Order of Business

I call Deputy Róisín Shortall to announce the Order of Business for the week and to make the proposals regarding the arrangements for the taking of that business.

Today's Government business shall be No. 8, motion re Horse and Greyhound Racing Fund Regulations 2016, referral to committee without debate; No. 9, motion re change to Standing Order No. 29, to be taken without debate; No. 10, motion re seventh report of the Committee of Selection, to be taken without debate; expressions of sympathy on the death of Mr. Peter Barry; and No. 1, Statute Law Revision Bill 2016 [Seanad] - Second Stage. Private Members' business shall be No. 27, Flood Insurance Bill 2016 - Second Stage, introduced by Fianna Fáil.

Wednesday’s Government business shall be No. 17, Health Insurance (Amendment) Bill 2016, Order for Report, Report and Final Stages; No. 18, Adoption (Amendment) Bill 2016 Order for Report, Report and Final Stages; and No. 1, Statute Law Revision Bill 2016 [Seanad] - Second Stage, resumed. Private Members’ business shall be No. 28, Secure Rent and Tenancies Bill 2016, Second Stage, introduced by Sinn Féin.

Thursday’s Government business shall be No. 1a, Planning and Development (Housing) and Residential Tenancies Bill 2016 [Seanad]; No. 30, Prisons (Solitary Confinement) (Amendment) Bill 2016 - Second Stage which will be debated in the evening slot, followed by No. 31, Cannabis for Medicinal Use Regulation Bill 2016 - Second Stage.

In relation to today's business, there are four proposals. It is proposed that:

(1) the motions re the Horse and Greyhound Racing Fund Regulations 2016, Referral to Committee, the change to Standing Order 29, and the seventh report of the Committee of Selection shall be taken without debate;

(2) Expressions of sympathy on the death of Peter Barry shall take place after the motions without debate following the Order of Business and shall be brought to a conclusion after 20 minutes, if not previously concluded, with each contribution not exceeding two minutes;

(3) Taoiseach’s Questions shall take place immediately following the expressions of sympathy; and

(4) Second Stage of the Flood Insurance Bill 2016 shall be brought to a conclusion, if not previously concluded, at 10 p.m.

In relation to Wednesday’s business there are two proposals. It is proposed that:

(1) There shall be no Taoiseach’s Questions and questions to the Minister for Agriculture, Food and the Marine shall take place after questions on promised legislation; and

(2) Second Stage of the Secure Rent and Tenancies Bill 2016 shall to be brought to a conclusion, if not previously concluded, at 6.30 p.m.

In relation to Thursday’s business, there is one proposal. It is proposed that the Dáil shall sit later than 7.48 p.m., to adjourn on the conclusion of proceedings on the Second Stage of the Cannabis for Medicinal Use Regulation Bill 2016, which shall take place for two hours following the Prisons (Solitary Confinement)(Amendment) Bill 2016 - Second Stage.

I have several proposals to put to the House. Is the proposal for dealing with Tuesday's business agreed to?

I have a question. In the first draft of the Order of Business from the Business Committee, I note that it was intended to have statements in the House today on the death of Mr. Fidel Castro, the former President of Cuba, but that has been deleted. Today is the day for recognising the contribution of Mr. Castro not only to the development of Cuba and its people but also internationally on many levels. Given that international figures are participating in ceremonies in Cuba today, it would be appropriate for us to reflect on his death and contribution. I appeal to the House that we do not let the day go by without ensuring that this is done. Whatever the reason behind the decision, and I hope it is only related to technical arrangements, if it cannot be facilitated today, though that is my appeal, I hope that it can be facilitated this week.

I seek clarification from the Taoiseach on same.

Deputy Barry, is your question on the proposal for Tuesday that I am putting before the House?

It relates to the Order of Business for the week, so the Leas-Cheann Comhairle can take it now or later. I do not mind.

We are just dealing with Tuesday's business at the moment. Does Deputy Shortall, on behalf of the Business Committee, have any comment to make, or the Government, on the question from Deputy Caoimhghín Ó Caoláin? If not, I will put the question.

I have no information on the reason that was withdrawn.

The country will be represented at the funeral today in Havana by Ambassador Hyland, who is based in Mexico.

I think it is appropriate that the House records its sympathy to the people of Cuba, the ambassador, Hermes Herrera, and the President of Cuba, whose brother, the former President, has died. It was the intention of the Business Committee.

