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Dáil Éireann díospóireacht -
Tuesday, 20 May 2025

Vol. 1067 No. 4

Saincheisteanna Tráthúla - Topical Issue Debate

Development Contributions

The development levy waiver was a powerful initiative introduced by the Government to bolster housing supply and ensure a pipeline of housing delivery. We saw some of our largest commencement numbers ever last year, with more than 60,000 homes commenced, 9% of which were first-time, one-off homes.

I come from and represent a rural constituency. I have a major concern with regard to couples or individuals buildings homes in rural areas ending up paying a development contribution to their local authorities. I raised this matter earlier with the Taoiseach. While people are quite happy to pay for their water and ESB connections, paying a development contribution to the council when they live in a rural area seems quite counterintuitive because they do not get lighting, sewerage facilities or footpaths in return. While it is understandable that councils cannot service everywhere, people need to know exactly where that money goes. At present, it is going into the council’s pot and is used to fund everything else the council does. Ultimately, it does not serve the person who contributes. We need to recognise that there is an unfair burden when it comes to these local contributions, not to mention the fact that people also have to install their own septic tanks and put in place their own infrastructure that they have to maintain and manage, which brings its own costs as well.

In respect of the contribution side of things, that money goes into a pot. It is not seen by the people who build their one-off homes. The people who do that need to be recognised. Multiple constituents have contacted me in the months since the waiver was discontinued because they realise that they now have new bills of between €5,000 and €10,000 for connection fees and the development contribution. We need to either ring-fence the funding to ensure it goes towards those local facilities or show that it is delivering local amenities as opposed to disappearing into the abyss. People do not feel like it is a fair charge, especially when they have to invest in infrastructure themselves. They do not get the lights or the footpaths.

We need to make it fairer for people who are constructing their own dwelling. While the Government does a good deal of work to put supports in place, such as the first home or help to buy schemes, to ensure that people have a deposit in place, we then take this development contribution on the other side. There is a better way of doing this. It is either a case of ring-fencing the funding or trying to ensure that this charge is not levied against one-off homes, specifically when those who build such homes have to deliver so much infrastructure themselves.

I am happy to take this matter on behalf of the Minister for Housing, Local Government and Heritage, Deputy James Browne. The Deputy made a valid point, and I thank him for raising this matter.

On 25 April 2023, the Government approved additional measures under the Housing for All action plan to incentivise the activation of increased housing supply and to help reduce housing construction costs, including the introduction of temporary time-limited arrangements for the waiving of local authority section 48 development contributions and the refunding of Uisce Éireann water and wastewater connection charges. The Government recognised that further measures needed to be put in place to help address cost and viability with a view to incentivising the activation of a pipeline of new housing commencements and assisting the delivery of supply as quickly as possible. The waiver scheme applied to all permitted residential development including multi-unit developments, self-build houses and one-off houses, as well as student accommodation and sheltered housing.

The scheme initially applied for one year to all permitted residential development that commenced on site between 25 April 2023, which was the date of the Government decision approving the measure, and 24 April 2024, and that are completed no later than 31 December 2025. On 23 April 2024, the Government approved an extension for the waiving of local authority section 48 development contributions in respect of residential developments commenced not later than 31 December 2024 and the refunding of Uisce Éireann water and wastewater connection charges in respect of residential development commenced not later than 30 September 2024. In April 2024, the final date for the completion of development works on qualifying houses under the schemes was extended from 31 December 2025 to 31 December 2026. There are no plans to extend or reintroduce the waiver scheme.

The waiver of local authority development contributions and the refund of Uisce Éireann connection charges directly reduce the upfront cost of construction. These savings, depending on location, represent a meaningful portion of soft costs in budgets. A total of 69,060 homes were commenced in 2024 as against 26,957 in 2022, representing an increase of 156% in comparison with 2022. This is the highest number of commencements on record since the compilation of data on annual residential commencements began to be recorded in 2015. It is likely that the waiver schemes contributed to the increasing level of housing starts post April 2023 in light of the timing of the introduction of those schemes. A certain proportion of planning permissions for housing development that were not being activated have now largely commenced due to this scheme. The time-limited nature of the waiver scheme provided a clear and urgent incentive for developers to act quickly. As already stated, there are no plans to extend the scheme any further.

