Micheál Martin (Cork South-Central, Fianna Fail)

I thank the ambassador for her work over the past number of years. We enjoyed our engagement with her and I really appreciate that.

Deputy McAuliffe raised the issue of Beaumont Hospital. There are four major projects under way there. The national development plan has allocated very substantial funding to the Department of Health and the HSE for the realisation of those projects. The key is to keep the pressure on to get them through the various stages. Health capital tends to be slow and health projects tend to be slow moving. We need to accelerate some of these projects and get them delivered. They are well under way in some respects, with planning going on and so on. I appreciate the point the Deputy made. Beaumont is a national centre for key disciplines and a very important centre.

Deputy Bacik raised the issue of access to and coverage of GP services. In terms of the budget, Estimates discussions are going on. I recall her colleague Senator McDowell saying the Government is being fiscally reckless. He thinks we are spending too much. On the other hand, Deputy Bacik and others will come along and say that we should spend more on health services. Expansion of eligibility and so on will have a cost attached to it. Public expenditure will grow significantly again this year but we have to watch the rate of growth, without question. That will limit what is possible within the health budget in the next couple of weeks and in the announcement in the budget itself. We are endeavouring to have a sustainable health budget along the lines of what we planned over the past two years, which has worked effectively enough in terms of outcomes and improvements and also in terms of fiscal sustainability for the health service. The increase in the budget has been exponential over the past number of years. In my reply, I went through all the various initiatives we have provided in terms of reducing costs for patients. Capacity is very important.

Regarding the inquiry we spoke about earlier into CHI and the publication of reports, I will talk to the Minister in respect of timelines. My understanding is that the Nayagam report will be ready before the end of the year. It needs to be published and it will be important in terms of feeding into any inquiry that will be established.

Deputies Cahill and O'Sullivan referred to the elective hospitals. I will pursue that issue. It is annoying in that going back to 2016 or 2017, there was a different Government planning a second hospital for Cork. We correctly looked at that when we came in after 2020 and we agreed on elective hospitals in Galway and Cork initially and in Dublin subsequently. Those projects have been progressing and are in planning, design and all of that, but they need to get a move on. We have a site in Galway and a site in Cork. The surgical hubs are moving as well. I have made it very clear to officials and to the HSE that these are commitments the Government has decided on and they need to be delivered and implemented. Sometimes, notwithstanding Government decisions, there can be elements in the system who think these things do not have to be delivered. It is my job to sort that out.

Deputy Cahill raised a very difficult and sad situation. I ask that we do everything we can to ask those people to come off hunger strike, which can be very damaging to people's health. There has been a long history of institutional abuse. There have been a lot of supports over the years for survivors of institutional abuse, going back even prior to the report of the Ryan commission being concluded. Redress happened for quite large numbers much in advance of any inquiries. Other initiatives were taken in terms of housing and so on. The Government will engage with the survivors but for their own health and well-being, it is important that they would come off the strike. I understand the Minister met with some of the survivors. I will follow up with her to see what can be done.

Deputy Tóibín spoke about the public inquiry into CHI. I used the words "timely" and "effective" and the Deputy made the point that he would prefer a permanent office of inquiry. He said inquiries can go on, which they can. We have had statutory public inquiries that have gone on for five or six years. I hope that will not be the case here. The Minister is endeavouring to work with the parents and advocates to see whether we can get a bespoke inquiry that will meet the needs and objectives of such an inquiry, which have to be to improve services and have a sustainable improvement in services for children with spina bifida and requiring spinal surgery.

Because of our Constitution and people's legal entitlements, very often these inquiries can evolve into adversarial-type inquiries. One concern we have, which we need to be very clear-eyed about, is the impact on current services. Presumably any inquiry would involve personnel working in the service. We have got to be very clear-eyed and ensure we design this in such a way that we maintain current services, and that we do not have any negative impact on the provision of services on an ongoing basis. A three-week timeline has been provided for work on this. I am confident that we can arrive at a conclusion to this that would be satisfactory all round.

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