Vol. 1036 No. 7
1. Deputy David Cullinane asked the Minister for Health when he will publish a plan for achieving universal GP care; when he will publish the details of the free GP expansion promised in the budget for 2023; and if he will make a statement on the matter. [17404/23]
My first question is in respect of the roll-out of free GP care. As the Minister will be aware, we discussed this at yesterday's meeting of the Joint Committee on Health. Will he give the House an update as to when the additional cards that were promised in budget 2023 will be delivered and the engagements he is having with the Irish Medical Organisation, IMO, to progress this matter?
I thank the Deputy for the question. As we are all aware, universal healthcare is something we are all signed up to through Sláintecare and are committed to very strongly in the programme for Government, and this is a core element of that. One of the three tests of universal healthcare is that care is either free or affordable for everybody who needs to use it. As the Deputy and colleagues will be aware, it is my intention to expand eligibility by approximately 500,000 GP cards, which is a substantial increase. The original plan had been to roll it out at the start of this month. The IMO and GPs around the country got in touch and asked that we wait and continue with our engagement with them and it is something I have agreed to do. I hope that we can do this by agreement but, regardless, I want to respect our GP community and the IMO and give the talks that bit of extra time - not a great deal of extra time, but some extra time - for some quite intensive discussions.
As the Deputy will be aware, approximately 2.1 million men, women and children have either a medical card or GP card. Essentially, as I said to the GPs this past weekend at the IMO conference, we have three groups of people accessing GP care. We have those with medical cards and GP cards for whom the State fund their access. We have people who pay the private fees of GPs and can afford to do so. We then have a third group of people who do not qualify for GP cards and who very much cannot afford the fee, be it €50, €60 or €70, to visit their GP. We know that there are people who need to see a GP, or whose child needs to see a GP, and they are putting off that visit. That is something that no GP that I have spoken to wants either. Essentially, we are doing a short round of intensive engagements with the IMO. I have put a very substantial amount on the table in respect of permanent recurrent funding to support general practice so that we can expand capacity in general practice at the same time as we increase demand through State-funded access.
The date of 1 April was not one I set but one that was set very clearly by the Minister in the budget for this year. Ministers make big announcements like this. It was a big announcement and it is significant that we are looking to expand free GP care to hundreds of thousands more citizens. It is something that I included in Sinn Féin’s alternative budget and is very similar to the Minister’s proposals. I also made the point in our alternative budget for this year that we need to put in place the building blocks and additional capacity and supports for GPs, who are also stretched, and we have to ensure that we can do this. Setting a date, however, and missing a target is not something that should be done because people need to have confidence when a Minister stands up on budget day and says he or she is going to do something on 1 April, that he or she has the ducks lined up, that it is going to be done and that this is an announcement that will be delivered upon. This has not been the case and yesterday I was still not given any timeframe as to when this will happen. I will, therefore, ask the Minister this question again today. Is it next month, May, June, July or when are we likely to see these 500,000 people getting the free GP card?
I thank the Deputy for his reply and I do not disagree with his analysis at all. It is frustrating to me that we did not bring it in this month. The Deputy is absolutely correct in that this was the plan and that was what we budgeted for and what we wanted to achieve. The GP community asked us to wait and the choice was to proceed, which we could have done in spite of that, or to give the process a bit more time out of respect for general practice to ensure that we get it right. I would have much preferred to have made the April deadline. We are going to give this a short extended period, very much out of respect for general practice and for the fantastic work it does and out of respect for the union to give it that extra bit of time.
A substantial amount is available and in discussions over the weekend with GPs I pointed out that there is money for a significant increase in practice nurses, investment in information technology, which is something that many GP practices want, and to examine fees for the general medical services, GMS, scheme and other measures we will use to try to make this work and get it right.
What we need more than ever now is a roadmap to full universal cover and an agreed timeframe with the representative bodies because for too long, we were trying to do this by age and have lengthy contracts with them, which actually did not work. The delivery of the free GP cards for six- and seven-year-olds was promised years ago and did not happen because of contractual disagreements and so on. An agreed plan between Government and the representative bodies is needed. How will those 500,000 cards be delivered? When will that be done? Beyond that, when will they delivered to the rest of the population? The eligibility for those 500,000 people below the median income needs to be expanded in respect of full cover under the medical card. We need an agreed timeframe and an agreed plan and I hope that that is something that, in time, will emerge from the Minister’s discussions with the IMO.