I am asking about one-off homes for self-builders who are taking on mortgages to build their homes. Let us call a spade a spade: they are contributing to the ultimate completion figures this Government wants to see. We want more units to be delivered. Self-builders make up almost 10% of those numbers on the basis of the commencement figures from last year.

The development levy waiver was a huge success. There were 69,000 commencements in 2024, which is absolutely incredible. Those are the type of numbers we need every year. I am very conscious, however, that the money from the development contribution goes to the councils and self-builders get nothing in return. They do not get footpaths, lighting or investment in their localities. It is unfair on councillors and local authorities that it goes into a pot and gets spent with the rest of the money as opposed to being ring-fenced for what it is for. Even the development contributions relating to housing estates are not ring-fenced for the delivery of footpaths and lighting in towns and villages. There needs to be a wider conversation in this regard.

If possible, I ask for the Minister of State to bring my request to consider the extension of the development levy waiver for one-off homes back to the Minister, Deputy Browne. This move would facilitate young people who are starting out on their journey of home ownership and who are trying to self-build. It would ensure they could do that without an overburdening cost, particularly when they are contributing to our completion figures.

One-off housing, particularly in rural areas like Roscommon, no more than my own area, is a really important part of housing output. It is important to the vibrancy of rural communities as well. I understand the argument the Deputy is making in respect of how you tie the contribution people are paying directly to a service that is being delivered in return.

I have outlined the position of the Department and the Minister that there will not be any extension to the waiver. Obviously, that benefited one-off housing and multi-unit developments. I thank Deputy Dolan for raising this matter and for putting the argument forward strongly on behalf of his constituents, particularly those young people who are looking to build one-off developments, in the context of the impact that development charges have on them. I will certainly relay the argument the Deputy has made to the Department and the Minister. I will ask them to take on board what he said.

Pension Provisions

I thank the Minister of State for being here at this ungodly hour. I have recently been in contact with a number of dedicated school secretaries across my constituency of east Cork who are campaigning for their rightful access to public service pensions.

Public service pensions are not just a benefit but a vital safeguard for workers' futures, providing security and dignity in later years. Public service status would see secretaries given access to the protections and pensions that come with this status and would end a 45-year injustice. It would see secretaries who work side by side with teachers and special needs assistants, SNAs, having the same rights and pension certainty on retirement, and proper wages. This campaign has been ongoing for decades now. Secretaries deserve better. They are not asking for the earth. All they want is pay equality and the improved working conditions and pensions they are entitled to. Secretaries provide an essential service to their schools, which would simply be unable to function without a secretary. They ensure our schools run smoothly day to day, which is crucial. They are the backbone of our schools. These are hardworking individuals, many of whom have served our schools and communities for decades, and they deserve the recognition and fair treatment of public servants.

Despite recent progress in securing employment on the Department of Education’s payroll, school secretaries still face significant inequalities and continue to be treated as second-class public servants. As it stands, a secretary could work 40 years in the same school, retire on the same day as a teacher or SNA and walk out the door with only a bunch of flowers while the teacher or SNA will leave with a work pension. How can we, in good conscience, justify a system where two people working in the same school and contributing equally to daily life at that school retire under vastly different circumstances? This is not just an administrative oversight but a moral failure. We are sending a message that the work of school secretaries is somehow less valuable and that their commitment, often over decades, does not warrant the same respect and security in retirement as that of others in the public sector.

In October 2020, the then Tánaiste, Leo Varadkar, gave a commitment in the Dáil that the Government would address the long-standing pay and employment issues secretaries were facing and finally secure pay equality and pension entitlement for school caretakers and secretaries. We have not had sight nor sound of this since.

To the school secretaries and all those involved in this campaign we in Sinn Féin say your efforts are seen, your voices are heard and your rights are supported. We stand with you in calling for a swift and just resolution to this pension row and will support you all the way. I am calling on this Government to act urgently. These workers have shown remarkable dedication to their job. They have gone above and beyond for schools and deserve fair treatment and the peace of mind that comes with access to proper pension schemes. It is only fair they receive the same recognition and entitlements as their colleagues such as teachers and SNAs. I have been absolutely battered and lobbied about this. I spoke to a lot of secretaries and they feel very underwhelmed. The secretary is the backbone of any committee, cumann or school. There is a massive injustice here. I am anxious to hear the Minister of State’s response.

