Nithe i dtosach suíonna - Commencement Matters – Seanad Éireann (27th Seanad) – Tuesday, 14 Jul 2026

Nithe i dtosach suíonna - Commencement Matters

Social Welfare Schemes

Senator Sharon Keogan

The Minister, Deputy Calleary, is welcome to the House. I rise to focus the attention of the House on a vital public service that sits at the very heart of social inclusion on this island, the free travel scheme. Specifically, I am calling on the Minister for Social Protection to investigate a comprehensive, seamless expansion of this scheme into Northern Ireland. The free travel scheme is a lifeline, providing dignity, independence and mobility to all our older citizens, full-time carers and people with disabilities, yet when an eligible pass holder reaches the Border, that independence is abruptly halted by an invisible wall of administrative bureaucracy.

I want to pre-empt what I expect the Minister is going to argue today. The Department will likely argue that a system already exists. It will point to the senior pass scheme, where a resident here can apply for a separate concessionary card to travel into the North. Let us be completely honest with ourselves. Forcing a 75-year-old pensioner or a vulnerable citizen to fill out a separate cross-Border application form, jump through bureaucratic hoops and wait weeks for a second piece of plastic is not a true all-Ireland strategy. It is a barrier. It is an administrative deterrent. It is also a scheme that leaves out those with disabilities and full-time carers.

We must recognise that the communities near the Border do not see their lives in two separate halves. For them, the Border is a line on a map, not a barrier to daily life. Families, social lives and basic daily activities span both sides of that line fluidly. When a pensioner or disabled person wants to visit a grandchild, go to the shop or attend a community event just a few miles away, they should not have to navigate a maze of international paperwork just to use a local bus. The current clunky separation of transport passes ignores the lived reality of these tight-knit cross-Border communities.

Let us be clear. A truly seamless, integrated system is a win-win that delivers massive practical benefits to residents of Northern Ireland as well. Northern seniors holding a senior smart pass love visiting the South, but the moment they cross the Border, their younger disabled neighbours and full-time carers are left completely stranded and forced to pay full adult fares. By working with the Northern authorities, Stormont and Westminster to recognise reciprocal rights seamlessly, we open up transit opportunities for all vulnerable Northern citizens, allowing them to travel, spend and visit family in the Republic without facing a financial or administrative wall.

The true value of an all-island approach is that it replaces confusion with total coherence. Right now, we have a messy, unequal patchwork of rules. A disabled citizen in the South gets 100% free travel, but across the Border, a disabled person only gets a half-fare pass, and a full-time carer gets absolutely nothing at all. This is a significant human rights gap on a single island. Sitting down with Stormont to deliver a single unified rule book for free travel means we lift everyone to the same high standards of dignity and mobility, ensuring that a person's vulnerability is not penalised simply because of the jurisdiction they happen to live in.

As a more general point, we must stop planning public transport inside geographic silos and start looking at our transit networks on a real, logical all-Ireland basis. To take the north west as an example, the city of Derry is a natural economic and transit hub for the vast majority of County Donegal. For citizens living in Donegal or Monaghan, it is frequently much faster and more practical to transit directly across Tyrone or Fermanagh to reach another part of the Republic than it is to navigate their way into Connacht. If our transport geometry is inherently cross-Border, our ticketing and free travel system must be exactly the same.

If the Government is genuinely committed to shared island initiatives, we must move past these clunky, outdated systems. An all-Ireland approach should be a default setting for public services, not an afterthought. We need a modern, integrated framework, where a free travel pass issued in Cork, Galway or Dublin can be tapped in Dublin on a train or bus ready for Belfast, Derry or Enniskillen. There should be no separate applications, additional passes or bureaucratic headaches. I urge the Minister to demonstrate real leadership and to initiative immediate feasibility talks on the matter.

Acting Chairperson (Senator Chris Andrews)

Before the Minister rises, I want to welcome the members of the IFA's national ready to lead group, who are guests of the Ceann Comhairle, Deputy Verona Murphy. She is obviously keeping them on a tight schedule.

Minister for Social Protection (Deputy Dara Calleary)

Gabhaim buíochas leis an gCathaoirleach agus leis an Seanadóir Keogan as an ábhar seo a ardú. There is not much that I disagree with the Senator on but, as she knows, there are considerable practicalities in much of this, which I will go through.

