Léim ar aghaidh chuig an bpríomhábhar

Seanad Éireann díospóireacht -
Wednesday, 27 Apr 2022

Vol. 284 No. 8

Nithe i dtosach suíonna - Commencement Matters

Third Level Fees

Before I call Senator Hoey I welcome the Minister of State, Deputy Rabbitte, to the House. She will be happy to hear that her name was used a lot during the Order of Business yesterday and in praise of her and her work in her Department.

I am here to talk about Bank of Ireland's announcement that it is withdrawing the graduate entry medicine, GEM, loan, the only loan available that is specific to graduate entry medicine students. It came with conditions such as a moratorium on paying back the loan before four years. I am not asking any Minister of State or Government to interfere in the commercial or operational decisions of any bank, even if we have a shareholding in that bank. I recognise that banks need to be able to do whatever they want so they are free to withdraw their loan product but on behalf of the students I have spoken to we are seeking engagement from Government on alternative financing options or funding supports.

A survey was done by a number of students who will be affected by this and about 10% of all the Irish GEM students responded to it over a couple of days, which is statistically significant. Some 92% of them said they require external financial support to pay the university fees and we all know how much those university fees are; they are €16,000 per year to study GEM. That is colossal money. It is €64,000 that they have to take out as a loan. Some 74% of those who responded have or would have eventually sought to avail of the Bank of Ireland loan and that is a significant number. A number of them worry they will not be able to apply for it due to the lack of a suitable guarantor. Some 71 of the 141 respondents said the fees caused them to delay studying medicine, which is significant when we have a crisis in the healthcare system. On top of that, an additional 100 out of the 140 respondents pay accommodation costs and we all know how expensive that is. A number of them felt compelled to add in additional comments and all of them are extremely concerned, including about their capacity to continue the course. Bank of Ireland has said it will allow them to finish it out so hopefully that has been dealt with. A number of respondents feel they will not be able to undertake graduate medicine because they do not have the option of this loan.

The biggest issue people have raised is that anyone who has spoken to Bank of Ireland, including myself, has not been able to get clarity on the alternative options which have been touted. A Bank of Ireland statement on this matter mentions that it has other loans available but as far as I can tell none of the other loans seems to offer the four-year moratorium. This would be unreasonable, when it is already an accelerated course, for GEM students who are already compressing medicine into four years. It is an intense course and their final year is extremely intense, as any medical studies are. To then have to start paying back the loan in that final year is not feasible or reasonable and that is something that has come back to me from the many students I have spoken to.

The fees were already exorbitant and we have had conversations before about how it is unrealistic to expect people to pay them. We will never have any sort of diversity in medicine if we have the likes of €16,000 per year fees and if we are locking people out of loans for that money because they cannot get guarantors or take out a personal loan. One of the responses I got from Bank of Ireland was that students could take out a personal loan but that has different requirements with it. A student who said she was planning on studying GEM in August 2023 said her only feasible option right now is to study in the North and even this is a risk as:

I want to live and work in the Republic and as of yet, the government has not fixed the issue of British trained doctors being allowed to apply for an Irish Intern year post-brexit. This means if I do move my partner and family for four years to save on fees I may never be able to come back and work on a training scheme here. It does seem like a neverending maze of dead ends when all I want to is to train as a doctor in my own country.

Has the Minister of State any light to shine at the end of this tunnel?

I am taking this matter on behalf of the Minister of State, Deputy Niall Collins. These speaking notes are his. However, I will, as a former banker, answer some of the Senator's questions at the end.

I thank Senator Hoey for raising this important issue, which has recently been brought to the Minister of State's attention. The loans available to GEM students are private arrangements between the relevant lenders and the students applying for such loans. Notwithstanding this, the Department has been made aware of reports regarding the specific loan scheme for GEM and is currently seeking further information on the issue. That the Department is doing this so reassuring.

The fee payable by a student can vary depending on a variety factors, including the type of course and the student's access route, for example, previous education. Entry to medicine in Irish higher education institutions is provided through undergraduate and graduate entry routes. GEM is one of the pathways to studying medicine. Students pursuing GEM programmes pursue them as second degree courses and, consequently, are not eligible for free fees funding or student grants.

One of the recommendations of the 2006 Fottrell report was the introduction of a new GEM programme. In order to widen access to GEM programmes and give assistance towards the financial burden, the fees of participating EU students are partly subsidised by the State via the Higher Education Authority, HEA. In the 2020-21 academic year, the State contribution was €11,524 per student, with the balance of fees payable by the student.