I thank the Deputy for raising this matter and allowing me to clarify the current position in relation to pay and conditions for school secretaries. As we know from our engagement with schools in our respective constituencies, the school secretary is very much at the heart of the school and is the key interface between students, parents, school leaders and other staff. Without them, our schools would be unsustainable. In supporting these vital school staff members, we also support the school community as a whole.

The majority of primary and voluntary secondary schools traditionally received assistance to provide for secretarial, caretaking and cleaning services under grant schemes. Where a school employed a staff member to support those functions those staff are not public servants but employees of individual schools and responsibility for terms of employment rests with the school. Since September 2023, the Department has been providing a payroll service for former grant-funded school secretaries. I am glad to be able to say that currently 85% of school secretaries have opted for the new package and are on the Department administered payroll. This happened on foot of an agreement reached in 2022 under the auspices of the Workplace Relations Commission that secretaries would move to a centralised payroll managed by the Department and receive new terms and conditions of employment.

As the Deputy knows, school secretaries now benefit from an alignment with the clerical officer grade III pay scale within education and training boards on a pro rata basis. In addition, it was agreed pay increases under future national agreements will be passed on to secretaries and this has happened with each pay increase since the implementation of the agreement. My Department has also improved the conditions for school secretaries with regard to sick leave, annual leave and maternity provisions for this category of staff. For example, where only 51% of grant-funded secretaries had paid sick leave previously, all those who have onboarded to the Department's payroll now have access to paid sick leave entitlements.

I acknowledge that Fórsa is looking to future improvements to terms and conditions for secretaries and recognise that for them public service status and access to a public service pension is understandably an important objective. The issue of public service status is complex and needs to have regard to the state of the public finances and the repercussive effects of any such proposals for other grant-funded groups of non-public servants. For those reasons, any proposals must be considered in detail by the Department of Education's officials and those in the Department of Public Expenditure, NDP Delivery and Reform as the granting or otherwise of public servant status is not within the scope of the Department of Education alone.

I thank the Minister of State for his response. I got the same response, probably word for word, less than two hours ago in a reply to a parliamentary question. I cannot stress enough how much these issues need to be resolved. The last line in the response from the Minister for Education was:

For those reasons, any proposals must be considered in detail by my own officials and those in the Department of Public Expenditure, NDP Delivery and Reform as the granting or otherwise of public servant status is not within the scope of this Department.

I would love to know which Department's scope it is within. It affects so many people. Immediate steps need to be taken by this Government to ensure all school secretaries are recognised as public servants, which they truly are. The granting of access to a fair, secure public service pension is about equality, and equality is not a privilege but a right. That has to be addressed. We will not have time to do it now but I would like to find out, perhaps through a parliamentary question, who or which Department is responsible for this. I ask the Government to look at this. Whatever Department is responsible, I ask that it act with fairness and give school secretaries the recognition and the retirement security they have more than earned. I gave the example of the difference between 40 years' service as an SNA or schoolteacher and 40 years' service as a secretary is that one leaves with a pension and the other gets a bunch of flowers and maybe a box of chocolates.

I respect the Minister of State’s response. Obviously, I am not happy with it and the people outside will probably not be happy with it, but we will certainly revisit this issue. We have had this issue for more than 45 years. We have recognition for SNAs and disability service workers, who are being discussed in the House this week. This is about giving recognition to those who are supplying that service. That is where governments have failed. It is why this country and our services have been failing.

I thank the Deputy for raising this matter on the floor of the House. I will pass on the argument and case he has made to the Minister for Education. As I said, there have been significant advancements, as I think we would all recognise. I laid them out in my earlier reply as well. The implementation of revised salary and annual leave entitlements for school secretaries in the February 2022 agreement is now fully operational and lessons learned from that process are playing a key role in the drafting and implementation of a similar deal to be offered to grant-funded school caretakers. The Minister's officials are also continuing to engage with Fórsa and remain committed to the ongoing process.