I would like an explanation as to why it was-----

If there is an opportunity, you will be able to expand on that. The Minister of State, Deputy Doherty, has indicated.

The House should agree to proceed with what was clearly initially intended.

I will put the question after the Minister of State, Deputy Doherty, intervenes.

I thank the Leas-Cheann Comhairle. Could I make a suggestion because I do not believe there was a clear intention yesterday? There was confusion among different people having different phone conversations, and a Business Committee meeting would be more appropriate to deal with this. Perhaps it could be added to the agenda on Thursday.

I am putting the question.

On a point of order-----

That it be discussed at the Business Committee.

Can I make a point before anybody discusses anything? Could we get the precedence and the protocols for what happens when leaders of state die?

Former leaders.

Former leaders. I am not aware of previous-----

Perhaps the Business Committee-----

There is an important issue here. I can think of former leaders of other states who passed away about whom there would be uproar in here if attempts were made to debate those, and I am not casting any aspersions on-----

The Business Committee-----

There are protocols attached to votes of sympathy that are long standing in the House. We need to establish those. We cannot make them up on a whim. It is my understanding that this happened after the Business Committee met.

The Business Committee has a brief for proposing the Order of Business and the Minister of State, Deputy Doherty, has suggested that the Business Committee would consider this, look at the protocols-----

With respect, I have suggested that the House would consider this proposal because clearly, and Members will have a copy of the Business Committee's proposal, it was decided and it has since been deleted. I propose-----

Are you proposing an amendment to No. 1?

Certainly. I do believe-----

And your amendment is-----

I believe that contributions on the death of Fidel Castro, who was a figure of major international importance and a friend of Ireland, and irrespective of the opinions of Members-----

Deputy Ó Caoláin, it is very clear. If you want to propose an amendment, propose an amendment and I will put it to the House.

Deputy Róisín Shortall rose.

Deputy Shortall, unless you have some proposal relating to the Business Committee, I am moving on.

I have. A new procedure was agreed at the Business Committee last week where there was disagreement among the parties on the taking of business. It was proposed that there would be telephone contact between the Members the night before and, if agreement could not be reached, a meeting of the Business Committee would be convened the following morning. I suggest that rather than dividing the House on this issue, we seek to reach agreement on it this evening, bearing in mind the suggestion made by Deputy Martin, and that we seek to resolve this matter tomorrow morning.

So the Business Committee will take the opportunity of considering it this evening.

Rather than divide the House, I am willing to accept that the Business Committee will reconsider the proposition and I hope it would strongly take on board my commendation. I am sure the view is reflected by many in this House that the death of Fidel Castro should be appropriately recorded in this House.

Having regard to the suggestions from the Minister of State and Deputy Shortall, is the proposal for dealing with Tuesday's business agreed? Agreed. Is the proposal for dealing with Wednesday's business agreed to?

There are more leaks coming from the expert water commission than can be found in the entire water system for the country.

This is not a Second Stage debate on leaks. We are not here to consider leaks - that might be a pun.

The question that I wish to ask is this.

There are expert leakers.

Given the level of leaking that is taking place and given the level of public concern at what is being said, can we agree that the Business Committee would discuss on Thursday the idea of setting aside time next week for a full discussion in the House on the water charges issue?

Deputy Barry has a representative on the Business Committee and I am sure she will raise that.

I might help the Leas-Cheann Comhairle here. As a result of the situation that applies, the Minister for Housing, Planning, Community and Local Government, Deputy Coveney, has informed me that this report will be published early this evening and will go directly to the specific committee set up in the Oireachtas to deal with it.

I thank the Taoiseach for that helpful intervention. In view of that, is the proposal for dealing with Wednesday's business agreed to? Agreed. Is the proposal for dealing with Thursday's business agreed to? Agreed.

One of the more optimistic sentences in the programme for Government reads, "We are committed to sustaining the progress made to date on waiting lists, and are committed to" further investment, etc. As the Taoiseach will be aware, the reality is that the waiting lists have gone in the opposite direction and are at an all-time record high. Quite appalling figures in a range of medical disciplines in almost every hospital throughout the country are going through the roof. There is a real crisis here. The programme for Government commits to "agree[ing] annual performance targets with each Hospital Group/Trust and CHO (Community Healthcare Organisation) on waiting times, linking to activity based funding.", and states, "We will establish a Performance Management Unit providing assistance to hospitals and service providers in reaching their targets." Given the abysmal results in terms of the worsening of the waiting times and the waiting lists, can the Taoiseach indicate what progress has been made on those programme for Government commitments?