The programme for Government committed to conducting a comprehensive review of the student grant scheme in 2021 to ensure that adequate student supports were in place. The report was conducted by Indecon and will be brought to the Government shortly. In terms of other available supports, students on GEM courses may also be eligible to apply to the student assistance fund for financial support. This fund is administered on a confidential and discretionary basis by the access office in the third level institution attended. In addition, tax relief at the standard rate may be available in respect of tuition fees paid for approved courses at approved colleges of higher education. Further information is available from a student's local tax office or the website of the Revenue Commissioners, www.revenue.ie.

Work is ongoing on the development of the new strategic action plan for equity of access, participation and success in higher education. This plan will seek to reflect and implement the vision that the higher education "student body entering, participating in and completing higher education at all levels reflects the diversity and social mix of Ireland's population" and that our higher education institutions are inclusive environments that support and foster student success and outcomes, equity and diversity and are responsive to the needs of students and wider communities.

This response, which the Minister of State has provided to me, is comprehensive and tells me that a great deal of work is ongoing. In light of the situation in which the students now find themselves, it is welcome that Bank of Ireland will facilitate them and follow through on the terms and conditions, thereby letting them finish out their four years. The loans were so helpful because they acknowledged the level of professionalism required in such courses, that they were intensive and that there would be an opportunity at the end to work and earn enough income to repay them. Removing the loans from the market makes it difficult for students to consider pursuing such careers. Parents may not have the funding or correct credit status to be successful guarantors.

I know the Minister of State read from notes on behalf of the Minister of State, Deputy Niall Collins, but what she read out were all of the problems with GEM. The solution seems to be that the Department is looking into the matter, which is not much for me to go back to the students with. While it is welcome that the Department is looking into the matter, students need to know what they are going to do and what will be available for them. I have read the statement from Bank of Ireland – we have had some back-and-forth discussions – that other options are available, but no examples were provided. The other options just seem to be what are available to everyone else, and as the Minister of State mentioned, those do not take into account the high level of intensity involved in these courses.

As far as I am aware, this is not happening because there has been a default. This is a stable loan facility and these are people who are repaying their loans. I am not a banker like the Minister of State was, but it does not seem to me to be a high-risk loan.

This situation is frustrating. The GEM scheme is unequal and continues the elitism of medicine. As far as I can tell, I have not been provided with an answer today that I can take back to those students.

The Government is looking into the matter. The loan's withdrawal was not of the Government's doing; it was sprung upon the Government, and now the Government is dealing with the matter as quickly as it can. The Minister of State has made it clear that he is in talks with the bank.

The Senator is right, in that the risk attached to this loan is minimal. That is why the bank is prepared to delay for four years, with no repayments. It will suspend interest for those four years as well. There is a market to recruit into the loan facility and the level of earnings at the end is enough to meet the repayments.

This is a priority for the Government. We do not want to be in such a situation where we cannot recruit young people into these courses because they cannot afford them.

Hospital Overcrowding

I thank the Minister of State for attending to address this important issue. If I look through my files from the long number of years I have been in the Houses, one of the issues that has arisen most often is that of the state of play at University Hospital Limerick, or Limerick Regional Hospital as it was previously known. Notwithstanding significant investment over the years, the situation has deteriorated and continues to deteriorate. Those of us who believed in the reorganisation of the hospital structure in the region took a fair amount of political heat at the time for doing what we believed was the right thing – focusing attention and developing a hospital that was best in class and best in practice and reached a high standard. Unfortunately, that has not happened.

There has been significant investment in the hospital's new accident and emergency unit and a new ward block, but demand continues to outstrip the services the hospital provides. I do not know whether this is due to bad planning or the poor use of its facilities, but something is amiss. The population in the mid-west region has not exploded or done anything other than what was expected over a prolonged period. Last Thursday, the number of people on trolleys in University Hospital Limerick's accident and emergency unit was 126. That was the highest ever in a hospital in the history of the State. Today, that number is 111. Yesterday, it was 113. Cork University Hospital had the next highest number yesterday at 63. That is a huge number and should not be that high. I suspect if we did not have the situation in Limerick, the people from Cork would be crying blue murder.