In the normal course, there are ongoing discussions with the public service unions on any and all matters relating to pay agreements. Any review of changes to the employment of school caretakers or other pay mechanisms can occur only under those processes and any such proposals would need to be considered in detail by the Department of public expenditure, as I said.

The reply also refers to the work being undertaken by the Department of, and Minister for, Social Protection on the development of an auto-enrolment pension scheme, which the Deputy will be aware of.

The substance of the Deputy's matter relates to the request for public service status for school secretaries and access to a pension. That is not in place at the moment but there have been significant advances on other matters of importance to school secretaries. The matter on which the Deputy advocates is an outstanding ask on which the Department is engaging. It will be a matter of further engagement with the Department of Education and also across government because of its implications for other similar categories. I thank the Deputy. I will pass on his advocacy in the Dáil this evening on behalf of school secretaries to the Minister.

Flood Relief Schemes

I am raising again the Blackpool flood relief scheme. We had three major floods there in 2010, 2012 and 2013. A decision was taken that a flood relief scheme would be put in place to make sure that the buildings in the area would not be adversely affected by a future increase in rainfall. Some 293 properties were previously adversely affected - 206 of them residential and 87 commercial. The announcement was made in 2018 that the scheme would proceed. It went from the Office of Public Works, OPW, to the Department of public expenditure. A decision was taken that the scheme would go ahead in March 2021. There was a judicial review and four years later nothing has been completed. Between 2022 and 2024 an environmental study was produced by the OPW, which went to the Department of public expenditure. Unfortunately, when action was eventually taken on the report, the report was out of date and we were back to the drawing board with a need to do a new report. My understanding is that a new report has been obtained by the OPW, which it has forwarded to the Department of public expenditure. I do not want to have a repeat of what happened between 2022 and 2024 when a report was left on someone's desk with no action being taken.

It is 15 years since the first major flooding and nothing has been done. Where are we with regard to pressing ahead with the flood relief programme for Blackpool? It is an old part of the city where there are huge problems with properties in that banks will not make finance available to purchasers because they are unable to get insurance to protect against flooding. One property owner who has run a business in the Blackpool area for more than 40 years wants to retire. He has put the property up for sale on a number of occasions. On two separate occasions a purchaser had signed contracts and then they ran into difficulties getting finance to proceed with the purchase. As a result, the sale of the property collapsed. It appears that anyone who wants to buy a property in Blackpool must be a cash purchaser because the banks will not lend money to people who want to buy and improve the area. This is an old part of the city, which is becoming derelict as a result of the scheme not being put in place.

Could the Minister of State outline the timescale for the Department to sign off on the scheme for Blackpool, the time it will take to carry out the public consultation, if that is required, and the time required prior to inviting tenders so that these works can proceed? It is one of the longest awaited schemes by the OPW and the Department of public expenditure and I want to see progress on it in 2025.

I thank the Deputy for raising this matter. It is something he has been relentlessly pursuing to ensure it progresses. I confirm that the Department has received supplementary information from the OPW following a request made under section 7B(4) of the European Union (Environmental Impact Assessment) (Arterial Drainage) Regulations 2019. The Department is making arrangements for a public consultation to be held on the supplementary information received to date. Details of this consultation will be made available in due course on the Department's website.

The Deputy will also be aware that ministerial consent for this scheme was provided in early 2021 but was subsequently overturned by a judicial review challenge taken by a local community group. The Department has since sought legal advice and taken measures to ensure the consent process complies with relevant national and EU environment law in order to account for the issues raised during the judicial review process. On foot of legal advice received by the Department and the recommendations of its retained environmental consultants, the Minister sought supplementary information from the OPW on the environmental impacts of the scheme. This request was made in February 2022, with the OPW supplying this information to the Minister in October of that year.

Following an examination of the environmental reports and supplementary information provided, and acting on the advice of independent environmental experts, the Minister sought further supplementary information from the OPW in November 2023. The OPW submitted the supplementary information to him on 17 April 2025. All supplementary information received by him will be made available for public consultation and details of this consultation will be made available on the Department's website.