Yes, it will. The Deputy will be aware that we are kicking off a strategic review of GP practice. It is based on a report that was published not long ago on the future of general practice. We accept that report. A team is being put in place now and I have appointed three GPs to the team to ensure that the voice of the doctor is very much front and centre on that.
Essentially, the process is that we have 500,000 cards to bring in this year. That comprises approximately 70,000 cards to cover six- and seven-year-olds and approximately 430,000 cards to take eligibility up to the median income. At that point we will have added significant eligibility, so we will probably need to pause for a bit.
The conversations we are having with the IMO relate to bringing in the 500,000 cards this year and the strategic review with the IMO, GPs and the experts. Coming out of that there will be recommendations for a new GP contract so there will be a negotiation of the GMS scheme. As part of that discussion I want to see exactly what the Deputy outlined. We want to move. It was called for in Sláintecare. It is backed by everybody, I think, in the House. We will then find a pathway critically and sustainably, while we add capacity to the system, for universal access so that every man, woman and child in this country ultimately will have State-funded access to general practice.
2. Deputy Gino Kenny asked the Minister for Health when the report of the review of abortion laws in Ireland will be published; the steps he will take to ensure the law is amended to fully reflect the repeal referendum result; and if he will make a statement on the matter. [17661/23]
My question centres around the review of the Health (Regulation of Termination of Pregnancy) Act 2018. The review has been published and, hopefully, the Minister will be able to furnish that in the coming weeks.
I thank the Deputy for the question. The answer is "Yes, very shortly". As he will be aware, the review of the operation of the Health (Regulation of Termination of Pregnancy) Act commenced in line with statutory commitments in December 2021, a bit over a year ago. The purpose of the review was to assess the effectiveness of the operation of the Act. It comprised two phases. The first was an exercise to gather evidence and information. This consisted of public consultation and a review of the operation of the Act from the perspectives of service users and providers. Essentially, it entailed listening to service users and providers and the members of the public interested in having an input into the review.
The second phase was led by an independent chair, Ms Marie O'Shea, to whom I express my very sincere thanks. I met her recently. I now have the report and have looked through it in detail. It is very clear that a lot of work was done by Ms O'Shea and others involved in putting it together. I recognise that.
The second phase was to assess the extent to which the objectives of the 2018 Act have been achieved – many have – and to analyse in that regard the findings of the three strands. The chair also drew on the findings of other relevant peer-reviewed research.
I confirm that I have received the report and gone through it in detail. I have met the independent chair and we have had very productive conversations. I have also met some of the clinical leads providing the services. What will happen next is that I will bring the report to the Government, which I hope to do very shortly. We will take it from there.
On the question of whether the report will be published, it absolutely will. We will also publish all the research papers that fed into it.
That is welcome, but people will want to know when the review will become public and the mechanism. Obviously, it has to be brought before the Cabinet. Will it go before the health committee? It would be good for members of that committee to scrutinise it. It is nearly five years since the referendum, which is hard to believe, and four years since the legislation was implemented. There are anomalies, to say the least, in the legislation, particularly concerning the three-day period. That has always been an obstacle to women, as has the 12-week limit. The current legislation needs to be reformed to make it accessible and to make it easier for women to access abortion care.
The report will be available to the Government and then to everybody else very shortly. It is a good report and it is very detailed. It is a very useful report. It has identified various things that work well and various things that we need to improve at an operational level. There are also some legislative recommendations in it. I have no doubt but that the health committee will take time to consider it. Then we will have a quite lively, and hopefully respectful, debate.
My driving concern relates to patient care and ensuring we have the best possible healthcare services in this country. However, I have no doubt that the report will generate debate, as we all expect. It is on a topic that is of much interest to many people, who are coming at it with the very best of intentions. We will be into the debate quite soon.
Can the Minister state when the report will be made available to Deputies or the health committee, and also to the public? Several people have probably read the review. Does the report recommend legislative change? Regarding the fundamentals of the current legislation, there is a lot to be changed, including in regard to the 12-week period and the criminalisation of doctors. Doctors are in a grey area regarding abortion services, particularly in respect of fatal foetal abnormalities. There is a huge grey area and doctors could be criminalised. Therefore, there is much to be examined regarding the review. Can the Minister indicate when it will be made public? Does it indicate to him that the current legislation needs to be changed?