This is not just about numbers, which the Minister of State knows as a hard-working, on-the-ground politician. She knows that, behind every number and statistic, there is an individual or family and there is heartache. As the trolley numbers continued to increase in recent weeks, the level of heartache and pain brought to my door by people who were looking out for a loved one was at an all-time high. Hand on heart, there is nothing that I can say to them that I believe would solve their problems.

I have reached a point where I think that the only appropriate response is to bring in an external and independent review team. I do not mind where they come from, but I will say where they cannot come from, namely, the hospital, the HSE or the Department of Health. I want a thorough investigation, audit, analysis or whatever you want to call it, and it needs to be done by someone who is entirely independent of the various vested interests.

I am not casting aspersions on any individual or group, but I will not have confidence in repeating anything I hear from the Minister of State, the Department or the Minister, with the greatest of respect to them, unless and until it is supported by a document prepared by a group of management consultants without any connection to the hospital, the HSE or the Department. If that requires going outside the State, it is the least we can do. Last Thursday, the figure was 126. Yesterday, it was 113 and today it is 111. I do not know what the figure will be tomorrow but I am sure it will peak again. We owe it to the families and the people who are affected. With the best will in the world, we like to say that if people are on death's door, they will be treated in the accident and emergency department and if people are only a little sick, they have to wait a little longer. That does not wash anymore because the truth is that when I talk to nurses and doctors on the ground, they tell me privately that it cannot be guaranteed that they are able to deliver care that will save the lives of individuals. That is a serious situation to be in. We need to get to the bottom of this. I keep being reassured there is no shortage of money or planning. There is, however, a shortage of solutions to a problem that has been around for a very long time and which predates the time in office of the Minister of State and, indeed, that of her predecessor.

I thank the Senator for the opportunity to address the House on this matter on behalf of the Minister for Health, Deputy Stephen Donnelly. I fully understand how important University Hospital of Limerick, UHL, is to the people of the mid-west and, indeed, that it is adequately resourced and staffed. In that regard, this Government, along with the Department of Health, is fully committed to improving patient services and having patient-centred care in Limerick. That commitment is reflected in the unprecedented level of funding that is being targeted right across the health service in budget 2022.

The UL Hospitals Group has reported that it is continuing to deal with record volumes of patients attending the UHL emergency department. In addition, waiting times for scheduled appointments and procedures remain significantly affected by the Covid-19 pandemic. While ongoing work continues to positively impact on waiting times and improve pathways to elective care, our acute hospitals, including UHL, continue to be impacted by operational challenges arising from Covid-19.

The Minister for Health fully acknowledges the distress overcrowded emergency departments and delays to elective treatment causes to patients, their families and front-line staff working in very challenging conditions, not just in Limerick but in hospitals throughout the country.

Despite the difficulties of the past two years, work is being done by the UL Hospitals Group to address these issues. Elective activity is reviewed daily in line with the hospital’s escalation plan, based on capacity and on the clinical need of patients. This includes elective patients coming in for time-critical investigations and procedures. UHL has also advised that it is undertaking additional ward rounds, accelerating discharges and identifying patients for transfer to model 2 hospitals. In addition, all patients who present to the emergency department with minor injuries at this time, such as suspected broken bones, cuts, bruises and sprains, are being redirected to the injury units in Ennis, Nenagh and St. John’s for treatment whenever clinically appropriate.

In recent years, there has been significant investment in UHL to address capacity issues, including a new emergency department that opened in 2017 and a new 60-bed modular ward block which provides modern, single-room inpatient accommodation with improved infection prevention and control capabilities as well as patient flow throughout the hospital. This follows the completion of two separate rapid-build projects which provided an additional 38 inpatient beds on site at UHL.

Further to that investment, Project Ireland 2040 includes provision for a 96-bed ward block at UHL. The evaluation of tenders is complete and the award of a works contract to the successful tenderer has been approved by the HSE board. The HSE will now be engaging with the successful bidder in the coming weeks with a view to the award of contract being finalised during the second quarter of 2022.

While acknowledging the difficulties faced by patients attending UHL, it is important to note that significant work is being done and every effort is being made to improve the situation at UHL. The Department will continue to closely monitor the situation in conjunction with the HSE.

It would be remiss of me not to acknowledge the front-line workers in the emergency department. They see the queues and acknowledge the issues. There were 121 trolleys occupied last Thursday, 60 of which were in the emergency department, and the other 61 were dispersed throughout the hospital to accommodate patients awaiting admission. That is no way that anybody with expertise wants to manage an emergency department. It must also be acknowledged that while there is substantial ongoing investment, there was chronic underinvestment for many years. This is not about numbers; it is about getting it right now.