I very much appreciate the work being done by officials in both the OPW and the Department of public expenditure, but there is frustration. As someone who comes from a legal background, I fully understand the dangers of rushing any decision and taking short cuts. Therefore, it is important in this case that the t's are crossed and the i's are dotted. I urge that the public consultation process proceeds at the earliest possible date because there are people who are very supportive of this project. I accept that people will challenge it again. It is their constitutional right to do so. We want to get on with the public consultation. The Department has the report. We must have the public consultation at the earliest possible date so that we can then proceed to the next stage when it has taken place.

It is not just about the public consultation but about getting information out on the advantage to the area of carrying out this work and making sure that properties and families are no longer in danger of a major flood occurring in the area. It can be seen in photographs from 2010 that there was up to 1.5 m of water in commercial premises and houses. It is a frightening experience for a business or family to have to deal with and therefore it is important that this scheme proceeds at the earliest possible date. Let us hold the public consultation, get on to the next step and engage with the contractors to get the scheme up and running. The scheme itself will take at least three years to complete. It will cause major disruption so it is important that it is planned very carefully and well by everyone involved.

I again thank the Deputy for raising this matter and for his continued advocacy on progressing the scheme. While the delays in the delivery of the scheme are a source of frustration for the Deputy's constituents and all in Blackpool, as he is aware it is imperative that the consent process progresses in a manner that is compliant with the relevant regulations. In the period since the original consent decision was overturned following the judicial review challenge, the Department has undertaken a number of measures to ensure the process is in compliance with the regulatory environment.

This has necessitated the requesting of supplementary information from the OPW in order to ensure that the Minister can reach a reasoned conclusion regarding the anticipated environmental impacts of the proposed scheme. This process has been informed at all stages by expert legal and environmental advice with a view to ensuring the process is sufficiently robust in the event of any future challenges that may brought. I encourage all those within the locality who have views on the environmental impacts of this scheme to participate in the public consultation process when it is opened by the Department.

I will relay to the Minister and the Department Deputy Burke's call for an urgent move forward in terms of getting to that consultation and beyond. I know the stress that can be associated with past flooding experiences, the dread that comes with what might happen in the future and the sense of urgency in terms of being able to put mitigation measures in place that can protect communities against that. I understand, therefore, the importance of seeing this process expedited and moved on. I will take his views on behalf of his constituents regarding the importance of moving on with this process and having a consultation commence as quickly possible and relay them strongly to the Minister and the Department.

The Government is getting €14 billion from Apple computers in my constituency. I would like it if some of that were spent in my constituency and not all of it outside of the constituency. The Blackpool flood relief scheme is one of the priorities that I want dealt with.

Patient Transport

Ar an gcéad dul síos, gabhaim buíochas leis an gCeann Comhairle for selecting this Topical Issue, albeit to be taken after midnight.

There is a concerning issue affecting the lives and health of many vulnerable people across County Tipperary, namely, the unacceptable and short-sighted cuts to hospital patient transport services. For many in rural areas of Tipperary, especially the elderly, the sick and those on low incomes, access to hospital appointments in places such as Clonmel, Limerick, Cork, Waterford and Dublin depends entirely on the patient transport services provided by the HSE or voluntary organisations, such as the Red Cross, Civil Defence and the Order of Malta, which I salute for the work they do. These are not luxury services; they are essential lifelines. I have been contacted by families, carers and community groups who are at breaking point. They are being told that transport is no longer available, services are being rationalised - that lovely word - and, in some cases, patients must find alternative arrangements. What alternatives do they have in rural parishes?

Public transport is limited or non-existent in much of Tipperary. Many of those patients are already frail, wheelchair users or recovering from major surgeries. They cannot drive themselves. Their family members may be working or living abroad. The result is missed appointments, delayed treatments and worsening conditions. Ultimately, this leads to pressure being piled back on our hospitals through avoidable admissions to accident and emergency departments.

In one case, a man waited four years - 48 months - for an appointment. He has no family. His neighbour who used to bring him to his appointments passed away a month ago and he had no one else to transport him to Cork. He was too frail to use public transport - it was non-existent in the first place. A taxi would have cost him €120; half of his pension would have been gone in one appointment. It is such a shocking situation.

In another case, a woman with a paraplegic daughter required an ambulance transfer. This woman literally had no other option. She could not just get a neighbour to drive her. In the end, she was forced to beg a voluntary organisation to transfer her and her daughter to her daughter's appointment, which did happen thanks to the volunteers and the voluntary ambulance.