It is worth noting that there are 3.2 million outpatient attendances at hospitals every year, that 100,000 patients have elective inpatient procedures and that 800,000 have planned day-care procedures. The number of patients who are waiting to be seen or treated, while unacceptably high, needs to be considered in the context of the total number of patients who are seen and treated.

The programme for Government commits to €50 million in 2017 for waiting list initiatives, with at least €15 million of this money allocated specifically to the National Treatment Purchase Fund, NTPF, which the Deputy has raised on a number of occasions. In direct response to those increases, the HSE has provided the Minister for Health with an action plan - to be implemented in the second half of this year - that is aimed at reducing the number of patients on waiting lists. Key actions of that plan include: clinical validation of patients waiting for inpatient or day-case procedures for over 15 months; focusing specifically on providing procedures for the 5% of patients on inpatient and day-case procedure waiting lists for over 18 months; and driving the process of improvement at hospital group and individual hospital level with the support of the special development unit.

Data has shown improvements in the overall endoscopy situation and in the waiting lists relating to and waiting times for endoscopy of 15 months. The Minister recently opened endoscopy units at the Beacon Hospital and Roscommon County Hospital. The Minister is conscious of the major role of the endoscopy procedure, both in advancing the treatment of gastrointestinal diseases and as a diagnostic and investigative tool significantly improving outcomes for patients. I will advise Deputy Martin in respect of the performance indicator system to which he refers.

More than 1,000 people in direct provision centres across this State will receive their Christmas bonuses this week - I say that with tongue in cheek to some degree. It will amount to €16.23 for adults and €13.26 for children.

Given that adults only receive €19.10 per week and children receive €15.60 per week, it is clear that all of these families will have what one could only call a very poor Christmas. The Government is responsible for a system of detention that guarantees poverty for asylum seekers. The McMahon report recommended increases in payments for children and the opportunity to work for adults while their cases are being assessed. When will these recommendations be implemented? Of the 4,301 people in direct provision centres at present, 614 are in direct provision for more than five years. It is a scandalous situation and absolutely unacceptable. In the most recent review of progress in implementing the McMahon report, the Government admits that 82 of the 173 recommendations have only been partially implemented or have seen no progress. When does the Taoiseach expect the outstanding recommendations to be implemented and can he update the House on the status of the immigration and residency reform Bill?

Finally, the key recommendation of the working group was the introduction of a single application procedure in the protection process. The International Protection Act 2015 provides for such a procedure. Can the Taoiseach indicate when he expects the commencement of the International Protection Act?

I will ask the Minister of State at the Department of Justice and Equality, Deputy Stanton, who is dealing with these issues and who has visited most of the direct provision centres, to respond to the Deputy.

I have visited most of the centres by now and much progress has been made with respect to the McMahon report. We are putting in place a provision whereby people can cook meals for their families and we are putting families into family-specific units. I have visited those and spoken to the people and they report that they are quite happy there. Many people move into and out of provision all the time so the number is approximately 4,000, as the Deputy said. We hope to have the legislation enacted at the end of this year, if not sooner. If not, it will be very early next year. Much work has been done on commencing the Act in law and having it working soon.

Mar Chathaoirleach ar Choiste na Gaeilge, na Gaeltachta agus na nOileán, tá soiléiriú ag teastáil uaim ar Acht nua na dteangacha oifigiúla. Cá bhfuil sé? Go háirithe, maidir leis an gcóras, cén chaoi is féidir leis an gcoiste an tAcht nua sin a phlé? Sin atá ag teastáil uaim. Tá a fhios agam go bhfuil an tAcht beartaithe ag an Rialtas ach tá muidne ar an gcoiste ag iarraidh go dtiocfadh sé os ár gcomhair go práinneach, ionas go mbeimid in ann obair as lámh a chéile agus Acht nua a chur chun cinn. An bhfuil gá le cinneadh sa Dáil chun an tAcht nua sin a chur os ár gcomhair nó an féidir leis an Taoiseach, an tAire sinsearach nó an tAire sóisearach an cinneadh sin a dhéanamh?