The free travel scheme provides free travel on the main public and private transport services in this State for those eligible. These include road, rail and ferry services provided by companies such as Bus Átha Cliath, Bus Éireann and Iarnród Éireann, as well as the Luas and additional services provided by over 70 private transport operators.

The all-Ireland free travel scheme is a reciprocal agreement between the Department of Social Protection and the Department for Infrastructure in Northern Ireland. It represents an agreement under which institutions in this State and in Northern Ireland recognise free travel arrangements for older people in each jurisdiction as equivalent arrangements.

The all-Island free travel scheme became operational in April 2007. The scheme enables those aged 66 and over and resident in the Republic to travel free of charge on all bus and rail services in Northern Ireland. Likewise, seniors in Northern Ireland travel free of charge on bus, rail and ferry services participating in the free travel scheme in this State.

As part of the agreement, the Northern Ireland authorities require that customers here wishing to avail of free travel in the North should do so using a senior smartpass as used for free travel by their Northern Ireland counterparts. This senior smartpass is compatible with electronic card readers used on Northern Ireland services. People from Northern Ireland can just present the senior smartpass to the operators in the free travel scheme here, and they will be issued with a ticket for travel.

Under the arrangements, the Northern authorities pay for travel undertaken within Northern Ireland by senior smartpass holders resident here, and Department of Social Protection pays for travel undertaken here by senior smartpass holders resident in Northern Ireland. As the Senator said, a separate application is required to receive a senior smartpass. However, this is not an overly burdensome process.

The Department has no objection to the Senator’s proposal, and I will ask my officials to work on examining options with the relevant Northern Ireland authorities to facilitate more seamless cross-Border travel. However, there are a number of practical issues that we also have to table.

Removing the need for separate applications or additional travel passes would require agreement, as well as integrated IT systems that would be able to accept and identify when the various travel passes are used to ensure proper remuneration to those who provide the travel service.

The various integrated ticketing systems that are used by transport providers are not funded by the Department of Social Protection, and the Department has no role in the provision or funding of such systems or instructing transport providers to invest in them.

My Department is, of course, available to help any free travel pass holder with their application for a senior smartpass, and I will look at promoting that service. As well as that, I will ask the officials to engage with my colleague, the Minister, Deputy O’Brien, around what else we can do to expand and make this service easier.

I must also point out that through the shared island fund, the Government is making significant investment in travel infrastructure in Northern Ireland in road, rail, bus and public transport. We want to continue to do that.

While the Senator raised a solid issue, the practicalities are immense. I am happy to examine how we can address those.

Senator Sharon Keogan

I thank the Minister, Deputy Calleary, and I appreciate that he will engage with the Minister, Deputy O'Brien, on this.

We live in the land of technology. We are told that we are a tech nation and the idea that it would require an agreement and would be a little bit difficult to have this IT system put in place quickly seems a little bit ridiculous. It is something that can be overcome easily.

The reality on the ground is that a partnership should not require an older person to fill out an entire separate cross-Border application form, submit a passport photograph and wait for weeks just to get a separate piece of plastic. If the technology exists to recognise contactless bank cards instantly across Europe, our transport networks can absolutely recognise a single public service card across our one island. The current set-up is a bureaucratic hurdle, not a solution. A solution could be found to this quite easily and I hope the Minister will engage with the Minister, Deputy O'Brien, to find that. I thank the Minister for coming in today.

Deputy Dara Calleary

I thank the Senator. Technology is absolutely very much part of our lives but it does, as the Senator will always point out in debates, need guardrails. We have to protect the data of those who use our passes on both sides of the Border. That is important. While we have no objection, and I will ask my officials to examine all the options and bring the Senator's issue to the attention of the Minister, Deputy O'Brien, any changes will require cross-Border agreement, as well as integrated IT systems. Bearing in mind that there are 70 private operators on top of the public operators, this is not an easy task. However, the free travel scheme is now benefiting over 1.17 million people who have direct benefit to the pass. When we look at the companion pass, which we extended last year, and spousal passes, over 2 million people are benefiting from the scheme. The scheme is meeting its objective of ensuing older people and people with disabilities can remain active and can travel. However, we will examine the processes again.

Acting Chairperson (Senator Chris Andrews)

I thank the Minister.