This is not a question of convenience. This is about dignity, equality of access and the right to timely medical care regardless of a person's address or income. Who made the decision to unilaterally cut this without any engagement? Why were the cuts made with no public consultation, no Dáil debate and no local agreement or engagement? Where is the assessment of the human cost to this? Will the Minister of State commit to immediately reviewing the criteria for access to patient transport services in Tipperary with a view to restoring full service? How can faceless bureaucrats decide this?

When I was elected to this House in 2007, the budget for the HSE was approximately €7 billion. Now, it is €24 billion and growing every year. How come it is affecting the most vulnerable? Earlier, the House spent five hours - Cara Darmody was in the Gallery with her dad - debating people's access to assessments of need and how the HSE was breaking the law hourly by not providing those assessments. Why are we allowing this cabal in the HSE to run amok, do what it likes, neglect people and flout the laws?

I thank the Deputy. What he raised this evening highlights an issue of concern. I want to give him an update on the patient transport service in County Tipperary.

The patient transport service, which provides non-emergency patient transport for some patients in the south-east region, was set up in 2013. It was set up on a discretionary basis by the HSE for the region. Hospitals there were given a budget to provide limited transport for patients to attend other acute services. The cost of providing the non-emergency patient transport service has increased year on year. The cost for providing this service has grown from more than €88,000 in 2019 to more than €127,000 in 2024. Due to this continued increase, Tipperary University Hospital has had to review the eligibility criteria for patients applying for access to the service. The review of the eligibility criteria is aimed at preserving this valuable service in order that those most in need and vulnerable patients can access it. It is important to clarify that patients travelling for radiation therapy and chemotherapy will not be affected by these changes. There are a number of criteria that need to be taken into consideration by Tipperary University Hospital when assessing a patient’s eligibility to access the service, including the patient’s exceptional medical need, age - 75 years and older - mobility, appointment and so on.

The Government fully acknowledges the concern and inconvenience for patients and their families that these changes at Tipperary University Hospital have caused. It continues to accommodate the patients most in need of this service in line with the revised eligibility criteria. The hospital robustly assesses patients’ eligibility and all patients must meet the revised criteria before being approved for the transport. It is actually done through the HSE. The assessment of a patient’s eligibility for the non-emergency patient transport service is determined by the local HSE service, which aims to provide for those most in need of access to this valuable service.

The Government has invested significantly in Tipperary University Hospital and the budget for the hospital has increased from almost €81 million in 2020 to more than €122 million in 2025, representing a significant increase of 51% in that time. Staffing has increased by 25% since 2020 from 968 to 1,212.

The cost of providing this important service has increased year on year and it is aimed at assisting those most in need.

I do not know. I remember six months ago, when the Minister of State was not in government and, like me, she was crying out about this. It is not a massive increase from €88,000 in 2019 to €127,000 in 2024; it is nothing in the scheme of things. The Minister of State mentioned all the extra staff. How many of them are penpushers and executives in made-up jobs - that is what they are - and not nurses or front-line staff? It is a shocking situation.

A month ago, I stood in Clonmel in front of St. Joseph's Hospital for the opening of the Slievenamon wing. I met a number of new executives, many of whom were from the Minister of State's area. I mean no disrespect to them, but they had positions that we never had before, namely, executives, directors of this and that and directors of everything except patient care. We are taking on people - of course we are - in management jobs.

Self-serving officials: that is what is wrong in the HSE. We have spineless Ministers who will not challenge them. We have spent five hours tonight talking about it here, all sides of the House condemning what is going on in the HSE. We have these mean, hungry, desperate cuts to vulnerable people. Thankfully, they will get radium injections or other treatment. What about a person who is paraplegic or an amputee? What about the people who have severe diabetes or many other conditions? We are picking and choosing who is sick and vulnerable while we have fat cats getting fatter and we have board members of the HSE, the runaway cost of the children's hospital and the disgraceful, diabolical lack of management and accountability.