Tabharfaidh an tAire sóisearach freagra don Teachta. Tá obair á dhéanamh agus tá obair déanta ag an Aire Stáit maidir leis seo. Déarfaidh mé leis go bhfuil sé práinneach go dtabharfadh sé eolas cruinn don Teachta agus don Teach.

I call the leader of the Rural Alliance, Deputy Mattie McGrath.

That is an unexpected promotion.

It is. Any day one gets it, one takes it. The programme for Government includes specific commitments in the health area, and Deputy Grealish has raised some matters regarding Galway. My question is about South Tipperary General Hospital. A total of 41 people are on trolleys there today, which is the highest number in the country. It is a small hospital compared to Cork University Hospital, CUH, or Beaumont Hospital, so this is totally intolerable. Despite the money announced for the winter initiative nothing has happened to help the hospital.

In spite of my colleague, Deputy Lowry, planning to helicopter in motel-type accommodation here, which is pie in the sky and which the Minister must have told him about or somebody else must have dreamt it, nothing has happened. There is a chronic situation in that hospital. If the Taoiseach and the Minister for Health are not going to open Cashel hospital, will they sell it and get a private operator to take it over and ask it to run it?

Is there proposed legislation for this?

Of course there is. It relates to chapter 6 of the programme for Government with respect to health initiatives. There is a chronic situation in Clonmel hospital. To have 41 people on trolleys in a hospital that size is outrageous.

I thank the Deputy for his brevity.

I am not sure Deputy Mattie McGrath is actually proposing that move or that he is telling the people down there that the hospital should be taken over by a private enterprise.

I am. If the Taoiseach is not going to open-----

Allow the Taoiseach to respond without interruption.

I will have the Minister for Health respond to Deputy McGrath on what is a valid question.

Page 64 of the programme for Government refers to the Government commitment to making greater use of effective but costly medicines. Page 33 of the Health Service Executive service plan indicates that 2016 will see new drugs being a significant feature. At the weekend we saw press reports that the decision has already been made not to make the game-changing and life-saving drug Orkambi available to those of the 1,200 cystic fibrosis sufferers in this country who are suitable to be treated with it.

I ask that a decision be made in the same vein as that made previously by the then Minister, the former Deputy, James Reilly, when he, despite a decision by the National Centre for Pharmacoeconomics, NCPE, and the committee within the HSE not to provide the drug Kalydeco to relevant and suitable patients, overruled that decision at the time and made it available. I ask that the Government immediately move to make a decision and direct that Orkambi be made available to those patients who require it such as that of the Golden family in Sligo whose daughter, Grainne, sadly passed away as a very young girl some 12 months ago. Her dying wish was that other children would not have to go through the same suffering and experience the same fate she had.

If it is merely the cost of the medicine rather than the value of life, I would make a simple point. The cost of acute beds per day is between €1,000 and €1,200. Many cystic fibrosis patients at their sickest spend up to nine months per year in an acute bed. At that cost, that works out between €270,000 and €324,000 per year. To provide this game-changing and life-saving drug to those people at a cost of €160,000 would be between 49% and 59% of the cost of providing the acute care that we are providing. In essence, it would be cost saving and free up many of the acute beds we heard Deputy Grealish and my leader, Deputy Micheál Martin, highlight as needing to be freed up because of the waiting list throughout the country. I appeal to the Taoiseach to take the right and just decision in this instance.

This is a matter that is of considerable stress and interest to those who suffer from cystic fibrosis for whom this might be an improvement in the quality of their lives. The company involved, Vertex, needs to be realistic in respect of what it is charging. The Minister, Deputy Harris, is not alone in his difficulties in respect of Orkambi for cystic fibrosis patients. The same situation applies in Australia, Canada, England and Scotland where this drug has not been approved as part of the public health system. The Minister has written to all the other Ministers for health in those countries seeking their co-operation in joining in a realistic set of discussions with Vertex in order that they can positively influence this drugs company to be more realistic in what it is demanding.