School Transport

Acting Chairperson (Senator Chris Andrews)

Before we start, I welcome Deputy Michael Cahill and his two guests. I suspect they may not have gone home since the weekend and are still celebrating Kerry's win. They are very welcome.

Senator Joanne Collins

I welcome the Minister of State and thank him for being here today. I want to discuss school transport, in particular rural schools more than city schools, and the different reasons certain children would go to different schools and not to the one that is geographically closest to them. There is a school in County Limerick called St. James’ National School, Cappagh. Its closest secondary school is Coláiste na Trócaire, Rathkeale and St. James' National School is the main feeder school. A lot of children who go to this school are not necessarily from Cappagh. Their closest secondary school would be in Askeaton town, which would be their address. Cappagh is also in Askeaton but Cappagh school for one reason or another is the primary school that all these children would have gone to. When you go to the school in Cappagh, you end up getting involved in sports clubs and community games, which is Cappagh and Rathkeale together, as in the face of reduced numbers, they link up everything. Living rurally a lot of the teams will link up across the area. Even though their closest secondary school is the secondary school in Askeaton, the only link they have to it is the geographical reason to go there. Every other link falls to Rathkeale. Their friend groups, their social groups and their sporting activities are all linked into Rathkeale. I have 19 children looking to see if there is a possibility of a school bus. When we look at the criteria they do not meet them all and it comes down to that one geographical limit. I feel sometimes the criteria are very black and white and it do not really take into account the realistic living conditions within rural Ireland and why children would go to different secondary schools. I am also conscious, with costs of petrol and diesel, that these parents are hoping their children could use a school bus rather than having - it would not be 19 families because there are one or two in some of the houses - potentially 15 more cars on the road dropping to and from school. I have spoken to the families and told them that geographically they may not be eligible because of the secondary school not being as close as the one down the road. They have said their children will be going to the Rathkeale secondary school regardless, because it is where all their friends are going.

The primary school is the feeder school and it is a natural progression from their primary education into secondary education. Could the Minister of State make a statement on it? I have been on to his office back and forth over the past couple of months but I am very conscious that this is our last week here in the Dáil and the Seanad. By the time we are all back from recess, the school term will have started. I am conscious that these parents are very eager to find out if there is a possibility of a school bus.

Minister of State at the Department of Education and Youth (Deputy Michael Moynihan)

I might address the issue, which was in relation to the increased capacity, specifically for County Limerick. Unfortunately, the Senator did not give me the exact details in relation to Cappagh or Rathkeale so I do not have the specific details to hand.

The school transport system is a huge operation that is managed by Bus Éireann on behalf of the Department of Education and Youth. The scheme has expanded significantly over the past six years. It is recognised that the school transport system is a vital support for families and its benefits extend to supporting parents and guardians who are accessing employment. It continues to support pupils living in rural and remote areas and children and young people with additional needs, as well as national sustainability and climate goals.

The scheme is demand-led and on the number of eligible children who apply and pay on time. Families are required to register their details on the Bus Éireann portal to have their eligibility for school transport assessed to make applications under the scheme. The portal for the 2026-27 school year closed on 8 May to allow Bus Éireann to plan and assign routes for the upcoming school year. The portal reopened on 3 July but any applications and payments made after this date will deemed late and will not be assessed until all on-time applications have been processed.

Since the portal closed, Bus Éireann has been assessing all the applications and planning routes and services for the 2026-27 school year. Routes may alter or extend depending on the number and location of children who will be availing of school transport for the year. The tickets have now begun to issue to families and will continue to issue throughout the summer. Where pupils are unsuccessful in receiving tickets, they will be notified as early as possible and a refund will issue from Bus Éireann. Under the terms of the Department's school transport scheme for children with special educational needs, children are eligible for transport where they are attending their nearest recognised school that is or can be resourced to meet the child's needs.

On the overall scheme, school transport, as the Senator rightly pointed out in her opening remarks, is a hugely valued support for families. The availability of the school ticket or bus seat is hugely important and I know from many years as a public representative the importance of this issue. I also know, since taking up this role, the importance that schools, school communities and families place on the expanding school system.