Then we make these mean cuts. We talked about the dirty dozen cuts by Charlie McCreevy in the past. This is so mean-spirited and we expect voluntary organisations like the Order of Malta, Civil Defence and Red Cross to burn out their ambulances and staff, who are volunteers, while officials and fat cats go around the conferences and everything else. Bring back the matrons to the hospitals to make the savings and have the hospitals clean, not plethoras of management who are not managing. They were never managers in the first place. Some of them got into those jobs by pull. It is a shocking situation when we treat vulnerable people in our society like this and the Minister of State cannot argue against it.

I thank the Deputy for raising the issue and giving me the opportunity to update him on transport in County Tipperary. The Deputy mentioned the Red Cross, Order of Malta and Civil Defence, and it is important we pay tribute to the great work they do. They are excellent. It is important the Deputy recognised them and that we all recognise them. I assure the Deputy the HSE and Tipperary University Hospital are committed to providing high-quality service in response to local needs. Tipperary University Hospital has reviewed the eligibility criteria for the non-emergency patient transport service so the most in need and vulnerable patients can still access it.

Non-emergency transport patient calls are planned for patients who require transport in a special converted taxi or minibus to attend pre-arranged medical appointments and who do not require a stretcher-equipped vehicle. The patient transport service was set up in 2013 on a discretionary basis by the HSE and provides non-emergency patient transport in south-east region hospitals. There is a budget there. I understand the Deputy's concerns. I will go back to the HSE and see whether it can be looked at. I understand there are vulnerable people out there. It is important to reiterate this is HSE-led. I thank the Deputy for highlighting the serious concerns he has raised.

Hospital Procedures

I am speaking on behalf of the families whose lives have been turned upside down by the hip dysplasia scandal, particularly those who have sat in my constituency office in Dundalk over the past couple of weeks upset about the care for their little children. How is the Department planning to support those families to get treatment and follow-up care for children who have had surgery for hip dysplasia? These families did everything right. They brought their children to hospital and trusted the system. They believed the care their children received was necessary and in their best interests. Now the families are in limbo.

The recent audit is welcome, necessary and important, but let us be honest: it has not brought certainty and will not bring trust or confidence in the system. Instead, it has brought fresh fear and confusion. More importantly, an audit will not sort out the issue I raise, which is that the families want and deserve financial supports. They want to be compensated or to be facilitated in getting their children treated elsewhere. Parents no longer know whether their child needed the surgery and no longer trust the hospital, the consultants or the system. Many of them are asking the heartbreaking question: was my child operated on needlessly? If that was the case, it was a grave violation and nothing short of a serious assault on that child. Can we as a Government and society seriously expect the families to return to the same hospital for follow-up care, check-ups and X-rays? Can we ask them to place their children back in the care of the system now they believe they could be harmed by that system? It is not tenable or reasonable. As a mother, I would not let them near my child if I thought there was a hint of a suggestion that surgeries had been done that were not necessary.

Many of these families are scraping together whatever money they can find to seek second opinions, mostly going to Northern Ireland, to ensure their child receives safe and trusted care. That situation should not exist in a functioning healthcare system. It is not acceptable these parents are paying out of pocket for something the State should ensure. Potentially, parents are getting loans to do this.

Let us be very clear. This is not the Government's fault but it is absolutely the Government's responsibility. Responsibility means stepping up with supports the families can trust. Sympathy is not enough; we need action. These families need immediate access to independent care pathways, financial support to access second opinions and trauma-informed services. Most of all, they need to know they are not alone in this. They felt abandoned by the hospitals, they feel abandoned by the doctors and they are desperately worried about their children. What happened is deeply serious. The outcome depends on how the State responds. Supporting the families would send a message to every family in the country that we will treat our children with respect and dignity and that we value accountability, and it would show that our healthcare is worthy of trust.

I thank the Deputy for raising this very serious issue. I have spoken to families and I see the concern and hurt. It is important this is raised in the House.

A clinical audit has been conducted by an external international expert on surgery for children with developmental dysplasia of the hip across Children's Health Ireland, CHI, and the National Orthopaedic Hospital Cappagh, NOHC. The clinical audit involved a random anonymised sample of patients aged one to seven years of age who had pelvic osteotomy procedures for developmental dysplasia of the hip, DDH, from 2021 to 2023 in CHI and the NOHC. The purpose of this audit is to assess whether the indications and threshold used to select patients with DDH for pelvic osteotomy procedures were in keeping with international standards of practice. The audit process is at an advanced stage. CHI and NOHC are committed to sharing the findings of the audit once it is completed.