I appreciate the Minister of State's upfront and frank appraisal of the situation. I accept that the 2040 project is there and 96 beds have been promised. I know the hospital will move quickly and I hope those beds can be provided even more quickly. However, something needs to happen in the interim. It is not enough to say that every effort is being made. I am not having a pop at the Minister of State but it is not acceptable to say every effort is being made and we will do our best because that does not cut it with the people who see the numbers rising every day as the situation develops.

The 2040 project and the moneys included in it will take two to three years to take effect. A staffing cohort will have to be put in place. That is a futuristic solution for people who are suffering today and will be for the next 12, 18 or 24 months. We need an urgent intervention. We need to sweat the asset at it stands and, unfortunately, I do not see that happening. It has not happened to date and that is why I want an independent expert review. We can all learn from experts and get a better understanding of a situation and learn to better manage the problem. The Minister of State and I know full well what the problem is, as do the people on the trolleys and their families. Quite frankly, the solution to resolve the problem right now is not there. The solution is designed for the future. As is always the way with the Department, it suggests there is a solution for the future, population will grow, etc. What we want is decisive intervention now that gives some chance of a dignified medical response to people from the region who have no choice but to attend the accident and emergency unit.

I again thank the Senator. I am all for a decisive and independent external review. I am all for leaving the vested interests of the HSE, management, the Department of Health and the hospital group outside the door. That is absolutely my position. However, that does not solve the issue for the 111 people on trolleys today. I believe there must be triaging of the issue. I compliment the management within the hospital group for what it has done with the facilities at Ennis, Nenagh and St. John's hospitals. I also compliment the hospital group for what it has done on elective procedures. However, there is a substantial problem with the emergency department in UHL. One consideration we must address is whether we have the consultants who can triage the patients who are coming through the doors of the hospital. We need to do that work now. We must examine whether we have the people on the ground who can make the decisions to move the trolleys along. I agree with the Senator. I will bring what he said to the attention of the Minister.

Health Strategies

The Traveller community is facing a mental health crisis. This is not the first time I have raised the issue in the House. The previous Minister of State with responsibility for mental health, former Deputy Jim Daly, recognised more than two years ago that there was a mental health crisis among the members of the Traveller community. The programme for Government promised a national Traveller mental health strategy. We are now two years into this Government's term. Without meaning any disrespect to the Minister of State, she is the wrong person for me to be talking to about this. I would have loved to have the Minister of State, Deputy Butler, here today. However, I will approach the Minister of State, Deputy Rabbitte, with a question. Where is that strategy? Where are we now in that regard? This is a matter of life and death. The signs of a mental health crisis are all around us. It is devastating and heartbreaking. The suicide rate is six times higher for Traveller women and seven times higher for Traveller men compared with the general population.

These studies were done in 2008. We need updated research on the rate of suicide within our community. Some 82% of Travellers have been affected by suicide. We all know someone who has died by suicide. More than half of Travellers reported that poor physical and mental health restricts their normal daily activities. These are not just statistics; these are people. As the Minister of State knows, the Traveller community experiences a great level of racism and exclusion. This has a dramatic impact on people's mental health, self-esteem, etc.

I stood with our community outside Leinster House on UN Human Rights Day in December. Once again we were making the one call - for action around Traveller mental health. The report of the Joint Committee on Key Issues affecting the Traveller Community called for the establishment of a national Traveller mental health strategy. That recommendation came from the National Traveller Mental Health Network, a collective of Traveller individuals and organisations across the island. The Minister of State, Deputy Butler, has met with the network and attended the launch of the national Traveller mental health submission. The recommendation is rooted in the Traveller experience and puts Traveller voices at the heart of the conversation around Traveller mental health. This is what we need. This is about our access. It is already included in the recommendations. We need a national Traveller mental health strategy; a ring-fenced budget for this critical work; and a national Traveller mental health steering group. We need the vital experienced voices of the Traveller community from the National Traveller Mental Health Network and we need a timeframe for the actions to make sure the work gets done.