We have been expanding it over recent years. In County Limerick alone, it has expanded from 6,200 in 2023 to 7,500 who were issued tickets last year. It has continued to expand. There are various rules and regulations governing it. We are trying to ensure we are providing transport at primary and post-primary levels, in the first instance, that is near schools. I do take the point around communities, depending on where they are at. It is always a crunch point when communities see the school that might not be the nearest as their natural hinterland or school. There is some recognition of that but, under the terms and conditions, the scheme is very clear in regard to how we are trying to ensure that we have transport across the country.

The Senator raised the issue and I will gladly take it up to see if we can get clarification for her on it. I might address some of the other points in my closing remarks.

Senator Joanne Collins

I thank the Minister of State. My apologies; I probably should have given the specifics but I have been back and forth to the Minister of State's office a bit on this. My one ask is that he might look at the criterion about the closest school geographically. The closest school for these children is the school they are most connected to, which would be Rathkeale.

That is where their sports and social clubs are and where all their friends go. A lot of these children would have been eligible for and would have used transport to primary school. However, because they are going a little further away to secondary school, they seem to be ineligible for transport.

I would appreciate if the Minister of State could indicate whether there is any leeway on the eligibility requirement that pupils attend their closest school. Could that be amended such that the closest school may be defined as the school to which they feel closest or are most linked to, rather than just the closest school geographically?

Deputy Michael Moynihan

By way of clarification, the State is subsidising the school transport scheme to the tune of €650 million, which is a rise of just over €200 million from only a few years ago. We have expanded the numbers using the service over the past four or five years from 120,000 to the 181,000 pupils that were carried last year. More than 11,000 routes are covered at both primary and secondary level. That gives a sense of the scale of the operation that is the school transport system right across the country.

The terms and conditions of the scheme go back quite some time. We undertake continuous reviews to try to capture more students who have not been deemed eligible for various reasons. For September 2026, the terms and conditions are as outlined in the Department's notices and on its website. In some instances, recognition is taken of where there is capacity and availability on routes. I do not have the specifics in front of me but I certainly will liaise with the Senator to see what we can do on the issue she raised.

Within the budget we have for this year, there is an ever-expanding demand on the system, with a huge number of people looking for increased services. We ran a number of pilot schemes over the past two or three years and we are evaluating whether they were successful. We must be very mindful of the amount of money we are spending on school transport. That amount continues to grow year on year. We are very committed to the school transport system and a lot of work is going into reviewing the terms and conditions into the future.

Senator Joanne Collins

I thank the Minister of State.

Child and Family Agency

Acting Chairperson (Senator Chris Andrews)

The next speaker is Senator Mark Duffy, who probably has not gone home since the weekend.

Senator Mark Duffy

I will be staying here until the Mayo team takes Sam Maguire home.

Acting Chairperson (Senator Chris Andrews)

You never know, Senator, this could be your year.

Senator Mark Duffy

I thank the Minister of State, Deputy Higgins, for being here to discuss this very important topic. I acknowledge the work the staff of Tusla do in County Mayo and across the country in very challenging circumstances and with very vulnerable people. They respond when others cannot and do not. While there are lots of different views and angles, with some cases getting a huge amount of spotlight, 99% of cases go unheard of because the outcome is a very positive and meaningful impact on young people's lives and on families, community life and society generally.

I seek an update on the development of headquarters for Tusla in Mayo. Discussions and work have been ongoing since 2023 with a local developer. A lot of time, resources and finances have been invested in the proposal for a site on Moneen Road, Castlebar, which would serve the whole county. It is a very ambitious plan for which permission was granted in 2023. At least €300,000 has been spent on it to date. I would welcome an update to provide clarity on the future of the project.

Minister of State at the Department of Children, Disability and Equality (Deputy Emer Higgins)

I thank the Senator for raising this important issue and offering me the opportunity to respond on behalf of the Minister, Deputy Foley.

I also thank the Senator for his comments on the staff who work in Tusla in very challenging and often vulnerable circumstances. It is good to put that on the record of the House.

It is also important to acknowledge that decisions relating to the acquisition or leasing of properties by Tusla, and indeed all public bodies, require careful consideration. Such decisions must balance long-term needs with the responsibility to secure value for taxpayers’ money, particularly where significant financial commitments are involved.

Regarding the specific situation in Castlebar that the Senator has raised, Tusla has indicated that following careful consideration, including extensive negotiations, which he referred to, and legal mediation with the developers, it was unable to reach an agreement. It has now concluded that the proposal did not represent a viable option. Unfortunately, this means Tusla has decided not to proceed with this development.

