry Leyden, please, allow the Leader to conclude?

The numbers on waiting lists are unacceptable. They are human beings, our fellow citizens and deserve better from the health system. It is time for an holistic change in the use of theatre space. Senator Colette Kelleher referred to Cork University Maternity Hospital. I very much welcome the appointment of Professor John Higgins to his new role. I support and wish him well and hope to see a change in the use of theatre space. We also need to see changes in the use of hospital beds. If at all possible, we need to see more beds being opened. Equally, consultants must look at their work practices, how they operate and do business. As Senator Paudie Coffey rightly pointed out, money is being allocated, but it is not just about resources. How is money allocated and where is it spent? Ireland has the second highest level of spending in the OECD on health services. That is something at which we need to look and change. The role of the HSE must be altered. The allocation for the National Treatment Purchase Fund, NTPF, this year will allow it to utilise capacity in the private acute hospital sector to provide treatment for those who have been waiting the longest. The HSE has been asked to submit an action plan to improve waiting lists in public acute hospitals for inpatient, day case and outpatient services. The HSE and the NTPF must work strategically and collaboratively. The Minister for Health has taken steps and while the action taken to date has been far too little, it is important that we work to end the blight of long waiting times for those who need to be seen. To go back to my fundamental point, they deserve better. They are not numbers or statistics but people.

Senator Catherine Ardagh raised the issue of female genital mutilation in the context of the Criminal Justice (Female Genital Mutilation) Act 2012. I share her views and agree that we must work collaboratively to end this awful scourge. I will be happy to work with her on the issue and thank her for highlighting it.

Senator Joan Freeman raised the issue of child mental health and specifically mental health service waiting lists. I do not see people being treated as second class citizens by anyone involved in the health system but mental health is an issue we must continue to push to the fore. I will be happy to invite the Minister of State at the Department of Health, Deputy Helen McEntee, who was in the House last week to come again to discuss the issue. She has secured more posts and increased funding for mental health services.

Senator Rose Conway-Walsh referred to an industrial dispute in County Mayo. It is a matter for the mechanisms of the State, specifically the Workplace Relations Commission. The Senator could raise it as a Commencement matter, but it is important that the mechanisms of the State be used to reach a resolution.

Senator John Dolan referred to an article in the Sunday Independent, but I would not believe everything I read in that newspaper because it does not always get everything right.

I did not say I believed it.

I certainly would not believe everything I read in that regard. In his Budget Statement the Minister for Public Expenditure and Reform made it quite clear that there would be a review of public expenditure. I hope the budget announced in 2017 will be seen as the budget for the disabled because the Senator is correct when he says expenditure has been-----

The budget for this year.

No, the budget to be announced in the autumn. I will certainly be happy to organise a debate, not with the Taoiseach but with the Minister for Health because he is the line Minister with responsibility. I will be happy to work with the Senator in that regard.

It is not for the Government-----

I make the point to the Senator that we have set up quite a few cross-party subgroups in the House. Perhaps we might consider setting up a disability subgroup too. In that way we could work across party lines, as we are doing on the issues of mental health and obesity and as we did on the issue of symphysiotomy in the previous Oireachtas. I will be happy to talk further to the Senator further about the issue. I will also be happy to raise it at the meeting of group leaders tomorrow because it is an important issue.

Senators Ivana Bacik and Martin Conway referred to the Government's decision on foot of the recommendations made in Mr. Justice Iarfhlaith O'Neill's report on whistleblowers. I welcome the announcement made earlier today.

I will be happy to organise debates on the situation Syria and US immigration policy.

Senator Martin Conway posed a question about the use of taxes and tax increases which, perhaps, is an issue for debate prior to the budget. I will be happy to ask the Minister for Finance to come to the House to debate it.

Senator Mark Daly spoke about the leader of the DUP and a multiplicity of other issues. I do not propose to get into the nuances of the election campaign in the North. However, I share the views of the Senator and those of Senator Lorraine Clifford-Lee on a different point about the Irish language, that it is important that people in the North who use Irish as their first language be supported in that regard. I have previously expressed the view which I reiterate today that the decision to withdraw funding for Irish language summer schools only to reinstate it was wrong. It should never have been withdrawn. The Government, as co-guarantor of the St. Andrew's Agreement, will continue to promote the use of the Irish language, including north of the Border.

In reference to Israel and Palestine, I will be happy to have the Minister for Foreign Affairs and Trade come to the House for a debate on the matter raised.

Senator Catherine Noone raised the issue of cyber safety. This is safer Internet usage week. All of us involved with children or those of us who have children of our own or who are in a position to influence should raise the issue of cyber awareness and safety in the context of Internet usage. There is a very good advertisement promoting cyber security which poses the question: "Would you let your child walk around Dublin, meeting several thousand people...?" That is potentially what can happen on the Internet. It is important, therefore, that we raise the point.

Senator Denis Landy referred to the greyhound industry. I will be happy to have the Minister for Agriculture, Food and the Marine, Deputy Michael Creed, come to the House to discuss the issue. I am not aware of the details of appointments or reappointments. The Senator may be aware that the matter was discussed by the Joint Committee on Agriculture, Food and the Marine. I will be happy to arrange such a debate in the House.

Senator Keith Swanick referred to President Trump's policy on the pharmaceutical and medtech industries. The points made by the Senator are ones of which we should be much be more cognisant, given the changes in policy flagged by President Trump. US investment in Ireland last year amounted to €343 billion, an increase of 28% on the figure for 2014. Ireland constitutes 1% of the European economy but attracted 20% of all US foreign direct investment in Europe in 2015. More than 140,000 people are directly employed in over 700 US firms in Ireland, accounting for over 74% of IDA Ireland-supported employment. It would be worrying if the changes flagged were to come about. I will be happy to have the Minister for Jobs, Enterprise and Innovation, Deputy Mary Mitchell O'Connor, come to the House to debate the issue.

Senator Lorraine Clifford-Lee referred to Irish being the official language of Ireland in the European Union. I hope there will be no change in that regard. I certainly would not support any such change. I will be happy to have the relevant Minister come to the House to discuss the issue. The Senator might also consider raising it as a Commencement matter. The point she raises is worthy of support and I am happy to support her in that regard.

Senator Aidan Davitt referred to the national development plan and the proposals of the Minister for Housing, Planning, Community and Local Government, Deputy Simon Coveney, in the context of Ireland 2040. I will be happy to arrange a debate on the issue of decentralisation and how the programme collapsed under a previous Government led by Fianna Fáil. The issue raised by the Senator with reference to Mullingar is one-----

Fine Gael pulled the plug.

Please allow the Leader to conclude.

Some 300 people signed up to move to Mullingar.

The issue raised by the Senator is one that both he and Senator Gabrielle McFadden have raised previously in the House. I will be happy to have it discussed again. Ireland 2040 is of importance and I will be happy to have the Minister, Deputy Simon Coveney, come to the House to debate it.

I have issued a request for the Minister for Health, Deputy Simon Harris, to come to the House for a debate on the issues arising from the programme aired last night.

Order of Business agreed to.