In 2006, A Vision for Change called for culturally inclusive mental health services. Years later, Traveller mental health has gotten worse. I fear that including Traveller mental health in 2020's Sharing the Vision did not give the crisis the focus it needs to turn the tide. This is a national crisis within the Traveller community. The solution to the crisis cannot be an add-on. The Traveller community needs a tailored, stand-alone mental health strategy to support and resource its needs and we need to make sure it is implemented. We cannot keep waiting for action. We genuinely cannot. Lives are on hold here.

I thank the Senator for raising this very important issue, which I am taking on behalf of the Minister of State, Deputy Butler. The Government has long recognised the particular disadvantages the Traveller community faces, and the importance of implementing specific strategies and policies to address these disadvantages. The Government’s approach to improving the lives of the Traveller community is outlined in the national Traveller and Roma inclusion strategy. This is a cross-departmental initiative that contains a set of specific actions aimed at improving the lives of Traveller and Roma communities in Ireland. A key health action in the strategy is to develop and implement a detailed action plan to address the specific health needs of Travellers, using a social determinants approach. The lead role in developing the action plan rests with the HSE social inclusion office, in conjunction with Traveller organisations. The strategy acknowledges that mental health difficulties and the increased risk of suicide are significant issues caused by many social determinants. It includes ten actions specifically relating to mental health and suicide among Travellers. These are being addressed as part of the comprehensive health action plan. It is envisaged that the mental health actions in the national Traveller and Roma inclusion strategy will be incorporated in the Traveller health action plan and will be aligned with the overall approach in our national mental health policy, Sharing the Vision. This will allow for an integrated and co-ordinated response to the specific health needs of Travellers. That is exactly what the Senator has outlined. I could be wrong but she said the Traveller community needs its own particular strategy. While the Minister of State, Deputy Butler, agrees with that, she says it needs to be part of and aligned with the national strategy.

Sharing the Vision and Connecting for Life also recognise Travellers as a priority group. Both recognise the vulnerability to, and increased risk, of mental health issues and suicidal behaviour for Travellers and that these should be considered in the way mental health services are delivered to Travellers. Sharing the Vision contains a series of recommendations to improve the mental health outcomes for the whole community. The policy places the individual at the heart of service delivery and contains recommendations for services to address and accommodate the specific needs and unique socioeconomic and cultural background of individual service users. The policy seeks to provide mental health services that recognise and respond to diversity, and advocates maximising the delivery of diverse and culturally competent mental health supports throughout all services, to respond to the needs of specific groups.

Importantly, individuals representing the Traveller community and other ethnic minority communities were appointed to the specialist group panel to support the national implementation and monitoring committee and will provide specialist input at various points in the implementation of the policy. Members of the Traveller community feature across many objectives and actions in Ireland’s national strategy to reduce suicide, Connecting for Life. They are strongly represented in 17 localised versions of the strategy, which are now in place across the country. Many of these have local Traveller groups and representatives on their implementation or oversight groups. With support from the HSE National Office for Suicide Prevention, Exchange House provides a range of Traveller-specific mental health and suicide prevention services to the Traveller community. In addition, the HSE has Traveller co-ordinators in each CHO area to assist members of the Traveller community in their interactions with the HSE.

As the Senator acknowledged, last December, the Minister of State, Deputy Butler, launched the ethnic minorities and mental health revised guidelines for mental health services and staff on working with people from ethnic minority communities. The guidelines aim to ensure equitable access to appropriate services and supports for everyone in Ireland. They are designed to assist mental health services and staff who work with people from ethnic minority communities in the delivery of culturally competent mental health services. I hope that answered some of the Senator's questions.

I thank the Minister of State. She is here on behalf of Deputy Butler. She said individuals have sat on that advisory group but it is not even a permanent structure. In the programme for Government we were promised a stand-alone mental health strategy. Unfortunately, we have not gotten the answers we needed today. I am not doing this for Eileen Flynn; I am doing this on behalf of the National Traveller Mental Health Network. When are the Government and the Minister going to honour what they committed to in the programme for Government? There is no end in sight for the mental health crisis within our community. Surely there needs to be accountability for the lack of action while members of our community die by suicide on a daily basis. Unfortunately, there is no satisfaction to be had from the Minister of State's reply to our community here today. It is really sad. There is no accountability for the actions promised in the programme for Government. It is not the Minister of State's fault; it is the lack of political will within the Department.