Although this proposal will not move forward, that does not diminish the importance of meeting service needs in the area. The Minister has asked me to directly reassure the Senator, and indeed the local community, that Tusla has secured a medium-term accommodation solution for Castlebar and remains actively engaged in identifying a sustainable long-term solution for the area at the earliest opportunity.

With regard to the background, and as the Senator has touched on, this project was designed on the basis of a 30-year operational lease, with the primary objective of delivering value for money over the lifetime of that lease. As part of its assessment, Tusla benchmarked the proposed rental and service charges against comparable facilities, including similar projects within both Tusla and the HSE. Following this review, Tusla concluded that the costs sought by the developer did not represent value for money over the proposed lease term. While the developer cited construction inflation as justification for the increases, Tusla determined that the level of increases sought could not be supported. In an effort to reach agreement, Tusla offered a significant uplift on its original offer. However, this was rejected by the developer. In the circumstances, Tusla concluded that any further cost increase could not be justified from a value-for-money perspective.

More broadly, the objective of any public service leasing or construction project is to meet service needs while ensuring the best use of public funds. Success is measured not only by delivery on time and within budget but by the long-term value and benefits of a project.

Effective projects begin with clearly identified service needs and are underpinned by strong governance, robust planning and sound decision-making. Careful planning and preparation are essential. The strongest projects are those that invest in feasibility studies, site assessments, stakeholder engagement and detailed design from the outset, because decisions made at the earliest stage often have the greatest impact on cost, quality and operational performance.

I appreciate that challenges such as inflation, supply chain disruption, planning delays and unforeseen site conditions may arise and may need to be managed to protect budgets, timelines and projected outcomes. These considerations highlight why value for money must underpin every stage of project delivery. It is about more than just securing the lowest cost option. It is also about achieving the right balance between cost, quality, efficiency and long-term benefit. To achieve this, public bodies must take a whole-of-life approach to decision-making. That is what happened here. These are the principles that have informed Tusla’s consideration of the proposal in Castlebar and ultimately led to the decision not to proceed in this instance.

Again, while this proposal will not move forward, it does not diminish the importance of meeting the service needs in the Senator’s area. The Minister wishes to reassure the Senator and the local community that Tusla has secured a medium-term accommodation solution for Castlebar and that she will continue to work towards a long-term solution.

Senator Mark Duffy

I thank the Minister of State for being here on behalf of the Minister, Deputy Foley, and for her detailed reply. While it is disappointing to hear the news here, at least it provides clarity and certainty for the project promoters and, indeed, staff and various stakeholders involved, many of whom have been in touch with me and are really passionate about ambitious and quality infrastructure to support Tusla and its needs.

The Minister of State mentioned that effective projects begin with a clearly identified service need and are underpinned by strong governance, robust planning and sound decision-making.

That the planning went through all the process, detailed designs and construction drawings, then to make a U-turn on it, is not good enough by Tusla. There clearly has been a breakdown in appropriate governance there and proper planning. We should not waste people's time or, indeed, taxpayers' money. The waste there of taxpayers' money resides in the fact that resources are going to be spent elsewhere to offer a medium-term solution, while the longer term solution has gone through the procurement, planning and design stages. It is not for me to be the arbiter of what is or is not value for money. That is for Tusla and the Minister to consider. However, to go so far down the road and do a U-turn is very unsatisfactory for the developer and many who would like to have seen this project be realised. There need to be more questions asked and clarity given by Tusla on this particular project. I reiterate my thanks to the Minister of State for the clarity she has been able to shed on the project with the update on the progress made so far.

Deputy Emer Higgins

I thank the Senator for his comments. I appreciate that this is not the news that he or his constituents are seeking. However, as he said, at least it is some level of clarity.

Tusla remains committed to providing the infrastructure and accommodation required to support vulnerable children, young people and families. Equally, it has responsibility to ensure that all investment decisions represent the best use of public funds. In this particular case, despite what I was told was extensive engagement, protracted negotiations and legal mediation, Tusla has concluded that the terms proposed by the developer did not represent appropriate value for money over the lifetime of the proposed lease and accordingly has decided not to proceed. Tusla recognises the impact of construction inflation. As a result, it made a significant uplift on its original offer. The additional increase sought could not be justified, however, when benchmarked against comparable projects across both Tusla and the HSE. That comes back to the value-for-money argument.