I am prohibited from giving the Deputy an exact date; suffice it to say that it will be made available very shortly. He can read into that what he wants.
This month?
The Deputy can read into that what he wants. It will be made available very shortly. Let us wait until we have the report before we get into operational and legislative recommendations.
Regardless of the report, which is a good one, the core focus for me and the HSE concerning the provision of services is increasing the number of maternity hospitals that are providing services. That only 11 of our 19 maternity hospitals are currently providing services is totally and utterly unacceptable. Therefore, I am working very closely with the HSE right now to increase the number from 11 to 17 this year. The plan for early next year is to increase it from 17 to 19.
There are a little over 400 GPs in the country providing services. The number has gone up by a lot, or by half, in recent times, but we want to ensure there is as much access as possible. Regardless of anything in the report, that is where much of my focus is this year.
3. Deputy David Cullinane asked the Minister for Health when he will publish a multi-annual capacity expansion plan for the health service and for hospitals in particular; and if he will make a statement on the matter. [17405/23]
I am sure the Minister will agree that reducing the health waiting lists, the time people must wait for care and the time people must wait in emergency departments needs to be a Government priority. I strongly believe we need a multi-annual plan that considers capacity throughout the healthcare system. It should set out medium- and long-term goals to increase capacity and start meeting some of the targets. Is it the Minister's intention to publish a multi-annual plan? If so, when will we see it?
The short answer is "Yes, and a consolidated plan". I fully agree. The Deputy and I have discussed this several times. We already have several multi-annual plans in place. The core infrastructural plan is the 2018 capacity review, which gives us targets, agreed by everyone in the House, for acute beds, critical care beds, nursing home beds, elective capacity and so forth. We are reviewing the 2018 capacity review. It probably underestimates fairly significantly the number needed. The report gives us a range of acute beds, from approximately 2,500 to approximately 7,500. We all latched onto the figure of 2,500 beds but the reality is that we need more, based on the 2016 baseline.
Coming up to Covid, we were on track for the annual increase in beds called for in the 2018 review. We are now well ahead of that. The Deputy will be aware that I am seeking Government agreement on an additional 1,500 beds. Since Covid arrived, we have added 970 beds. The plan is to bring the figure up to 1,179 by the end of the year. The addition of 1,500 beds represents a massive increase in hospital capacity.
Intensive care unit, ICU, provision is also going very well. At the end of this year, we will have seen a substantial increase. We have had a substantial increase but we should have more than 350 ICU beds by the end of this year. This will make a big difference. We are going much further. Again, the plan is to exceed the figures in the 2018 review.
The three elective hospitals go way beyond what the 2018 capacity review put in place. We have a multi-annual plan for infrastructure and it is being reviewed. I believe the targets will increase. We are in a good place regarding most of the targets. We probably need a broad political discussion on nursing home beds. The commission on care will be examining this also, determining how we can keep people at home.
My point is not so much about the capacity review because beds comprise only one of the ingredients needed. Having spoken to many hospital managers and front-line healthcare staff, I realise that if we are to reduce waiting lists, we will need more beds. The reason there was such a wide range given for the number of beds that may be required, from 2,500 to 7,500, was the figure was dependent on what would happen in the community, including in respect of nursing home beds, recovery beds and step-down beds and the rolling out of the enhanced community care programme. The more that happens, the fewer beds we may need, but we do need more beds. We may not agree on the precise number.
We just need to get evidence-based approaches to this so we can again agree what we need via a revised bed capacity review. However, we also need public diagnostic capacity and surgical theatre capacity in hospitals and, crucially, all of the enhanced community care roll-out that is needed to ensure people can get the right care at the right time in the right place. That is the joined-up multi-annual plan I want to see - not just a plan regarding beds because beds are only one part of it. We need staff to staff those beds. That has to form part of it, including workforce planning. If we just concentrate on beds alone, we will miss the causes of what is driving waiting lists.