An action plan is currently being drafted in advance of the final audit report. This plan includes identification of groups of patients not included in the audit sample but who may be affected by any findings of the audit. A communications plan is being developed to support the publication of the final report and further communications to patients and families. As a patient safety precaution, a single cross-site pre-operative decision-making process for any planned DDH surgery in CHI and NOHC has been implemented. All cases are being reviewed before any decision for surgery is made by clinicians from CHI Crumlin, Temple Street and NOHC. This multidisciplinary team, MDT, commenced the first week of March 2025. In addition, CHI is establishing an expert reference group, including international experts, to develop the standards and criteria for the MDT decision-making process for CHI.

An early recommendation from the audit is that, in line with best practice, patients who have DDH surgery should have clinical follow-up at skeletal maturity. This is at about age 14 or 15, when bones have fully grown and developed. Clinical advice is that this follow-up is part of normal post-operative care. Plans are being put in place for patient follow-up in line with good practice and will consider any recommendations on clinical follow-up from the final report. CHI and NOHC have issued letters to all patients and families who have had this procedure since 2010 to provide reassurance and information about the audit and to ensure all potential cases have been included. The total number of letters sent to date is 2,259. The majority, 1,757, have been from CHI, while 502 have been from Cappagh. The number of patients and families involved is subject to ongoing refinements due to clinical review.

The HSE funds certain treatments in other EU member states and, as the Deputy knows, we have a similar scheme for the UK or Switzerland, when this treatment is not available in Ireland. As surgery for children with DDH is available in Ireland, financial supports for treatment outside of the State are not available. However, I assure the Deputy that currently all cases for DDH are being reviewed by a single cross-site pre-operative decision-making process before any decision for surgery is made by clinicians from CHI at Crumlin, CHI at Temple Street and NOHC.

I thank the Minister of State, and I understand she is reading out an answer from the Department and it is not her line responsibility.

I am getting a huge of sense of frustration here. My question was on the financial support. The Minister of State said that certain treatments are available in Ireland and therefore, it is a "No". I am sorry; this is not a normal situation, where the trust breaks down. I will repeat what I said: if there was even a hint of a suggestion that my children were operated on wrongly or unnecessarily, I would not let anyone in that hospital touch them. Their little bodies are precious. To a point, it is disingenuous of the Department to come back here and tell a parent that the hospital should be trusted with the dignity and integrity of their child's little body. I am sorry but the Department is going to have to look at this again, listen to parents, reconsider and support parents, whether it is to get a different doctor to come from abroad to look at these files who is not associated with CHI or Temple Street or who has anything to do with them. It is an unprecedented situation and it calls for an unprecedented response. We need to instil trust in these parents and families.

It is hugely disappointing that we are at this point where the Department is right and proper in doing these audits and all the processes. I have nothing to disagree with. However, where a child's health and physical body is concerned, and their tiny wee bones that could be operated on unnecessarily, they and their families deserve the respect and to be told, "Yes, we will make sure that we will get a doctor that you can trust and believe."

I assure the Deputy that the Minister and the Department are taking this very seriously. This is very serious, and we know that. Nobody wants anyone, particularly those children or their families, to be in this position today. I can guarantee that the Minister is very conscious of the concern that will be felt by all the patients and families affected. The audit process is nearly complete and she has been advised that it will be finalised and completed soon. She will be in a position to comment further once the audit is published. I assure the Deputy that the she is committed to this, as are all of us in the Department of Health.

She is also committed to ensuring reform remains centred around putting children and their families at the very heart of this. I do understand. As I said, I have spoken to families in my constituency of Carlow-Kilkenny and I have seen the hurt and pain. I assure the Deputy that the Minister is committed to this, as we all are. We will come back to her with more information. I thank her. It is important that we work together on this and make sure that the children and families are to the forefront of this, and they will be.

Cuireadh an Dáil ar athló ar 12.34 a.m. go dtí 9 a.m., Dé Céadaoin, an 21 Bealtaine 2025.
The Dáil adjourned at 12.34 a.m. until 9 a.m. on Wednesday, 21 May 2025.
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