While it is very disappointing that this project could not proceed on the terms proposed, it is essential that all public investment decisions are guided by strong governance, rigorous scrutiny and a steadfast commitment to value for money. As mentioned previously, the Minister, Deputy Foley, wishes to reassure the local community that the need for services in Castlebar remains a priority. That is why a medium-term accommodation solution has been secured. Identifying and delivering a sustainable, long-term solution for the Senator's area remains a priority.

Medical Aids and Appliances

Senator Shane Curley

Gabhaim buíochas leis an Aire Stáit as ucht teacht isteach inniu. I thank the Minister of State for coming into the House.

Thousands of people living with type 2 diabetes remain unable to access continuous glucose monitoring, CGM, devices because Ireland has yet to undertake a health technology assessment, HTA, for its use in this patient cohort. Only recently, this House debated access to continuous glucose monitoring. In the Minister's response, it was confirmed that reimbursement cannot currently be extended because no Irish HTA has been undertaken for patients with type 2 diabetes. While that explains the current position, it also highlights the central issue that needs to be addressed, that we need to catch up to our European counterparts. If we look at some of the European countries with the highest regarded health systems, for example France, Germany and the Netherlands, not only have they carried out the HTA but they provide reimbursement for type 2 diabetes patients who get CGMs.

More than 300,000 people in Ireland are living with diabetes, almost 90% of whom have type 2 diabetes. With an ageing population, rising obesity levels and increasingly sedentary lifestyles, the prevalence of type 2 diabetes is expected to continue growing in the years ahead. Every year that a HTA is delayed is another year in which we lack the evidence needed to determine whether CGM technology should be made available to defined cohorts of people in an environment where other countries in the European Union are so far ahead of us.

CGMs allow patients and clinicians to monitor glucose levels in real time, improving diabetes management and giving many patients greater confidence in managing their condition. CGMs are available for patients with type 1 diabetes, but people with type 2 diabetes remain excluded, not because the technology lacks potential but because the evidence-gathering process required to inform reimbursement decisions has not yet begun in Ireland. This is at a time when we are lagging so far behind our British and European counterparts. The HSE has also confirmed that its preferred sensor review remains ongoing, yet no timeline has been provided for its completion or publication.

Will the Minister commit to engaging with HIQA and the HSE to scope a rapid HTA for clearly defined cohorts with type 2 diabetes? If so, when will this be done? Will the Minister provide an updated timeline for the completion and publication of the HSE's preferred sensor review? I am not asking that we make a reimbursement decision today but to begin the evidence-gathering process that will allow one to be made in due course. The first step is commissioning a rapid HTA. The second is providing certainty on the preferred sensor review. Both are practical, evidence-based steps that would represent meaningful progress to better care for people living with type 2 diabetes. I would be keen to hear what the current plans are to expand access to CGMs as the disparity in patient access has been made clear to me.

Minister of State at the Department of Culture, Communications and Sport (Deputy Charlie McConalogue)

I thank Senator Curley for raising this important matter. I am taking this Commencement matter on behalf of the Minister for Health, Deputy Jennifer Carroll MacNeill.

The State acknowledges the importance of access to new and innovative medicines and medical devices for patients and is acutely aware of the challenges patients diagnosed with diabetes face. By way of background, continuous glucose monitoring, CGM, systems provide an alternative approach to self-monitoring of blood glucose using blood glucose test strips with an associated blood glucose meter. These CGM systems comprise of sensors, transmitters and a mechanism to display the results such as readers, receivers or a smart device application.

Under the Health Act 2007, the Health Information and Quality Authority, HIQA, has a statutory remit to evaluate the clinical and cost effectiveness of health technologies and provide advice to the Minister for Health. HIQA conducts health technology assessments for programmes and services at the specific request of the HSE or the Department of Health, which may include medical devices. Reimbursement support for CGM sensors at this point in time is based on the HIQA health technology assessment and is for patients with type 1 diabetes mellitus regardless of age, who have required insulin from the outset. Reimbursement does not extend to other cohorts such as people with type 2 diabetes who require insulin, which is the issue the Senator is raising today, or patients previously diagnosed with type 2 diabetes which is now classified as type 1 diabetes based on laboratory investigations such as C-peptide measurement or diabetes-specific autoantibodies.