The Minister has also invited Cystic Fibrosis Ireland for an up-to-date briefing on where the process is at now. He has been in touch with Opposition spokespersons about this. However, as Professor Barry said yesterday, it is time for the company to put patients first and to reduce its price significantly. A five-year gross budget impact would be almost €400 million and the NCPE noted the significant opportunity cost associated with reimbursing the drug. We are fully supportive of the discussions that need to take place directly with the company on a renewed basis. These are not political decisions. Politicians are not in a position to be qualified to make the clinical judgments as to the extent of improvement in the quality of life for the patient and the cost that is being charged.

The HSE has been involved with Vertex since June of this year. It is disappointing that Vertex has given no ground. I have the letter here from the Minister for Health to the Australian Minister asking that people would get together in a number of countries and talk to Vertex in this respect. The NCPE which undertook the assessment of Orkambi noted that the drug was not considered cost-effective at the price of almost €160,000 per patient per year as submitted by the manufacturer. The clinical assessment of the NCPE estimated that the cost-effective price in this instance was closer to €30,000 or five times less than what the company is demanding. The five-year gross budgetary impact would be almost €400 million and, therefore, the company needs to be realistic in its discussions with the HSE based on the professional clinical assessment of the value of the drug in terms of the improvement of the quality of life of the patient. The other countries I have mentioned are in the very same boat. This drug has not been approved on the public health system for cystic fibrosis sufferers in those countries. I hope that Vertex becomes realistic in its discussions about the price it is demanding and what might be more appropriate, which would not only allow cystic fibrosis sufferers to benefit from Orkambi but many others to benefit from other drugs as well. I hope the discussions take place again quickly. The Minister will brief cystic fibrosis sufferers to give them the up-to-date position.

I want to raise again with the Taoiseach the issue of school transport again. I raised the issue a month ago and was told the findings would be published. We still have no findings. I attended a meeting with Bus Éireann officials last week along with the Minister of State at the Department of Education and Skills, Deputy Halligan, and many other Deputies from rural constituencies who are experiencing serious problems with this issue. The meeting was nothing more than a deflection from the real issues at play. The meeting was to discuss communication problems between public representatives and Bus Éireann. This is not good enough. The elected members of Edenderry municipal district in County Offaly wrote to the Minister of State about this issue at least one month ago but they have received no reply. This is another example of rural neglect. These are rural communities with no public transport. Children are being dropped off at school at 7 in the morning and this is just not good enough. We need the review published as soon as possible because this issue is unacceptable and it will not go away. I will keep agitating.

The Minister of State, who is dealing with this, is not present. Perhaps the Minister for Education and Skills might like to comment on it.

This scheme has a budget of €175 million. Under it, there are guaranteed places for people who fall within the eligible categories and, after that, concessionary places are made available. We have maintained a high level of commitment in this area but most of the requests are for people to move outside the established rules. The Minister of State has undertaken to examine it and he has sought with Opposition Members to find resolutions but these are not easy to find. That is why it is taking considerable time to consider this.

I call Deputy Healy-Rae and ask him to remember that Deputy Durkan needs time to ask his question.

I have to raise again the serious problem of elderly people in County Kerry waiting for cataract operations. I have raised this many times previously and, indeed, Deputy Michael Healy-Rae has raised it as well. It is just not good enough. We have five Ministers for health and we have a raft of HSE managers, yet many elderly people will not be able to see this Christmas-----

Indicate to the Taoiseach-----

Just one second. They have to wait for a year and a half to two years for an operation that takes little over an hour. It is very unfair to leave people blind in the latter days of their lives for so long. We have five Ministers for health. If they are not able to deal with the problem - I have it raised many times before - they will have to pull out because they cannot give people a simple operation. What will they do about it? Will this be left-----

If the Deputy continues, I will not be able to allow the Taoiseach to reply.

Do not be sorry. The Taoiseach has seven seconds to reply.

It is very bad for people.

The Deputy has to consider that I cannot overrule the Order of Business, even for the Taoiseach. The Taoiseach has five seconds.

It can be very debilitating for an elderly person who is unable to read or watch a television because of cataracts. They take time, though, to be appropriate for an operation. I will have the Minister for Health look at the waiting list in Kerry and advise the Deputy of what the position might be.

I will have to apologise to Deputy Durkan unless it is a short question. He is normally orderly.

When will the Garda Síochána (malicious injuries compensation) Bill come before the House?

Legal advice has been received on that and it is being analysed. Progress is being made and we will advise the Deputy of the up-to-date position.