I agree with all that. We have a beds plan and a hospital building plan so the multi-annual bits and pieces are in place, and we also have the community care plan. The enhanced community care programme is the multi-annual plan and is really going from strength to strength. I am opening another three primary care centres tomorrow. That is going really well. We have community care, beds and hospitals. Diagnostics is going very well. The GP access to diagnostics programme did more than a quarter of a million scans last year. Essentially, now via the GP, we are providing free access to all diagnostics for everybody regardless of whether someone has a medical card or GP card. It is going really well. We are using a lot of private capacity for that so this is an area where we can definitely look at building further public capacity. The final piece of the jigsaw is a multi-annual workforce approach. We are involved in a European project on that and that work is being done through this year. Ultimately, what would be great is a single piece of paper that brings it all together and gives a five- or ten-year capacity plan in respect of community care, acute care, workforce and infrastructure.
Hopefully if the electorate has good sense, I will be the Minister who produces that single piece of paper and plan that will deliver a lot of what the Minister talked about but that has not been delivered. All those ingredients are part of what is needed to reduce waiting lists because while there has been some positive movement in terms of long waiters, far too many people are still waiting for access to healthcare.
I welcome the 1,500 beds that have been announced. We discussed this yesterday. We need to do what the Minister spoke about very quickly, namely, doing it at pace and dealing with the layers of bureaucracy in the HSE capital approval process and all the other issues that make it difficult to deliver them at pace. We also need to make sure it is on the basis of need. While it may take a bit longer for some hospitals to deliver these beds for all sorts of practical reasons, we cannot simply say to those hospitals that are ready to go, "Listen, you can have all the beds" and it not be based on health need. I raised the issue in Waterford hospital, where 160 beds are needed, yesterday, so it must be on the basis of need but there also needs to be speed.
Between the Deputy and the Minister of State at the Department of Health, Waterford is well represented in Dáil Éireann. It is also well represented in Seanad Éireann. Let us not lose sight of the fact that over the past three years, we have seen an historic expansion of capacity. More beds have been added than at any time in a very long time, there has been more access to diagnostics than in a very long time and more new hospitals signed off than in God knows how long. We are up to nearly 20,000 additional whole-time equivalents in the HSE. We have built up an entire primary care system from scratch over the past two and a half years and, therefore, we are in the middle of an historic expansion of public service capacity. I agree that we must get faster at delivering beds and physical infrastructure, including e-health. That is the focus of this - not signed off or agreed but progressing this plan around a rapid build programme.
4. Deputy Denis Naughten asked the Minister for Health the status of plans to introduce a no-fault vaccination compensation scheme for severe adverse reactions to State-promoted vaccination programmes; and if he will make a statement on the matter. [16903/23]
Commitments were given the past two programmes for Government to introduce a no-fault vaccine compensation scheme. This was again promised by the former Taoiseach, Deputy Micheál Martin, in advance of the introduction of the Covid vaccination programme.
My engagement on this issue with various Ministers for Health has been ongoing for the past 250 months or more than two decades. We now have claims related to adverse reactions to the Covid vaccine. When will a compensation scheme be introduced in this State, as is the case in many other countries?
I acknowledge the Deputy’s very long-standing work on this issue. My Department and the HSE work continuously to monitor and improve patient safety and reduce incidents of harm. The Government recently approved the establishment of an interdepartmental working group to examine the rising cost of health-related claims and consider mechanisms to reduce costs. The group will examine the rising cost of clinical negligence claims in the health system with a particular focus on high-value claims, many of which relate to obstetrics, and identify measures that could be put in place to reduce future costs and, more importantly, reduce harm to patients and minimise adverse incidents. The group is chaired independently, which is very important, by an expert healthcare professional, Dr. Rhona Mahony, and its membership is taken from across key Departments and agencies.
With regard to vaccination, patients concerned with a possible side effect or adverse reaction following a vaccination should, in the first instance, consult with their medical practitioner who can refer them as necessary to appropriate services following clinical assessment.
It should also be noted that vaccines can only be approved and used if they comply with all the requirements of quality, safety and efficacy set out in relevant EU pharmaceutical legislation. Any authorised vaccine will be subject to ongoing monitoring in Ireland by the Health Products Regulatory Authority, HPRA. The latest safety updates from the HPRA regarding Covid-19 vaccinations are available on the authority's website.
Regarding a vaccine damage compensation scheme, during the pandemic, all available Department of Health resources were devoted to the public health response. This has meant that work the Deputy is rightly calling for could not be progressed. It had been planned to progress it but it was not progressed. Further scoping work is required to pull the group together and to move this forward again as we must.