The health technology assessment recommended the establishment of a single managed access programme for all CGM systems for all individuals with type 1 diabetes mellitus regardless of age, noting that such a system would need clearly defined criteria for access. Following on from the recommendations in this HTA, the HSE’s medicines management programme, in conjunction with the HSE primary care reimbursement service, and with the support of the HSE chief clinical officer, introduced an online reimbursement application system for all CGM sensors on 1 December 2023. Since the introduction of the reimbursement application system for CGM sensors, 5,439 additional individuals have been approved for reimbursement support for this technology. In December 2025, there were paid claims for CGM sensors for 22,012 individuals on the community drug schemes.

In 2025, 72% of new users of CGM sensors were commencing on a preferred CGM sensor. The HSE has identified preferred CGM products based on cost-effectiveness to manage this expenditure. A second review of CGMs is taking place, which will include an update of the preferred CGM sensors evaluation. To date, a health technology assessment of CGM sensors for people with type 2 diabetes mellitus or other types of diabetes excluded from the HTA referenced above, such as latent autoimmune diabetes in adults, type 3c diabetes, monogenic forms of diabetes and so on has not been undertaken. Therefore, there is limited information to support the extension of reimbursement to this cohort, including cost-effectiveness assessment and budget impact of same.

On 21 May, Diabetes Policy and Services Review: A Strategy for Better Care was launched by the Minister for Health. This is Ireland's first national strategy for diabetes and it sets out recommendations for action in relation to type 1 diabetes, type 2 diabetes, diabetes in pregnancy and paediatric diabetes. The strategy marks a major milestone in diabetes care in Ireland and represents the development of a unified approach to its delivery. The Government is considering all recommendations of the strategy for progression.

The Senator's key ask is for a HTA to be carried out on expanding reimbursement for CGM sensors to those with diabetes other than type 1. That has not been carried out and there is therefore limited information to support extension of the reimbursement to this cohort, including the cost-effectiveness assessment and the budget impact of same. The Senator believes a HTA would inform that and enable a decision to be made. I thank him for highlighting the issue and will revert to the Minister for Health for further consideration.

Senator Shane Curley

Gabhaim buíochas leis an Aire Stáit. I appreciate that. The issue we are trying to delve into is not the fact a HTA has not been carried out yet - we know the data does not exist in Ireland yet - but to get the timeline for carrying one out.

The Government has rightly placed renewed emphasis on improving diabetes care through the recently launched diabetes policy and services review. Commissioning the evidence needed to assess innovative technologies for people with type 2 diabetes would be entirely consistent with those objectives. If we are serious about delivering on that strategy, innovative technologies must be assessed using clinical evidence so that future policy decisions can be made with confidence.

This is also about ensuring health services keep up with innovation. As the number of people living with type 2 diabetes continues to grow, delaying a HTA will delay the gathering of the evidence needed to inform policy decisions. I hope the Minister will engage with HIQA and the HSE on scoping a rapid HTA for clearly defined cohorts of people with type 2 diabetes.

There are costs of not doing this. Let us look at the cost of the current situation versus what we could achieve and at the financial benefit to the State of investing in this in the short term to avoid longer term complications. I am not a medical expert but the cost implications of the health complications arising from not investing in CGMs and not having real-time data on blood sugar levels have been explained pretty clearly to me.

Deputy Charlie McConalogue

From engaging with constituents of mine who manage diabetes, I know the impact CGM can deliver for them and how it ensures the most effective management of diabetes to maintain health at its optimum and prevent side effects developing over time. The Senator has laid that out carefully. Diabetes care is something the Government has been working to improve, has improved and wants to continue to develop services on.

The Minister for Health met with Diabetes Ireland in April this year and attended Diabetes Ireland's conference in May. She has been made aware of its perspectives on access to CGM sensor technology. I will refer the Senator's strong advocacy for a HTA back to the Minister and ask her to continue to engage with him on the matter.

Cuireadh an Seanad ar fionraí ar 1.18 p.m. agus cuireadh tús leis arís ar 1.33 p.m.

Sitting suspended at 1.18 p.m. and resumed at 1.33 p.m.

Seanad Éireann díospóireacht - Tuesday, 14 Jul 2026