I again thank the Senator. I appreciate that she is not doing this on her own behalf but on behalf of the Traveller community. When I leave here today I will ask Deputy Butler to meet with the Senator to discuss this matter. As she recognised, I am not Deputy Butler so I am not in charge of the entire brief but I will facilitate a meeting between her and the Senator to address the actions that have been laid out.

I thank the Minister of State for her time.

Driver Licences

I thank the Minister of State for coming here to discuss this very important topic. I raise the cost of renewing driver licences for people with disabilities. When I renew my licence, as a person without a disability, it costs €55 for ten years. Those with a disability must renew their licence every three years at a cost of €35 each time. That means that over the ten-year period they have to pay out three fees of €35 and must also get a medical certificate from their doctor. That can cost between €50 and €60 per visit. Let us say that at three times €50 that costs €150 in addition to €105. It is an exorbitant cost to someone with a disability. We must admit that sometimes people find it stressful when they are going to get their driver licence. They might be afraid that they do not have their documentation. However, the costs are very high.

There is another issue around the primary medical certificate. I know of someone with a disability who applied for the primary medical certificate last November. The person received a letter in mid-November to say that they were not eligible but that they could appeal it. It is now April yet no one has been appointed by the Department to the appeals board to assess these applications. Therefore, the person who is looking to get the primary medical certificate and the licence has the added cost and has to get taxis everywhere. That is a huge additional cost which such people might not have if there was a decision on the certificate. It is not fair that we put this added burden on people with a disability. There is a list of 23 conditions which a person who has any of them must apply for the three-year licence. It is a huge cost on hundreds of thousands of people. It is not fair and needs to be addressed.

The Minister for Transport thanks the Senator for raising this matter. Driving licences are usually issued for a ten-year period at a cost of €55. An applicant may be issued with a one-year or a three-year licence for medical reasons. The fee for a three-year licence is €35. There is no fee for a one-year licence.

To drive a vehicle, a driver must meet strict medical standards. Driver fitness standards are developed on foot of EU law and international best practice. The relevant Irish legislation is the Road Traffic (Licensing of Drivers) Regulations 2006, as amended.

On application or renewal of a driving licence, applicants are asked a range of questions about medical conditions or disabilities that may affect their ability to drive. The response to those questions will dictate whether there is a need for medical certification by a GP to grant, refuse or impose restrictions on a licence.

A clinical guidance document, Sláinte agus Tiomáint Medical Fitness to Drive Guidelines, is compiled by the Road Safety Authority, in conjunction with the National Office for Traffic Medicine. It provides guidelines for medical professionals to assist in their assessment of an individual applicant's fitness to drive a motor vehicle. The guidelines are reviewed and updated annually, with the 2022 edition launching this Thursday, 28 April. The information in these guidelines is intended to assist doctors and other healthcare professionals in advising their patients on fitness to drive, on the requirements for reporting to the National Driver Licence Service, and guidance on reviews of stability, progression or improvement in these conditions.

The fee charged by a general practitioner to complete a medical report for the purposes of applying for a driving licence is not a matter for the Department of Transport. The cost of the medical report is not covered under the medical card or GP visit card schemes. People can approach their local community welfare officer for assistance if they are struggling with the cost of obtaining their medical report.

I know the Minister of State is here to read out what was given to him but I must say that is very disappointing. It is the cost of the licence and the cost involved in getting it. I understand the cost to the doctor is not covered by the Department of Transport but the fact that a person having to get three licences over the nine-year period is a matter covered by the Department of Transport and is something that should be addressed by the Minister. I would like the Minister of State to take that back to the Minister for Transport. It is costing people €105 and that is within the control of the Minister for Transport. That needs to be addressed. It is not fair that someone with a disability has to pay €105 when I pay €55 to have the same licence over the same period.

To reiterate, there is no fee payable for a one-year driver licence for a person who must renew it annually due to a medical condition that must be assessed regularly. The fee for the three-year licence is €35. The community welfare system is available to anyone struggling with specific costs including those related to their transport needs. I very much take the Senator's point. The effective costs relate to the medical certificate. Perhaps it is one of the issues, of which there are many, that falls between the stools of two Departments. There may be a role for the Department of Health and the Department of Social Protection on this too. I will take the Senator's point back to the Minster, Deputy Ryan.

I thank the Minister of State. I appreciate that.

Cuireadh an Seanad ar fionraí ar 11.07 a.m. agus cuireadh tús leis arís ar 11.30 a.m.
Sitting suspended at 11.07 a.m. and resumed at 11.30 a.m.