I am deeply disappointed by the Minister’s response. Scoping reports were done by the former Minister for Health, Deputy Micheál Martin, who gave a commitment when he was Minister to deliver on this. Every other Minister for Health since then has given this commitment. We have this height of reports on this issue. This scheme has been introduced in 25 countries.
The reality is that vaccination compensation schemes boost public confidence in respect of successful vaccination programmes. Vaccination programmes are vital to maintain herd immunity against a range of diseases. In respect of the emerging academic evidence on post-viral chronic conditions such as long Covid, ME, chronic fatigue syndrome, multiple sclerosis, Alzheimer's disease, Parkinson's disease and Lyme disease, viruses are now being associated with these conditions so we need a proactive rather than a reactive approach to this.
I fully accept and appreciate the Deputy’s frustration. As he noted, he has been talking about this for more than 20 years. I fully accept that. He will be aware that in mid-June 2018, the Government received a comprehensive report from Mr. Justice Charles Meenan on clinical negligence. My understanding is that it was intended in early 2020 to do exactly what the Deputy is calling for - to pull this group together, examine the international evidence and introduce something here for exactly the reasons outlined by him. Then Covid happened and the public health experts and doctors, the Chief Medical Officer, the deputy Chief Medical Officer, the bioethicists and all the people we would normally have involved in this were for obvious reasons pulled almost exclusively into the Covid response. Let us all hope that Covid is in the rear-view mirror and now is the time we can pull this group together.
Back in 2020, the recommendation was that a vaccine injury scheme should be introduced as a matter of urgency. The Minister knows that there is a culture of fighting claims within the State Claims Agency and the health profession. There are parents who have been advocating on behalf of disabled children for more than 50 years and the doors have been slammed in their faces by the health profession telling them it is all in their heads.
The Minister's predecessor, in the 1980s, paid a £10,000 compensation package to get parents to shut up in relation to this. It is not good enough that decades later we are still talking about another report, another review and no action.
That is a partial characterisation. A lot of the work required to do this was undertaken. On foot of a request from my Department, the Health Research Board did an extensive international evidence review. It looked at Denmark, Finland, Norway, Sweden, China, Japan, Korea, Taiwan, New Zealand, the US and the UK.
It was done ten years before that.
That was a legitimate part of the work, which was submitted to my predecessor in March 2019. The very clear advice I have is that the Department was fully intent on doing this. It is complex. Sensitive policy decisions have to be made and extensive legal advice has to be obtained. I accept the Deputy’s bona fides on this and I agree we need this scheme. At this point, the only reason we do not have it is that all the people required to put it together were, for obvious reasons, pulled on to Covid for two years. Now is a good time to push that work back into action.
5. Deputy Kathleen Funchion asked the Minister for Health when he will provide for the recognition of parentage for children born through surrogacy; and if he will make a statement on the matter. [17406/23]
57. Deputy Kathleen Funchion asked the Minister for Health the progress or update on the recognition of parentage for children born through surrogacy (details supplied). [15390/23]
I thank my colleague, Deputy Cullinane, for allowing me to ask a priority question. I am anxious to get an update on the surrogacy legislation. I mentioned in the previous round of questions to the Minister for Children, Equality, Disability, Integration and Youth that a great announcement has been made but as he is not the lead Minister, he had limited information. I am anxious to know, as are families, at what stage this legislation is, what the timeframe for it is and when we will see it at the committee.
I propose to take Questions Nos. 5 and 57 together.
I thank the Deputy. This matter is also important to me and we are pushing very hard on it. The assisted human reproduction, AHR, legislation would have been passed and in operation by now. With broad political agreement, we paused it to ensure we could bring in some substantial amendments on Committee Stage around surrogacy. In mid-September last year, I secured Government approval for the policy approach in respect of the regulation of international surrogacy. The Deputy will be aware that we have accepted nearly all the recommendations in the report. There were a few on which the officials came back and indicated they did not work. We have discussed these with various members of the group and the advocacy groups. People broadly agreed with them. Some were technical, while others were on protecting the surrogate, the intending parents or the child. I do not think there was any controversy around the proposed changes.
The formal drafting process by the Office of Parliamentary Counsel, which is being done with the Departments of Health, Justice, and Children, Equality, Disability, Integration and Youth, is well under way. It involves comprehensive drafting. As I have said to colleagues in the Dáil and Seanad and the advocacy groups, we have asked the three Departments to put together heads of Bill and then detailed legislation that ordinarily would take several years to complete. We have asked them to do this in a very short time and they have done so. I was happy that we were able to go to the Government before Christmas to get full approval. The drafting is well under way. I will need to bring the final detailed amendments back to the Cabinet for approval. I will then refer the Bill to the Joint Committee on Health and it will be in its hands. I expect, based on how committed everyone is to it, that the committee will find time as quickly as possible. It is crucial that the final detailed provisions are robust. The need to be able to withstand rigorous scrutiny considering the range and complexities involved and the rights of the various parties. It is entirely possible that aspects of the legislation will be challenged by different parties and it needs to be able to stand up to scrutiny. It is intended that the new parts, as well as the recognition of certain past surrogacy arrangements, will be introduced. We will, therefore, address retrospective and future-looking elements.
I reiterate my commitment to ensuring that both the goal for providing the route to formal recognition of past surrogacy arrangements or surrogacy arrangements in other jurisdictions is achieved and that a robust regulatory framework for AHR more broadly is put in place. The AHR Bill has been slightly lost in the very understandable focus on surrogacy but, apart from the surrogacy element, the AHR Bill is also very important. It provides the legislative framework for IVF and many other measures we intend to introduce later this year.
In short, my hope and intention is that we will be debating the legislation in the House in the summer term. I would love to have it through all the Houses and signed off by the President before the Dáil goes into recess.
I am delighted to hear the Minister hopes the Bill will be signed off before the summer recess. That is what we all hope for.
The AHR Bill was at pre-legislative stage in 2017, so it preceded the Joint Committee on International Surrogacy by five years. I do not think the Minister was intending to suggest otherwise but surrogacy certainly did not cause the delay to the AHR Bill. I want to make that clear.
I am really anxious for parents who are waiting on the retrospective element of this. I had asked the Minister for Children, Equality, Disability, Integration and Youth if there was a way to deal with retrospection now given that we know we are bringing in this legislation. I am delighted to hear that the Government has taken on the recommendations of the Joint Committee on International Surrogacy because it worked very hard and its recommendations were excellent. That was good news and there was a great day in December but we are now at the end of April. The Minister stated he hoped the Bill will be passed before the summer recess. I hope it will be pushed by the Government and we will have it before the summer recess.
I would love to see that happen. It depends on the time the Joint Committee on Health is able to give over to the Bill. I am conscious the committee has a huge amount of work on its plate but hopefully it will give over the time. I will get it over to it for its review shortly.
We need to do the retrospective element as part of the legislation. It is really important. Like Deputy Funchion and many other colleagues, I have met the parents, the mums and dads, and the kids. It is going to be a great day when we pass this legislation and rightly recognise these children, their rights and the rights of their parents. It will be a very important day and it will happen this year. I know people have been waiting a long time. We need to do it as part of the legislation so it is robust and on a statutory basis.
I will make two other points. I mention in particular my constituents, Brian and Kathy Egan, from my home town of Callan in County Kilkenny. They are currently in the High Court in relation to this. They are an example of a family who are courageously putting their story out there at a very difficult time in their lives. It shows that not everyone has the time. That is why I will continue to raise this matter at every opportunity. As soon as I know the Bill is with the Joint Committee on Health, I will be on to it asking it very nicely to push it along.
On retrospection, I always chance asking if it can be dealt with now because, as the saying goes, if you do not ask, you will never know. When the legislation is passed, does the Minister expect that people will then be able to go for parental orders? There is some concern in the groups that this could be delayed if an agency is established for people engaging in surrogacy in the future. That is understandable. Will the retrospective element be signed off as soon as the legislation is up and running?
The Egans were in with us as part of the group when we announced this. It was a great honour to meet them.
The answer to the Deputy’s question is "Yes". On whether the retrospective element requires the new agency to be set up, the answer is "No". We are very deliberately putting the legislation together in such a way that parents will be able to go for court orders and it will not require the agency to be set up. The agency will take time to set up. It will need to hire staff and will then be involved in developing a number of regulations.
Critically, as soon as this legislation is passed and signed by the President, there may be some procedural issues that will have to be put in place. I have no doubt there are. However, once that is done, it will be a matter of parents seeking and receiving court orders under the new Act.
